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Objective: To investigate the association between interleukin-8 (IL-8) levels in gingival crevicular fluid (GCF) and total oral fluid (TOF) and the responsiveness to steps 1 and 2 of periodontal therapy., Materials and Methods: One-hundred and fifty-nine patients affected by periodontitis received steps 1 and 2 of periodontal therapy. At baseline, TOF and GCF samples were collected and analysed for IL-8 (Il-8 TOF /IL-8 GCF ) using flow cytometry. Therapy outcomes were relative proportions of residual periodontal pockets (PPD%), pocket closure (PC) rates and pocket probing depth (PPD) reductions; these were associated with IL-8 TOF /IL-8 GCF ., Results: High IL-8 TOF was significantly associated with higher residual PPD% (p = 0.044) and lower PPD reduction compared to low IL-8 TOF (high 0.79 ± 1.20 mm vs. low 1.20 ± 1.20 mm, p < 0.001) in non-smokers, while in smokers high IL-8 GCF was related to lower PPD reduction (high 0.62 ± 1.22 mm vs. low 0.84 ± 1.12 mm, p = 0.009). Furthermore, high baseline IL-8 TOF was significantly associated with poorer PC rates compared to medium and low concentrations in both non-smokers (high 41% vs. medium 55% vs. low 58%, p < 0.001) and smokers (high 34% vs. medium 44% vs. low 46%, p < 0.001)., Conclusion: High IL-8 concentrations at baseline had a significant impact on residual PPD%, PC rates and PPD reduction. The findings suggest that, especially in non-smokers, baseline IL-8 levels collected from the TOF could serve as a component in the estimation of responsiveness to steps 1 and 2 of periodontal therapy., (© 2024 The Author(s). Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Objectives: This randomized, controlled, double-blinded clinical trial aimed to evaluate the efficacy of octenidine hydrochloride and chlorhexidine mouthwashes as adjuncts to instrumentation in stage I-II periodontitis patients., Methods: Forty-five patients with mild-to-moderate periodontitis were randomly allocated to three groups: 0.1% octenidine dihydrochloride (OCT), placebo, and 0.12% chlorhexidine (CHX) mouthwashes. Patients were instructed to use the mouthwash after instrumentation for twice a day up to 3 weeks. Periodontal parameters such as probing pocket depth (PPD), clinical attachment loss (CAL), O'Leary plaque index (PI), Loe and Silness gingival index (GI), Lobene stain index (SI), and oral soft tissue changes were recorded at baseline and once every week for 3 weeks. The visual analogue scale (VAS) was also recorded as a self-administered questionnaire at the end of the study. The one-way ANOVA was used to compare VAS scores between the groups. The repeated measures ANOVA and post hoc Newman-Keuls tests were used to assess the differences in the periodontal parameters between groups at different time intervals. The Kruskal-Wallis test was used to compare the mean SI., Results: There was a significant reduction in the mean GI of the OCT and CHX groups compared to placebo (p < 0.05). OCT usage resulted in significantly less staining, according to mean SI, when compared to CHX. Furthermore, VAS scores revealed that OCT was significantly the preferred mouthwash (p < 0.01)., Conclusion: Adjunctive octenidine hydrochloride may be an alternative to chlorhexidine in its ability to control the periodontal parameters in patients with stage I-II periodontitis. Further larger studies are necessary to confirm these findings., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: The aim of this randomized controlled trial was to assess clinical and patient reported outcomes of subgingival instrumentation (SI) with adjunctive use of diode laser (DL) versus SI alone in the treatment of periodontitis., Methods: Participants requiring non-surgical periodontal treatment were randomly allocated into two treatment groups: SI with DL or SI alone. Clinical parameters [full mouth bleeding and plaque scores (FMBS and FMPS), probing pocket depth and clinical attachment level] were recorded at baseline, three and 6 months post-treatment. Visual analogue scale was used to evaluate postoperative participants' perception of pain, swelling, bleeding, bruising and root sensitivity. The impact of periodontal treatment on quality of life was assessed using the General Oral Health Assessment Index (GOHAI) at 6 months., Results: A total of 22 participants with stage III/IV periodontitis completed the 6-month follow-up. SI with or without DL resulted in statistically significant reduction in FMBS, FMPS, PPDs, and percentage of PPDs of ≥5 mm at 3- and 6-month follow-up visits (p = 0.001 to <0.001). The participants in SI/DL group had a greater reduction in the percentage of deep PPDs (≥5 mm) compared to those receiving SI alone, but statistically significant differences between the two groups were not observed (16.40 ± 9.57 vs. 32.50 ± 38.76 at 3 months and 7.20 ± 6.86 vs. 19.50 ± 35.06 at 6 months). The difference in the mean total GOHAI scores was not statistically significant at 6 months with total GOHAI scores of 7.25 ± 2.45 and 5.40 ± 3.06 for SI and SI/DL groups, respectively., Conclusion: Within the limitations of this study, the use of DL as an adjunct to SI in the treatment of stage III/IV periodontitis did not produce significant additional improvement in clinical parameters or patient reported outcomes in the 6-month observation period., (© 2024 The Authors. International Journal of Dental Hygiene published by John Wiley & Sons Ltd.)

Background: The combination of photodynamic therapy (PDT) and LL-37 has never been tested in an animal study and our research team background suggests this strategy might be a promising alternative to intensify periodontitis resolution. This study aimed to assess the effects of multiple sessions of PDT with chlorin-e6 conjugated to the antimicrobial peptide LL-37 loaded nanoemulsion, as adjunctive therapy in experimental periodontitis in rats., Methods: Experimental periodontitis was induced in 81 rats. After disease establishment, animals were assigned to three groups: SRP (scaling and root planning); SRP + 1PDT, SRP followed by a single PDT session; SRP + 4PDT (n = 27), SRP followed by four PDT sessions at 0, 24, 48 and 72 h after SRP. Animals were subjected to euthanasia at 7, 14 and 28 days, and samples were submitted to osteoclast quantification, immunological and microtomography analysis., Results: All treatments resulted in significant periodontal improvements and there was no significant difference between the groups in both local inflammatory response and healing process. Minimal adjunctive effects could be found for the combined therapy in terms of cytokine levels (IL-1β and IL-10), with no statistical significance. However, the number of TRAP-positive osteoclasts per mm of alveolar bone linear surface for the group treated with PDT sessions was significantly lower than those treated with SRP only., Conclusions: Multiple PDT sessions with chlorin-e6 and LL-37 nanoemulsion as an adjunct to scaling and root planning reduced the presence of osteoclast in the local site but did not contribute towards bone regeneration and IL-1β and IL-10 levels., Competing Interests: Declaration of competing interest This manuscript has been read and approved in final form by all authors and the authors declare no conflicts of interest., (Copyright © 2024. Published by Elsevier B.V.)

Aim: To compare the subgingival microbiota of patients receiving supportive periodontal care (SPC) with and without subgingival instrumentation, over 2 years., Materials and Methods: This study was a randomized clinical trial that included 62 participants (50.97 ± 9.26 years old; 40 females) who completed non-surgical periodontal therapy. Participants were randomly assigned to receive oral prophylaxis with oral hygiene instructions alone (test) or in combination with subgingival instrumentation (control) during SPC. Pooled subgingival biofilm samples were obtained from four sites per patient at SPC baseline and at 3, 6, 12, 18, and 24 months. Real-time polymerase chain reaction was used for absolute quantification of Eubacteria and the target bacteria Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. Data were analysed using generalized estimating equations, taking into consideration the clustering of observations within individuals., Results: No significant differences were found between the experimental groups regarding the mean counts of Eubacteria and target bacteria, as well as the periodontal parameters at the sampled sites. Although significant variability in bacterial counts was present during SPC, all counts after 2 years were not statistically different from those at baseline. Bacterial counts were associated with the presence of plaque, bleeding on probing, mean probing depth ≥3 mm, and follow-up period., Conclusions: SPC with or without subgingival instrumentation can result in comparable subgingival microbiological outcomes., Clinical Trial Registration: clinicaltrials.gov: NCT01598155 (https://clinicaltrials.gov/study/NCT01598155?intr=supragingival%20control&rank=4#study-record-dates)., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: To demonstrate the potential application of mixed reality (MR) holographic imaging technology in subgingival scaling and root planing (SRP) for patient with advanced periodontitis., Methods: This case series comprised the analysis of 1566 sites from 261 teeth of 10 patients with advanced periodontitis. Digital CBCT scans and intraoral scans of the patients were digitally acquired preoperatively and aligned to create a three-dimensional periodontal visualization model. Through rendering, interactive holographic images were displayed using MR. The surgeon first used MR images to communicate with the patients, and then facilitated SRP under their guidance. Probing pocket depth (PPD), clinical attachment loss (CAL), Plaque index (PI), and bleeding on probing (BOP) parameters were recorded at baseline and at 8-week postoperatively. Patient-reported outcome indicator questionnaires on self-efficacy were also collected., Results: PPD, CAL, PI, and BOP significantly decreased at 8-week following MR hologram-assisted SRP (p<0.001). For sites with PPD≥4 mm, PPD and CAL declined by 2.33±1.23 mm and 0.69±1.07 mm, respectively. PI significantly decreased from 1.94±0.61 to 0.82±0.58 (p < 0.001) and BOP sites decreased significantly from 84.11% to 40.25%. After receiving MR holograms for condition communication, most patients had a better perception of the effectiveness of SRP treatment and the benefits it brings. 80% of the subjects expressed their willingness to undergo MR-assisted periodontal treatment in the future., Conclusion: These results provide preliminary support for MR hologram-assisted digital SRP. With this technology, images of the gingiva and alveolar bone can be displayed in real time, accurately and three-dimensionally. This improves SRP effectiveness, diminishes complications, and enhances patients' confidence in the treatment., Clinical Significance: MR holographic imaging-based digital SRP is a clinically feasible and promising adjunctive periodontal treatment option. It may contribute to improved non-surgical treatment efficacy in patients with severe periodontitis., Competing Interests: Declaration of competing interest The authors declare there is no conflict of interests., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Growing evidence suggests the type of periodontal treatment could differentially influence the reduction of key cardiovascular risk mediators in periodontitis patients. This randomized, controlled clinical trial compared the impact of minimally invasive non-surgical therapy (MINST) with quadrant-wise subgingival instrumentation (Q-SI) on C-reactive protein (CRP) together with lipoprotein-associated phospholipase A 2 (Lp-PLA 2 ) levels, and clinical periodontal outcomes in patients with periodontitis. Moreover, it was evaluated if baseline CRP levels impacted the efficacy of non-surgical periodontal therapy protocols., Methods: Forty-two periodontitis patients were enrolled and randomly treated by means of MINST (n = 21) or Q-SI (n = 21). The outcomes assessed were serum CRP and Lp-PLA 2 , and periodontal parameters (probing depth [PD], clinical attachment level [CAL], full-mouth bleeding score [FMBS]), at baseline and at follow-ups at 1, 3, and 6 months and at 1 year after treatment., Results: At 1 year, MINST significantly reduced, among others, mean PD (p = 0.007), mean CAL (p = 0.007), the number of pockets >4 mm (p = 0.011) and ≥6 mm (p = 0.005), and FMBS (p = 0.048) compared to Q-SI. Generalized multivariate analysis evidenced that high baseline CRP (p = 0.039) and FMBS (p = 0.046) levels, together with MINST treatment (p = 0.007) were significant predictors of PD reduction at 1-year follow-up. Moreover, the Jonckheere-Terpstra test showed that patients with high baseline CRP levels gained more benefits from MINST treatment at 1-year follow-up than they did from Q-SI., Conclusion: Patients receiving MINST showed a greater reduction in CRP levels than patients with Q-SI after 1 year of follow-up. Moreover, patients with high baseline levels of CRP and Lp-PLA 2 gained more benefits from the MINST approach at 1-year follow-up., (© 2024 The Author(s). Journal of Periodontology published by Wiley Periodicals LLC on behalf of American Academy of Periodontology.)

Background: The aim of the randomized controlled clinical trial study was to evaluate the effectiveness in reducing pathologically increased pocket probing depths (PPD > 3 mm) using the Guided Biofilm Therapy (GBT) protocol (adapted to the clinical conditions in non-surgical periodontal therapy (NSPT): staining, air-polishing, ultrasonic scaler, air-polishing) compared to conventional instrumentation (staining, hand curettes/sonic scaler, polishing with rotary instruments) both by less experienced practitioners (dental students)., Methods: All patients were treated according to a split-mouth design under supervision as diseased teeth of quadrants I/III and II/IV randomly assigned to GBT or conventional treatment. In addition to the treatment time, periodontal parameters such as PPD and bleeding on probing (BOP) before NSPT (T0) and after NSPT (T1: 5 ± 2 months after T0) were documented by two calibrated and blinded examiners (Ethics vote/ Trial-register: Kiel-D509-18/ DRKS00026041)., Results: Data of 60 patients were analyzed (stage III/IV: n = 36/ n = 24; grade A/ B/ C: n = 1/ n = 31/ n = 28). At T1, a PPD reduction of all diseased tooth surfaces was observed in 57.0% of the GBT group and 58.7% of the control group (p = 0.067). The target endpoint (PPD ≤ 4 mm without BOP) was achieved in 11.5% for GBT (conventional treatment: 11.2%; p = 0.714). With the exception for number of sites with BOP, which was at T1 15.9% in the GBT group and 14.3% in the control group (p < 0.05) no significant differences between the outcomes of the study were found. At 30.3(28.3) min, the treatment time was significantly shorter in GBT than in the control group at 34.6(24.5) min (p < 0.001)., Conclusions: With both protocols (GBT/ conventional instrumentation) comparably good clinical treatment results can be achieve in NSPT in stage III-IV periodontitis patients., Trial Registration: The study was registered before the start of the study and can be found under the number DRKS00026041 in the German Clinical Trials Register. The registration date was 19/08/2021., (© 2024. The Author(s).)

Background: This single-blind randomized controlled trial was aimed to evaluate the microbiological and clinical effects of Zeger therapy on gingival health., Methods: Twenty-four adults with gingivitis were recruited and monitored micro-biologically and clinically at baseline (Day 0), 4 weeks (Day 29) after therapy. All volunteers received one-stage full-mouth supragingival scaling as basic oral health care for baseline, and then randomly divided into experimental (koumiss, n = 12) or control (none, n = 12) group. The koumiss was used once a day for 4 weeks., Results: The microbial diversity of the experimental group increased significantly after drinking koumiss (p < 0.05), mainly owing to increasing of Gram-positive bacteria (p = 0.038) and oral health-related microbes (Rothia, Corynebacterium, Actinomyces, Saccharibacteria&#95;TM7, etc.), decreasing of Gram-negative bacteria (p = 0.009) and periodontal disease-related microbes (Porphyromonas, Fusobacterium, Veillonella, etc.), while the microbial diversity of the control group had no significant change (p > 0.05). However, there was no significant difference between the two groups in the clinical parameters (p > 0.05)., Conclusions: Zeger therapy promotes the diversity of supragingival microbiome in adults with gingivitis and increases the abundance of some beneficial flora while decreasing some harmful without clinical parameters marked changing, which holds promise for improving of gingivitis and may be a valuable oral health care approach in the future., Trial Registration: The clinical trial was approved by the Medical Ethics Committee of West China Hospital of Stomatology, Sichuan University, batch No. WCHSIRB-D-2021-428. Before patient registration began, the prospective clinical trial was registered in www., Clinicaltrials: gov public repository in China under the registration number ChiCTR2200060555 on 04/06/2022., (© 2024. The Author(s).)

Background: To compare acceptance and preference of topical lidocaine gel anesthesia with articaine injection anesthesia in patients with moderate periodontitis undergoing scaling and root debridement., Methods: Ninety-one patients completed this randomized multicenter split-mouth controlled study and underwent two separate periodontal treatment sessions on different days, one with a topical intrapocket lidocaine gel application and the other with an articaine injection anesthesia in a different order depending on randomization. Parameters measured were the patients' preference for topical lidocaine gel anesthesia or injection anesthesia with articaine (primary efficacy criterion), their maximum and average pain, and their intensity of numbness as well as experience of side effects; the probing depth; and the dentists' preference and their evaluations of handling/application, onset and duration of anesthetic effect, and patient compliance., Results: After having experienced both alternatives, 58.3% of the patients preferred the topical lidocaine gel instillation into the periodontal pockets. The safety profile of the lidocaine gel differed positively from the safety profile of articaine injection in type and frequency of adverse drug reactions. The dentists' acceptance and preference regarding either anesthetic method studied were balanced., Conclusions: Instillation of lidocaine gel into the periodontal pocket is a preferred alternative to injection anesthesia for most of the patients and an equivalent alternative for dentists in nonsurgical periodontal therapy., (© 2024 The Authors. Journal of Periodontology published by Wiley Periodicals LLC on behalf of American Academy of Periodontology.)

Objectives: This study attempted to develop 2 biodegradable periodontal chips containing Salvadora persica (miswak) or benzyl isothiocyanate (BITC) extracts and evaluate their clinical effectiveness in managing periodontitis., Methods: This clinical trial was conducted at the Faculty of Dentistry, Universiti Teknologi MARA Shah Alam, Selangor, Malaysia, from September 2010 to April 2012. Periodontal chips were formulated using S. persica , benzyl isothiocyanate (BITC) and chitosan extracts. All patients were treated with full mouth scaling and root planing at baseline. Thereafter, the periodontal pockets (≥5 mm in length) were divided into 4 groups: the control group; group 2 (plain chitosan chip); group 3 ( S. persica extract); and group 4 (BITC extract). Plaque index (PI), bleeding on probing (BOP), periodontal probing pocket depth and clinical attachment levels were recorded at days 0 and 60 only., Results: A total of 12 patients participated in this study. Overall, 240 periodontal pockets were evaluated. The study revealed significant improvements in PI, BOP and reduction in periodontal pocket depth in all 4 groups ( P <0.05). The improvement in clinical attachment level was significantly higher ( P <0.001) among the group that received S. persica chips compared to the control and other chip-treated groups., Conclusion: Periodontal chips containing S. persica can be used as adjuncts to treat patients with periodontitis., Competing Interests: CONFLICTS OF INTEREST: The authors declare no conflict of interests., (© Copyright 2024, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Objectives: To compare the effects of powered and manual toothbrushing following scaling and root planing on bleeding on probing and other clinical indicators of periodontitis., Materials and Methods: This was a randomized, examiner-blind, parallel-design, 24-week clinical study. Eligible subjects were 18-75 years of age with Stage I or II periodontitis. All subjects received scaling and root planing (SRP) within 28 days of enrollment. Thereafter, subjects were randomized to twice daily at-home use of either a powered toothbrush (PTB) or a manual toothbrush (MTB). Randomization was balanced for gender and periodontitis stage. No other oral hygiene aids were permitted. Subjects were evaluated every 4 weeks for the following measures: bleeding on probing (BOP), surface plaque (MPI), probing pocket depth (PPD) and clinical attachment level until Week 24., Results: Of 328 randomized subjects, 299 subjects completed the study. For BOP at Week 24, the Least Squares (LS) Mean, standard error (SE) reduction from baseline was 0.24 (0.01) for the PTB group and 0.02 (0.01) for the MTB group, resulting in a statistically significant treatment difference of 0.22 (0.01), p-value < 0.0001. There were also concomitant reductions in MPI and PPD at Week 24, resulting in statistically significant (p-value < 0.0001) LS Mean (SE) treatment differences of 0.86 (0.04) and 0.24 (0.01), for MPI and PPD, respectively., Conclusion: When combined with SRP, daily home oral hygiene maintenance including a powered toothbrush significantly reduced clinical symptoms of periodontitis and surface plaque levels compared to a manual toothbrush in a Stage I/II periodontitis population. (ClinicalTrials.gov Identifier: NCT04254770)., (© 2024 Philips Oral Healthcare LLC. International Journal of Dental Hygiene published by John Wiley & Sons Ltd.)

Aim: This study evaluated the efficacy of quadrantwise subgingival instrumentation (Q-SI) versus one-stage full-mouth subgingival instrumentation (FM-SI) on probing depth and periodontal pathogen reduction over a 6-month follow-up period, as well as whether baseline periodontal pathogens influenced the impact of periodontal treatment protocols on outcomes., Methods: Patients with periodontitis were randomized to receive Q-SI (n = 43) or FM-SI (n = 45). Patients were instructed and motivated to maintain optimal oral hygiene during the treatment sessions. Clinical (probing pocket depth [PPD], clinical attachment loss [CAL], and bleeding on probing [BOP]) and periodontal pathogens were assessed at baseline and after 30, 90, and 180 days. Total bacterial load and periodontal pathogens were analysed via real-time PCR., Results: At the 6-month follow-up, the median PPD decreased from 4.8 mm (interquartile range [IQR]: 4.3-5.2) to 2.6 mm (IQR: 2.3-2.9) in FM-SI patients and from 4.7 mm (IQR: 4.1-5.2) to 3.2 mm (IQR: 2.4-3.5) in Q-SI patients (p < .001). At 6 months, FM-SI was more effective at reducing the median proportions of Porphyromonas gingivalis (Pg), Aggregatibacter actinocomyctemcomitans, and Tannerella forsythia (Tf) (p < .001 for each value). Multilevel linear regression analysis demonstrated that high baseline PPD (p = .029), Pg (p = .014), and Tf (p < .001) levels and the FM-SI protocol (p < .001) were statistically significant predictors of PPD reduction at 6 months. Furthermore, PPD reduction was significantly greater in the FM-SI group when lower baseline Pg levels were detected., Conclusion: The FM-SI was more effective than the Q-SI in reducing the mean PPD and number of periodontal pathogens in periodontitis patients over a 6-month follow-up period. Higher baseline PPD and Pg levels had a negative impact on PPD reduction at 6 months after FM-SI., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: This study aimed to evaluate the effect of virtual reality distraction (VRD) on dental anxiety during scaling and root planing (SRP) in periodontitis patients., Materials and Methods: This randomized controlled split-mouth study included 60 patients who scored 9 or above on the dental anxiety scale (DAS) and required SRP in at least two quadrants with at least five teeth and two sites with a probing depth of ≥4 mm. Randomly chosen quadrants were treated using virtual reality glasses, and other quadrants were treated without glasses at the same visit. During VRD, a video of nature scenes was projected onto the screen in front of the patient's eyes. DAS and a visual analogue scale about patient feelings were applied at the end of the procedure., Results: With VRD, the scale value of pain and discomfort level (VASP) was significantly reduced (p = 0.01, d = 0.57). Starting treatment without glasses significantly decreased VASP in both control and test sides (p = 0.00, d = 0.85; p = 0.00, d = 0.80, respectively) and increased the sensation of immersion and realism (p = 0.03, d = 0.45; p = 0.02, d = 0.46, respectively). Intraoperative and postoperative DAS values were significantly lower in patients who started treatment without VRD (p = 0.04, d = 0.34; p = 0.02, d = 0.44, respectively). Of the patients, 63.3% preferred VRD in the subsequent treatment. While patient preference did not correlate with sex, it correlated with age (r = -0.48, p = 0.01)., Conclusions: The VRD and initiating SRP procedure with VRD affected the pain and discomfort level in anxious periodontitis patients. In addition, the anxiety level was also affected by starting the procedure with glasses., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The main aim of periodontal therapy is to halt the progression of periodontitis. Curcumin, one of the main components of Curcumin longa, has been well known to possess antimicrobial, anti-inflammatory, and even anticarcinogenic properties. This systematic review assessed the impact of local application of curcumin in the pocket on the clinical and microbiologic parameters as an adjunct to scaling and root planing in periodontitis patients., Methods: The electronic literature search retrieved 61 studies from PubMed, MEDLINE, and ScienceDirect. After screening titles, abstracts, and keywords and reading through these articles, we identified 9 articles meeting all inclusion criteria, which were included for systematic review., Results: There was a significant difference in both clinical parameters in a short duration of a month after curcumin chips were placed as an adjunct to scaling and root planing as compared to the control. Local application of curcumin also results in slight to significant reduction in the red complex microorganisms., Conclusion: This review suggested that local application of curcumin can be considered as a viable adjunct to mechanical debridement in periodontitis. However, further studies need to be conducted to establish its optimum dose, delivery method, and frequency in achieving the best clinical outcomes., (© 2024. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Objectives: The present study aimed to assess and compare the effect of Morus alba and chlorhexidine gel as an adjunct to scaling and root planing (SRP) in treating stage II periodontitis., Methods: A single-blind, randomized controlled trial was conducted on 180 patients with stage II periodontitis who received full-mouth SRP. They were randomly assigned to receive chlorhexidine digluconate (CHX) gel, Morus alba (MA) and placebo gel for Groups A, B and C, respectively, at the baseline, 15 days and 30 days. Plaque index (PI), Gingival index (GI), periodontal pocket depth (PPD) and quantitative analysis (culture) of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia were assessed at baseline and 45 days. Analysis of variance was used to compare the significant difference in PI, GI, PPD and microbiological parameters between the three groups after the intervention, followed by post hoc Mann-Whitney U and Tukey's HSD test for clinical and microbiological parameters, respectively., Results: Intergroup comparison of the PI, GI and microbiological parameters between the MA and CHX groups at the end of 45 days did not show a statistically significant difference (p > 0.05), whereas a statistically significant difference was observed for PPD between MA and CHX groups with the mean difference of 0.18 mm (p = 0.002)., Conclusion: Morus alba gel was found to be effective in decreasing PPD. However, there was no difference between Morus alba and chlorhexidine gel as an adjunct to SRP in treating stage II periodontitis., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: This multi-arm, randomized, double-blinded, controlled clinical trial was designed to evaluate the clinical efficacy of 0.5% green tea (GT), 0.2% chlorhexidine (CHX) and aloe vera (AV) mouthwash as compared to the control (CNT) group (scaling and polishing alone with no mouthwash) in the management of dental biofilm induced gingivitis among 18-40-year-old patients., Material and Methods: Sixty patients with generalized dental biofilm-induced gingivitis were randomly allocated to four study groups (n = 15 each) for treatment, namely Group GT, Group CHX, Group AV and Group CNT after scaling and polishing were administered to all the patients. Plaque index (PI), gingival index (GI) and sulcular bleeding index (SBI) were recorded at baseline, 14th and 21st day., Results: PI, GI and SBI at various time intervals (baseline, 14th and 21st day) showed high statistically significant differences within the group (p < 0.01). Among these, the maximum percentage change was found in the CHX group followed by GT when evaluated from baseline to 21st day. The least percentage change was found in the AV group for PI and GI while the CNT group showed the least percentage change for sulcular index when evaluated from 14th to 21st day. Inter-group results showed high statistically significant differences (p < 0.01) for PI and GI when evaluated between baseline to 14th day and baseline to 21st day. SBI also showed statistically significant differences (p < 0.05) when evaluated between baselines to 14th day and baseline to 21st day., Conclusion: Green tea mouthwash displayed a significant reduction in plaque index, gingival index and sulcular bleeding index. 0.5% green tea catechin has equivalent anti-plaque efficacy as 0.2% chlorhexidine gluconate and can be considered a potent alternative to prevent and treat gingival diseases., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The purpose of this study was to compare the effectiveness of three different instruments on cement loss, porosity and micro-crack formation, which was not evaluated before, following scaling and root planning (SRP) using micro-computed tomography (micro-CT)., Methods: In this experimental study, 30 single-rooted extracted human teeth were used and divided into three groups. All the teeth were scanned with micro-CT before and after SRP. Group 1: SRP was performed with Gracey curettes, Group 2: SRP was performed by using an ultrasonic device, and Group 3: SRP was performed by using diamond burs. Cement loss from the root surface, porosity, and micro-crack formation in the root dentine were analysed. Micro-CT is used for qualitative and quantitative analysis of samples. The obtained data were analysed statistically (p < 0.05)., Results: Minimum cement loss following SRP was detected with ultrasonic scaler (26.98 mm 3 ), whereas the highest was created by diamond burs (96.20 mm 3 ) (p < 0.05). The total porosity values after SRP were 0.278%, 0.334% and 0.252% for Groups 1, 2 and 3, respectively. Although Group 3 had the least porosity values, there was no statistically significant difference between the groups. The highest micro-crack formation was seen in Group 2 and the lowest was in Group 1 with a significant difference (p < 0.05)., Conclusions: More cement loss was observed with diamond burs. Ultrasonic devices appear to be a viable alternative to instrumentation with curettes. However, ultrasonic devices should be used carefully because of micro-crack formation since the micro-crack resulting from instrumentation with hand instruments is the least of all., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: There is insufficient clinical and microbiological evidence to support the use of diode laser and air-polishing with erythritol as supplements to scaling and root planning(SRP). The aim of the current study is to evaluate the clinical and microbiologic efficacy of erythritol subgingival air polishing and diode laser in treatment of periodontitis., Methods: The study encompassed twenty-four individuals seeking periodontal therapy and diagnosed with stage I and stage II periodontitis. Eight patients simply underwent SRP. Eight more patients had SRP followed by erythritol subgingival air polishing, and eight patients had SRP followed by diode laser application. At baseline and six weeks, clinical periodontal parameters were measured, including Plaque Index (PI), Gingival Index (GI), periodontal Probing Depth (PPD), and Clinical Attachment Level (CAL). The bacterial count of Aggregatibacter actinomycetemcomitans(A.A), Porphyromonas gingivalis (P.G) was evaluated at different points of time., Results: The microbiological assessment revealed significant differences in the count of A.A. between the laser and erythritol groups immediately after treatment, indicating a potential impact on microbial levels. However, the microbial levels showed fluctuations over the subsequent weeks, without statistically significant differences. Plaque indices significantly decreased post-treatment in all groups, with no significant inter-group differences. Gingival indices decreased, and the laser group showed lower values than erythritol and control groups. PPD and CAL decreased significantly across all groups, with the laser group exhibiting the lowest values., Conclusion: The supplementary use of diode laser and erythritol air polishing, alongside SRP, represents an expedited periodontal treatment modality. This approach leads to a reduction in bacteria and improvement in periodontal health., Trial Registration: This clinical trial was registered on Clinical Trials.gov (Registration ID: NCT06209554) and released on 08/01/2024., (© 2024. The Author(s).)

Background: The purpose of this publication is to report on the 12-month clinical and radiographic results comparing the surgical use of the Er,Cr:YSGG laser (ERL) and minimally invasive surgical technique (MIST) for the treatment of intrabony defects in subjects with generalized periodontitis stage III, grade B., Methods: Fifty-three adult subjects (29 females and 24 males; 19-73 years) with 79 intrabony defects were randomized following scaling and root planing (SRP) to receive ERL monotherapy (n = 27) or MIST (n = 26). Fifty subjects completed the study. Recession (REC), probing depth (PD), clinical attachment level (CAL), treatment time, and standardized radiographs were assessed and compared for each treatment group. Clinical measurements were recorded at baseline, 4-6 weeks following SRP, and 6 and 12 months following surgical therapy. Radiographic results were compared to baseline at 6 and 12 months following surgical therapy., Results: The following primary and secondary outcome variables were non-inferior with the following margins: CAL with a non-inferiority margin of 0.7 mm (p = 0.05), PD with a non-inferiority margin of 0.7 mm (p = 0.05), and REC with a non-inferiority margin of 0.4 mm (p = 0.05). Standardized radiographs suggest similar bone fill of 1.14 ± 1.73 mm for MIST and 1.12 ± 1.52 mm for ERL., Conclusions: This is the first multicenter, randomized, masked, and controlled study demonstrating the ERL is not inferior to MIST at 12 months in terms of clinical outcomes and similar to MIST in terms of radiographic bone fill for the surgical treatment of intrabony defects., (© 2023 The Authors. Journal of Periodontology published by Wiley Periodicals LLC on behalf of American Academy of Periodontology.)

Objectives: This study aimed to evaluate the impact of scaling and root surface debridement (SRP) on salivary bacterial counts and systolic and diastolic blood pressure in hypertensive patients with chronic periodontitis, with a focus on clinical significance., Methods: An observational trial included 24 chronic periodontitis patients, eleven of them were hypertensive patients. Non-surgical periodontal treatment was administered to all patients, with clinical parameters including gingival index (GI), plaque index (PI), and probing pocket depth (PPD) recorded. Saliva samples were collected before and after SRP to quantify total bacterial counts and specific bacterial counts., Results: Two months following SRP, PI and PPD in every subject under study demonstrated good responses. In hypertension patients, the salivary bacterial count was significantly higher following SRP (P = 0.0221). The incidence of Porphyromonas gingivalis in hypertension patients significantly decreased after treatment (P = 0.0386). Despite this, there was no discernible decrease in blood pressure following treatment., Conclusions: SRP alone was ineffective in reducing overall bacterial counts, but P. gingivalis levels responded favorably. Regular periodontal assessment is crucial for hypertensive individuals to mitigate cardiovascular risk., Clinical Significance: Periodontal therapy in hypertensive patients may improve oral health but might not significantly impact blood pressure. Regular periodontal evaluation is essential for managing cardiovascular risk in hypertension., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Aim: To evaluate the effect of subgingival delivery of progranulin (PGRN)/gelatin methacryloyl (GelMA) complex as an adjunct to scaling and root planing (SRP) on an experimental periodontitis dog model with Class II furcation involvement (FI)., Materials and Methods: A Class II FI model was established, and the defects were divided into four treatment groups: (a) no treatment (control); (b) SRP; (c) SRP + GelMA; (d) SRP + PGRN/GelMA. Eight weeks after treatment, periodontal parameters were recorded, gingival crevicular fluid and gingival tissue were collected for ELISA and RT-qPCR, respectively, and mandibular tissue blocks were collected for micro computed tomography (micro-CT) scanning and hematoxylin and eosin (H&E) staining., Results: The SRP + PGRN/GelMA group showed significant improvement in all periodontal parameters compared with those in the other groups. The expression of markers related to M1 macrophage and Th17 cell significantly decreased, and the expression of markers related to M2 macrophage and Treg cell significantly increased in the SRP + PGRN/GelMA group compared with those in the other groups. The volume, quality and area of new bone and the length of new cementum in the root furcation defects of the PGRN/GelMA group were significantly increased compared to those in the other groups., Conclusions: Subgingival delivery of the PGRN/GelMA complex could be a promising non-surgical adjunctive therapy for anti-inflammation, immunomodulation and periodontal regeneration., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The aim of this study was to assess the efficacy of photodynamic therapy (PDT) as an adjunct to scaling and root planing (SRP) on clinical parameters and microbial composition in subgingival plaque of periodontitis patients., Methods: Seventeen patients were included in this split-mouth randomized clinical trial. Sites with probing pocket depth (PPD) ≥5 mm in combination with bleeding on probing in different quadrants were randomized into the control group, the group with a single PDT application right after SRP, and the group with three repeated PDT applications 1 week after SRP. The subgingival plaque was collected for 16S rRNA gene sequencing at baseline, Week 2, and Week 8., Results: Seventeen patients with 60 sites completed this 8-week follow-up, and 157 subgingival plaques were successfully analyzed by sequencing. Significant improvements were observed in two primary outcomes: PPD at Week 8 and subgingival microbial composition. Compared to the control group, the repeated-PDT group showed a notable improvement in PPD, substantial alterations in the microbial profile, including a reduction in α-diversity and anaerobic bacteria, and an increase in aerobic bacteria at Week 2. Secondary outcomes, such as clinical attachment level and sulcus bleeding index, also showed improvement at Week 8. Furthermore, both the single- and repeated-PDT groups exhibited a decrease in periodontopathogens and an increase in beneficial bacteria compared with baseline., Conclusion: PDT promotes changes in the microbial composition of periodontitis patients' subgingival plaque in a direction favorable to periodontal health, and repeated PDT is a promising adjunctive therapy for periodontal treatment., (© 2024 American Academy of Periodontology.)

Background: Periodontal disease poses a significant global health challenge. Traditional treatments focus on reducing inflammation and bacterial load, yet novel approaches are continually being investigated. Recent research suggests that IL-37, a potent anti-inflammatory cytokine, may play a crucial role in modulating the inflammatory processes associated with periodontal disease. In conjunction with IL-37, low-level laser therapy (LLLT) has gained attention for its potential in promoting tissue repair, reducing inflammation, and enhancing cellular processes. This study aims to investigate the effects of LLLT on IL-37 in periodontal disease management., Methods: Thirty patients were enrolled: the G1 group patients were treated with only scaling and root planning-SRP, the G2 group was treated with SRP and LLLT. Before treatment (T0) all periodontal probing pocket depth and bleeding on probing were obtained. Before (T0) and 10 (T1), 30 (T2) and 60 (T3) days after treatment, was achieved plaque sample and specimens of gingival crevicular fluid. Diode laser wavelength range was used between 600-1000 nm and 0.04-60 J/cm 2 energy density for 3-s spotlights., Results: In all patients PPD, BOP and IL-37 have shown healing improved parameters., Conclusions: Although LLLT is widely recommended for its biostimulatory and anti-inflammatory roles, it only showed additional short-term merits in reducing the pocket depth after conventional SRP. Its long-term adjunctive benefits remain unclear. Future RCTs with better study designs, adequate sample power and longer durations of follow-up are required to assess the effectiveness of LLLT as an adjunctive treatment strategy in patients with periodontal disease.

Background: Idiopathic gingival enlargement is associated with plaque, but other contributing factors are unclear. The prognosis of idiopathic gingival enlargement is closely related to the patient's oral hygiene habits and regular follow-up., Case Presentation: This article reports a case of a 32-year-old male patient with idiopathic gingival enlargement. The patient presented to the department of stomatology with a 2-month history of gingival swelling and pain on the right upper posterior teeth. During the treatment, oral hygiene instruction, supragingival cleaning, subgingival scaling, and root planning were carried out, and part of the hyperplastic gingiva was taken and sent for pathology. Pathological examination showed gingival enlargement with chronic suppurative inflammation. At 4-month follow-up, the patient's periodontal condition remained basically stable, and the gingival enlargement did not recur., Conclusion: The treatment of this case resulted in significant reduction of gingival swelling and patient's pain reduction through non-surgical treatment and good plaque control, indicating that patients with idiopathic gingival enlargement can also achieve ideal results through non-surgical treatment. Through oral hygiene instruction, the patient mastered the method of self-plaque control, which is conducive to the long-term stabilization of the periodontal situation., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: This study aimed to demonstrate the efficacy of erbium, chromium-doped:yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser-assisted nonsurgical periodontal therapy in periodontitis patients during 8 weeks of healing., Methods: A split-mouth, single-blinded, randomized controlled clinical trial was conducted on 12 patients diagnosed with stage III/IV periodontitis and had a minimum of two teeth with probing pocket depth (PPD) > 5 mm in at least two quadrants. Upon randomization, each quadrant was assigned for conventional scaling and root planing (SRP) procedure or laser-assisted therapy (SRP + laser) using radial firing tip (RFPT 5, Biolase). Clinical measurements and gingival crevicular fluid collection were performed for statistical analysis., Results: In the initial statistical analysis on the whole subject teeth, modified gingival index (MGI) reduction was greater in test group at 1(P = 0.0153), 4 (P = 0.0318), and 8 weeks (P = 0.0047) compared to the control in the same period. PPD reduction at 4 weeks in test group was -1.67 ± 0.59 showing significant difference compared to the control (-1.37 ± 0.63, P = 0.0253). When teeth with mean PPD ≥5 mm were sorted, MGI decrease was significantly greater in test group at 1 (P=0.003) and 8 week (P=0.0102) follow-ups. PPD reduction was also significantly greater in test group at 4 week period (-1.98 ± 0.55 vs -1.58 ± 0.56, test vs control, P=0.0224)., Conclusions: Er,Cr:YSGG-assisted periodontal therapy is beneficial in MGI and PPD reductions during early healing period., (© 2024. The Author(s).)

Aim: The study aims to compare the effectiveness of scaling root planing alone and scaling root planing with oxygen-releasing gel in the treatment of chronic periodontitis., Materials and Methods: A split-mouth randomized controlled trial was designed on 25 systemically healthy participants with 50 sites having chronic periodontitis. Two sites were selected for each patient and were randomly allocated into two groups. A total of 50 sites were selected and divided into two groups with 25 test sites in group I (Test group) and 25 control sites in group II (Control group). Group I received scaling and root planing (SRP) followed by placement of BlueM oral gel, while group II received SRP alone. Probing pocket depth (PPD), clinical attachment level (CAL), gingival index (GI), and bleeding on probing (BOP) were recorded at baseline and after 6 weeks and were compared accordingly., Results: The results revealed a reduction in PPD, CAL, GI, and BOP in both groups. However, the test group showed a statistically significant reduction when compared with the control group in the above-mentioned clinical parameters., Conclusion: The results suggested that the use of oxygen-releasing gel with SRP provided additional benefits in the management of chronic periodontitis by promoting greater reductions in the clinical parameters., Clinical Significance: BlueM oral gel, i.e. the oxygen-releasing gel as a local drug delivery, may be an excellent adjunct to SRP in treating chronic periodontitis. How to cite this article: Singh A, Vasudevan S, Palle AR, et al. Comparative Evaluation of Scaling and Root Planing with and without Oxygen-releasing Gel in the Treatment of Chronic Periodontitis: A Split-mouth Study. J Contemp Dent Pract 2024;25(5):445-452.

Background: Virtual simulation (VS) technology has been widely utilised in various aspects of oral education. This study aimed to evaluate the impact of VS technology in a scaling and root planing (SRP) teaching programme and explore an effective teaching approach., Method: A total of 98 fourth-year undergraduates from Guanghua School of Stomatology at Sun Yat-sen University were enrolled in this study and randomly assigned to either the VS teaching group or the traditional teaching (TT) group. All participants received SRP training before undergoing an operational examination. Subsequently, questionnaires were administered to both students and teachers involved in the programme to assess the teaching effect and fidelity of the VS training system. Unpaired Student t test was used to analyse the final test scores and residual rates amongst students., Results: The overall residual rate of the calculus in the VS group was significantly lower than that in the TT group (48.81% ± 13.50% vs 56.89% ± 13.68%, P<.01). The difference was particularly notable in posterior teeth, proximal surfaces, and deep pockets. Additionally, the VS group students achieved higher final grades compared to the TT group (86.92 ± 6.10 vs 83.02 ± 6.05, P<0.01). In terms of teaching effectiveness assessment, the VS group students provided higher scores than the TT group, except in the areas of mastery of position, finger rests, and efficiency., Conclusions: The implementation of VS technology demonstrated improvements in students' performance in SRP teaching. Therefore, a novel integrated pedagogic approaches method that combines VS technology with traditional teaching approaches could be further explored in future training programmes., Competing Interests: Conflict of interest None disclosed., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The control of dental biofilm regrowth after nonsurgical periodontal therapy is associated with better clinical outcomes. However, many patients have difficulty achieving optimal plaque control. Subjects with diabetes, in which immune and wound-healing responses are typically impaired, may benefit from intensive antiplaque control regimens after scaling and root planing (SRP)., Objectives: This study aimed to evaluate the effects of an intensive, at-home, chemical, and mechanical antiplaque regimen as an adjunct to SRP for the treatment of moderate to severe periodontitis. A secondary objective was to compare responses in subjects with type 2 diabetes and nondiabetics., Methods: This was a 6-mo, single-center, parallel-group, randomized trial. The test group received SRP and oral hygiene instructions, and subjects were instructed to use a 0.12% chlorhexidine gluconate mouthrinse twice a day for 3 mo and utilize rubber interproximal bristle cleaners twice a day for 6 mo. The control group received SRP and oral hygiene instructions. The main outcome was change in mean probing depth (PD) from baseline to 6 mo. Secondary outcomes included change in sites with deep PDs, mean clinical attachment level, bleeding on probing, plaque index, hemoglobin A1C, fasting blood glucose, C-reactive protein, and taste assessment. This study was registered at ClinicalTrials.gov as NCT04830969., Results: In total, 114 subjects were randomized to either treatment. Eighty-six subjects completed the trial with no missing visits. Neither an intention-to-treat nor a per-protocol analysis showed statistically significant differences between treatment groups in mean PD at 6 mo. In a subgroup analysis, subjects with diabetes in the test group showed a statistically significant greater reduction in mean PD at 6 mo when compared to subjects with diabetes receiving the control treatment (Δ = 0.15, P = 0.04), while there were no differences within nondiabetics (Δ = 0.02, P = 0.75)., Conclusion: Outcomes in subjects with diabetes may be improved by chemo-mechanical antiplaque measures after nonsurgical periodontal therapy., Knowledge Transfer Statement: This study suggests diabetic subjects may benefit from an intensive, at-home, chemical, and mechanical antiplaque regimen to improve nonsurgical periodontal therapy outcomes., Competing Interests: Declaration of Conflicting InterestsThis study was funded by Sunstar, Inc. who manufactures Paroex and Soft-Picks. Sunstar employees who are coauthors in this manuscript participated in the study design but did not participate in data analysis or manuscript writing.

Background: The aim of this study was to evaluate the effect of active oxygen-releasing gel as an adjuvant, with and without antimicrobial photodynamic therapy (aPDT), in the treatment of residual pockets in periodontal patients with type 2 diabetes mellitus (DM2)., Methods: Patients with residual pockets with probing depth (PD) ≥4 mm and bleeding on probing (BOP) were divided into the following groups: SI (n = 17)-subgingival instrumentation in a single session; BM (n = 17)-SI followed by local application of active oxygen-releasing gel inside the periodontal pocket for 3 min; BM + aPDT (n = 17)-SI followed by application of BM for 3 min and pocket irrigation with methylene blue, and 660-nm diode laser irradiation at 100 mW for 50 s. The periodontal clinical parameters, serum levels of glycated hemoglobin, and immunological analysis of crevicular fluid were evaluated. All data were submitted to statistical analysis (α = 5%)., Results: A significant reduction in BOP was verified at 90 and 180 days in the BM + aPDT group. The percentage of sites with PD ≥ 4 mm was significantly reduced at 90 days in BM + aPDT and BM, whereas after 180 days only BM showed a significant reduction. In the BM + aPDT group, there was a significant reduction in tumor necrosis factor α levels at 90 days. There were no differences between the treatments., Conclusion: The use of adjuvant active oxygen-releasing gel, with or without aPDT, resulted in the same clinical benefits as SI in the treatment of residual pockets in poorly controlled DM2 patients., (© 2023 American Academy of Periodontology.)

Class IV dental diode lasers have been introduced as a nonsurgical therapy for periodontal pockets in veterinary and human dentistry. This retrospective case series evaluates the use of Class IV dental diode laser therapy for abnormal periodontal pockets in a specialty veterinary dental practice. A hypothesis that the Class IV diode dental laser is a useful adjuvant modality in canine periodontal pocket therapy in the reduction of clinical pocket depth was made. This article discusses and demonstrates diode laser use in periodontal pocket therapy in a specialty veterinary dental practice and reviews the current literature. Inclusion in this study was limited to client-owned dogs with noted periodontal pocketing on any tooth type between 3 and 6 mm, which were treated with closed root planing (RP/C) and laser therapy who returned in 6 to 7 months for recheck of the pockets from the years 2017 to 2020. Twelve patients met the inclusion criteria. A total of 128 periodontal pockets were included in the study. Each periodontal pocket was a case receiving therapy. The mean periodontal pocket depth before the treatment is measured as 3.35 mm. The mean pocket depth of the periodontal pockets following treatment was 0.59 mm. The mean improvement in periodontal pocket depths after diode laser therapy when considering patient and tooth number using linear mixed-effects modeling was 2.63 mm (95% confidence interval [CI]: 1.81-3.46, P  < .0001). No statistically significant results were observed for pocket type, as P values were greater than .05., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Design: The paper by Kubberød et al. is a single-centre, double-blinded, prospective randomised control trial, comparing the radiographic alveolar bone levels in patients with periodontal disease following different treatment protocols over a 5-year period. In total, 184 patient were recruited to the study, and 161 (87.5%) of the patients returned for follow up over a 5-year period. The patients underwent a 3-month, pre-treatment oral hygiene phase before being randomised to one of 4 treatment regimens: (i) same day full mouth disinfection + adjunctive metronidazole; (ii) same day full mouth disinfection + placebo; (iii) scaling and root planing + adjunctive metronidazole; (iv) scaling and root planing + placebo. Scaling and root planing was carried out over a period of 2 to 4 weeks. The participants were enroled in maintenance treatment at 3, 6 and 12 months, then bi-annually for 5 years following active treatment. Radiographic recordings were taken at baseline pre-treatment and then at the 5-year follow up examination. Clinical periodontal measurements such as plaque/bleeding scores, and PPD/CAL (in mm) were also recorded pre/post-treatment., Case Selection: Participants for this study were recruited over 2 years from referrals to a specialist periodontal clinic in Norway. The patients were aged between 35-75 and at the time of inclusion into the trial, had no systemic conditions relevant to periodontitis. The participants underwent a 3-month pre-treatment oral hygiene phase to attempt to reduce the risk of false pocketing at the initial baseline measurements. For inclusion into the trial, participants were required to have more than 5 persistent sites of PPD > 5 mm, and < 15% plaque sites following the pre-treatment hygiene regime. Participants were also only eligible if there were no known reactions to metronidazole or known to carry microorganisms resistant to metronidazole., Data Analysis: Bland-Altman plots were used to allow for assessment of the reproducibility of the radiographic measurement carried out for the examiner assessing the radiographs. Linear regression was used to describe the degree of bone loss noted over the 5-year period., Results: Firstly, the authors describe the radiographic examiners results from the Bland-Altman plots, which shows the examiner to have an error range of -0.04 to 0.01 mm in 95% of cases with the error intervals (-0.47,0.40), (-0.60,0.54) and (-0.55,0.56). Secondly, the authors present the number of periodontal pocket sites (interproximal) examined at the base and at the 5-year follow up. The average number of sites with readings for RBL, CAL and PPD at base line averaged from 41.2 and 43.7 depending on the treatment arm. This was lower at the 5-year follow up, between 30.2 and 36.9. The number of sites with no data (indicating loss of tooth) also increased from baseline to the 5-year follow up, from 4 to 13. Lastly, the results show the change in RBL, CAL and PPD from baseline to 5-year follow up, post-treatment for all 4 treatment protocols. This shows that metronidazole in conjunction with mechanical debridement has a small but statistically insignificant positive effect on RBL and CAL gain. Full mouth disinfection was found to result in less reduction in PPD compared with scaling and root planing; however, this was also found to be statistically insignificant., Conclusions: Regardless of the treatment protocol, all patients demonstrated a reduction in PPD. The FDIS+MTZ group had no statistically significant change in the RBL. However, the other treatment regimens showed overall bone loss over the 5-year period, which again is statistically unimportant. Overall, the authors conclude that resolution of periodontitis induced inflammation is better observed through clinical measurements of the soft tissues, such as PPD and CAL, versus radiographic examination. This was particularly evident as the discrepancies between RBL and CAL were largest for shallower PPDs., (© 2024. The Author(s), under exclusive licence to British Dental Association.)

Background: Periodontitis is a microbially induced disease destroying structures anchoring teeth to jaw bones. Although metronidazole in combination with spiramycin is the effective conventional treatment of stage III grade C periodontitis, it has several systemic side effects. Laser therapy is widely used nowadays as an adjunct to scaling and root planing (SRP) to modulate inflammatory host response and eradicate microbes, due to bactericidal and detoxifying effects. Since microbiological analysis is one of the diagnostic methods identifying periodontal risk; our research aimed to investigate the efficacy of intra-pocket application of diode laser (980 nm) versus antibiotic therapy in enhancing clinical and microbiological parameters in stage III grade C periodontitis., Methods: A randomized controlled clinical trial was conducted on fifty patients with stage III grade C periodontitis, divided equally into two groups. We managed test group by SRP with intra-pocket application of diode laser (980 nm) and the control group by SRP with systemic antibiotic administration (spiramycin and metronidazole). Then, we measured periodontal pocket depth (PPD) and clinical attachment loss (CAL) for both groups, before treatment (baseline), four and twelve weeks after. Moreover, we collected gingival crevicular fluid from both groups at baseline, four and twelve weeks after treatment and analyzed by real-time polymerase chain reaction to detect the relative count of Aggregatibacter actinomycetemcomitans and Porhyromonas gingivalis., Results: Compared to baseline, all assessed clinical and microbiological parameters attested improvement at the end of the study period in each group individually with no significant difference between the two studied groups. Although, at twelve weeks, flare up of bacterial levels was detected with systemic antibiotic administration., Conclusion: Laser therapy can be considered as an effective treatment modality in stage III grade C periodontitis, avoiding the systemic antibiotic side effects and solving the recurrence problems due to bacterial resistance by long term usage., Trial Registration: NCT05222737 retrospectively on 03/02/2022, Clinicaltrial.gov., (© 2024. The Author(s).)

Objectives: To systematically evaluate randomised controlled trials (RCTs) on whether adjuvant application of antimicrobial photodynamic therapy (aPDT) through the technique of irradiation in the external region of the periodontal pocket with optic-fibre tip offers benefits to scaling and root planning (SRP)., Methods: Five databases were searched by two independent reviewers according to pre-specified eligibility criteria up to April 2023. No restrictions regarding date of publication, language and minimum follow-up period were imposed. The Cochrane Collaboration's Risk of Bias tool (RoB 2.0) was used for quality appraisal and Grading of Recommendations, Assessment, Development and Evaluation for assessing the certainty of evidence., Results: A total of 1388 publications were identified and reviewed for eligibility. Four of them fulfilled the inclusion criteria. The sample consisted of a total of 83 patients with periodontitis. In these, 330 periodontal sites were evaluated. The clinical findings of the majority of the included studies demonstrated that patients who received the association of aPDT + RAR with the protocol evaluated here, obtained clinical results similar to patients who received only the SRP alone. In none of the evaluated RCTs, clinical advantages were observed that would categorise this aPDT protocol as superior to conventional treatment., Conclusion: Applying aPDT after SRP with external irradiation of the periodontal pocket does not seem to result in any clinical benefit compared to the use of SRP alone in patients with periodontitis., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: This study aimed to compare the efficacy of three different techniques, namely virtual simulation technology (VS), traditional pathological typodont (TT), and quail egg (QE), in pre-clinical training of periodontal ultrasonic scaling. It also aimed to propose an integrated teaching approach for ultrasonic scaling teaching., Methods: This single-blind randomized multi-arm trial enrolled 108 fourth-year students from Guanghua School of Stomatology at Sun Yat-sen University. The participants were randomly, evenly assigned to VS, TT, or QE group. First, the participants received theoretical review on ultrasonic scaling and demonstrative teaching. Then in the 90-minute operation training by group, students used traditional typodont equipped in head-simulators, raw quail eggs, or scaling module of the UniDental VS system respectively. Then all participants practiced on pathological models for 30 min. In the final operation examination, participants were instructed to remove the supra- and sub-gingival calculi pre-set on designated teeth by ultrasonic scalers within 30 min. Their performances were evaluated by residual calculus rate and a multi-perspective scoring scale. After the examination, questionnaires were provided to assess the teaching effects of each method and the fidelity of VS. Statistical analysis was carried out using one-way, two-way ANOVA, and multiple t-test., Results: Students in VS group had significant higher total test scores than QE group (87.89 ± 6.81, 83.53 ± 8.14) and TT group (85.03 ± 6.81). VS group scored higher in several dimensional comparisons with the other two groups, especially in difficult situations. QE group had higher scores particularly in force application and supra-gingival scaling. TT group scored the highest in pivot stability practice and body position training. Students gave higher scores when assessing the fidelity of VS than experienced teachers., Conclusion: The study highlights the importance of specialized pre-clinical training on ultrasonic scaling for dental students. The methods adopted in current study (VS, TT and QE) each offered unique advantages in education, which can be combined to create an integrative teaching procedure. This procedure aims to provide an effective, advisable and normative pre-clinical training procedure for ultrasonic scaling. By utilizing the strengths of each method, dental educators can deliver high-quality training and ensure that students are well-prepared for clinical practice., (© 2024. The Author(s).)

Background: High occlusal forces in patients with untreated periodontitis may reflect occlusal trauma-associated periodontal conditions. Occlusal analysis using T-scan might provide the distribution of occlusal loading forces in periodontitis patients. The study aimed to evaluate the effect of occlusal trauma in periodontitis patients and occlusal calibration using a T-scan., Materials and Methods: A total of 30 periodontitis patients were recruited for the study. Patients were categorized into two groups: Group I: scaling and root planing followed by T-scan recording and no occlusal calibration; Group II: scaling and root planing followed by occlusal calibration using T-scan. Clinical parameters, orthopantomogram (OPG) and T-scan evaluation were evaluated at baseline, 3-month and 6-month intervals., Results: Significant improvements in clinical parameters were noted at different time intervals after occlusal calibration using T-scan. At 3-month intervals, mean pocket depth showed statistically significant difference among the test group in the right (upper and lower) and left lower quadrant at P = 0.01, 0.002 and 0.005, respectively. Mean clinical attachment level (CAL) showed statistically significant difference among the test group in the right upper, right lower and left lower quadrants at P = 0.02, 0.001 and 0.009, respectively, at 3 months. The comparison of the mean gingival index (GI) at 6 months showed statistically significant difference among test and control groups at 6 months in different study quadrants (P = 1 in right upper, 0.009 in right lower, <0.001 in left upper and <0.001 in left lower). Mean pocket depth at the 6-month follow-up showed statistically significant difference among the test group in all the study quadrants (P = <0.001 in right upper, <0.001 in right lower, 0.003 in left upper and 0.005 in left lower). Mean CAL showed statistically significant difference among the test group in all the study quadrants at 6-month intervals (P = 0.02 in right upper, <0.001 in right lower, 0.01 in left upper and 0.04 in left lower). The bone defect height showed a statistically significant difference only in the right upper quadrant among both the test groups at the 6-month follow-up (P = 0.02). Comparing the mean percentage of force on both sides of the jaw showed a statistically significant difference among the test group at 6 months (P = 0.001 on the left side and 0.001 on the right side)., Conclusion: The occlusal correction using T-scan showed a positive association between probing pocket depth (PPD) and CAL at different time intervals from baseline to 6 months when these parameters were compared after occlusal adjustments., (Copyright © 2024 Copyright: © 2024 Indian Journal of Dental Research.)

Aim: This study aimed to compare the efficacy of subgingivally applied probiotics as an adjunct to scaling and root planing (SRP) vs SRP alone in patients with periodontitis., Materials and Methods: Patients diagnosed with periodontitis, with probing pocket depth (PPD) of 5-7 mm on at least two teeth on contralateral sites, were selected for the study and randomly allocated to the test group (n = 31) who underwent SRP along with subgingival application of probiotic paste and the control group (n = 31) who underwent only SRP. Clinical parameters were evaluated in both groups at baseline and after 12 weeks. The viability of probiotic bacteria was evaluated in the test group at baseline, day 4 and day 8., Results: All clinical parameters showed a statistically significant difference between baseline and 12 weeks on intragroup and intergroup comparison, with a greater improvement in the test group. Microbiological evaluation showed that the mean colony-forming units (CFUs) in the test group were 38.39 ± 7.76, 7.25 ± 2.72 and 1.57 ± 1.29 at baseline, day 4 and day 8, respectively. The mean CFUs significantly reduced with an increase in time from baseline to 8-day time interval., Conclusion: It was seen that the probiotic bacteria remained viable in the periodontal pocket for up to 8 days after placement, but stable improvements were seen in all clinical parameters even at 12 weeks, indicating its prolonged efficacy. Thus, commercially available probiotics can prove to be an inexpensive method to treat periodontitis when combined with SRP., (Copyright © 2024 Copyright: © 2024 Indian Journal of Dental Research.)

Surgical procedures, radiotherapy, and chemotherapy, individually or in association, are current oncological treatments. Among the most used chemotherapy drugs, 5-fluorouracil (5FU) is an antimetabolite with a broad spectrum of action. This study evaluated the effects of probiotics (PRO) as an adjuvant to the treatment of experimental periodontitis (EP) in rats immunosuppressed with 5FU.108 rats were randomly allocated to six different groups: EP; SS - systemic treatment with saline solution (SS); 5FU - systemic treatment with 5FU; 5FU+PRO - systemic treatment with 5FU, followed by the local administration of Saccharomyces cerevisiae ; 5FU+SRP - systemic treatment with 5-FU, followed by scaling and root planing (SRP); and 5FU+SRP+PRO - systemic treatment with 5FU followed by local treatments with SRP and PRO. Immunosuppression was obtained at two points: at the time of ligature installation and after 48 h. Six animals from each group were euthanized at seven, 15, and 30 d and hemimandibles were collected and processed for histopathological, histometric, and immunohistochemical analysis. Data were subjected to statistical analysis (α=5%). At 7 d, the 5FU+PRO group showed less bone resorption and better structured connective tissue compared with the EP, SS, 5FU+SRP, and 5FU+SRP+PRO groups. At 15 d, the 5FU+SRP group showed a greater intensity of the inflammatory response (p<0.05). At 30 d, the 5FU+SRP+PRO group showed better structured bone tissue and a higher percentage of bone tissue (PBT) than the EP, SS, 5FU, and 5FU+PRO groups (p<0.05). The use of Saccharomyces cerevisiae as monotherapy or as an adjuvant to periodontal therapy may have a positive effect on bone repair in immunosuppressed conditions.

Objectives: To compare the clinical outcomes obtained with either mechanical subgingival debridement in conjunction with a sodium hypochlorite and amino acids containing gel followed by subsequent application of a cross-linked hyaluronic acid gel (xHyA) gel, or with mechanical debridement alone., Materials and Methods: Fourty-eight patients diagnosed with stages II-III (Grades A/B) generalised periodontitis were randomly treated with either scaling and root planing (SRP) (control) or SRP plus adjunctive sodium hypochlorite/amino acid and xHyA gels (test). The primary outcome variable was reduction of probing depth (PD), while changes in clinical attachment level (CAL), bleeding on probing (BOP) and plaque index (PI) were secondary outcomes. The outcomes were assessed at baseline, at 3 and 6 months following therapy., Results: All patients completed the 6 months evaluation. At 6 months, the test group showed statistically significantly better results in terms of mean PD reduction (2.9 ± 0.4 vs 1.8 ± 0.6 mm, p < 0.001). Similarly, mean CAL gain was statistically higher in the test group compared to the control one (test: 2.6 ± 0.5 vs control: 1.6 ± 0.6 mm, p < 0.001). Mean BOP decreased from 81.8 ± 16.2% to 48.9 ± 14.5% in control (p < 0.001) and from 83.2 ± 15.5% to 17.6 ± 11.5% in test (p < 0.001) groups with a statistically significant difference favouring the test group (p < 0.001). Mean PI scores were reduced statistically significantly in both groups (from 38.8 ± 26% to 26.5 ± 20.5% in control (p = 0.039) and from 60.6 ± 10.9% to 12.7 ± 8.9% in test group (p < 0.001)), with a statistically significant difference between the groups (p < 0.001). The number of moderate pockets (4-6 mm) were reduced from 1518 (41.2%) to 803 (22.6%) in the control and from 1803 (48.6%) to 234 (7.7%) in the test group with a statistically significant difference between the groups (p < 0.001), while the number of deep pockets (≥ 7 mm) changed from 277 (7.6%) to 35 (1.0%) in the control and from 298 (8.7%) to 4 (0.1%) in test group (p = 0.003)., Conclusion: Within their limits the present data indicate that: a) both treatments resulted in statistically significant improvements in all evaluated clinical parameters, and b) the adjunctive subgingival application of sodium hypochlorite/amino acid and xHyA to SRP yielded statistically significantly higher improvements compared to SRP alone., Clinical Relevance: The combination of sodium hypochlorite/amino acid and xHyA gels to subgingival mechanical debridement appears to represent a valuable approach to additionally improve the outcomes of non-surgical periodontal treatment. Clinical Trial Registration Number NCT04662216 (ClinicalTrials.gov)., (© 2023. The Author(s).)

Objectives: To study the effects of one or two repeated subgingival instrumentations (RSI) in achieving the endpoints of therapy (EoT) in open pockets [residual probing pocket depth (PPD) ≥ 6 mm and PPD 4-5 mm with bleeding on probing (BoP)] after steps I-II of therapy., Materials and Methods: Twenty-five patients (3,552 total sites; 1,450 open pockets) with stage III-IV periodontitis received steps I-II of periodontal therapy and were re-evaluated after 4-6 weeks (T1). Residual pockets received RSI at T1 and at 3 months (T2). EoT (PPD < 4 or PPD < 6 BoP-) rate at T1, T2 and 6 months (T3) was computed. The number of needed surgeries and treatment costs were calculated., Results: At T1, 67.6% of open pockets achieved EoT. At residual PPD ≥ 6 mm at T1 (n = 172), one and two RSI resulted in 33.1% and 45.9% of EoT at T2 and T3, respectively. At residual PPD 4-5 mm with BoP at T1 (n = 298), one and two RSI resulted in 66.8% and 72.1% of EoT at T2 and T3, respectively. PPD at T1 predicted EoT after RSI in both cases, while tooth type only in residual PPD 4-5 mm BoP + . At T1, mean number of surgeries per patient and associated costs were significantly higher than after one/two RSI., Conclusions: RSI may achieve EoT in residual PPD 4-5 mm BoP + and PPD ≥ 6 mm in a considerable number of cases., Clinical Relevance: These findings may support the administration of one/two cycles of RSI prior to surgical approach., Protocol Registration: ClinicalTrials.gov identification number: NCT04826926., (© 2023. The Author(s).)

Objectives: To assess sodium alendronate as a local adjunctive therapy for treating experimental periodontitis in male rats treated with chemotherapy., Design: One-hundred-eighty male rats were randomly divided into two groups (n = 90) based on the systemic treatments: PSS, physiological saline solution; and 5-Fluorouracil, and then, subdivided into three subgroups (n = 30): NT, no treatment; scaling and root planing; and sodium alendronate. Treatments were performed 7 days after induction of experimental periodontitis. Specimens were collected at 14, 22, and 37 days after induction. Alveolar bone level, percentage of bone in the furcation, percentage of non-vital bone in the furcation, histopathologic features, and immunolabeling pattern for tartrate-resistant acid phosphatase (TRAP) and osteocalcin (OCN) were evaluated., Results: The lowest amount of alveolar bone and highest amount of non-vital bone was found in group 5-Fluorouracil when no treatment was performed. In animals receiving 5-Flurouracil and subjected to periodontal treatment, adjunctive sodium alendronate resulted in higher percentage of bone in the furcation and higher alveolar bone loss, when compared with scaling and root planing alone. Better structural and cellularity patterns were found in the periodontal tissues when sodium alendronate was used, regardless of systemic treatment. Higher TRAP-expression was found when no treatment was performed. Sodium alendronate didn't affect the immunolabeling pattern of osteocalcin in the presence of 5-Fluorouracil., Conclusion: Adjunctive therapy with local sodium alendronate prevented alveolar bone loss and improved the histopathological features of the periodontal tissues following scaling and root planing in male rats with experimental periodontitis receiving anticancer chemotherapy with 5-Fluorouracil., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: To investigate the impact of supragingival scaling on the clinical outcomes of subgingival instrumentation completed after 1 week., Method and Materials: In 27 patients with Stage II and Stage III periodontitis, pairs of contralateral quadrants were randomly assigned into test group 1 (single sitting scaling and root planing) and test group 2 (supragingival scaling followed by subgingival instrumentation after 1 week). Periodontal parameters were recorded at baseline, 2, 4, and 6 months; Gingival crevicular fluid vascular endothelial growth factor (VEGF) estimation was done at baseline in both groups and 7 days after supragingival scaling in test group 2., Results: At 6 months, significantly better improvement in test group 1 at sites with periodontal probing depth (PPD) > 5 mm; (∆PPD = 2.32 mm vs 1.41 mm, P = .001; ∆clinical attachmen level [CAL] = 2.34 mm vs 1.39 mm, P = .001) was observed. Supragingival scaling resulted in significant reduction in gingival crevicular fluid VEGF (42.46 to 27.88 pg/site) after 1 week. Regression analysis explained 14% variance in VEGF to baseline PPD at sites with PPD > 4 mm; and 21% variance in CAL improvement to VEGF at sites with PPD > 5 mm. The percentage of sites with PPD = 5 to 8 mm reaching the clinical endpoint was 52% and 40% for test group 1 and test group 2, respectively. Better results were noticed in bleeding on pocket probing-positive sites in both groups., Conclusion: The sites with PPD > 5 mm where supragingival scaling was followed by subgingival instrumentation after 1 week resulted in less favourable treatment outcomes. (Clinical trial registry NCT05449964).

Background: This study evaluated the effectiveness of a novel pocket therapy (Er:YAG laser-assisted comprehensive periodontal pocket therapy [Er-LCPT]) for residual pocket treatment, compared with conventional mechanical treatment alone, in a randomized controlled clinical trial., Methods: Two sites in 18 patients having residual periodontal pockets of ≥5 mm depth, extant following initial active therapy, or during supportive therapy, were randomized into two groups in a split mouth design: the control group received scaling and root planing (SRP) by curette, and the test group received Er-LCPT using curette and laser. With Er-LCPT, after root debridement, inflamed connective tissue on the inner gingival surface and on the bone surface/within extant bone defects was thoroughly debrided. Furthermore, removal of proximate oral epithelium and coagulation of the blood clot in the pocket entrance were performed with laser. Clinical parameters were evaluated, before and after treatment, through 12 months., Results: Both groups showed significant improvements in clinical parameters. With Er-LCPT, pocket debridement was thoroughly and safely performed, without any adverse side effects and complications, and favorable healing was observed in most of the cases. At 12 months, Er-LCPT demonstrated significantly higher probing pocket depth reduction (2.78 mm vs. 1.89 mm on average; p = 0.012, Wilcoxon signed-rank test), clinical attachment gain (1.67 mm vs. 1.06 mm; p = 0.004) as primary outcomes, and reduced BOP value (0.89 vs. 0.56; p = 0.031), compared with SRP alone., Conclusion: The results of this study indicate that Er-LCPT is more effective for residual pocket treatment, compared with SRP alone., (© 2023 American Academy of Periodontology.)

Background: Prospective studies have reported conflicting results regarding the adjunctive effect of antimicrobial photodynamic therapy (aPDT) on clinical and microbiological parameters in individuals under periodontal maintenance therapy (PMT). This study aimed to evaluate the clinical and microbiological adjunctive effects of aPDT using indocyanine green (ICG) in residual sites with probing depth (PD) ≥5 mm during PMT in comparison with scaling and root planing (SRP) alone., Methods: A split-mouth randomized controlled clinical trial was conducted with 24 individuals in a PMT program. Contralateral quadrants with eligible residual sites were randomly assigned to either SRP + aPDT (test group) or SRP alone (control). aPDT included ICG dye and diode laser (909 nm) performed together with SRP and repeated 15 days after. Periodontal clinical parameters, periodontal inflamed surface area (PISA) index, and subgingival biofilm samples were collected at baseline (T1), 3 (T2), and 6 months later (T3). Microbiological analyses were performed by quantitative real-time polymerase chain reaction., Results: Significant improvements were observed in all clinical and microbiological parameters in both groups from T1 to T3. However, no significant differences were observed regarding plaque index, PD, and clinical attachment level. Test group showed significantly greater reductions in bleeding on probing (BOP), PISA index, and Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans levels, when compared with controls., Conclusions: Both treatments resulted in significant clinical periodontal improvements, but with no significant differences between groups except from inflammation parameters. aPDT using ICG resulted in significant reductions in BOP and PISA index, as well as in P. gingivalis and A. actinomycetemcomitans levels., (© 2023 American Academy of Periodontology.)

Background: Periodontitis worsens the hyperglycaemia in patients with type 2 diabetes mellitus (T2DM). Subgingival instrumentation, with or without surgical access, is the gold-standard treatment for periodontitis. The aim was to summarize the evidence on the effect of subgingival instrumentation (with or without open flap) on the reduction of glycosylated haemoglobin (HbA1c)., Methods: Nine electronic databases were searched up to 15 February 2023. Twelve randomized controlled trials with at least 6 months of follow-up were included. Studies using systemic or local-delivery antimicrobial therapies were excluded. Meta-analyses were performed using the random-effects model. The sources of heterogeneity were assessed by applying linear meta-regression. Risk of bias was assessed by RoB 2, and certainty of evidence by GRADE., Results: Eleven studies were included in the quantitative analyses (1374 patients). Subgingival instrumentation resulted in 0.29% lower HbA1c (95% confidence interval: 0.10-0.47; p = .03) compared with non-active treatment., Discussion: None of the 12 studies were assessed as having low risk of bias. The percentage of females and the time of diabetes diagnosis significantly explained the high level of heterogeneity. Subgingival periodontal therapy results in a significant and clinically relevant improvement in glycaemic control over 6 months in patients with T2DM and periodontitis. The grade of evidence was moderate., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: The present study aimed to evaluate the local effect of antimicrobial photodynamic therapy (aPDT) as adjunctive treatment for Grade C periodontitis in molars teeth., Method and Materials: Thirty-eight molar teeth from 11 patients were included in this split-mouth randomized clinical trial. The teeth were randomly divided into two groups (n = 19 each) that were submitted to conventional scaling and root planing in addition to aPDT (test group) and to scaling and root planing in addition to aPDT simulation (control group). The following periodontal parameters were obtained prior to treatment (baseline) and at 3 months after the intervention: bleeding on probing, probing depth, gingival recession, clinical attachment level, and furcation level. A 5% significance level was adopted in the statistical analysis., Results: Both groups exhibited improvement in the clinical parameters (P < .001). However, the reductions in bleeding on probing and probing depth were greater in the test group (P < .001). There were no significant differences in the other clinical parameters between groups (P ≥ .130)., Conclusions: Molar teeth treated with aPDT and scaling and root planing showed superior clinical improvement compared to those submitted only to scaling and root planing. aPDT may be used as adjunctive treatment for Grade C periodontitis affecting molar teeth since it seems to improve the clinical response to conventional debridement.

Objectives: The aim of the present study was to evaluate the effect on systemic inflammation of subgingival instrumentation (SI) with or without antibiotics. Moreover, systemic parameters were compared between periodontally healthy (PH) individuals and periodontitis patients., Method and Materials: Patients with generalized periodontitis: stage III and PH individuals were recruited. Forty eight periodontitis patients were randomly allocated to each treatment group; systemic antibiotics for seven days after completion of SI (AB group), or SI alone (SI group). Periodontal parameters, serum high-sensitivity C-reactive protein (hsCRP), and hematological parameters were assessed at baseline and at week 8. Multivariate analysis was applied to analyze predictive effect of treatment allocated and improvement in periodontal parameters on change in systemic parameters., Results: At baseline, hsCRP, total leukocyte count (TLC), neutrophil, and monocyte count were significantly higher in periodontitis patients. There was comparable reduction in neutrophil count in both treatment groups. At week 8, change in periodontal parameters was similar in treatment groups, except for probing pocket depth (PPD). Improvement in both PPD and clinical attachment level (CAL) and CAL alone was predictive of change in TLC and lymphocyte count, respectively., Conclusion: This study failed to demonstrate the significant benefit of systemic antibiotics as an adjuvant to SI on improvement in periodontal inflammation and systemic inflammatory parameters, despite significantly higher reduction in PPDs.

Nonsurgical periodontal therapy can be subject to iatrogenesis, which includes all the complications directly or indirectly related to a treatment. These complications include both operator-dependent harms and errors and the consequences and adverse effects of the therapeutic procedures. The complications arising following nonsurgical periodontal treatment can be categorized as intraoperative and postoperative and can affect both soft and hard tissues at an intra-oral and extraoral level. Soft-tissues damage or damage to teeth and restorations can occur while performing the procedure. In the majority of cases, the risk of bleeding associated with nonsurgical therapy is reported to be low and easily controlled by means of local hemostatic measures, even in medicated subjects. Cervicofacial subcutaneous emphysema is not a frequent extraoral intraoperative complication, occurring during the use of air polishing. Moreover, side effects such as pain, fever, and dentine hypersensitivity are frequently reported as a consequence of nonsurgical periodontal therapy and can have a major impact on a patient's perception of the treatment provided. The level of intraoperative pain could be influenced by the types of instruments employed, the characteristics of tips, and the individual level of tolerance of the patient. Unexpected damage to teeth or restorations can also occur as a consequence of procedural errors., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: To assess the root surface roughness and substance loss induced by chemical and chemomechanical challenges on root surfaces pretreated with ultrasonic instrumentation, a hand scaler, or erythritol airflow., Materials and Methods: One hundred twenty (120) bovine dentin specimens were used in this study. Specimens were divided into eight groups and treated as follows: groups 1 and 2: polished with 2000- and 4000-grit carborundum papers but not instrumented ('untreated'); groups 3 and 4: hand scaler; groups 5 and 6: ultrasonic instrumentation; groups 7 and 8: erythritol airflow. Samples from groups 1, 3, 5, and 7 then underwent a chemical challenge (5 x 2 min HCl [pH 2.7]), whereas samples from groups 2, 4, 6, and 8 were subjected to a chemomechanical challenge (5 x 2 min HCl [pH 2.7] + 2 min brushing). Surface roughness and substance loss were measured profilometrically., Results: The least substance loss through chemomechanical challenge was noted after erythritol airflow treatment (4.65 ± 0.93 µm), followed by ultrasonic instrumentation (7.30 ± 1.42 µm) and the hand scaler (8.30 ± 1.38 µm); the last two (hand scaler and ultrasonic tip) did not differ statistically significantly. The highest roughness after chemomechanical challenge was observed on ultrasonically treated specimens (1.25 ± 0.85 µm), followed by hand-scaled specimens (0.24 ± 0.16 µm) and those subject to erythritol airflow (0.18 ± 0.09 µm); there was no statistically signficant difference between the latter two, but they both differed statistically significantly from the ultrasonically treated specimens. No statistically significant difference in substance loss through the chemical challenge was observed between specimens pretreated by the hand scaler (0.75 ± 0.15 µm), ultrasonic tip (0.65 ± 0.15 µm), and erythritol airflow (0.75 ± 0.15 µm). The chemical challenge smoothed the surfaces treated with the hand scaler, ultrasonic tip, and erythritol airflow., Conclusion: Dentin pretreatment with erythritol powder airflow resulted in a higher resistance to chemomechanical challenge than did dentin treated ultrasonically or with the hand scaler.

Purpose: This study aimed to evaluate the impact of dietary supplementation with omega-3 polyunsaturated fatty acids (PUFAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) combined with scaling and root planing (SRP) in untreated periodontitis stage III and IV., Methods: Forty patients were randomly assigned to the test group receiving SRP plus omega-3 PUFAs (n = 20) or control group receiving SRP alone (n = 20). Clinical changes of pocket probing depths (PD), clinical attachment level (CAL), bleeding on probing (BOP) and rates of closed pockets (PPD ≤ 4 mm without BOP) were evaluated at baseline and after 3 and 6 months. Phorphyromonas gingivalis, Tanarella forsythia, Treponema denticola and Aggregatibacter actinomycetemcomitans counts were analysed at baseline and at 6 months. Serum was subjected to lipid gas chromatography/mass spectrometry analysis at baseline and at 6 months., Results: Significant improvement of all clinical parameters at 3 and 6 months was observed in both groups. For the primary outcome "change of mean PD," no significant difference was detected between the groups. Patients treated with omega-3 PUFAs demonstrated significantly lower rates of BOP, higher gain of CAL and higher number of closed pockets at 3 months in comparison to the control group. After 6 months, no clinical differences between the groups were found, with the exception of lower BOP rates. Moreover, in the test group, the number of key periodontal bacteria was significantly lower than in the control group at 6 months. Increased proportions of serum n-3 PUFAs and decreased proportions of n-6 PUFAs were detected at 6 months in the patients from the test group., Conclusion: High-dose omega-3 PUFA intake during non-surgical treatment of periodontitis results in short-term clinical and microbiological benefits. The study protocol was approved by the ethical committee of Medical University of Lodz (reference number RNN/251/17/KE) and registered at clinicaltrials.gov (NCT04477395) on 20/07/2020., (© 2023. The Author(s).)