•This randomized controlled clinical study has evaluated the effects of a novel modality of photodynamic therapy (i.e. transgingival photodynamic therapy or tg-aPDT) for the treatment of ...periodontitis.•The additional use of tg-aPDT adjunctive to scaling and root planing (SRP) resulted in statistically significantly higher reduction of bleeding on probing compared to mechanical debridement alone.•Tg-aPDT may represent a valuable modality for controlling inflammation and further bleeding in residual periodontal pockets.
Recent data from preclinical studies and case series suggest that transgingival irradiation with diode lasers may represent a novel modality for antimicrobial photodynamic therapy (aPDT). However, at present, there is lack of data from controlled clinical studies on the use of transgingival antimicrobial photodynamic therapy (tg-aPDT) in the treatment of periodontitis.
To evaluate the clinical effects of tg-aPDT used in conjunction with nonsurgical mechanical instrumentation during supportive periodontal therapy (SPT).
Forty stage II and III periodontitis patients enrolled in SPT were randomly assigned to two groups of equal size. At baseline, study sites had to show sites with pocket probing depth (PPD) of ≥ 5 mm and Bleeding on Probing (BOP). Full mouth and site-specific Plaque-Index scores (PI), BOP, PPD, and Clinical Attachment Level (CAL) were recorded at baseline (BL), three months (3 M), and 6 months (6 M), respectively. The primary outcome variable was the change in the number of sites with BOP. Treatment was performed under local anaesthesia after random allocation to one of the following groups 1) Subgingival scaling and root planing (SRP) + tg-aPDT (test) or 2) SRP alone (control).
Thirty-nine patients completed the study. Full mouth PI and BOP improved over six month, however without statistically significant difference between the groups. At 6 M, BOP-levels were statistically significantly lower in test sites (25.0 %) compared to the control sites (65.0 %), (p < 0.025). PPD improved in both groups with comparable mean values at 3 M (PPD test: 5.21 ± 0.92 mm; PPD control: 4.45 ± 1.36 mm) and 6 M (PPD test: 5.11 ± 1.10 mm; PPD control: 4.35 ± 1.14 mm). Additionally, CAL slightly improved in both groups with comparable mean values at 3 M (CAL test: 6.79 ± 1.72 mm; CAL control: 5.30 ± 2.43 mm) and 6 M (CAL test: 6.26 ± 1.70 mm; CAL control: 5.50 ± 2.33 mm).
Within its limits, the present results appear to indicate that the use of tg-aPDT adjunctive to SRP may represent a new modality for controlling inflammation and further bleeding in residual periodontal pockets.
The 1st European Workshop on Periodontal Education in 2009 made recommendations regarding the scope of periodontal education at undergraduate (UG), postgraduate (PG) and continuing professional ...development (CPD) levels, defining competencies and learning outcomes that were instrumental at the time in helping to define periodontal teaching curricula. The 19th European Workshop on Periodontology and 2nd European Consensus Workshop on Education in Periodontology (Education in Periodontology in Europe) was held in 2023 to identify changes and future developments in periodontal education (including those informed by the COVID-19 pandemic) and embracing methods and formats of periodontal teaching and training. The aim of this review was to assess current knowledge regarding education methods in periodontology, including traditional face-to-face (F2F) teaching and the move to student-centred methods, virtual learning methods and use of digital technology, as well as blended teaching and learning (including teaching delivery and assessment) at UG, PG and CPD levels.
Systematic searches were conducted to identify relevant studies from the literature. Data were extracted and descriptive summaries collated.
The pandemic was a major disruptor of traditional F2F teaching but provided opportunities for rapid implementation of alternative and supplementary teaching methods. Although online learning has become an integral part of periodontal education, teachers and learners alike favour some form of F2F teaching. Blended teaching and learning are feasible in many areas of periodontal education, both for knowledge and skills acquisition as well as in assessment. Student-centred methods and blended approaches such as the flipped classroom seem highly effective, and online/virtual classrooms with both synchronous and asynchronous lectures are highly valued. Learning with haptic methods and virtual reality (VR) enhances the educational experience, especially when VR is integrated with traditional methods. The quality of the teacher continues to be decisive for the best knowledge transfer in all its forms.
Live F2F teaching continues to be highly trusted; however, all types of student-centred and interactive forms of knowledge transfer are embraced as enhancements. While digital methods offer innovation in education, blended approaches integrating both virtual and traditional methods appear optimal to maximize the achievement of learning outcomes. All areas of periodontal education (UG, PG and CPD) can benefit from such approaches; however, more research is needed to evaluate their benefits, both for knowledge transfer and skills development, as well as in assessment.
Tutor-supported comprehensive care training at the University of Bern School of Dental Medicine (SDM) has been used for many years. Therefore, the aim of this study was to evaluate dental students' ...opinions on tutor-supported training to identify key aspects of future course organisation that are important for students to achieve the minimum requirements for their graduation. A digital survey was developed and distributed among all fourth- and fifth-year dental students enrolled in the SDM in 2014 and 2016. A total of 28 (41.2%) and 21 (36.2%) students participated in the survey in 2014 and 2016, respectively. The average age of all respondents was 25.8 (±4.0) years. The proportion of females was 75% with no differences between groups, neither among classes nor years of the survey. The students felt well prepared following the bachelor's degree pre-clinical programme and a two-week introduction immediately preceding the clinical course. During clinical training, the students' experiences with their assigned tutors were positive even though waiting times for tutors during patient care as well as organisational efforts to manage attestations and logbooks were mentioned. For each discipline, patient assignment (ρ=0.54, p<0.0001) and frequently meeting with their tutors (ρ=0.56, p<0.0001) revealed the highest correlation with 1) achieving minimum requirements and 2) improving treatment planning skills in both fourth- and fifth-year dental students. In conclusion, tutor-supported comprehensive care training is well accepted by dental students while focusing on both patient assignment and frequent discussions with tutors may help students to better achieve minimum requirements in clinical dental education.
Aim
To investigate the spontaneous regeneration of the implanto‐mucosal and dento‐gingival unit after complete removal of keratinized tissue (KT).
Materials and Methods
One hemi‐mandible per dog (n = ...4) was allocated to receive three dental implants (test sites, premolar region), whereas three premolars on the contralateral side were controls. After osseointegration, the entire KT (buccal + lingual) was surgically excised on all test and control sites, leaving the bone exposed. Clinical measurements were performed before excision (T0) and after 12 weeks (T1). Following healing, the animals were euthanized, and the specimens were histologically processed. Descriptive statistical analyses were performed.
Results
Clinical measurements revealed that at T1, on all teeth, a band of KT was spontaneously regenerated (mean width: 2.60 ± 0.66 mm), whereas on implants, KT was detected only occasionally at mesial or distal but not at buccal sites (mean total: 0.35 ± 0.53 mm; p < .0001). Histologically, spontaneous regeneration of the dento‐gingival unit was evident, displaying masticatory mucosa. At the implant sites, on the other hand, the implanto‐mucosal unit was characterized by a non‐keratinized epithelium and elastic fibres, indicating the characteristics encountered in alveolar mucosa.
Conclusion
After excision of KT at implant sites, the spontaneous regeneration of the soft tissue is characterized by a non‐keratinized epithelium typical for alveolar mucosa, while at tooth sites the spontaneous regeneration was characterized by soft tissue resembling gingiva.
It is not exactly known whether guided growth or definitive epiphysiodesis techniques are superior in treating limb length discrepancy (LLD). The purpose of the present study was therefore to find ...out if definitive epiphysiodesis is associated with more powerful LLD correction than tension band plate epiphysiodesis.
Pediatric patients with LLD treated either with tension band plating as a guided growth technique (temporary epiphysiodesis) or a percutaneous drilling technique (definitive epiphysiodesis) around the knee and a minimum follow-up of 12 months were included in this retrospective study. Radiographic measurements were performed by two independent reviewers. The reduction in side difference between preoperative radiographs and last follow-up was calculated and compared between surgical techniques.
Thirty-eight patients (mean age 13.6 years) were included, 17 treated with temporary and 21 with definitive epiphysiodesis. Average follow-up was at 578 days. The reduction of the LLD in 12 months was 5.7 mm in patients treated with temporary epiphysiodesis and 8.4 mm with definitive epiphysiodesis, respectively (p = 0.22). In both groups, LLD could be statistically significantly reduced after 12 and 24 months. Definitive epiphysiodesis had a lower revision rate (4.8% vs. 17.6%). Intra- and interobserver reliability of the measurements was excellent.
As in earlier studies supposed, temporary epiphysiodesis with tension band plating seems to correct LLD less powerful compared to definitive percutaneous epiphysiodesis. However, in the present study, the differences of LLD correction were not statistically significant. We do not recommend the use of tension band plates for LLD correction due to inferior correction with higher complication and revision rate.
Background: Periodontitis is the major cause of tooth loss in adults and is linked to systemic illnesses, such as cardiovascular disease and stroke. The development of rapid point‐of‐care (POC) ...chairside diagnostics has the potential for the early detection of periodontal infection and progression to identify incipient disease and reduce health care costs. However, validation of effective diagnostics requires the identification and verification of biomarkers correlated with disease progression. This clinical study sought to determine the ability of putative host‐ and microbially derived biomarkers to identify periodontal disease status from whole saliva and plaque biofilm.
Methods: One hundred human subjects were equally recruited into a healthy/gingivitis group or a periodontitis population. Whole saliva was collected from all subjects and analyzed using antibody arrays to measure the levels of multiple proinflammatory cytokines and bone resorptive/turnover markers.
Results: Salivary biomarker data were correlated to comprehensive clinical, radiographic, and microbial plaque biofilm levels measured by quantitative polymerase chain reaction (qPCR) for the generation of models for periodontal disease identification. Significantly elevated levels of matrix metalloproteinase (MMP)‐8 and −9 were found in subjects with advanced periodontitis with Random Forest importance scores of 7.1 and 5.1, respectively. The generation of receiver operating characteristic curves demonstrated that permutations of salivary biomarkers and pathogen biofilm values augmented the prediction of disease category. Multiple combinations of salivary biomarkers (especially MMP‐8 and −9 and osteoprotegerin) combined with red‐complex anaerobic periodontal pathogens (such as Porphyromonas gingivalis or Treponema denticola) provided highly accurate predictions of periodontal disease category. Elevated salivary MMP‐8 and T. denticola biofilm levels displayed robust combinatorial characteristics in predicting periodontal disease severity (area under the curve = 0.88; odds ratio = 24.6; 95% confidence interval: 5.2 to 116.5).
Conclusions: Using qPCR and sensitive immunoassays, we identified host‐ and bacterially derived biomarkers correlated with periodontal disease. This approach offers significant potential for the discovery of biomarker signatures useful in the development of rapid POC chairside diagnostics for oral and systemic diseases. Studies are ongoing to apply this approach to the longitudinal predictions of disease activity.
The main aim of the present study was to gain a better understanding of the management of dental anxiety reported by dental practitioners in western Switzerland. In 2013, an 18-item electronic ...questionnaire was sent to dental practitioners in the Swiss Romandy. A total of 140 (18.6%) questionnaires were included in the analysis. About four out of five practitioners (79.4%) involved with dental emergency service had at least one occurrence with dental phobic patients. The majority of the respondents stated that both dental anxiety and dental phobia increases stress in the dental practice with frequencies of 90.0% and 88.5%, respectively. Among the 119 respondents using anxiety reduction methods (85.0%), an overall of 51 (42.9%) reported using pharmacological methods while 89.9% (n = 107) used psychological methods. Female dentists were using psychological anxiety reduction methods three times more frequently than male dentists reaching borderline statistical significance (OR = 3.0, p = 0.0591). Out of 140 respondents, only 28 (20.1%) received education and training in dental anxiety reduction methods. The majority of these (66.4%; n = 83) stated that their education was inadequate and 55.8% (n = 77) requested further education and training. It can be concluded that more education and training of dental anxiety reduction methods are needed.
Aim
To investigate the healing after heterotopic mucosa transpositioning at dental implants and teeth.
Materials and Methods
One hemimandible per dog (n = 4) was allocated to receive 3 implants ...(test), whereby 3 premolars on the contralateral side served as controls. After osseointegration, a Z‐plasty was performed on the buccal aspect of the test and control sites to heterotopically move the zone of keratinized tissue (KT) into a region with non‐keratinized tissue (nKT) and vice versa. Clinical measurements were performed before (T0) and at 12 weeks following heterotopic transposition (T1). Thereafter, specimens were processed for histological analysis.
Results
Clinical measurements revealed that at T1, a band of KT was reestablished at teeth (mean: 2.944 ± 1.866 mm), whereas at implants, the transpositioned nKT resulted in a mucosa without any signs of keratinization (mean: 0 mm; p < .0001). At implant sites, the probing attachment level loss was more pronounced compared to tooth sites (−1.667 ± 1.195 mm and −1.028 ± 0.878 mm, respectively; p = .0076). Histologically, the transpositioned nKT, was accompanied by the formation of KT at the tooth but not at implant sites. The supracrestal soft tissues were statistically significantly higher at tooth compared to implant sites (2.978 ± 0.483 mm and 2.497 ± 0.455 mm, p = .0083). The transpositioned KT remained mostly unaltered in its morphological characteristics.
Conclusions
The findings of this study indicate that: (a) transpositioned KT may retain its morphological characteristics; and (b) transpositioned nKM was accompanied by the formation of KT at the tooth but not at implant sites.
Background
To evaluate periodontal disease progression (PDP) and potentially detectable effects of a single episode of scaling and root planing (se‐SRP) in subjects lacking professional dental care ...and oral hygiene practices for >40 years.
Methods
In 2013, se‐SRP was offered to all available subjects from the original cohort of 480 males initially established in 1970. From a total of 75 attending the previous examination in 2010 (baseline), 27 consented to receive the intervention while 18 declined and served as controls. Clinical data were recorded again in 2014 (follow‐up) similarly to the previous surveys (1970 to 2010).
Results
Subjects’ mean age in 2010 was 62.5 (± 3.6, test) and 61.9 (± 3.8, control) years. At follow‐up, both groups presented with elevated tooth loss of 1.2 (from 15.5 ± 9.0, test) and 1.5 (from 17.9 ± 6.6, control) resulting in 1,392 (test) and 1,061 (control) sites available for further analysis. In both groups, clinical attachment level (CAL) loss and probing depths (PD) deteriorated. PD increase of 0.22 mm (± 1.70) in the test group was significantly higher compared with the control group (0.08 mm ± 1.30) (P <0.0001) demonstrating unaffected PDP. Computed estimates of further PDP revealed CAL and PD reductions in subjects aged ≥40 years. Specifically, the latter was positively correlated with tooth loss in subjects aged ≥40 years (P = 0.69, P = 0.0012) and ≥50 years (r = 0.62, P <0.0001).
Conclusion
se‐SRP in previously untreated periodontitis subjects aged ≥50 years may be ineffective in reducing PDP thus demanding advanced preventive measures, treatment in the first half of life, and sustained access to supportive care.
Periodontal therapy is highly dependent on a patient's long-term adherence with regard to oral hygiene, diet, and regular check-ups at the dentist. Motivational Interviewing (MI) is a ...client-centered, directive method for encouraging a patients' behavioral health change. The aim of this systematic review was to reveal the effects of MI as an adjunct to periodontal therapy.
Three databases (PubMed, Cochrane Library, and Web of Science) were reviewed for randomized controlled clinical trials. Articles were included when using MI as an adjunct to periodontal therapy and presenting clinical periodontal and oral hygiene related parameters. Two authors independently coded the relevant articles.
The search yielded 496 articles. After analysis and exclusion, a total of five papers could be included. The quality of the articles ranged between 72-88%. The two independent raters showed a high inter-rater reliability (Cohens-Kappa = 0.89). In two studies MI showed a significant positive effect on bleeding on probing and plaque values. One study showed improvement of self-efficacy in interdental cleaning. Two studies showed no influence of MI on periodontal parameters of the patients.
The use of MI as an adjunct to periodontal therapy might have a positive influence on clinical periodontal parameters (plaque values, gingival, and periodontal inflammation) and psychological factors related to oral hygiene (self-efficacy). Due to the low body of evidence further studies are needed. Future studies should include fidelity measures of the applied MI, a high number of counselors, several MI sessions, and long-term study follow-up to show potential effects.
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