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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]

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]

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]

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]