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Aim: To evaluate site-related changes in periodontal pocket depth (PPD) after non-surgical periodontal therapy and to identify predictors for PPD changes in a retrospective patient data analysis., Materials and Methods: PPD, clinical attachment level, bleeding on probing, tooth mobility (TM), furcation involvement (FI), abutment status, adherence to supportive periodontal care (SPC) and SPC follow-ups were obtained from fully documented patient data before periodontal therapy (baseline, T0), after active periodontal therapy (APT, T1) and during SPC (T2). PPD changes were classified into deteriorated or unchanged/improved at the site level. Multi-level logistic regression analysis was performed to identify factors influencing PPD changes during SPC., Results: This retrospective study included 51 females and 65 males (mean T0 age: 54.8 ± 10.1 years, 25 smokers, 12 diabetics) suffering from Stage III/IV periodontitis. Evaluation outcome: T0/16,044 sampling sites/2674 teeth; T1/15,636/2606; T2/14,754/2459. During 9.0 ± 2.3 years SPC, PPD decreased (-1.33 ± 0.70 mm) by 21.8% of the sites, remained unchanged by 41.4% and increased (1.40 ± 0.78 mm) by 36.8%. Distopalatal FI (p < .001, odds ratio [OR]: 0.252, 95% confidence interval [CI] for OR: 0.118-0.540), residual pockets (p < .001, OR: 0.503, 95% CI: 0.429-0.590) and TM Degrees I-III (Degree I: p = .002, OR: 0.765, 95% CI: 0.646-0.905; Degree II: p = .006, OR: 0.658, 95% CI: 0.489-0.886; Degree III: p = .023, OR: 0.398, 95% CI: 0.180-0.879) correlated significantly with increasing PPD., Conclusions: Over 75% of PPD remained unchanged or increased during SPC. Distopalatal FI, TM Degrees I-III and residual pockets after APT lead to worsening of periodontal pockets., (© 2024 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Aim: To analyse the efficacy of non-surgical therapy (NST) in terms of pocket closure (PC) and changes in percentage and number of pockets., Materials and Methods: Three databases (PubMed, EMBASE, and Scopus) were searched up to January 2020. Prospective studies with a minimum follow-up of 12 months and presenting data in terms of PC or number or percentage of pocket depths (PDs) before and after NST on systemically healthy patients were included. Random-effect meta-analyses were performed., Results: After screening 4610 titles and abstracts, 27 studies were included. Of these, 63.9% of PC was reported by one study. The percentage of PDs ≤3 mm changed from 39.06% to 64.11% with a weighted mean difference (WMD) of 26.14% (p < .001). This accounted for a relative increase of healthy sites of 64.13%. The mean percentage of PD ≥5 mm was 28.23% and 11.71% before and after treatment, respectively, with a WMD of 15.50% (p < .001). The WMD in the number of PDs ≥5 mm before and after treatment was 24.42 (p = .036). The mean number of residual PPD ≥5 after NST was 14.13., Conclusions: NST is able to eradicate the majority of the pockets. However, residual pockets after NST may remain and should be considered cautiously for further treatment planning., (© 2021 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Objectives: Residual pockets are a risk factor of periodontitis progression. This study evaluated the efficacy of periodontal endoscopy (PE) during scaling and root planning (SRP) of residual pockets in chronic periodontitis patients after initial periodontal treatment., Materials and Methods: A single-blinded, randomized controlled clinical trial was conducted in systemically healthy subjects presenting at least three residual pockets with a probing depth (PD) ≥ 5 mm in each quadrant. Subjects were randomly allocated to one of two trial groups using a computer-generated program: SRP + PE (test group) or SRP alone (control group). Clinical parameters (PD, clinical attachment level (CAL), bleeding on probing (BOP), and plaque index (PLI)) were then measured at baseline, 3-, and 6-month follow-up., Results: A total of 1629 sites in 37 patients were examined. Both treatments significantly improved all clinical outcomes (PD, CAL, BOP, and PLI) from baseline to 6 months (P < 0.05), although greater reductions in PD and PLI were observed in the test group at both 3- (PD: 3.45 ± 0.56 vs. 4.14 ± 0.59 mm; PLI: 0.55 ± 0.23 vs. 0.73 ± 0.27) and 6-month follow-up (PD: 3.12 ± 0.63 vs. 4.0 ± 0.68 mm; PLI: 0.49 ± 0.21 vs. 0.72 ± 0.28, respectively; P = 0.001 for PD and P = 0.021 for PLI). No significant differences in CAL or BOP were observed., Conclusions: SRP + PE resulted in significant reductions in PD and PLI compared to SRP alone in residual pockets with a PD ≥ 5 mm., Clinical Relevance: The findings highlight the benefits of SRP + PE, supporting use as an alternative strategy in nonsurgical periodontal treatment., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: At present the clinical efficacy of single (S) versus multiple (M) applications of antimicrobial photodynamic therapy (aPDT) is controversially discussed., Aim: To systematically evaluate the clinical efficacy of adjunctive S and M applications of aPDT to subgingival debridement (SD) in the treatment of residual periodontal pockets., Methods: An electronic search was carried out for randomized controlled clinical trials (RCTs) reporting on SD with the adjunctive use of S- or M-aPDT applications., Results: Statistically significantly higher improvement in bleeding on probing (BOP) and probing depth (PD) reduction was found for SD + S-aPDT versus SD, with Mean difference (MD) = -16.8 (95% CI: -30.7 to -2.91; p = 0.02) and 0.4, (95% CI: 0.02 to 0.78, p = 0.04), respectively. Regarding BOP, there was also a statistically significant difference when SD + M-aPDT was compared with SD alone, with a MD of -5.13 (95% CI: -7.20 to -3.07; p < 0.00001). For all parameters, SD + S-aPDT demonstrated the best treatment ranking of probability results, followed by SD + M-aPDT and SD alone., Conclusions: Within their limits, the present data indicate that in periodontal patients enrolled in maintenance: a) single and multiple adjunctive applications of aPDT following SD resulted in statistically significant BOP reduction compared to SD alone, and b) repeated applications of aPDT did not seem to result in superior outcomes compared to single applications., (Copyright © 2021. Published by Elsevier B.V.)

The aim of the present study was to evaluate the adjunctive effect of hyaluronic acid (HA) gel in the treatment of residual periodontal pockets over a 12-month period. Periodontal patients presenting at least one residual periodontal pocket 5-9 mm of depth in the anterior area were recruited from six university-based centers. Each patient was randomly assigned to subgingival instrumentation (SI) with the local adjunctive use of HA for test treatment or adjunctive use of local placebo for control treatment at baseline and after 3 months. Clinical parameters ( )probing depth (PD), bleeding on probing (BoP), plaque index (PI), recession (REC), clinical attachment level (CAL)) and microbiological samples for the investigation of the total bacterial count (TBC) and presence of specific bacterial species ( Porphyromonas gingivalis , Treponema denticola , Tannerella forsythia , Fusobacterium nucleatum ) were taken at baseline and every 3 months, until study termination. PD was determined as the primary outcome variable. From a total of 144 enrolled, 126 participants (53 males, 73 females) completed the entire protocol. Both treatments resulted in statistically significant clinical and microbiological improvements compared to baseline. Although the local application of HA showed a tendency for better results, there was a lack of statistically significant differences between the groups.

Purpose: To evaluate the efficacy of adjunctive aids to scaling and root planing (SRP) on clinical outcomes in treating periodontal patients included in regular periodontal maintenance programs., Materials and Methods: The electronic databases MEDLINE (Pubmed), EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for relevant articles published up to 1st January, 2020. Randomised controlled clinical trials of SRP with or without the use of adjuncts and published in English were included. A meta-analysis using the random-effects model was performed on the selected qualifying articles., Results: Nineteen studies were included in the systematic review and sixteen in the meta-analysis. The overall effect of adjunctive aids was statistically significant for reduction in probing depth (PD) (0.376 mm, 95% CI [0.144 to 0.609]) and clinical attachment level (CAL) gain (0.207 mm, 95% CI [0.0728 to 0.340]). No statistically significant differences were observed for changes in bleeding on probing (BOP) (p > 0.05). Among the different adjuncts, statistically significant positive effects were demonstrated for adjunctive photodynamic therapy (PD reduction 0.908 mm, 95% CI [0.227 to 1.589] and CAL change (0.457 mm, 95% CI [0.133 to 0.782]) and tetracycline fibers (PD reduction 0.534 mm, 95% CI [0.290 to 0.778] and CAL gain 0.280 mm, 95% CI [0.0391 to 0.521])., Conclusions: Despite high heterogeneity of the investigated data, based on the findings of a current systematic review, adjunctive aids (in particular, photodynamic therapy and tetracycline fibers) combined with SRP provide statistically significant clinical benefits compared to SRP alone. Due to the large number of included studies with high risk of bias, future studies should be based on adequate methodological procedures to improve the overall quality of reporting and to reduce the risk of bias.

Objective: To evaluate the efficacy of scaling and root planing (SRP) with a periodontal endoscope in the treatment of residual pockets in patients with periodontitis after initial periodontal therapy., Methods: Patients with residual pockets [probing depth (PD)≥5 mm] were included and randomly assigned to the endoscope group (SRP with a periodontal endoscope) or SRP group (SRP alone). The PD, attachment loss (AL), and bleeding on probing (BOP) of residual pockets were recorded before treatment and at 3 and 6 months after treatment. Data were analyzed with SPSS 20.0 software., Results: Compared with the baseline values, the percentage of PD≥5 mm sites, PD, AL, and BOP (+)% in the endoscope group and SRP group at 3 and 6 months after treatment decreased (P<0.05). Compared with the values at 3 months after treatment, the percentage of PD≥5 mm sites, PD, AL, and BOP (+)% at 3 and 6 months after treatment decreased in the endoscope group (P<0.05), whereas no statistical difference in these values was observed in the SRP group (P>0.05). Compared with those in the SRP group, the percentage of PD≥5 mm sites and PD at 3 and 6 months after treatment and AL and BOP (+)% at 6 months after treatment in the endoscope group decreased (P<0.05)., Conclusions: SRP with a periodontal endoscope shows a better effect in improving the PD, AL, and BOP of residual pockets (PD≥5 mm) in patients with periodontitis after initial periodontal therapy and has advantages in improving the long-term curative effect of this therapy.

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., (© 2019 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Background: No nomogram of peri-implantitis was reported before which is valuable for risk-estimating, clinical decision-making, and better-patients-communicating., Purpose: To identify the risk indicators and develop a nomogram prediction model of peri-implantitis in treated severe periodontitis patients., Materials and Methods: A prospective study was conducted on 100 patients with 214 implants. Periodontal and peri-implant parameters were evaluated at implant surgery procedure (T1), and at follow-up (T2). Risk factors were analyzed by logistic regression analyses with generalized estimating equations. Nomogram was developed and the discriminatory ability of the model was analyzed., Results: The incidence of peri-implantitis at patient-level and implant level were 16% and 11.2% respectively, with no implant lost. The variables associated with peri-implantitis were the PD T1  ≥ 6 mm (%) > 10%, the implant position, length, and diameter after adjusting for covariates. A nomogram prediction model of peri-implantitis were developed with factors of PD T1  ≥ 6 mm (%) > 10% and implant placed in posterior. The area under the ROC curves of stepwise model was 0.794., Conclusions: The residual pockets and implants position were identified as predictors for the peri-implantitis. The nomogram can be used to estimate the risk of peri-implantitis in treated severe periodontitis patients., (© 2018 Wiley Periodicals, Inc.)

Purpose: To evaluate the clinical efficacy of antimicrobial photodynamic therapy (aPDT) adjunctive to scaling and root planing (SRP) in the treatment of residual pockets for chronic periodontitis patients on supportive periodontal therapy (SPT)., Method: Bibliographic databases of MEDLINE and Cochrane Library were thoroughly searched up to July 2016 for eligible randomized controlled trials (RCTs). Mean differences (MD) and the corresponding 95% confidence intervals (CI) were synthesized for probing depth (PD) reduction and clinical attachment level (CAL) gain. The I 2 test and Q statistics were employed to assess inter-study heterogeneity. Subgroup analysis was performed based on the enrollment of smokers., Result: Four RCTs fulfilling the eligibility criteria were included. Pooled estimates demonstrated statistically significant improvements in both PD reduction (MD=0.69, CI: 0.11-1.28, p=0.02) and CAL gain (MD=0.60, CI: 0.11-1.10, p=0.02) for SRP+aPDT versus SRP alone. Meta-analysis of studies with smokers failed to produce a significant additional effect in PD (MD=0.32, CI: -0.30 to 0.94, p=0.31) and CAL (MD=0.42, CI: -0.26 to 1.09, p=0.23) when SRP was associated with aPDT. However, significant enhancements in PD reduction (MD=1.23, CI: 0.74-1.72, p<0.001) and CAL gain (MD=0.96, CI: 0.31-1.62, p=0.004) were observed for studies excluding smokers., Conclusion: Pooled evidence indicates an additional clinical improvement in the maintenance of residual pockets in favor of SRP+aPDT compared with SRP alone. Subgroup analysis demonstrates an adverse impact of smoking on clinical effect of the combined therapy. Substantial heterogeneity and the paucity of included studies undermine the statistical power of this meta-analysis. Future well-designed and large-scale clinical trials evaluating the adjunctive efficacy of aPDT in periodontal maintenance phase are critically needed., (Copyright © 2016 Elsevier B.V. All rights reserved.)