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Aim: To investigate the potential benefit of enamel matrix derivative (EMD) as adjunct to re‐instrumentation of residual pockets persisting after steps 1 and 2 of periodontal therapy. Material and Methods: 44 adult patients participated in a multicentre feasibility randomized clinical trial with split‐mouth design. They had presented at re‐evaluation after initial non‐surgical periodontal therapy (steps 1 and 2 of periodontal therapy) for generalized periodontitis with at least 2 teeth with residual probing pocket depths (PPD) ≥5 and ≤8 mm, with bleeding on probing (BOP). Two teeth with similar PPD were randomized to receive re‐instrumentation either with (test) or without (control) adjunctive flapless administration of EMD. Differences in the changes of PPD and BOP from baseline to 6 and 12 months were analysed, and the frequencies of pocket closure (PPD ≤4 mm and no BOP) compared. Results: For the primary outcome "change of mean PPD after 6 months," a significant additional benefit of 0.79 ± 1.3 mm (p <.0001) could be observed for the test group. At 12 months, this difference could be maintained (0.85 ± 1.1 mm; p <.0001). The frequency of pocket closure in the test group was 69% at 6 and 80% at 12 months and significantly higher than in the control group with 34% and 42%, respectively (p <.01). Conclusions: The results of the present feasibility study indicate a benefit of adjunctive EMD during non‐surgical retreatment (step 3 of periodontal therapy) of residual deep pockets. [ABSTRACT FROM AUTHOR]

AIM: This study was undertaken to evaluate the diffusion of hydroxyl ions through dentin after obturation with Gutta percha and various sealers and subsequent re-instrumentation. MATERIAL AND METHODOLOGY: Sixty extracted single rooted maxillary incisors were used. The canals were cleaned and shaped till size 50 K-file. 3% Sodium Hypochlorite and RC Prep was used during cleaning and shaping. The samples were divided into 4 groups, stored in 10 ml of freshly prepared distilled water and pH of the distilled water was measured after 7 days-(E1).The canals were filled with calcium hydroxide and the pH was measured after 7, 14, 21, 28 days- pH 1. They were later obturated with Gutta percha and sealers, labelled as Group A- Endoflas, Group B- Endoseal MTA, Group C- Resino Seal and Group D- Apexit Plus. The pH was measured (F). The obturating material was removed and the pH was measured after 7 days-(E3). The samples were re-instrumented and the pH was measured (E4). The empty canals were filled with calcium hydroxide and the pH was measured as (pH 2) at 7, 14, 21, 28 days. Statistical analysis was done using the Kruskal Wallis, Mann-Whitney U test and two way ANOVA. RESULT: The results showed a statistically significant difference between the average values of pH 1 and pH 2 showing a rise in pH for pH 2 indicating in hydroxyl ion diffusion. The pH showed variations for different sealers showing difference in diffusion of hydroxyl ions with maximum values for Zinc Oxide Eugenol based sealers and least for resin based sealers. CONCLUSION: Hence from this study it can be concluded that reinstrumentation increased the diffusion of hydroxyl ions from the dentin and the type of sealers obturating the canals did alter the diffusion. [ABSTRACT FROM AUTHOR]

Aim: To examine the adjunctive effect of a Lactobacillus reuteri probiotic (ATCC PTA 5289 & DSM 17938) on the re‐instrumentation of residual pockets. Materials and Methods: This randomized, double‐blind, placebo‐controlled study included 39 previously non‐surgically treated periodontitis patients. A re‐instrumentation was carried out, and probiotic and/or placebo drops were applied according to the study protocoll. Patients afterwards received lozenges to use 2×/day for 12 weeks. Probing pocket depth (PPD), recession, bleeding on probing and plaque levels were analysed, next to the microbiological impact. Results: No effects of the probiotic drops could be found. However, after 24 weeks, the overall PPD in the probiotic lozenges group (2.64 ± 0.33 mm) was significantly lower compared to the control lozenges (2.92 ± 0.42 mm). This difference was even more pronounced in moderate (4–6 mm) and deep (≥7 mm) pockets. In the probiotic lozenges group, there were also significantly more pockets converting from ≥4 mm at baseline to ≤3 mm at 24 weeks (67 ± 18% versus 54 ± 17%) and less sites in need for surgery (4 ± 4% versus 8 ± 6%). However, the probiotic products did not influence the microbiological counts of the periodontopathogens. Conclusion: The adjunctive consumption of L. reuteri lozenges after re‐instrumentation improved the PPD reduction, without an impact on pocket colonization with periodontopathogens. [ABSTRACT FROM AUTHOR]