Search

Aim The aim of this systematic review was to evaluate the efficacy of anti-plaque chemical formulations for managing gingivitis, in 6-month, home-use, randomised clinical trials ( RCTs). Material and Methods A protocol was designed, including inclusion and exclusion criteria to identify RCTs assessing gingival and/or bleeding indices. Electronic and hand-searches identified relevant papers, which were screened and evaluated for inclusion. Full-papers were retrieved and relevant information was extracted (also plaque indices), including quality and risk of bias. Mean treatment effects were calculated to obtain weighted mean differences ( WMD) and 95% confidence intervals. Results After the process of screening and selection, 87 articles with 133 comparisons, were included in the review. The additional effects of the tested products were statistically significant in terms of Löe & Silness gingival index (46 comparisons, WMD −0.217), modified gingival index ( n = 23, −0.415), gingivitis severity index ( n = 26, −14.939%) or bleeding index ( n = 23, −7.626%), with significant heterogeneity. For plaque, additional effects were found for Turesky (66 studies, WMD −0.475), Silness & Löe ( n = 26, −0.109), and plaque severity ( n = 12, −23.4%) indices, with significant heterogeneity. Conclusion Within the limitations of the present study, formulations with specific agents for chemical plaque control provide statistically significant improvements in terms of gingival, bleeding and plaque indices. [ABSTRACT FROM AUTHOR]

Aim To report the evidence on the effect of mechanical and/or chemical plaque control in the simultaneous management of gingivitis and caries. Material and Methods A protocol was designed to identify randomized ( RCTs) and controlled ( CCTs) clinical trials, cohort studies and prospective case series ( PCS), with at least 6 months of follow-up, reporting on plaque, gingivitis and caries. Relevant information was extracted from full papers, including quality and risk of bias. Meta-analyses were performed whenever possible. Results After the screening of 1,373 titles, 15 RCTs, 10 CCTs and 2 PCS were included. Low to moderate evidence support that combined professional and self-performed mechanical plaque control significantly reduces standardized plaque index [ n = 4; weighted mean difference ( WMD) = 1.294; 95% CI (0.445; 2.144); p = 0.003] and gingivitis scores [ n = 4; WMD = 1.728; 95% CI (0.631; 2.825); p = 0.002]. The addition of fluoride to mechanical plaque control is relevant for caries management [ n = 5; WMD = 1.159; 95% CI (0.145; 2.172); p = 0.025] while chlorhexidine rinses are relevant for gingivitis. Conclusion Mechanical plaque control procedures are effective in reducing plaque and gingivitis. The addition of fluoride to mechanical plaque control is significant for caries management. Chlorhexidine rinse has a positive effect on gingivitis and inconclusive role in caries. [ABSTRACT FROM AUTHOR]

Aims To compare gingival crevicular fluid ( GCF) cytokines/chemokines levels between periodontally healthy subjects and subjects diagnosed with chronic periodontitis ( Ch P), before and after non-surgical periodontal treatment, and to establish their predictive value for periodontal disease progression. Methods Studies indexed in MEDLINE and EMBASE published in English, Portuguese and Spanish were eligible for this review. Database searches up to December 2015, and manual search of the reference list from reviews and selected articles was performed. Only studies providing data on GCF cytokines/chemokines levels in subjects diagnosed with Ch P and periodontally healthy controls were included. Cross-sectional, case series, single-arm clinical studies, randomized controlled trials and prospective/retrospective cohort studies were included. Meta-analyses were conducted for those cytokines/chemokines with at least three available studies. Results GCF levels of IL-1 β, IL-6, IFN- γ and MCP-1/ CCL2 were significantly higher in subjects diagnosed with Ch P than periodontally healthy subjects. A significant decrease in GCF levels of IL-1 β and IL-17 was observed after non-surgical periodontal treatment, whereas a significant increase was observed for IL-4. Conclusion Evidence for significant differences between periodontal health and Ch P was observed for a few cytokines and one chemokine. No conclusions could be drawn with regards to increased risk of disease progression. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim: To answer the following PICO question: In systemically healthy humans with peri‐implant mucositis, what is the efficacy of patient‐performed or administered (by prescription) measures used adjunctively to submarginal instrumentation, as compared to submarginal instrumentation alone or combined with a negative control, in terms of reducing bleeding on probing (BOP), in randomized controlled clinical trials (RCTs) with at least 3 months of follow‐up? Materials and Methods: Three databases were searched until April 2022. Weighted mean differences (WMDs) with 95% confidence intervals (CIs) and predictive intervals were calculated. Results: Sixteen parallel RCTs corresponding to 14 studies with low/moderate risk of bias were included. Test groups showed greater reductions in BOP (%) than control groups (nstudies = 16; npatients = 650; WMD = 14.25%; 95% CI [9.06–19.45]; p <.001; I2 = 98.7%). The greatest WMD in BOP reductions (%) were obtained by antiseptics (ns = 5; np = 229; WMD = 22.72%; 95% CI [19.40–26.04]; p < 0.001; I2 = 94.8%), followed by probiotics (ns = 6; np = 260; WMD = 12.11%; 95% CI [3.20–21.03]; p =.008; I2 = 93.3%) and systemic antibiotics (ns = 3; np = 101; WMD = 5.97%; 95% CI [1.34–10.59]; p =.012; I2 = 58.1%). Disease resolution was scarcely reported (n = 6). Conclusions: Significant clinical improvements can be obtained when professional submarginal instrumentation is combined with patient‐performed or administered (by prescription) adjunctive measures, although a complete disease resolution may not be achieved. [ABSTRACT FROM AUTHOR]

Aim A systematic review/meta-analysis was performed to evaluate pain during probing, scaling and root planing using intra-pocket anaesthesia versus placebo in adult patients. Methods A search was performed in PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database, Brazilian Library in Dentistry, Cochrane Library and Grey literature. IADR abstracts, unpublished trials registries, dissertations and theses were also searched for randomized clinical trials comparing the clinical effectiveness of intra-pocket anaesthesia and placebo. Risk/intensity of pain was the primary outcome. The risk of bias tool from the Cochrane Collaboration was used for quality assessment. Meta-analysis was performed on studies considered at low risk of bias. Results A total of 1740 articles were identified. Eleven remained in the qualitative synthesis, and nine studies were considered at 'low' risk of bias for meta-analysis. Standardized Hedge's g mean difference for pain intensity using visual analogue scale and Heft-Parker pain scales was −0.576 (95% confidence interval [ CI] −0.94 to −0.22; p = 0.002) and for verbal rating scale pain scale it was −1.814 (95% CI −3.38 to −0.245; p = 0.023). The odds ratio for the risk of pain was 0.025 (95% CI 0.003 to 0.25; p = 0.002) and the odds ratio for the need for rescue anaesthesia it was 0.358 (95% CI 0.174 to 0.736; p = 0.005). Conclusions The anaesthetic gel decreases the risk and intensity of pain during probing/ SRP. [ABSTRACT FROM AUTHOR]

Focused Question In patients with peri-implant mucositis, what is the efficacy of professionally administered plaque removal ( PAPR) with adjunctive measures on changing signs of inflammation compared with PARP alone? Materials and Methods After electronic database and hand search, 19 full-text articles were independently screened by two reviewers. Finally, a total of seven studies fulfilled the inclusion criteria. The weighted mean difference ( WMD) in bleeding on probing- ( BOP) (primary outcome), gingival index- ( GI) and probing pocket depth- ( PD) reductions was estimated (random effect model). Results WMD in BOP reduction between test and control groups amounted to −8.16% [ SD = 4.61; p = 0.07; 95% CI (−17.20, 0.88)] not favouring adjunctive antiseptic or antibiotic (local, systemic) therapy over PAPR alone. WMD in GI and PD reductions amounted to −0.12 [ SD = 0.13; p = 0.34; 95% CI (−0.38, 0.13)] and −0.056 mm [ SD = 0.10; p = 0.60; 95% CI (−0.27, 0.16)] not favouring adjunctive (antiseptics, systemic antibiotics, air abrasive device) over control measures respectively. Most studies evaluated reported on residual BOP and GI scores after therapy. Conclusions Adjunctive therapy may not improve the efficacy of PAPR in reducing BOP, GI and PD scores at mucositis sites. Despite clinically important improvements, a complete disease resolution may not be expected by any of the treatment protocols investigated. [ABSTRACT FROM AUTHOR]

Aim The objective of this study was to investigate whether the response to periodontal treatment differs among obese, overweight or normal-weight patients. Materials & Methods Both randomized and non-randomized studies were identified from searches up to July 2013. Risk of bias was assessed with the Downs-Black checklist, the Cochrane tool and the GRADE framework. Quantitative synthesis was conducted with random-effects meta-analyses in subgroups for systemically healthy and diabetic patients. Results A total of 15 studies including 867 patients were included. No significant difference was found for any clinical periodontal parameter between overweight/obese and normal-weight patients. Periodontal treatment in systemically healthy overweight/obese patients was associated with higher decrease in TNFα levels (1 study) and higher decrease in HbA1c levels (1 study) compared to systemically healthy normal-weight patients. Contrary to diabetic normal-weight patients, periodontal treatment in diabetic overweight/obese patients was associated with an increase in adiponectin levels (2 studies) and a decrease in leptin levels (2 studies). However, the quality of existing evidence is low due to inconsistency, imprecision and lack of studies. Conclusions Whereas no difference was found in clinical periodontal parameters, significant differences in inflammatory or metabolic parameters were found between overweight/obese and normal-weight patients, but existing evidence is weak. [ABSTRACT FROM AUTHOR]

Objectives To systematically review the performance of access flap ( OFD) in the treatment of class II furcation defects ( FD). Methods RCTs evaluating surgical treatment of class II FD with OFD, minimum 6 months follow-up were identified. Screening, data extraction, and quality assessment were conducted independently by three reviewers. The primary outcomes were tooth survival and change in the horizontal clinical attachment level ( HCAL). Changes in vertical clinical attachment level ( VCAL), reduction of pocket probing depth ( PPD), recession increase ( REC), horizontal ( HBL), and vertical bone level ( VBL) were also collected. Results The search identified 1571 studies out of which 11 articles met the inclusion criteria. Data analysis was performed on 199 patients and 251 FD. Tooth survival was seldom reported. Altogether with inflammatory amelioration, the weighted mean differences were for HCAL 0.96 mm [ CI: (0.60, 1.32), p < 0.001], 0.55 mm [ CI: (0.00, 1.10), p = 0.05] for VCAL gain. PPD reduction over 6 months was 1.38 mm [ CI: (0.91, 1.85), p < 0.01]. Potential risk of bias was identified. Conclusions Teeth with mandibular class II furcation involvement treated with OFD show significant clinical improvements 6 months after surgery. Nevertheless, in order to better understand the magnitude of these changes and their clinical relevance, prospective long-term trials are needed. [ABSTRACT FROM AUTHOR]

Aim To perform a systematic review to evaluate the erbium-doped: yttrium, aluminium and garnet (Er: YAG) laser versus scaling and root planing ( SRP) as alternative or adjuvant for chronic periodontitis treatment. Material and Methods We performed a literature search using six electronic databases and completed by manual searches up to July 2013. We conducted a meta-analysis as well as heterogeneity, sensitivity, subgroup and power analyses to clarify and validate the pooled results. The 3-, 6- and 12-month clinical outcomes were evaluated. Results Twelve eligible randomized clinical trials were finally included. Our meta-analysis showed that Er: YAG laser resulted in similar clinical improvements as SRP 3 months postoperatively. For subgroups by laser level, quality of trials and fluorescence feedback device, the results remained consistent. The 6- and 12-month observations between Er:YaG laser and SRP demonstrated no difference but inconclusive, due to large heterogeneity. The advantage of Er: YAG laser adjuvant to SRP for periodontitis treatment was not significant. Conclusions This systematic review indicated that the clinical efficacy of Er: YAG laser was similar to SRP 3 months postoperatively. The clinical benefits of Er: YAG laser as adjuvant to SRP was still lacking. Since Er: YAG laser has certain advantages, it could be expected to be a novel short-term alternative choice for chronic periodontitis. [ABSTRACT FROM AUTHOR]

Objective To review the effectiveness of enamel matrix derivative ( EMD) in the treatment of periodontal pockets of suprabony defects. Methods Randomized Clinical Trials comparing open flap debridement (OFD) versus EMD in periodontal suprabony defects were identified through electronic and manual search. Screening, data extraction and quality assessment were conducted. The primary outcome measures were tooth survival (TS) and clinical attachment level ( CAL) gain. Pocket probing depth ( PPD) reduction and recession ( REC) increase were secondary outcome measures. Information concerning clinical and radiological bone gain was also collected. Results The search identified 1170 studies, three articles reporting on (99 subjects/358 teeth) met the inclusion criteria and were included. No tooth was lost during follow-up (8-12 months). The adjunctive mean benefit of EMD was: 1.2 mm for CAL gain [confidence interval (CI): (0.9, 1.4), p < 0.00001, I2 = 66%], 1.2 mm for the PPD reduction ( CI: [0.8, 1.5], p < 0.0001, I2 = 0%), −0.5 mm for the REC increase ( CI: [−0.8, −0.2], p = 0.003, I2 = 0%). Potential risk of bias was identified. Conclusions No differences were noted in TS but EMD application resulted in clinical and radiographic additional benefits compared to OFD alone. Nevertheless, the paucity of data, the risk of methodological and potential publication bias suggests caution in interpreting these results while supporting multicenter studies for this specific application. [ABSTRACT FROM AUTHOR]

Aim To assess the failures and complications of short (<10 mm) implants supporting single crowns in the posterior region and its potential risk factors (RkF). Materials and Methods Prospective studies were screened according to eligibility criteria, followed by contact with authors. Quality assessment was performed using a standardized protocol. Mean implant failure proportion ( FP), biological and prosthetic failure proportions ( BFP/ PFP) and marginal bone loss ( MBL) including 95% confidence intervals were estimated using random-effects models for meta-analysis. Results Sixteen studies with a medium methodological quality (mean score: 8 ± 3; 2-14) had data collected. In summary, 762 short implants were followed up for up to 120 months in 360 patients (mean follow-up: 44 ± 33.72 months; mean dropout rate: 5.1%). The means FP, BFP, PFP and MBL were 5.9% (95% CI: 3.7-9.2%), 3.8% (95% CI: 1.9-7.4%), 2.8% (95% CI: 1.4-5.7%) and 0.83 mm (95% CI: 0.54-1.12 mm) respectively. Quantitative analysis showed that placement in the mandible ( p = 0.0002) and implants with length ≤8 mm ( p = 0.01) increased FP, BFP and MBL, whereas qualitative assessment revealed that crown-to-implant ratio did not influence MBL. Conclusions Single crowns supported by short implants in the posterior region are a predictable treatment option with reduced failure rates, biological/prosthetic complications and minimal bone loss. [ABSTRACT FROM AUTHOR]

Aim Matrix metalloproteinase-1 promoter -1607 1G/2G (rs1799750) polymorphism have been shown to confer genetic susceptibility to chronic periodontitis ( CP), but the results are inconsistent. Materials and Methods A meta-analysis and systematic review was performed to accomplish a more precise estimation of the relationship. Results Pooled estimates revealed that there was no significant association between this polymorphism and CP risk in Caucasian and Asian populations. In addition, it was reported by three Brazilian studies that no significant association was found for this polymorphism with CP risk in a Brazilian mixed population. Besides, there was no significant association of this polymorphism with mild to moderate and severe CP risk in both Caucasian and Asian populations. Moreover, both non-smokers and smokers did not have a significant association between this polymorphism and susceptibility to CP in Caucasian population. Conclusions Matrix metalloproteinase-1 promoter −1607 1G/2G (rs1799750) polymorphism may have no effect on the disease susceptibility of CP in Caucasian, Asian and Brazilian mixed populations. Besides, this polymorphism may not play a direct role in severity of CP among both Caucasian and Asian populations, and between this polymorphism and smoking there may be no interactions to be associated with CP risk in Caucasian population. [ABSTRACT FROM AUTHOR]

Aim To conduct an individual patient data ( IPD) meta-analysis to assess the effect of smoking cessation ( SC) on clinical outcomes following the non-surgical periodontal treatment in patients with chronic periodontitis. Methods MEDLINE, EMBASE and CENTRAL were searched up to, and including, August 2012. Prospective cohort studies of at least 6 months' duration were included if the participants met the following criteria: (1) smokers who had expressed an interest in quitting the habit; and (2) a diagnosis of periodontitis. Search was conducted by two independent reviewers. IPD meta-analyses were undertaken using multiple linear or Poisson regression to evaluate the impact of SC on five different dependent variables. Results Of 2455 potentially eligible articles, two studies were included. The two studies found that SC seems to promote additional beneficial effects in reducing probing depths ( PD) and improving attachment level following non-surgical periodontal treatment. The IPD approach allowed data combination but it might not have usefully added strength to the data in this review. Conclusion SC seems to be an important component of periodontal therapy, and smokers should be encouraged to quit as part of their overall periodontal management; however, only a limited base of evidence was available for analysis. [ABSTRACT FROM AUTHOR]

Objectives The objective of this study was to systematically review the epidemiological evidence for an association between periodontitis ( PD) and incident atherosclerotic cardiovascular disease ( ACVD), including coronary heart disease (CHD), cerebrovascular disease and peripheral arterial disease. Methods Systematic review of cohort and case-control studies on the association of clinically or radiographically diagnosed PD and ACVD. Results Overall, 12 studies were included in this study (six studies on CHD, three studies on cerebrovascular disease, two studies on both coronary heart and cerebrovascular disease mortality and one study on peripheral arterial disease). All but one study reported positive associations between various periodontal disease measures and the incidence of ACVD, at least in specific subgroups. The association was stronger in younger adults and there was no evidence for an association between PD and incident CHD in subjects older than 65 years. Only one study evaluated the association between PD and secondary cardiovascular events. Conclusions There is evidence for an increased risk of ACVD in patients with PD compared to patients without. However, this may not apply to all groups of the population. There is insufficient evidence for an association between PD and the incidence of secondary cardiovascular events. [ABSTRACT FROM AUTHOR]