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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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The subject risk assessment may estimate the risk for susceptibility for progression of periodontal disease. It consists of an assessment of the level of infection (full mouth bleeding scores), the prevalence of residual periodontal pockets, tooth loss, an estimation of the loss of periodontal support in relation to the patient's age, an evaluation of the systemic conditions of the patient and finally, an evaluation of environmental and behavioral factors such as smoking. All these factors should be contemplated and evaluated together. A functional diagram may help the clinician in determining the risk for disease progression on the subject level. This may be useful in customizing the frequency and content of SPT visits. [ABSTRACT FROM AUTHOR]

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.

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]

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 PDT1 ≥ 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. [ABSTRACT FROM AUTHOR]

Objective To assess the long-term survival of implants inserted in periodontally susceptible patients and to investigate the influence of residual pockets on the incidence of peri-implantitis and implant loss. Materials and methods For 70 patients, comprehensive periodontal treatment was followed by installation of 165 Straumann® Dental implants. Subsequently, 58 patients entered a University supportive periodontal therapy ( SPT) program and 12 had SPT in a private practice. The follow-up time ranged from 3 to 23 years (mean 7.9 years). Bleeding on probing ( BOP), clinical attachment level ( CAL), and peri-implant probing depths ( PPD) were evaluated at baseline (T0), completion of active treatment (T1), and at follow-up (T2). Peri-implant bone levels were assessed on radiographs at T2. Patients were categorized as having implants not affected by peri-implantitis (non- PIP), or affected by peri-implantitis ( PIP). Results From 165 implants inserted, six implants were lost, translating into a cumulative survival rate of 95.8%. Solid screw implants yielded significantly higher survival rates than the hollow cylinder and hollow screw implants (99.1% vs. 89.7%). Implants lost due to peri-implant infection were included in the PIP groups. When peri-implantitis ( PPD≥ 5 mm, BOP+) was analyzed, 22.2% of the implants and 38.6% of patients had one or more implants affected by peri-implantitis. Using the peri-implantitis definition ( PPD≥6 mm, BOP+), the prevalence was reduced to 8.8% and 17.1%, respectively. Moreover, all these implants demonstrated significant (≥2 mm) bone loss at T2. At T1, the non- PIP group had significantly ( P = 0.011) fewer residual pockets (≥5 mm) per patient than the PIP group (1.9 vs. 4.1). At T2, the PIP group displayed an increased number of residual pockets compared to T1, whereas in the non- PIP group, the number remained similar to T1. At T2, mean PPD, mean CAL and BOP were significantly higher in the PIP group compared with the non- PIP group. The prevalence of peri-implantitis was lower in the group that was in a well organized SPT at the University. Conclusions In periodontitis susceptible patients, residual pockets ( PPD ≥5 mm) at the end of active periodontal therapy represent a significant risk for the development of peri-implantitis and implant loss. Moreover, patients in SPT developing re-infections are at greater risk for peri-implantitis and implant loss than periodontally stable patients. [ABSTRACT FROM AUTHOR]

Perinetti G, Paolantonio M, Cordella C, D'Ercole S, Serra E, Piccolomini R: Clinical and microbiological effects of subgingival administration of two active gels on persistent pockets of chronic periodontitis patients. J Clin Periodontol 2004 doi: 10.1111/j.1600-051X.2004.00481.x. © Blackwell Munksgaard, 2004. The present controlled, single-blind study was performed to assess and compare the clinical healing and the microbiological findings following repeated intrasulcular applications of 1% metronidazole or 1% chlorhexidine gels in persistent periodontal pockets previously treated by scaling and root planing (SRP). Sixty-three systemically healthy subjects, 25 males and 38 females (mean age 48.4±7.2 years), diagnosed for chronic periodontitis were enrolled in this study. They underwent SRP and received oral hygiene instructions (OHI). Three months later, at baseline, a single persistent pocket with a probing depth (PD) of 5–9 mm was chosen as the experimental site in each patient; the subjects were stratified into three matched experimental groups on the basis of the treatment to be performed, which consisted of the subgingival administration of 1% metronidazole gel (MG, n=19), 1% chlorhexidine gel (CG, n=20) or placebo gel (PG, n=24). The treatments consisted of four repeated administrations of subgingival gels, each separated by 7 days, starting at the baseline. Clinical assessment was performed at the baseline and at the 180-day follow-up, after the end of treatment. For microbiological evaluations, subgingival plaque was sampled from the experimental sites at baseline, prior to the first subgingival gel administration, and at 7, 15, 30 and 90 days after the end of the treatment (days 28, 36, 51 and 111 from baseline). Plaque accumulation did not change significantly in all three groups. Bleeding on probing and clinical attachment levels reduced in the MGs and CGs only. PD was significantly reduced by the same amount in all experimental groups. In the MGs and CGs a remarkable reduction in the frequencies of detection of several periodontopathic micoorganisms was recorded after the treatment. The same was not seen for the PGs. Subgingival administration of MG or CG, both at 1%, may have a role in the management of persistent pockets during chronic periodontitis. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This article attempts to establish some of the general laws relating to spatial aspects of general systems theory, i.e., how forces, impulses, and ideas (matter, energy, and information) spread, diversify, and compete with one another, and how the earlier history of observed structures can be traced by backtracking. Principles that have long been accepted for nonliving and low-level living systems are recognized in the activities of individual human beings, groups, and supranational systems. [ABSTRACT FROM AUTHOR]

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.