Background
The aim of this study was to evaluate whether the combination of enamel matrix derivative (EMD) with subepithelial connective tissue graft (SCTG) plus coronally advanced flap (CAF) would ...improve the treatment outcomes of Miller class I and II gingival recessions when compared with the same technique (SCTG plus CAF) alone.
Methods
The study was designed as a randomized, parallel, controlled, double‐blinded clinical trial. Forty‐two patients were randomly assigned in the test group (SCTG plus EMD) and in the control group (SCTG). Patients had at least one gingival recession ≥ 2 mm. The clinical parameters were evaluated at baseline and at 14 d, 1, 3, 6 and 12 mo follow‐up time points.
Results
Forty‐two patients, 21 in the test group (SCTG plus EMD) and 21 in the control group (SCTG), aged 21–48 years (mean age 31 ± 8.56) were initially included in the study. Both treatments, STCG plus EMD and SCTG, resulted in a significant final mean root coverage (2.91 ± 0.95mm and 2.91 ± 1.29 mm, respectively) (p < 0.001) and in a high mean percentage of root coverage (82.25 ± 22.20% and 89.75 ± 17.33%, respectively) (p < 0.001), 1 year after surgery. The differences in mean root coverage recorded for the two techniques after 1 year, were not statistically significant (p = 0.19). Complete root coverage was achieved in 56.5% of patients treated with SCTG plus EMD and in 70.6% of patients treated with SCTG (p = 0.275), 1 year after treatment.
Conclusions
The present study failed to demonstrate any additional clinical benefits when EMD was added to SCTG plus CAF.
Aims
This study evaluated pain associated with electronic probing comparing two commercially available probe tip designs using standardized force.
Material and Methods
Twenty adult patients with ...slight‐moderate chronic periodontitis received periodontal probing using controlled‐force electronic probe at 2 visits. In visit 1, a random arch was probed with either a ball‐end (0.6 mm diameter, 408 kPa; Test) or straight (0.45 mm diameter, 726 kPa; Control) probe tip. The opposing arch was then probed using the other probe tip. Discomfort associated with each probing episode was recorded using visual analogue scale (VAS). 7 days later, tip assignments were alternated from visit 1 and VAS re‐scored. VAS scores were compared by probe tip, arches and visits.
Results
Both tips provided similar VAS scores (median 13.5 for ball‐end and 14 for straight, p = .3713). However, the straight tip was associated with decreased VAS scores in the maxilla (p = .01). Overall, VAS values did not differ by arch or study visit. Individual VAS scores showed high levels of correlation between study visits and between tips used (R2 = .86 and 0.64, respectively, p < .0001).
Conclusions
Both probing approaches were associated with low levels of pain on probing. The straight tip may be perceived as more comfortable in the maxilla.
ABSTRACT
Purpose: A recent in vivo study has shown considerable contamination of internal implant and suprastructure components with great biodiversity, indicating bacterial leakage along the ...implant‐abutment interface, abutment‐prosthesis interface, and restorative margins. The goal of the present study was to compare microbiologically the peri‐implant sulcus to these internal components on implants with no clinical signs of peri‐implantitis and in function for many years. Checkerboard DNA‐DNA hybridization was used to identify and quantify 40 species.
Material and Methods: Fifty‐eight turned titanium Brånemark implants in eight systemically healthy patients (seven women, one man) under regular supportive care were examined. All implants had been placed in the maxilla and loaded with a screw‐retained full‐arch bridge for an average of 9.6 years. Gingival fluid samples were collected from the deepest sulcus per implant for microbiological analysis. As all fixed restorations were removed, the cotton pellet enclosed in the intra‐coronal compartment and the abutment screw were retrieved and microbiologically evaluated.
Results: The pellet enclosed in the suprastructure was very similar to the peri‐implant sulcus in terms of bacterial detection frequencies and levels for practically all the species included in the panel. Yet, there was virtually no microbial link between these compartments. When comparing the abutment screw to the peri‐implant sulcus, the majority of the species were less frequently found, and in lower numbers at the former. However, a relevant link in counts for a lot of bacteria was described between these compartments. Even though all implants in the present study showed no clinical signs of peri‐implantitis, the high prevalence of numerous species associated with pathology was striking.
Conclusions: Intra‐coronal compartments of screw‐retained fixed restorations were heavily contaminated. The restorative margin may have been the principal pathway for bacterial leakage. Contamination of abutment screws most likely occurred from the peri‐implant sulcus via the implant‐abutment interface and abutment‐prosthesis interface.
The purpose of the present study is to evaluate the 10-year results following treatment of intrabony defects treated with an enamel matrix protein derivative (EMD) combined with either a natural bone ...mineral (NBM) or β-tricalcium phosphate (β-TCP).
Twenty-two patients with advanced chronic periodontitis and displaying one deep intrabony defect were randomly treated with a combination of either EMD + NBM or EMD + β-TCP. Clinical evaluations were performed at baseline and at 1 and 10 years. The following parameters were evaluated: plaque index, bleeding on probing, probing depth, gingival recession, and clinical attachment level (CAL). The primary outcome variable was CAL.
The defects treated with EMD + NBM demonstrated a mean CAL change from 8.9 ± 1.5 mm to 5.3 ± 0.9 mm (P <0.001) and to 5.8 ± 1.1 mm (P <0.001) at 1 and 10 years, respectively. The sites treated with EMD + β-TCP showed a mean CAL change from 9.1 ± 1.6 mm to 5.4 ± 1.1 mm (P <0.001) at 1 year and 6.1 ± 1.4 mm (P <0.001) at 10 years. At 10 years two defects in the EMD + NBM group had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. In the EMD + β-TCP group three defects had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. Compared with baseline, at 10 years, a CAL gain of ≥3 mm was measured in 64% (i.e., seven of 11) of the defects in the EMD + NBM group and in 82% (i.e., nine of 11) of the defects in the EMD + β-TCP group. No statistically significant differences were found between the 1- and 10-year values in either of the two groups. Between the treatment groups, no statistically significant differences in any of the investigated parameters were observed at 1 and 10 years.
Within their limitations, the present findings indicate that the clinical improvements obtained with regenerative surgery using EMD + NBM or EMD + β-TCP can be maintained over a period of 10 years.
Background and Objective
This cross‐sectional case–control study was conducted to provide a comparative evaluation of clinical periodontal measurements, together with serum levels of certain ...bioactive peptides and inflammatory cytokines, in relation to obesity. For this purpose, clinical periodontal measurements and the levels of serum leptin, adiponectin, interleukin‐6 (IL‐6), C‐reactive protein and soluble intercellular adhesion molecule‐1 of obese female individuals and their nonobese counterparts were compared.
Material and Methods
Sixty obese (body mass index (BMI) > 30) and 31 nonobese (BMI < 30) female subjects were recruited for the present study. Before any periodontal intervention, serum samples were obtained and full‐mouth clinical periodontal measurements were recorded at six sites per tooth. ELISA was used for the biochemical analysis. Data were tested statistically.
Results
Clinical attachment level was significantly higher in the obese group compared with the nonobese control group (p < 0.05). Serum levels of leptin and IL‐6 were significantly higher in the obese group (p < 0.05). BMI correlated with the serum levels of inflammatory molecules (p < 0.05), but not with clinical periodontal parameters, in the obese group.
Conclusion
In conclusion, obesity does not seem to have a prominent effect on clinical periodontal parameters but it does have many correlations with circulating inflammatory molecules. As suggested in the literature, increased levels of leptin and IL‐6 in the obese group might be one explanation for a possible relationship between obesity and periodontal disease. A prospective study is warranted to clarify, in greater detail, the effects of obesity on periodontal health.
Abstract The extraction of an impacted third molar violates the surrounding soft and bony tissues. The surgeon's access to the tooth, for which there are various surgical approaches, has an important ...impact on the periodontium of the adjacent second molar. The aim of this review was to analyze the relationships between the different flap techniques and postoperative periodontal outcomes for the mandibular second molars (LM2) adjacent to the impacted mandibular third molars (LM3). An electronic search of MEDLINE and other databases was conducted to identify randomized controlled trials fulfilling the eligibility criteria. To assess the impact of flap design on the periodontal condition, the weighted mean difference of the probing depth reduction (WDPDR) and the weighted mean difference of the clinical attachment level gain (WDCAG) at the distal surface of LM2 were used as the primary outcomes. The results showed that, overall, the different flap techniques had no significant impact on the probing depth reduction (WDPDR −0.14 mm, 95% confidence interval −0.44 to 0.17), or on the clinical attachment level gain (WDCAG 0.05 mm, 95% confidence interval −0.84 to 0.94). However, a subgroup analysis revealed that the Szmyd and paramarginal flap designs may be the most effective in reducing the probing depth in impacted LM3 extraction, and the envelope flap may be the least effective.
Chronic periodontitis (ChP) is a multifactorial disease influenced by microbial and host genetic variability; however, the role of beta-defensin-2 genomic (DEFB4) copy number (CN) variation (V) in ...ChP remains unknown. The association of the occurrence and severity of ChP and DEFB4 CNV was analyzed. Our study included 227 unrelated Caucasians, that is, 136 ChP patients (combined ChP) and 91 control individuals. The combined ChP group was subdivided into the severe ChP and slight-to-moderate ChP subgroups. To determine DEFB4 CNV, we isolated genomic DNA samples and analyzed them by relative quantitation using the comparative CT method. The serum beta-defensin-2 (hBD-2) level was determined via ELISA. The distribution pattern and mean DEFB4 CN did not differ significantly in combined ChP cases vs. the controls; however, the mean DEFB4 CN in the severe ChP group differed significantly from those for the control and slight-to-moderate ChP groups. Low DEFB4 CN increased the risk of severe ChP by about 3-fold. DEFB4 CN was inversely associated with average attachment loss. Mean serum hBD-2 levels were highest in the controls, followed by the slight-to-moderate ChP group and the severe ChP group. The results suggested an association between decreased DEFB4 CN and serum hBD-2 levels and periodontitis severity.
Objectives
To evaluate the efficacy of a slow release doxycycline gel (SRD) adjunctively administered to non‐surgical therapy in subjects with recurrent or persistent periodontitis but acceptable ...oral hygiene during supportive periodontal care.
Material & methods
In this single blind, parallel group, multicentre study, 202 of 203 recruited periodontal maintenance subjects with recurrent or persistent periodontitis were randomly assigned to subgingival ultrasonic/sonic instrumentation (USI) with (test) or without (control) subsequent administration of SRD in all residual periodontal pockets ≥4 mm. Intergroup differences in probing depth, BOP reductions, treatment time, probing attachment levels were evaluated at 3, 6 and 12 months. The primary outcome was the inter‐group difference in absolute change of probing pocket depth (PPD) 3, 6 and 12 months after intervention.
Results
At baseline, the two groups were comparable. At 3 months, the test group showed a significantly higher decrease in mean probing depth than the control group at 3 months (mean difference = 0.11 mm, 95% CI 0.03–0.19 mm, p = 0.003). Administration of SRD resulted in significantly greater odds of transition of bleeding pockets ≥5 mm to a category of non bleeding sites with PPD ≤4 mm at 3 and 6 months (O.R. = 1.4, 95% CI 1.2–1.8 at 3 months). At 6 months, SRD benefit was observed only in the deeper pockets. 7.5% of subjects (no significant difference between test and control) showed disease progression (attachment loss ≥2 mm) and were exited from the study. No difference in the incidence of adverse events was observed between groups.
Conclusion
The trial results show that topically administered SRD may provide short‐term benefit in controlling inflammation and deep pockets in treated periodontal patients participating in a secondary prevention programme and able to maintain a satisfactory level of oral hygiene.
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