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This study was conducted to compare the success of implants restored with angled abutments to implants restored with standard abutments. Eighty-one implants in 24 patients were evaluated for up to 36 months. Measurements included probing depths, gingival level, gingival index, and mobility. No significant difference could be found for any of the parameters examined between implants restored with angled and standard abutments. This suggests that the angled abutment may be considered a suitable restorative option when implants are not placed in ideal axial positions. [ABSTRACT FROM AUTHOR]

Background: In the Periodontitis and Vascular Events (PAVE) pilot study, periodontal therapy was provided as an intervention in a secondary cardiac event prevention model through five coordinated cardiac-dental centers.Methods: Subjects were randomized to either community care or protocol provided scaling and root planing to evaluate effects on periodontal status and systemic levels of high-sensitivity C-reactive protein (hs-CRP).Results: After 6 months, there was a significant reduction in mean probing depth and extent of 4- or 5-mm pockets. However, there were no significant differences in attachment levels, bleeding upon probing, or extent of subgingival calculus comparing subjects assigned to protocol therapy (n = 151) to those assigned to community care (n = 152). Using intent-to-treat analyses, there was no significant effect on serum hs-CRP levels at 6 months. However, 48% of the subjects randomized to community care received preventive or periodontal treatments. Secondary analyses demonstrated that consideration of any preventive or periodontal care (i.e., any treatment) compared to no treatment showed a significant reduction in the percentage of people with elevated hs-CRP (values >3 mg/l) at 6 months. However, obesity nullified the periodontal treatment effects on hs-CRP reduction. The adjusted odds ratio for hs-CRP levels >3 mg/l at 6 months for any treatment versus no treatment among non-obese individuals was 0.26 (95% confidence interval: 0.09 to 0.72), adjusting for smoking, marital status, and gender.Conclusion: This pilot study demonstrated the critical role of considering obesity as well as rigorous preventive and periodontal care in trials designed to reduce cardiovascular risk. [ABSTRACT FROM AUTHOR]

Background: Population-based clinical and laboratory studies have reported findings providing support for a possible relationship between periodontal disease and cardiovascular disease. The Periodontitis and Vascular Events (PAVE) pilot study was conducted to investigate the feasibility of a randomized secondary prevention trial to test whether treatment of periodontal disease reduces the risk for cardiovascular disease. Methods: Five clinical centers recruited participants who had documented coronary heart disease and met study criteria for periodontal disease. Eligible participants were randomized to receive periodontal therapy provided by the study or community dental care. Follow up telephone calls and clinic visits were planned to alternate at 3 month intervals after randomization, with all participants followed until at least the 6 month clinic visit. Participants were followed for adverse events and periodontal and cardiovascular out-comes. Results: A total of 303 participants were randomized Recruitment that involved active participation of a cardiologist with responsibility for the patients worked best among the strategies used. Of those who had not withdrawn, 93% completed the 6 month contact. During follow up, 11% of the 152 subjects in the community dental care group reported receiving periodontal therapy outside of the study. Conclusions: If appropriate recruitment strategies are used, this pilot study demonstrated that it is feasible to conduct a secondary prevention trial of periodontal therapy in patients who have had coronary heart disease. If a community dental care group is used, sample size estimation needs to take into account that a non trivial proportion of participants in this group may receive periodontal therapy outside of the study. [ABSTRACT FROM AUTHOR]

Adequate and transparent reporting is necessary for critically appraising published research. Yet, ample evidence suggests that the design, conduct, analysis, interpretation, and reporting of oral health research could be greatly improved. Accordingly, the Task Force on Design and Analysis in Oral Health Research-statisticians and trialists from academia and industry-identified the minimum information needed to report and evaluate observational studies and clinical trials in oral health: the OHStat Guidelines. Drafts were circulated to the editors of 85 oral health journals and to Task Force members and sponsors and discussed at a December 2020 workshop attended by 49 researchers. The guidelines were subsequently revised by the Task Force's writing group. The guidelines draw heavily from the Consolidated Standards for Reporting Trials (CONSORT), Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), and CONSORT harms guidelines and incorporate the SAMPL guidelines for reporting statistics, the CLIP principles for documenting images, and the GRADE indicating the quality of evidence. The guidelines also recommend reporting estimates in clinically meaningful units using confidence intervals, rather than relying on P values. In addition, OHStat introduces 7 new guidelines that concern the text itself, such as checking the congruence between abstract and text, structuring the discussion, and listing conclusions to make them more specific. OHStat does not replace other reporting guidelines; it incorporates those most relevant to dental research into a single document. Manuscripts using the OHStat guidelines will provide more information specific to oral health research., (Copyright © 2024 Task Force on Design & Analysis in Oral Health Research 2024. Published by Elsevier Inc. All rights reserved.)

Adequate and transparent reporting is necessary for critically appraising research. Yet, evidence suggests that the design, conduct, analysis, interpretation, and reporting of oral health research could be greatly improved. Accordingly, the Task Force on Design and Analysis in Oral Health Research-statisticians and trialists from academia and industry-empaneled a group of authors to develop methodological and statistical reporting guidelines identifying the minimum information needed to document and evaluate observational studies and clinical trials in oral health: the Oral Health Statistics (OHStat) Guidelines. Drafts were circulated to the editors of 85 oral health journals and to task force members and sponsors and discussed at a December 2020 workshop attended by 49 researchers. The final version was subsequently approved by the task force in September 2021, submitted for journal review in 2022, and revised in 2023. The checklist consists of 48 guidelines: 5 for introductory information, 17 for methods, 13 for statistical analysis, 6 for results, and 7 for interpretation; 7 are specific to clinical trials. Each of these guidelines identifies relevant information, explains its importance, and often describes best practices. The checklist was published in multiple journals. The article was published simultaneously in Journal of Dental Research Clinical and Translational Research, the Journal of the American Dental Association, and the Journal of Oral and Maxillofacial Surgery. Completed checklists should accompany manuscripts submitted for publication to these and other oral health journals to help authors, journal editors, and reviewers verify that the manuscript provides the information necessary to adequately document and evaluate the research., (Copyright © 2024 Task Force on Design & Analysis in Oral Health Research 2024. Published by Sage Publications, Inc. on behalf of International Association for Dental, Oral, and Craniofacial Research and by Elsevier Inc. on behalf of American Dental Association and American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Adequate and transparent reporting is necessary for critically appraising published research. Yet, ample evidence suggests that the design, conduct, analysis, interpretation, and reporting of oral health research could be greatly improved. Accordingly, the Task Force on Design and Analysis in Oral Health Research-statisticians and trialists from academia and industry-identified the minimum information needed to report and evaluate observational studies and clinical trials in oral health: the Oral Health Statistical (OHStat) Guidelines. Drafts were circulated to the editors of 85 oral health journals and to Task Force members and sponsors and discussed at a December 2020 workshop attended by 49 researchers. The guidelines were subsequently revised by the Task Force's writing group. The guidelines draw heavily from the Consolidated Standards for Reporting Trials, Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), and Consolidated Standards for Reporting Trials harms guidelines and incorporate the Statistical Analysis and Methods in Published Literature guidelines for reporting statistics, the Clinical and Laboratory Images in Publications principles for documenting images, and the Grading of Recommendations Assessment, Development and Evaluation indicating the quality of evidence. The guidelines also recommend reporting estimates in clinically meaningful units using confidence intervals, rather than relying on P values. In addition, OHStat introduces 7 new guidelines that concern the text itself, such as checking the congruence between abstract and text, structuring the discussion, and listing conclusions to make them more specific. OHStat does not replace other reporting guidelines; it incorporates those most relevant to dental researches into a single document. Manuscripts using the OHStat guidelines will provide more information specific to oral health research., (Copyright © 2024 © Task Force on Design & Analysis in Oral Health Research 2024. Published by Elsevier Inc. All rights reserved.)

Adequate and transparent reporting is necessary for critically appraising research. Yet, evidence suggests that the design, conduct, analysis, interpretation, and reporting of oral health research could be greatly improved. Accordingly, the Task Force on Design and Analysis in Oral Health Research-statisticians and trialists from academia and industry-empaneled a group of authors to develop methodological and statistical reporting guidelines identifying the minimum information needed to document and evaluate observational studies and clinical trials in oral health: the OHstat Guidelines. Drafts were circulated to the editors of 85 oral health journals and to Task Force members and sponsors and discussed at a December 2020 workshop attended by 49 researchers. The final version was subsequently approved by the Task Force in September 2021, submitted for journal review in 2022, and revised in 2023. The checklist consists of 48 guidelines: 5 for introductory information, 17 for methods, 13 for statistical analysis, 6 for results, and 7 for interpretation; 7 are specific to clinical trials. Each of these guidelines identifies relevant information, explains its importance, and often describes best practices. The checklist was published in multiple journals. The article was published simultaneously in JDR Clinical and Translational Research, the Journal of the American Dental Association, and the Journal of Oral and Maxillofacial Surgery. Completed checklists should accompany manuscripts submitted for publication to these and other oral health journals to help authors, journal editors, and reviewers verify that the manuscript provides the information necessary to adequately document and evaluate the research., (Copyright © 2024 Task Force on Design & Analysis in Oral Health Research 2024. Published by Elsevier Inc. All rights reserved.)

Background: Using a single-blind, randomized, controlled, multicenter, practice-based clinical trial, a volume-stable collagen matrix (VCMX) was compared with connective tissue graft (CTG) for soft tissue augmentation around existing dental implants., Methods: Sixty patients (31 VCMX and 31 CTG) were included. The primary outcome was a soft tissue thickness change 3 mm below the gingival margin (GM). Secondary outcomes included clinical measures, such as keratinized tissue widths (KTw), probing pocket depths, and pink esthetic scores, and patient-reported outcomes (PRO)., Results: There were no significant differences between test and control patient demographics or clinical measures throughout the 1-year study. VCMX "grafts" were by design larger than CTG, and surgery time was less (27% less, p = 0.0005). Three millimeters below the GM (primary endpoint), tissue thickness increase was noninferior for VCMX compared with CTG (0.93 ± 0.80 mm vs. 1.10 ± 0.51 mm, respectively), inferior (by 0.25 mm) at 1 mm, and noninferior at 5 mm. Postoperative pain was significantly less for VCMX patients (p < 0.0001), but all other PRO measures, including esthetics and satisfaction, improved similarly for both therapies., Conclusions: Given the inclusion criteria for this study, namely soft tissue augmentation around existing implants with some evidence of KTw and minimal recession, VCMX provided soft tissue thickness and volume increases similar (noninferior) to CTG. Clinical measures and PRO were similar between therapies-site sensitivity and esthetics improved similarly for both therapies-but surgery time and pain following surgery were significantly less for VCMX., (© 2023 American Academy of Periodontology.)

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.)

Aims: Brensocatib is a reversible inhibitor of dipeptidyl peptidase 1 (cathepsin C), in development to treat chronic non-cystic fibrosis bronchiectasis. The phase 2, randomized, placebo-controlled WILLOW trial (NCT03218917) was conducted to examine whether brensocatib reduced the incidence of pulmonary exacerbations. Brensocatib prolonged the time to the first exacerbation and led to fewer exacerbations than placebo. Because brensocatib potentially affects oral tissues due to its action on neutrophil-mediated inflammation, we analyzed periodontal outcomes in the trial participants., Materials and Methods: Patients with bronchiectasis were randomized 1:1:1 to receive once-daily oral brensocatib 10 or 25 mg or placebo. Periodontal status was monitored throughout the 24-week trial in a prespecified safety analysis. Periodontal pocket depth (PPD) at screening, week 8, and week 24 was evaluated. Gingival inflammation was evaluated by a combination of assessing bleeding upon probing and monitoring the Löe-Silness Gingival Index on 3 facial surfaces and the mid-lingual surface., Results: At week 24, mean ± SE PPD reductions were similar across treatment groups: -0.07 ± 0.007, -0.06 ± 0.007, and -0.15 ± 0.007 mm with brensocatib 10 mg, brensocatib 25 mg, and placebo, respectively. The distribution of changes in PPD and the number of patients with multiple increased PPD sites were similar across treatment groups at weeks 8 and 24. The frequencies of gingival index values were generally similar across treatment groups at each assessment. An increase in index values 0-1 and a decrease in index values 2-3 over time and at the end of the study were observed in all groups, indicating improved oral health., Conclusions: In patients with non-cystic fibrosis bronchiectasis, brensocatib 10 or 25 mg had an acceptable safety profile after 6 months' treatment, with no changes in periodontal status noted. Improvement in oral health at end of the study may be due to regular dental care during the trial and independent of brensocatib treatment., Knowledge Transfer Statement: The results of this study suggest that 24 weeks of treatment with brensocatib does not affect periodontal disease progression. This information can be used by clinicians when considering treatment approaches for bronchiectasis and suggests that the use of brensocatib will not be limited by periodontal disease risks. Nevertheless, routine dental/periodontal care should be provided to patients irrespective of brensocatib treatment., Competing Interests: Declaration of Conflicting InterestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: J.C. Gunsolley was a paid consultant (biostatistical and periodontal) for the WILLOW trial but received no compensation for the work on this manuscript. C. Fernandez is an employee of Insmed Incorporated. O. Sibila has received a grant from Zambon and personal or other fees from Bayer Healthcare, Insmed Incorporated, and Grifols. J.D. Chalmers has received grants and personal fees from AstraZeneca, Boehringer–Ingelheim, GSK, Zambon, and Insmed Incorporated; a grant from Gilead; and personal fees from Novartis and Chiesi. F.A. Scannapieco reports no conflicts of interest.

A biologic is a therapeutic agent with biological activity that is administered to achieve an enhanced regenerative or reparative effect. The use of biologics has progressively become a core component of contemporary periodontal practice. However, some questions remain about their safety, indications, and effectiveness in specific clinical scenarios. Given their availability for routine clinical use and the existing amount of related evidence, the goal of this American Academy of Periodontology (AAP) best evidence consensus (BEC) was to provide a state-of-the-art, evidence-based perspective on the therapeutic application of autologous blood-derived products (ABPs), enamel matrix derivative (EMD), recombinant human platelet-derived growth factor BB (rhPDGF-BB), and recombinant human bone morphogenetic protein 2 (rhBMP-2). A panel of experts with extensive knowledge on the science and clinical application of biologics was convened. Three systematic reviews covering the areas of periodontal plastic surgery, treatment of infrabony defects, and alveolar ridge preservation/reconstruction and implant site development were conducted a priori and provided the foundation for the deliberations. The expert panel debated the merits of published data and exchanged experiential information to formulate evidence-based consensus statements and recommendations for clinical practice and future research. Based on an analysis of the current evidence and expert opinion, the panel concluded that the appropriate use of biologics in periodontal practice is generally safe and provides added benefits to conventional treatment approaches. However, therapeutic benefits and risks range based on the specific biologics used as well as patient-related local and systemic factors. Given the limited evidence available for some indications (e.g., gingival augmentation therapy, alveolar ridge preservation/reconstruction, and implant site development), future clinical studies that can expand the knowledge base on the clinical use of biologics in periodontal practice are warranted., (© 2022 The Authors. Journal of Periodontology published by Wiley Periodicals LLC on behalf of American Academy of Periodontology.)

Postextraction bone grafting and implant placement help preserve alveolar bone volume. Collagen wound dressings and soft tissue graft substitutes may help protect extraction socket bone grafts and provide better gingival contours. This randomized, controlled, multicenter, and double-blinded study was conducted to compare a control (wound dressing) and a test (soft tissue graft) substitute in nearly intact extraction sockets. Both test and control sockets were grafted with a xenogeneic bone graft. Graft containment, extraction socket soft tissue gap closure, gingival contour, and gingival thickness were examined over 16 weeks, at which time implants were placed. Healing was uneventful for both groups, and there was no significant difference (P < .05) between the times required to close the extraction socket soft tissue gap (~80% of sites closed by 8 weeks). Bone grafts were covered and contained longer in the test group (~4 weeks vs ~2 weeks), with less contour disruption out to 4 weeks; however, at implant placement, soft tissue contours in both groups were comparable, and soft tissue thicknesses were not significantly different.

Background: A number of studies in patients with periodontitis have compared scaling and root planning (SRP) combined with an adjunctive treatment to SRP alone. Within that literature, an array of studies with overlapping investigators has consistently yielded substantially greater effects of adjunctive treatments than had been previously noted. This report investigates discrepancies between that cluster of research and the most recent American Dental Association (ADA) systematic review., Methods: This review was preregistered at https://osf.io/4meyd/. A search using the Scopus platform identified 32 articles published from 2010 to 2017 by investigators affiliated with the Government Dental College and Research Institute (GDCRI) in Bangalore, India. The primary outcome used in this meta-analysis was the change in clinical attachment level (CAL) after 6 mo. Effect sizes were estimated using Comprehensive Meta-Analysis software after categorizing agents into groups based on pharmacologic similarity., Results: The search identified 32 studies encompassing 5 sets of adjunctive agents. Across the GDCRI studies, the CAL averaged 1.67 mm (95% confidence interval [CI]: 1.43-1.91 mm), substantially exceeding values reported in the ADA review (mean: 0.39 mm, 95% CI: 0.27-0.51 mm). For categories of studies in which comparable subgroup estimates were available, the evaluations yielded overlapping estimates of SRP alone, but CAL estimates were discrepant for both locally delivered antimicrobials (GDCRI studies: mean: 1.45 mm, 95% CI: 0.63-2.27 mm; ADA review: mean: 0.38 mm, 95% CI: 0.16 -0.60 mm) and systemic antibiotics (GDCRI studies: mean: 1.35 mm, 95% CI: 0.97-1.73 mm; ADA review: mean: 0.39 mm, 95% CI: 0.21-0.57 mm)., Conclusion: In the literature on adjunctive agents supplementing SRP, findings from investigators linked to GDCRI stand out as having significantly more favorable estimated effects. Meanwhile, some agents studied by GDCRI-linked investigators have not been investigated by other researchers. In the absence of a clear explanation for discrepant results, it is recommended that unusually favorable reported effects of adjunctive agents be viewed with caution., Knowledge Transfer Statement: The present meta-analysis observed an unusually large effect size of adjunctive agents to scaling and root planning in studies conducted by the same research group. These results were not consistent with trials on adjunctive agents and previous reports. As this research group has exclusively tested most of the agents, their results must be viewed with caution until other independent groups replicate the studies and reproduce the effect size.

Introduction: On the topic of adjuncts to scaling and root planing (SRP), numerous randomized clinical trials (RCTs) were published by a single group of authors and frequently reported unusually large effect sizes. A meta-analysis in part 1 of this project failed to explain the causes for these unusual findings. We assessed the reporting quality and trial registration discrepancies to examine the possibility of replicating the work of this research group as well as the overall rigor of the research methodology., Methods: This study was preregistered at the Open Science Framework (https://osf.io/4meyd/). The Scopus platform was utilized for the RCT search on SRP adjuncts in intrabony defects in patients with periodontitis as compared with SRP alone. The search analysis was limited from 2010 to 2017, and RCTs on SRP adjuncts published by a single research group were selected for screening and inclusion. RCT registration records were assessed for consistency., Results: Out of 92 studies that were retrieved from Scopus and PubMed, 32 were included for quality assessment per the CONSORT guidelines (Consolidated Standards of Reporting Trials). Results showed that all RCTs were characterized by a low reporting quality. The majority of CONSORT items scored <50%, including critical items (randomization, registration, and blinding). When registration records were compared with published RCTs, several discrepancies were found. The per-protocol follow-up duration was compared against the study's initiation and termination dates. Only 38% of the RCTs presented a follow-up period within the initiation and termination dates. The remaining RCTs showed inconsistent follow-up in comparison with the initiation and termination dates., Conclusion: RCTs by this group were characterized by poor adherence to reporting quality guidelines. Crucial RCT elements, such as randomization, blinding, and primary outcomes, were not reported properly. RCT registration records revealed systematic inconsistencies when compared with RCT publication. Therefore, the unusually large effects reported by this group should be viewed with extreme caution., Knowledge Transfer Statement: The included randomized clinical trials were characterized by poor adherence to reporting quality guidelines, missing information about important trial items, and discrepancies between the reports and trial registrations. This quality assessment should guide clinical research and show clinicians that they should be cautious when applying evidence in their clinical practice.

Background: The autogenous connective tissue graft (CTG) with coronally advanced flap (CTG+CAF) is the "gold standard" for recession defect coverage; however, researchers continue to pursue lower morbidity, more convenient and unlimited supply harvest graft substitutes, including those that could provide soft tissue volume augmentation., Methods: A randomized, controlled, double-masked comparison of a volume-stable collagen matrix (VCMX) versus CTG was conducted at four clinical investigation sites. Single, contralateral, within patient matched-pair, RT1 recession defects were treated with VCMX+CAF (test) and CTG+CAF (control). The primary efficacy end point was percent root coverage at 6 months. Secondary efficacy end points included clinical measures such as soft tissue volume, attachment level, and keratinized tissue width. Patient-reported outcomes included measures such as discomfort, esthetics, and overall satisfaction; 6-month end point results were followed for 1 year., Results: Thirty patients received control and test therapies, and all patients were available for follow-up measures. Average percent root coverage for CTG+CAF was 90.5% ± 14.87% versus 70.7% ± 28.26% for VCMX+CAF, P <0.0001. Both therapies produced significant soft tissue volume increases (84.8 ± 47.43 mm 3 control versus 48.90 ± 35.58 mm 3 test, P = 0.0006). The test, harvest graft substitute produced less postoperative pain and was preferred by patients at the 6-month end point. All other end point measures were not significantly different., Conclusions: VCMX+CAF root coverage was inferior to CTG+CAF but produced less morbidity and was preferred by patients. Case/patient selection and surgical technique appear key to achieving successful results with the harvest graft alternative., (© 2021 American Academy of Periodontology.)

Background: The purpose of this follow up study was to determine if a xenogeneic collagen matrix (CMX) is as effective as free gingival graft (FGG) in preventing further recession 6+ years following vestibuloplasty., Methods: This study was a single-blind (examiner), randomized, controlled, split-mouth study of 30 subjects with insufficient zones of KT (< 2 mm), associated with at least two, paired teeth. The study utilized a within subject treatment comparison to examine non-inferiority according to primary and secondary endpoints 6+ years after therapy. The original study primary efficacy endpoint was keratinized tissue width (KTw); however, in this report, prevention of recession (Rec) was also examined, along with traditional, secondary clinical measures, histopathology of mucosal biopsies and exploratory, patient reported outcomes (PROs) for pain and satisfaction., Results: A total of 23 of the 30 original, study patients were available for 6 to 8-year postoperative assessment, and these patients were representative of the original patient population. For preventing further Rec, CMX was not inferior to FGG (ΔRec = -0.07 ± 1.26 mm for CMX and -0.17 ± 0.78 mm for FGG, P = 0.710). There were no adverse results observed, and histological assessment indicated normal, keratinized gingiva for both therapies. Tissue texture and color match to surrounding, native tissues were significantly better for CMX, and patients preferred CMX over FGG therapy., Conclusions: CMX appears to be a suitable substitute for FGG 6+ years after therapy., (© 2020 American Academy of Periodontology.)

Background: The purpose of this publication is to report on the six-month clinical results and patient-reported outcomes (PROs) comparing the surgical use of the erbium, chromium-doped: yttrium, scandium, gallium, and garnet (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 adults (29 females and 24 males; aged 19 to 73 years) with 79 intrabony defects were randomized following scaling and root planing (SRP) to receive ERL monotherapy (n = 27) or MIST (n = 26). Recession, probing depth (PD), clinical attachment level (CAL), treatment time, and PROs were assessed and compared for each treatment group. Clinical measurements were recorded at baseline, 4 to 6 weeks following SRP, and 6 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 0.6 mm (p = 0.05), PD with a non-inferiority margin of 0.5 mm (p = 0.05). Recession with a non-inferiority margin of 0.4 mm (p = 0.05). Faster procedure times were found for ERL (16.39 ± 6.21 minutes) versus MIST (20.17 ± 5.62 minutes), p = 0.0002. In the first 2 to 3 days of post-therapeutic diary outcomes, subjects reported less bruising, facial swelling, and use of ice pack for the ERL group., Conclusions: This is the first multicenter, randomized, masked, and controlled study demonstrating the ERL is not inferior to MIST in terms of clinical outcomes but is superior in PROs for the surgical treatment of intrabony defects., (© 2020 American Academy of Periodontology.)

Objective: Poor reporting in randomized clinical trial (RCT) abstracts reduces quality and misinforms readers. Spin, a biased presentation of findings, could frequently mislead clinicians to accept a clinical intervention despite non-significant primary outcome. Therefore, good reporting practices and absence of spin enhances research quality. We aim to assess the reporting quality and spin in abstracts of RCTs evaluating the effect of periodontal therapy on cardiovascular (CVD) outcomes., Methods: PubMed, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and 17 trial registration platforms were searched. Cohort, non-randomized, non-English studies, and pediatric studies were excluded. RCT abstracts were reviewed by 2 authors using the CONSORT for abstracts and spin checklists for data extraction. Cohen's Kappa statistic was used to assess inter-rater agreement. Data on the selected RCT publication metrics were collected. Descriptive analysis was performed with non-parametric methods. Correlation analysis between quality, spin and bibliometric parameters was conducted., Results: 24 RCTs were selected for CONSORT analysis and 14 fulfilled the criteria for spin analysis. Several important RCT elements per CONSORT were neglected in the abstract including description of the study population (100%), explicitly stated primary outcome (87%), methods of randomization and blinding (100%), trial registration (87%). No RCT examined true outcomes (CVD events). A significant fraction of the abstracts appeared with at least one form of spin in the results and conclusions (86%) and claimed some treatment benefit in spite of non-significant primary outcome (64%). High-quality reporting had a significant positive correlation with reporting of trial registration (p = 0.04) and funding (p = 0.009). Spinning showed marginal negative correlation with reporting quality (p = 0.059)., Conclusion: Poor adherence to the CONSORT guidelines and high levels of data spin were found in abstracts of RCTs exploring the effects of periodontal therapy on CVD outcomes. Our findings indicate that journal editors and reviewers should consider strict adherence to proper reporting guidelines to improve reporting quality and reduce waste., Competing Interests: No authors have competing interest.

An effective treatment regime for peri-implantitis (P-I) should include disinfection and regeneration of peri-implant tissues. Twenty consecutive patients exhibiting 23 P-I implants with 84 deep (≥ 6 mm) defects were treated using an Er:YAG laser for implant surface decontamination, removal of defect granulomatous tissues, and grafting therapy for bony defect resolution. Probing pocket defects (PPD) ≥ 6 mm (deep probing depths) before surgery were reduced on average to approximately 3.5 mm at 12 months. Probing depths < 6 mm (shallow probing depths) remained stable (mean PPD 3.2 mm at 12 months). Radiographs indicated PPD reductions were achieved along with peri-implant defect fill.

Results of a cluster-randomized trial of a Screening and Brief Intervention for heavy drinkers in dental practice are reported. Data were obtained from 103 heavy drinking patients recruited from randomized intervention (7; n = 50) and control (6; n = 53) practices. Analysis of data revealed that 6-month decreases in total drinks per week were significantly (p < .05) greater for heavy drinking intervention (43%) than control patients (21%)-a 4 drink per week difference. Similar decreases were obtained for quantity and frequency among intervention patients compared to control patients. Despite power limitations, the 6-month results support the effectiveness of the Screening and Brief Intervention., (© The Author(s) 2014.)

Background: Standard recommendations for oral hygiene practices have focused on mechanical methods (toothbrushing and interdental cleaning). Published evidence indicates antimicrobial mouthrinses provide oral health benefits beyond mechanical methods alone. The purpose of this meta-analysis was to evaluate the combined effectiveness of mechanical methods with essential oil-containing mouthrinses (MMEO) versus mechanical methods (MM) alone in achieving site-specific, healthy gingival tissue and reducing plaque and gingivitis., Types of Studies Reviewed: All industry-sponsored clinical trials investigating the antigingivitis and antiplaque effects of essential oil (EO)-containing mouthrinses conducted from 1980 to 2012 were reviewed; 29 of 32 studies met the inclusion criteria of 6 months or longer duration, randomized, observer-masked, placebo-controlled, and with individual-level site-specific data. By-study treatment effects were estimated through generalized linear models for binary data and analysis of covariance for continuous data, and then combined using standard meta-analysis techniques; heterogeneity was also assessed., Results: Summary odds ratios for a healthy gingival site and for a plaque-free site were, respectively, 5.0 (95% confidence interval [CI], 3.3-7.5) and 7.8 (95% CI, 5.4-11.2) for MMEO participants versus MM participants at 6 months. The summary percentage reductions in whole-mouth mean gingivitis and plaque at 6 months were 16.0 (95% CI, 11.3-20.7) and 27.7 (95% CI, 22.4-32.9), respectively. Responder analyses using aggregate individual-level data showed 44.8% of MMEO participants and 14.4% of MM participants achieved at least 50% healthy sites in their mouths at 6 months. Similarly, 36.9% of MMEO participants and 5.5% of MM participants achieved at least 50% plaque-free sites in their mouths at 6 months., Conclusions and Practical Implications: This is the first meta-analysis to demonstrate the clinically significant, site-specific benefit of adjunctive EO treatment in people within a 6-month period (that is, between dental visits)., (Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.)

The aim of this study was to conduct a review of articles about tobacco or alcohol published from 1980 to 2010 in the Journal of the American Dental Association (JADA), Journal of Dental Education (JDE), and Journal of Public Health Dentistry (JPHD) in an attempt to identify trends by decade in topics relevant to oral health consequences, oral cancer linkages, and cessation counseling. NVivo qualitative analysis software was used to code abstracts using the keywords "tobacco" or "alcohol." The search identified 269 articles: tobacco=211 (78%), alcohol=58 (22%). This number represented 2.4% of the total articles published in these journals for the specified years. While the percentage of tobacco-related articles increased over this period (with highs in the 1990s of 4.1% in the JDE and 9% in the JPHD), the percentage of alcohol articles reached only 1% for JADA and 3.3% for the JPHD in the 2000s. The number of tobacco-related articles addressing oral health effects, oral cancer linkages, and cessation counseling increased in the 1990s. Although there were modest increases in the number of articles about alcohol-related oral health effects and oral cancer linkages (particularly in the JPHD in the 2000s), only two articles (in JADA in the 2000s) addressed alcohol cessation counseling. This study concluded that tobacco and alcohol have received limited, though increasing, attention in these three major journals between 1980 and 2010, with alcohol receiving less attention than tobacco. These results suggest a need for more published studies on tobacco and alcohol interventions in dental and allied dental education to prepare students to contribute to this aspect of their patients' health.

Background: Nucleic acid sensing has emerged as one of the important components of the immune system triggering inflammation. The aim of this study is to determine the expression of bacterial DNA sensors, including Toll-like receptor 9 (TLR-9), DNA-dependent activator of interferon-regulatory factors (DAI), and absent in melanoma 2 (AIM2) in chronic periodontitis (CP versus healthy) (H) tissues., Methods: Thirty-five CP and 27 H gingival biopsies were included. Real-time quantitative polymerase chain reaction was performed to determine mRNA levels of AIM2, DAI, and TLRs (TLR-1 through TLR-9). The difference in gene expression for each sensor between CP and H tissues was calculated using analysis of covariance. The Spearman test was used to determine correlations among innate receptors. The expression of TLR-9, AIM2, and DAI in gingival tissues was further confirmed using immunohistochemistry., Results: The present results reveal statistically significant upregulation of TLR-9 (P <0.006), DAI (P <0.001), and TLR-8 (P <0.01) in CP tissues compared to H sites. Although mRNA expression was not changed significantly between groups for other receptors, the present results reveal significant correlations between receptors (P <0.05), suggesting that cooperation between multiple components of the host immune system may influence the overall response. Immunohistochemistry further confirmed expression of TLR-9, AIM2, and DAI in gingival tissues., Conclusions: This study highlights a possible role for nucleic acid receptors in periodontal inflammation. Future investigations will determine whether cytoplasmic receptors and their ligands can be targeted to improve clinical outcomes in periodontitis.

Background: Smile esthetics have been shown to play a major role in the perception of whether a person is attractive, and whether they are perceived as friendly, trustworthy, intelligent, and self-confident. A proposed major determinant of the esthetics of a smile is the amount of gingival display, which can be excessive in cases of altered passive eruption. The aim of this study is to see whether altering the amount of gingival display of patients would affect dental professionals' and laypersons' perceptions of the aforementioned social parameters., Methods: Patients were identified as having altered passive eruption and excessive gingival display. Smiling "control" photographs were taken and then digitally altered so as to lengthen the teeth and thus reduce the amount of gingival display. These became the "test" photographs. The control and test photographs were shown in random order. The control group of evaluators consisted of senior dental students, and the test group of evaluators comprised students who had no formal dental training. Groups were asked to rate, on a visual analog scale, each picture's attractiveness, friendliness, trustworthiness, intelligence, and self-confidence., Results: The test pictures with less gingival display were consistently and statistically significantly rated higher for all five social parameters than were their control counterparts (P <0.0001). When analyzed as an isolated effect, there were no statistically significant differences between the control group and the test group of evaluators when rating the pictures. Pictures depicting African Americans were judged to be more trustworthy (P = 0.0467) and self-confident (P = 0.0490) than pictures depicting white individuals. Pictures depicting women were judged to be more trustworthy (P = 0.0159) and intelligent (P = 0.0329) than pictures depicting men. All the social parameters were positively and statistically significantly correlated with each other (P <0.0001)., Conclusions: Excessive gingival display did negatively affect how attractive a person's smile is judged to be. In addition, how friendly, trustworthy, intelligent, and self-confident a person was perceived to be was inversely related to the amount of gingival display. Untrained laypeople were just as sensitive to these differences as senior dental students.

Aim: The aim of this review was to critically appraise the evidence on the impact of periodontal treatment of cardiovascular diseases (CVDs) biomarkers and outcomes., Methods: A systematic search was performed in Cinhal, Cochrane, Embase and Medline for relevant articles up to July 2012. Duplicate screening and reference hand searching were performed. Data were then summarized and evidence graded in tables., Results: The search resulted in: (a) no evidence on the effects of periodontal therapy on subclinical atherosclerosis, serum levels of CD40 ligand, serum amyloid A and monocyte chemoattractant protein-1, (b) limited evidence on the effects of periodontal therapy on arterial blood pressure, leucocyte counts, fibrinogen, tissue necrosis factor-α, sE-selectin, von Willebrand factors, d-dimers, matrix metalloproteinases, oxidative stress and CVD events, and (c) moderate evidence suggesting a negligible effect of periodontal therapy in reducing interleukin-6 and lipids levels, whilst a positive effect in reducing serum C-reactive protein levels and improving endothelial function., Conclusions: Periodontal therapy triggers a short-term inflammatory response followed by (a) a progressive and consistent reduction of systemic inflammation and (b) an improvement in endothelial function. There is however limited evidence that these acute and chronic changes will either increase or reduce CVD burden of individuals suffering from periodontitis in the long term., (© 2013 European Federation of Periodontology and American Academy of Periodontology.)

Although brief alcohol interventions have proven effective in a variety of health care settings, the present article describes the development of the first brief intervention for heavy drinkers in dental practice. Elements of motivational interviewing and personalized normative feedback were incorporated in a 3- to 5-minute intervention delivered by dental hygienists. The intervention is guided by a one-page feedback report providing personalized normative feedback regarding the patient's current oral health practices, their drinking in comparison to others, and oral cancer risk associated with current smoking and drinking. Future publications will present data regarding intervention effectiveness from an ongoing randomized trial.

Background: It was hypothesized that if periodontal infections predispose low birth weights and premature birth, then such outcomes should be apparent when the mother has aggressive periodontitis (AgP)., Methods: Birth weight data were collected by questionnaire from females with AgP, their periodontally healthy siblings, and unrelated periodontally healthy women. Both prospective and retrospective birth outcome data were used. Because many of the periodontal evaluations were performed after the births, there were incomplete data regarding most of the risk factors for low birth weight. We determined associations between mothers' periodontal diagnoses and clinical variables and the reported birth weights., Results: There were no significant differences in mean birth weights of babies born to control subjects or AgP patients. This was true whether all the births were considered or only those reported <1 or 2 years before periodontal examination. For periodontally healthy controls, 13.2% of babies born to siblings of AgP patients and 12.8% of babies born to unrelated mothers weighed <2,500 g, whereas 9.9% of those born to mothers with generalized AgP and 10.3% of those born to mothers with localized AgP weighed <2,500 g., Conclusions: Because of the relative rarity of AgP in the population, and attendant difficulties in performing a prospective study of its association with pregnancy outcomes, we used a compromised approach using prospective data as well as weaker retrospective data assuming that disease onset was likely before the births. Our results, within the limitations of this approach, indicate no evidence that AgP in the mother predisposes low birth weights. AgP has many unique biologic characteristics that differentiate it from chronic forms of periodontal disease, and the possible lack of its association with birth weight may be another such characteristic.

Objective: To explore the correlation of student and faculty assessments of, second-year dental students' (D2s) communicative skills during simulated patient interviews., Methods: Eighty-two D2s, 14 student instructors and 8 faculty used a 5-point scale, (1=poor-5=excellent) to assess 12 specific communicative skills of D2s generating assessment sources of self, peer-group, student instructor, and faculty. Mean scores and comparisons between assessment sources were calculated. Spearman correlations evaluated relationships between specific skills and assessment sources., Results: Mean assessment score and standard error for peer-group (4.14 ± 0.04), was higher than self (3.86 ± 0.06, p<0.05) yet slightly higher than student instructor (4.07 ± 0.04) and faculty (3.93±0.10). Regarding assessment sources, the degree of correlation from highest to lowest was peer-group and student instructor (ρ=0.46, p<0.0001), self and student instructor (ρ=0.35, p<0.002), self and peer-group (ρ=0.28, p<0.02). The correlations between student instructor and faculty, faculty and self, and faculty and peer-group were nonsignificant., Conclusion: Student assessments were different from faculty by mean score and correlation index. Future studies are needed to determine the nature of the differences found between student and faculty assessments., Practice Implications: Peer, student instructor and faculty assessments of dental students' communicative skills are not necessarily interchangeable but may offer uniquely different and valuable feedback to students., (Published by Elsevier Ireland Ltd.)

Objective: To determine the prevalence of white spot lesions (WSLs) in orthodontic patients at 6 and 12 months into treatment using the visual examination method., Materials and Methods: Patients 6 and 12 months into treatment were examined for the presence of WSLs. The control group consisted of patients who were examined for WSLs immediately after bonding. Upon clinical evaluation, teeth were given a visual score based on the extent of demineralization., Results: The percentages of individuals having at least one WSL were 38%, 46%, and 11% for the 6-month, 12-month, and control groups, respectively. The 6-month (P  =  .021) and 12-month groups (P  =  .005) were significantly different from the control group but were not significantly different from each other (P  =  .50). Of subjects in the study who had at least one visible WSL, 76% were males and 24% were females (P  =  .009)., Conclusions: This clinical study showed a sharp increase in the number of WSLs during the first 6 months of treatment that continued to rise at a slower rate to 12 months. Clinicians should evaluate the oral hygiene status of patients during the initial months of treatment and, if necessary, should implement extra measures to prevent demineralization.

Purpose: There is still considerable controversy regarding whether hyperbaric oxygen (HBO) therapy used preoperatively and postoperatively will prevent osteoradionecrosis in previously irradiated patients undergoing tooth extraction. The purpose of this systematic review was to evaluate the best evidence available in an attempt to find an answer to this question., Materials and Methods: The literature search on Medline covered the period from January 1948 to March 2008. Included were randomized clinical trials, prospective studies without randomization, case-control studies, retrospective studies, and observational studies with and without control groups. This search retrieved 696 citations, which was reduced to 14 acceptable publications based on an assessment of methodologic quality. They included 1 randomized clinical trial, 8 cohort-controlled studies, and 5 observational studies. These were analyzed for radiation dose, type of radiation, use of adjunctive cancer treatments, number and location of extractions, method of extraction, HBO protocol, and use of adjunctive therapy besides HBO., Results: Most of the studies had a small sample size, lacked specific inclusion and exclusion criteria, did not report the interval between radiation and extraction, and provided limited information on the method of extraction. There was also variation in HBO protocols, radiation dosage, the use of antibiotics, and the use of adjunctive cancer therapy., Conclusion: On the basis of the best available evidence, there is currently insufficient information to show that the use of HBO reduces the incidence of osteoradionecrosis in irradiated patients requiring tooth extraction., (Copyright © 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: Although it is generally advised to provide patients with as much information as possible during the informed consent process, little is known about the amount and type of information that patients actually desire. The purpose of this study was to address this question., Patients and Methods: We gave 212 patients (93 men and 119 women) presenting to an emergency clinic for oral surgery, ranging in age from 18 years to more than 50 years, a questionnaire containing 12 questions at their initial visit that asked them how much information they would like about the general and specific risks associated with the procedure. They were also asked when they would like to receive that information and whether they would like it in written form., Results: Of the patients, 57% wanted to know about all complications, 33% wanted to know only about the most common complications, and 10% did not want to know anything about possible complications. The desire to know about complications increased along with their suggested frequency. Seventy-eight percent said they would like written as well as verbal information, and most wanted it provided before scheduling their operation and again just before undergoing it. The only difference between the responses from men and women was that significantly more men wanted to know about the risk of surgery not improving their symptoms and the risk of nerve damage. There was no relationship between the age of the patient and the responses given., Conclusion: A thorough informed consent process generally provides more information than most patients desire., (Copyright 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: The goal of this study is to determine whether HIV infection or high-risk behaviors associated with HIV infection are related to alveolar bone loss in a sample of subjects screened at a dental school clinic., Methods: Subjects were included in this study (N = 355) if they were HIV positive or had high-risk behaviors associated with HIV infection as identified by health risk behavior screening questionnaire. Bone loss measurements were obtained from radiographs. Both bivariate relationships and multivariate relationships between alveolar bone loss and three sets of variables were evaluated: high-risk behavior questions, demographic variables, and HIV infection., Results: The following variables were found related to alveolar bone loss in bivariate relationships: age (P < or = 0.0001); smoking (pack-years) (P < or = 0.0001); race (P < or = 0.002); gender (P < or = 0.032); male-male sex (P <0.001); diabetes (P < or = 0.015); sharing of needles (P < or = 0.02); and hepatitis C positive (P < or = 0.05). In the multiple regression model, age, smoking, race, gender, and male-male sex remained significant. In both analyses, HIV-positive individuals had similar bone loss compared to those who were HIV negative., Conclusions: These results suggest that HIV infection is not related to alveolar bone loss in individuals with high-risk behaviors for HIV infection. These results also suggest that previously reported relationships between HIV infection and increased alveolar bone loss may be explained by other factors, such as smoking. Individuals in this study population with risk behaviors associated with HIV infection smoked at a high rate and, because of the smoking behavior, have a high rate of periodontal disease.

Objective: The goal of this report is to present the current state of the evidence evaluating the efficacy of anti-plaque, anti-gingivitis mouthrinses and to determine the clinical relevance of the evidence., Material and Methods: To accomplish this goal a two stage approach was used. First a systematic review of the literature was done to find any systematic review that evaluated the efficacy of anti-plaque, anti-gingivitis mouthrinses from long term (six months) randomized placebo controlled clinical trials. Secondly, the clinical relevance was determined by comparing the percent reduction in plaque and gingivitis attributable to the anti-plaque, anti-gingivitis mouthrinses to change over time in the placebo groups attributable to adult prophylaxis and oral hygiene instructions., Results: Three systematic reviews and one meta-analysis were found that evaluated the efficacy of anti-plaque, anti-gingivitis mouthrinses. The systematic reviews concluded that there is strong evidence supporting the efficacy of chlorhexidine and essential oils as anti-plaque, anti-gingivitis mouthrinses. The evidence for cetyl pyridinium chloride (CPC) was weaker due to few clinical trials testing the same formulations of CPC. There was one meta-analysis of studies from a manufacture of Delmopinol, but it was not a systematic review of the literature. The report based on the meta-analysis concluded that Delmopinol was an effective anti-plaque, anti-gingivitis agent. Evaluation of clinical relevance by estimating percent reduction due to the active agents and changes over time in the placebo groups, demonstrated that the clinical effect of both chlorhexidine and essential oil containing mouthrinses met or exceeded reductions over time for placebo groups. Again the results for CPC were less consistent, but were similar to reductions over time in the placebo groups., Conclusions: These results suggest that the clinical benefits of anti-plaque, anti-gingivitis mouthrinses are similar to the benefits of oral prophylaxis and oral hygiene instructions at six month recall appointments., (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)

Objective: Dietary caloric restriction (CR) has been found to reduce systemic markers of inflammation and may attenuate the effects of chronic inflammatory conditions. The purpose of this study was to examine the effects of long-term CR on naturally occurring chronic inflammatory periodontal disease in a nonhuman primate model., Methods: The effects of long-term CR on extent and severity of naturally occurring chronic periodontal disease, local inflammatory and immune responses, and periodontal microbiology, were evaluated in a cohort of 81 (35 female and 46 male; 13-40 y of age) rhesus monkeys (Macaca mulatta) with no previous exposure to routine oral hygiene. CR monkeys had been subjected to 30% CR for 13-17 y relative to control-fed (CON) animals starting at 3-5 y of age., Results: Same sex CR and CON monkeys exhibited similar levels of plaque, calculus, and bleeding on probing. Among CON animals, males showed significantly greater periodontal breakdown, as reflected by higher mean clinical attachment level and periodontal probing depth scores, than females. CR males exhibited significantly less periodontal pocketing, lower IgG antibody response, and lower IL-8 and ss-glucuronidase levels compared to CON males, whereas CR females showed a lower IgG antibody response but comparable clinical parameters and inflammatory marker levels relative to CON females. Long-term CR had no demonstrable effect on the periodontal microbiota., Conclusion: Males demonstrated greater risk for naturally occurring periodontal disease than females. Long-term CR may differentially reduce the production of local inflammatory mediators and risk for inflammatory periodontal disease among males but not females.

Background and Objective: Dietary manipulation, including caloric restriction, has been shown to impact host response capabilities significantly, particularly in association with aging. This investigation compared systemic inflammatory and immune-response molecules in rhesus monkeys (Macaca mulatta)., Material and Methods: Monkeys on continuous long-term calorie-restricted diets and a matched group of animals on a control ad libitum diet, were examined for systemic response profiles including the effects of both gender and aging., Results: The results demonstrated that haptoglobin and alpha1-antiglycoprotein levels were elevated in the serum of male monkeys. Serum IgG responses to Campylobacter rectus, Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis were significantly elevated in female monkeys. While only the antibody to Fusobacterium nucleatum was significantly affected by the calorie-restricted diet in female monkeys, antibody levels to Prevotella intermedia, C. rectus and Treponema denticola demonstrated a similar trend., Conclusion: In this investigation, only certain serum antibody levels were influenced by the age of male animals, which was seemingly related to increasing clinical disease in this gender. More generally, analytes were modulated by gender and/or diet in this oral model system of mucosal microbial challenge.

Background: Low-calorie diets are commonplace for reducing body weight. However, no information is available on the effects of a reduced-calorie diet on periodontal inflammation and disease. The purpose of this study was to evaluate the clinical effects of a long-term calorie-restriction (CR) diet on periodontitis in an animal model of periodontitis., Methods: Periodontitis was induced in 55 young, healthy, adult rhesus monkeys (Macaca mulatta) by tying 2.0 silk ligatures at the gingival margins of maxillary premolar/molar teeth. Animals on a CR diet (30% CR; N = 23) were compared to ad libitum diet controls (N = 32). Clinical measures, including the plaque index (PI), probing depth (PD), clinical attachment level (CAL), modified gingival index (GI), and bleeding on probing (BOP) were recorded at baseline and 1, 2, and 3 months after ligature placement., Results: Significant effects of CR were observed on the development of inflammation and the progression of periodontal destruction in this model. Compared to controls, CR resulted in a significant reduction in ligature-induced GI (P <0.0001), BOP (P <0.0015), PD (P <0.0016), and CAL (P <0.0038). Periodontal destruction, as measured by CAL, progressed significantly more slowly in the CR animals than in the controls (P <0.001)., Conclusions: These clinical findings are consistent with available evidence that CR has anti-inflammatory effects. Moreover, these experimental findings are the first observations, to the best of our knowledge, that CR dampens the inflammatory response and reduces active periodontal breakdown associated with an acute microbial challenge.

Background: During the last 15 years, a substantial number of population-based, clinical, laboratory, and animal studies have been published that reported findings on the relationship between periodontal disease and cardiovascular disease. The Periodontitis and Vascular Events (PAVE) pilot study was conducted to investigate the feasibility of a randomized secondary prevention trial to test whether treatment of periodontal disease reduces the risk for cardiovascular disease. This article describes the occurrence of adverse events during the pilot study., Methods: The PAVE pilot study was a multicenter, randomized trial comparing periodontal therapy to community dental care. Baseline and follow-up clinic visits included a periodontal examination; blood, subgingival plaque, and crevicular fluid specimen collection; and medical and dental histories. Telephone follow-up contacts were scheduled to occur 3 months after randomization and every 6 months thereafter to assess adverse events or endpoints., Results: Cardiovascular adverse events occurred with similar frequency (23 versus 24 [P = 0.85] in the community control and the treatment groups, respectively). There were 15 serious adverse events (SAEs) with a non-significantly higher percentage occurring in the community care group (6.6% versus 3.3%; P = 0.19). A time-to-event analysis of patterns of SAEs indicated that subjects in the periodontal therapy group tended to be less likely to experience an SAE over the entire 25 months of the study., Conclusion: For those individuals who remained in the study, it appears that provision of periodontal scaling and root planing treatment to individuals with heart disease resulted in a similar pattern of adverse events as seen in the community care group, which also received some treatment.

Background: Smoking increases the risk for periodontal disease and reduces the healing response. We examined the antimicrobial and clinical effects of scaling and root planing (SRP) with and without minocycline HCl 1 mg microspheres (MM) relative to smoking status in subjects with periodontitis., Methods: A total of 127 subjects (46 never smokers, 44 former smokers, and 37 current smokers) with moderate to advanced periodontitis were randomized to receive MM + SRP (N = 62) or SRP alone (N = 65). Subgingival plaque samples collected at baseline and day 30 were examined for the presence of 40 periodontal bacteria by DNA probe analysis., Results: MM + SRP reduced red-complex bacteria (RCB) numbers and proportions to a greater extent than SRP alone, irrespective of smoking status. RCB numbers were not reduced by SRP in current smokers. The difference in the reduction in numbers of RCB by SRP relative to MM + SRP in current smokers was statistically significant (P <0.05). Numbers and proportions of orange complex bacteria (OCB) were reduced in all groups treated with MM + SRP. Proportions of OCB increased in current smokers treated with SRP alone. In current smokers, MM + SRP significantly reduced probing depth (PD), increased clinical attachment level (CAL), and reduced bleeding on probing (BOP) to a greater extent than SRP alone (P <0.05)., Conclusions: SRP alone was ineffective at reducing numbers or proportions of RCB or OCB in current smokers, whereas MM + SRP significantly reduced both. MM + SRP also improved PD, BOP, and CAL to a greater extent than SRP alone independent of smoking status.

Background: The objective of this trial was to measure the antimicrobial effects of a minocycline HCl microsphere (MM) local drug-delivery system when used as an adjunct to scaling and root planing (SRP). DNA probe analysis for 40 bacteria was used to evaluate the oral bacteria of 127 subjects with moderate to advanced chronic periodontitis., Methods: Subjects were randomly assigned to either SRP alone (N = 65) or MM + SRP (N = 62). The primary endpoints of this study were changes in numbers and proportions of the red-complex bacteria (RCB) and the sum of Porphyromonas gingivalis, Tannerella forsythia (formally T. forsythensis), and Treponema denticola relative to 40 oral bacteria at each test site from baseline to day 30. Numbers of RCB from the five test sites were averaged to provide a value for each subject., Results: MM + SRP reduced the proportion of RCB by 6.49% and the numbers by 9.4 x 10(5). The reduction in RCB proportions and numbers by SRP alone (5.03% and 5.1 x 10(5), respectively) was significantly less. In addition, MM + SRP reduced probing depth by 1.38 mm (compared to 1.01 mm by SRP alone), bleeding on probing was reduced by 25.2% (compared to 13.8% by SRP alone), and a clinical attachment level gain of 1.16 mm (compared to 0.80 mm by SRP alone) was achieved., Conclusion: These observations support the hypothesis that RCBs are responsible for periodontal disease and that local antimicrobial therapy using MM + SRP effectively reduces numbers of RCBs and their proportions to a greater extent than SRP alone.

Background and Methods: The author conducted a systematic review of the literature to evaluate the efficacy of antigingivitis and antiplaque products in six-month trials. He searched electronic databases for six-month randomized clinical studies that evaluated both antiplaque and antigingivitis properties of dentifrices or mouthrinses. In addition, the author solicited unpublished studies from manufacturers., Results: Seventeen studies support the antiplaque, antigingivitis effects of dentifrices containing 0.30 percent triclosan, 2.0 percent Gantrez copolymer. There was no evidence of efficacy for triclosan products containing either soluble pyrophosphate or zinc citrate. Dentifrices with stannous fluoride had statistically significant, but marginally clinically significant, evidence of an antiplaque effect; however, there was both a statistically and clinically significant antigingivitis effect. The largest body of studies (21 studies) supported the efficacy of mouthrinses with essential oils. A smaller body of studies (seven) supported a strong antiplaque, antigingivitis effect of mouthrinses with 0.12 percent chlorhexidine. Results for mouthrinses with cetylpyridinium chloride varied and depended on the product's formula., Conclusions: The studies in this systematic review provide strong evidence of the antiplaque, antigingivitis effects of multiple agents. These results support the use of these agents as part of a typical oral hygiene regimen.

Scaling and root planing is a common procedure in clinical practice. Despite the frequency of the procedure, the control of pain associated with scaling and root planing has not been well studied. Recently, studies have pointed out a need for pain control during the procedure in a significant number of subjects-perhaps as many as 30% of patients. This need for pain control is similar to the need for instrumentation during maintenance therapy. The need also is similar whether hand instrumentation or ultrasonic equipment is used. The current most used form of pain control is local anesthesia injections. However, many patients object to the use of "the needle." Therefore, there is a need for a noninjectable form of pain control that is effective.

Background: Licensure examinations in dentistry have become an increasing concern, owing to ethical issues in the use of patients, difficulties in seeing relationships between outcomes of licensure examinations and performance in educational programs, and questions on the reliability of "one-shot" clinical examinations. Using data from a nine-year period, the authors compared the results of clinical licensing tests and the academic class ranks of the candidates., Methods: The authors studied data for 835 dental school graduates of one school from 1994 through 2002. They compared the dental graduates' results from the North East Regional Board, or NERB, of Dental Examiners examinations with their class ranks. The authors used analysis of variance to analyze the differences among passing, failing and "no data" groups, kappa statistic and logistic regression for variation, and receiver operating characteristic, or ROC, curves for diagnostic utility., Results: The class rank of graduates who passed and failed NERB's restorative section of the examination did not differ. Differences for other sections of the examination were statistically significant but small. The variation in restorative and manikin exercises over time was highly significant. No consistency existed between these tests, and their ROC curves indicated no utility for diagnosing class rank., Conclusions: The authors' analysis of nine years' data called into question the reliability and validity of initial licensure examinations based on certain of the one-time tests used by NERB. Future study should determine if the results generalize to other schools and clinical testing agencies., Practice Implications: If the results of this study can be generalized to all U.S. licensure examinations, basing licensing decisions on clinical licensure examination alone risks licensure decisions of low validity. Use of patients in examinations of questionable validity may be unethical because they may have been subjected to risk of irreversible damage without contribution to a valid decision-making process by the licensing authority.

The purpose of this study was to compare students' in-school academic performance with their scores on the North East Regional Board (NERB) of Dental Examiners' Dental Simulated Clinical Examination (DSCE; written) and the written examination given by the National Board of Dental Examiners, Part II (NBDE Part II). A second purpose was to evaluate whether requiring the DSCE in addition to the NBDE II is of benefit in assessing the qualifications of candidates for licensure. Results on the first attempt at passing the two examinations were compared for 836 graduates (1994-2002) of one dental school. Mean scores on the examinations and mean grade point average (GPA) of those who passed the two examinations did not differ. Mean GPAs of those who failed the two examinations also were not significantly different. Scores on the two exams and GPA significantly correlated with each other. Correlation coefficients were higher between GPA and scores on the NBDE II than between GPA and scores on the DSCE. The failure rates on first attempts were 6 percent on the DSCE and 7 percent on the NBDE II. The results of this study suggest that the DSCE does not materially assist in the licensure decision for candidates who passed the NBDE Part II, as the results on the two exams are very similar.