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Aim: The aim of this review is to assess study design and risk of bias related to primary outcome in recently published randomized controlled trials (RCTs) in periodontology. Method: An electronic (Medline, EMBASE and Cochrane library) and a manual search were completed to detect RCTs in humans, with an outcome in the field of periodontology and published in English from January 2018 up to March 2020. Results: Data extraction of 318 publications meeting the inclusion criteria was performed by two reviewers. Most studies adopted a parallel‐group superiority design in a university setting. Overall, 54% of papers reported the primary outcome and relative sample size calculation, while only 37% also included reproducibility estimates relative to the primary outcome. Papers published in journals with higher impact factors had better compliance with primary outcome reporting and lower overall risk of bias scores. Conclusion: Improvements in the quality of RCTs in periodontology are still needed. The importance of defining a clinically relevant study primary outcome and building the study around it needs to be emphasized. Furthermore, RCTs in periodontology could consider, when appropriate, some of the study design options which facilitate application of the principles of personalized medicine. [ABSTRACT FROM AUTHOR]

Background/Objective The objective of this study was to assess how authors of systematic reviews ( SRs) with meta-analyses published in periodontology and implant dentistry evaluate risk of bias ( ROB) in primary studies included in these reviews. Material/Methods A literature search for SRs with meta-analyses was performed in PubMed and Cochrane library databases up to July 20th 2014. The reference lists of included articles were screened for further reviews. The standards of evaluating ROB in primary studies were evaluated by using a 14-item checklist based on the Cochrane approach for evaluating ROB. Standards in ROB evaluations in Cochrane and paper-based SRs were compared using the Fisher's exact test. All searches, data extraction and evaluations were performed independently and in duplicate. Results Seventy SRs were included (45 paper-based and 25 Cochrane SRs, respectively). The median percentage of items addressed was 58% (interquartile range 4-100%). Cochrane SRs more frequently included ROB assessments than paper-based reviews in terms of examiner blinding ( p = 0.0026), selective outcome reporting ( p = 0.0207) and other bias ( p = 0.0241). Conclusions The ROB evaluation in primary studies currently included in SRs with meta-analyses in periodontology and implant dentistry is not sufficiently comprehensive. Cochrane SRs have more comprehensive ROB evaluation than paper-based reviews. [ABSTRACT FROM AUTHOR]

Aim: Selective outcome reporting (SOR) is a type of bias that occurs when the primary outcome of a trial protocol is changed or omitted in the paper. The purpose of this study was to evaluate the prevalence of SOR in publications of randomized clinical trials (RCT) concerning dental implants. Materials and Methods: Two reviewers independently screened protocols registered at ClinicalTrials.gov until February/2019. If the protocol met the eligibility criteria, the reviewers tried to identify the corresponding publication. Data extraction was carried out by the same reviewers. Primary and secondary outcomes were recorded for each trial and compared to outcomes previously described in protocols. Results: A total of 49 protocols were included. SOR was identified in 27 (55.1%) trials. The major discrepancies were as follows: protocol‐defined primary outcome omitted in the publication (n = 6, 12.2%), new primary outcome introduced (n = 8, 16.3%), discrepancy in the primary outcome time frame (n = 17, 34.7%) and new secondary outcome introduced (n = 31, 63.3%). SOR was significantly associated with industry funding (p = 0.04) and timing of registration (p = 0.04). Conclusions: Our results indicate a high rate of SOR in dental implants clinical trials. Use of registry data during the peer‐review process may help decreasing SOR. [ABSTRACT FROM AUTHOR]

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]

Objective: To assess methods, quality and outcomes of systematic reviews (SRs) conducted to evaluate the effectiveness of root coverage (RC) procedures in the treatment of recession-type defects (RTD). Methods: MEDLINE and EMBASE were searched up to and including April 2010 to identify SRs investigating the effectiveness/efficacy of surgical interventions for the treatment of patients with RTD. Searching was conducted independently by two reviewers, and data extraction was based on the methodological criteria applied and on the effects of interventions reported by each SR. The checklist proposed by Glenny and colleagues, the Overview Quality Assessment Questionnaire and the "Assessment of Multiple systematic Reviews", instrument were used to assess the quality of SRs. Additionally, the methodological criteria applied by included reviews were compared with those proposed by the Cochrane Collaboration. Results: Search strategy identified 716 potentially eligible articles, of which 12 papers regarding 10 SRs were included in the study. Results from different SRs showed that subepithelial connective tissue grafts associated or not to coronally advanced flaps can be used to reduce recession depth and improve the width of keratinized tissue. All quality assessment tools showed that most of the SRs were of good methodological quality, but they also highlighted key points that could be improved in future reviews. Only two SRs followed in full the guidelines proposed by the Cochrane Collaboration. Conclusions: All SRs agree that RC may be anticipated by different surgical procedures. However, differences in the methodological quality between reviews were quite evident, and thus making a clear indication that there is a need of standardization of the methods that will be applied by future SRs. As a result, a standardized checklist for reporting SRs was proposed by the authors. [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]

Aim The aim of this systematic review and network meta-analysis (NMA) was to compare the efficacy of different anti-plaque chemical agents, in 6-month, home-use, randomized clinical trials (RCTs), in terms of plaque index (PlI) changes. Material and Methods RCTs assessing PlI were identified, screened, and evaluated for inclusion. Relevant information was extracted, and quality and risk of bias were assessed. Mean differences between baseline-end were calculated to obtain weighted mean differences and 95% confidence intervals. NMA protocols were applied to assess direct and indirect comparisons among products using Turesky PlI. Results Eighty-three papers were included: 49 examined dentifrices, 32 mouthrinses and 2 both. The NMA analysed 51 studies including data from 4242 and 4180 subjects for dentifrices and mouthrinses respectively. For dentifrices, triclosan-copolymer and chlorhexidine showed the greatest effect, with significant differences when compared with stannous fluoride. For mouthrinses, essential oils and chlorhexidine showed the greatest effect, with significant differences when compared with delmopinol, alexidine and cetylpyridinium chloride. Conclusion Within the limitations of this study (including the severe imbalance in the amount of evidence), dentifrices containing triclosan-copolymer or chlorhexidine and mouthrinses containing essential oils or chlorhexidine showed the greatest effect on PlI scores as assessed with NMA. [ABSTRACT FROM AUTHOR]

Aims To update the existing scientific evidence on the efficacy of local antimicrobials as adjuncts to subgingival debridement in the treatment of chronic periodontitis. Material and Methods Fifty-six papers were selected, reporting data from 52 different investigations. All the studies reported changes in probing pocket depth ( PPD) and clinical attachment level ( CAL) and most in plaque index (PlI) and/or bleeding on probing ( BOP). Meta-analyses were performed with the data retrieved from the studies fulfilling the inclusion criteria. Results The overall effect of the subgingival application of antimicrobials was statistically significant ( p = 0.000) for both changes in PPD and CAL with a weighted mean difference ( WMD) of −0.407 and −0.310 mm respectively. No significant differences occurred for changes in BOP and PlI. Subgingival application of tetracycline fibres, sustained released doxycycline and minocycline demonstrated a significant benefit in PPD reduction ( WMD between 0.5 and 0.7 mm). The rest of the tested outcomes demonstrated a high heterogeneity. The local application of chlorhexidine and metronidazole showed a minimal effect when compared with placebo ( WMD between 0.1 and 0.4 mm). Conclusions The scientific evidence supports the adjunctive use of local antimicrobials to debridement in deep or recurrent periodontal sites, mostly when using vehicles with proven sustained release of the antimicrobial. [ABSTRACT FROM AUTHOR]

Aim To systematically evaluate the efficacy of chlorhexidine ( CHX) mouthrinses on plaque, gingival inflammation and staining in gingivitis patients. Material & Methods Medline, EMBASE and Cochrane Central Register of Controlled Trials were searched through April 2011. Randomized controlled clinical trials comparing CHX to placebo/control mouthrinses or oral hygiene ( OH) ≥4 weeks were included. Results Among 1355 titles, 30 publications fulfilled the selection criteria. Meta-analysis ( MA) showed significant weighted mean differences ( WMD) favouring CHX. This was −0.39 [95% CI: −0.70; −0.08] for the Plaque Index Silness & Löe, −0.67 [95% CI: −0.82; −0.52] for the Plaque-Index Quigley & Hein ( PIQH), −0.32 [95% CI: −0.42; −0.23] for the Gingival Index ( GI), −0.08 [95% CI: −0.10; −0.05] for the bleeding aspect of the GI, −0.21 [95% CI: −0.37; −0.04] for the Papillary BIeeding Index, −0.16 [95% CI: −0.26; −0.07] for Bleeding on Marginal Probing and 0.91 [95% CI: 0.12;1.70] for the Lobene Stain Index. MA of studies with a low risk of author-estimated bias showed a WMD of −0.68 [95% CI: −0.85; −0.51] for the PIQH and −0.24 [95% CI: −0.29; −0.20] for the GI in favour of CHX. Relative to control, the reduction with CHX for plaque was 33% and for gingivitis 26%. CHX rinsing groups demonstrated significantly more staining. Conclusions In gingivitis patients, CHX mouthrinses together with OH versus placebo- or control mouthrinse provide significant reductions in plaque and gingivitis scores, but a significant increase in staining score. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study was to provide a systematic review of randomized controlled and/or comparative clinical trials published in the international peer-reviewed literature in the English language, up to and including July 2007, concerning the efficacy of all treatment modalities implemented for the therapy of peri-implantitis. Material and Methods: PubMed and The Cochrane Library databases were searched electronically and numerous journals were examined manually. In the first phase of selection, the titles and abstracts, and in the second phase, complete papers were screened independently and in duplicate by three reviewers (S. K., I. K. K. and M. T.). Results: The search yielded 1304 possibly relevant titles and abstracts. After the first phase of selection, 13 publications were singled out for a rigorous evaluation. Following the second phase, five studies were selected. Conclusions: The selected studies are too limited in number and exhibit small sample sizes and short follow-up periods. Therefore, there is a definite need for more well-designed, preferably longitudinal, randomized controlled clinical trials. Within the limitations of the selected studies, mechanical debridement combined with antiseptic/antibiotic therapy, the Er:YAG laser or regenerative techniques may be used for treating peri-implantitis, but the indications for each of these techniques have not been delineated clearly. [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: The purpose of the present study was to assess root coverage outcomes 10 years after connective tissue graft plus coronally advanced flap (CTG + CAF) or CAF alone, at single RT2 maxillary gingival recession. Materials and Methods: Twenty‐one of the original 29 patients (11 treated with CAF + CTG and 10 with CAF alone) were available for the 10‐year follow‐up. A blinded and calibrated examiner performed all the measurements. Outcome measures included complete root coverage (CRC), recession reduction (RecRed), root coverage aesthetic score (RES), and keratinized tissue (KT) gain. A visual analogue scale was used to evaluate patient satisfaction. Results: CRC was maintained in 63% of the test group and 20% of the control group after 10 years, with a significant difference favouring CAF + CTG (p =.030). Furthermore, the addition of CTG was associated with greater KT gain (p =.0002) and greater papilla tip recession (p =.023) than with CAF at the last follow‐up. No difference was detected regarding RecRed, RES, and patient satisfaction. Conclusions: Adding CTG under CAF improved the probability of maintaining complete root coverage 10 years after single maxillary RT2 recession treatment. [ABSTRACT FROM AUTHOR]

Aim: To assess the effect of periodontal treatment on HbA1c and diagnostic parameters of patients with metabolic syndrome (MetS). Materials and Methods: One hundred and fifty‐eight patients with MetS and moderate and severe periodontitis were included. They were randomized into a test group (n = 79), which received non‐surgical periodontal treatment, and a control group (n = 79), which received no treatment. Medical treatment was delivered to both groups. Clinical periodontal, anthropometric and serological parameters were assessed at baseline, 3 and 6 months. The main outcome was glycated haemoglobin (HbA1c) levels, and the secondary outcomes were changes in the MetS parameters, C‐reactive protein (CRP) and HOMA indexes. Results: Significant reductions in all periodontal parameters were observed in the test group, compared with the control group, at 3 and 6 months (p <.001). HbA1c levels, MetS parameters, CRP and HOMA indexes showed no significant differences between the test group and the control group at 3 and 6 months. Conclusions: Periodontal treatment led to a substantial reduction in periodontal inflammation, although there was no significant effect on the parameters used for MetS diagnosis in patients with early diagnosed and well‐controlled MetS. [ABSTRACT FROM AUTHOR]

Aim: This meta‐research study aimed to investigate the level of compliance with the Sex and Gender Equity in Research (SAGER) Guidelines for the inclusion, analysis, and reporting of sex/gender, in periodontitis‐related randomized controlled trials (RCTs). Materials and Methods: Following the inclusion of RCTs related to the treatment of periodontitis published between 2018 and 2019, we applied the SAGER checklist to assess the adherence to sex/gender reporting guidelines. We used non‐parametric descriptive statistics and correlation models to test the association of the dependent outcome with other variables. Results: One hundred and one articles were included in the analysis. The female enrolment ranged between 30% and 94%. Twenty‐six studies enrolled less than 50% of female participants. The overall SAGER score (OSS) of item fulfilment ranged between 0 and 7 items with an average of 1.9 items signifying poor guideline adherence to the SAGER guidelines. These findings were not associated with the corresponding author gender (p =.623), publication year (p =.947), and funding source (p =.133). However, a significant but negative correlation with journal impact factor (r = −0.253, p =.026) was observed. Conclusions: Sex and gender were frequently disregarded in clinical trial reporting. This oversight might limit the understanding of sex/gender differences in periodontitis‐related clinical trials. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the clinical non‐inferiority of a 3‐day protocol of systemic antibiotics adjunctive to subgingival instrumentation (SI) compared with a 7‐day‐protocol in patients with Stage III/IV Grade C periodontitis. Materials and Methods: Fifty systemically healthy patients (32.7 ± 4.3 years) with aggressive periodontitis (AgP; Stage III/IV Grade C periodontitis) were treated by SI and adjunctive amoxicillin and metronidazole and were randomly assigned to Group A: (n = 25) 500 mg antibiotics (AB) 3 times a day for 3 days, followed by placebo 3 times a day for 4 days, or Group B: (n = 25) 500 mg AB 3 times a day for 7 days. Clinical, microbial, and immunological parameters were assessed at baseline, 3 months, and 6 months, and patient‐related outcomes were assessed after 2 weeks. The primary outcome variable was the number of residual sites with pocket depth (PD) ≥6 mm at 6 months. Results: For the primary outcome variable (the number of residual sites with PD ≥6 mm at 6 months), the null hypothesis was rejected and non‐inferiority of the 3‐day AB protocol compared with the 7‐day AB protocol was demonstrated (the upper limits of the 95% confidence interval for intention to treat analysis: [−2.572; 1.050] and per protocol analysis: [−2.523; 1.318] were lower than the assumed margin of Δ = 3.1). Comparable clinical improvements were obtained for all parameters with both antibiotic protocols (p >.05). All investigated periodontopathogens and pro‐inflammatory host‐derived markers were statistically significantly reduced without differences between the treatments (p >.05). Conclusions: These findings indicate that in patients with AgP (Stage III/IV Grade C periodontitis), a 3‐day systemic administration of amoxicillin and metronidazole adjunctive to SI may lead to non‐inferior clinical outcomes after 6‐months with fewer adverse events compared with a 7‐day‐protocol. [ABSTRACT FROM AUTHOR]

Aim: To compare connective tissue graft (CTG) with collagen matrix (CMX) in terms of increase in buccal soft tissue profile (BSP) at 1 year when applied at single implant sites. Materials and Methods: Patients with a single tooth gap in the anterior maxilla and horizontal mucosa defect were enrolled in a multi‐centre randomized controlled trial. All sites had a bucco‐palatal bone dimension of at least 6 mm, received a single implant and an immediate implant restoration using a full digital workflow. Sites were randomly allocated to the control (CTG) or test group (CMX) to increase buccal soft tissue thickness. The primary outcome was the increase in BSP at 1 year when compared with the pre‐operative situation based on superimposed digital surface models. The changes in BSP over time were registered at a buccal area of interest reaching from 0.5 mm below the soft tissue margin to 4 mm more apical. Secondary outcomes included patient‐reported, clinical and aesthetic outcomes. Results: Thirty patients were included per group (control: 50% females, mean age 50.1; test: 53% females, mean age 48.2). The increase in BSP at 1 year was 0.98 mm (98.3% confidence interval [CI]: 0.75–1.20) for CTG and 0.57 mm (98.3% CI: 0.34 to 0.79) for CMX. The mean difference of 0.41 mm (98.3% CI: 0.12 to 0.69) in favour of CTG was significant (p <.001). Based on an arbitrarily chosen threshold for success of 0.75 mm increase in BSP, 89.7% of the patients in the control group and 10% of the patients in the test group were successfully treated (odds ratio = 77.90; 95% CI: 13.52 to 448.80; p <.001). Sites treated with CMX demonstrated 0.89 mm (98.3% CI: 0.49 to 1.30) more shrinkage between postop and 1 year than sites treated with CTG. In addition, CMX resulted in significantly more marginal bone loss (0.39 mm; 95% CI: 0.05 to 0.74; p =.026) than CTG. There were no significant differences between the groups in terms of patients' aesthetic satisfaction (p =.938), probing depth (p =.917), plaque (p =.354), bleeding on probing (p =.783), midfacial recession (p =.915), Pink Esthetic Score (p =.121) and Mucosal Scarring Index (p =.965). Conclusions: CTG remains the gold standard to increase soft tissue thickness at implant sites. Clinicians need to outweigh the benefits of CMX against considerable resorption of the graft. This study was registered in ClinicalTrials.gov (NCT04210596). [ABSTRACT FROM AUTHOR]

Aim: Leucocyte‐ and platelet‐rich fibrin (L‐PRF) has been tested for enhancing alveolar ridge preservation (ARP), but little is known about the local release profile of growth factors (GF), and the clinical equipoise related to its efficacy remains. This study compared the patterns of GF release, early soft tissue healing, and alveolar ridge resorption following unassisted healing and L‐PRF application in non‐molar extraction sockets. Materials and Methods: Atraumatic tooth extraction of two hopeless teeth per patient was followed by unassisted healing or L‐PRF placement to fill the socket in 18 systemically healthy, non‐smoking subjects. This intra‐individual trial was powered to assess changes in horizontal alveolar ridge dimensions 1 mm below the crest of alveolar bone. GF concentrations in wound fluid were assessed with a multiplex assay at 6, 24, 72, and 168 h. Early healing was evaluated with the wound healing index and changes in soft tissue volumes on serial digital scans. Hard tissue changes were measured on superimposed CBCT images after 5 months of healing. Results: L‐PRF resulted in higher GF concentrations in wound fluid (WF) than in the control, but no differences in release patterns or time of peak were observed. No inter‐group differences in early healing parameters were observed. Alveolar bone resorption was observed in both groups. No significant inter‐group differences were observed in hard tissue healing 1, 3, or 5 mm apical to the original bone crest or in the ability to digitally plan a prosthetically guided implant with or without bone augmentation. Conclusions: L‐PRF increased the GF concentrations in WF of extraction sockets without shifting the pattern observed in unassisted healing, while the increased delivery did not translate into clinical benefits in early wound healing or ARP. The current findings question the assumption that increased local concentrations of GF by L‐PRF translate into improved clinical outcomes. Additional definitive studies are needed to establish the benefits of L‐PRF in ARP (ClinicalTrials.gov NCT03985033). [ABSTRACT FROM AUTHOR]

Aim: This randomized placebo‐controlled clinical trial evaluated the effects of multispecies probiotic containing Lactobacillus rhamnosus HN001™, Lactobacillus paracasei Lpc‐37®, and Bifidobacterium animalis subsp lactis HN019™ as an adjunct to mechanical debridement (MD) on changes in bleeding on probing (BOP) in edentulous patients with peri‐implant mucositis (PiM). Materials and Methods: Patients were randomly assigned to test (probiotic) or control (placebo) groups. All sites with PiM received MD and topical gel application (probiotic or placebo) at baseline and 12 weeks. After initial MD, patients consumed probiotic or placebo capsules twice a day for 12 weeks. Clinical (modified sulcus bleeding index [mSBI]; modified plaque index [mPI]; probing depth [PD]; and BOP) and immunological parameters were collected at baseline and after 12 and 24 weeks. Data were statistically analysed (p <.05). Results: Thirty‐six patients with PiM were recruited. The test group presented higher prevalence (p <.05) of cases of restored peri‐implant health at 24 weeks than did the control group (72.2% and 33.3%, respectively). No significant difference was observed between test (n = 18) and control (n = 18) groups for mPI and PD. mSBI %—score 0 was higher in the test group than in the control group at 24 weeks (p <.05). When compared with baseline, both groups presented reduced BOP at 12 and 24 weeks (p <.05). BOP was lower in the test group than in the control group at 12 (mean difference = −14.54%; 95% confidence interval [CI] = −28.87 to 0.22; p =.0163) and 24 (mean difference = −12.56%; 95% CI = −26.51 to 1.37; p =.0090) weeks. At 24 weeks, only the test group presented lower levels of interleukin (IL)‐1β, IL‐6, IL‐8, and tumour necrosis factor (TNF)‐α than those at baseline (p <.05). Conclusions: The multispecies probiotic (administered locally and systemically) containing L. rhamnosus HN001™, L. paracasei Lpc‐37®, and B. lactis HN019™ as an adjunct to repeated MD promotes additional clinical and immunological benefits in the treatment of PiM in edentulous patients (ClinicalTrials.gov NCT04187222). [ABSTRACT FROM AUTHOR]

Aim: To assess the efficacy of the adjunct use of a subgingival erythritol powder air‐polishing device (EPAP) in comparison to conventional subgingival instrumentation alone during initial non‐surgical periodontal therapy. Materials and Methods: Twenty‐one patients with generalized Stages 2 and 3 grade B periodontitis were included in this single centre, single blinded, split‐mouth, randomized clinical trial. Teeth on the control side were treated with conventional hand and ultrasonic instrumentation, while those on the contralateral test side was treated using EPAP as adjunct to conventional subgingival instrumentation with hand and ultrasonic instruments. Three months after initial instrumentation, persisting pockets of ≥4 mm were re‐treated, in both control and test sides, again with the respective treatment approach—subgingival instrumentation alone on control, and subgingival instrumentation + EPAP on test side. Clinical parameters such as probing pocket depth (PPD), bleeding on probing, and relative attachment level were recorded at baseline and 3 and 6 months following the initial instrumentation. Subgingival plaque samples were collected at baseline, immediately post surgery, as well as at 1 week, 1 month, 3 months, and 6 months after initial instrumentation. Results: In the test group after 6 months, a significantly larger number of initially deep pockets (PPD ≥ 5.5 mm) were reduced to shallow (PPD ≤ 3.4 mm), and a larger attachment gain was observed. No statistically significant microbiological differences could be found between test and control group. Conclusions: The results of the present study indicate that the adjunct use of subgingival airflow therapy with EPAP during initial non‐surgical periodontal therapy might be beneficial in initially deep pockets (PPD ≥ 5.5 mm). [ABSTRACT FROM AUTHOR]

Aim: The aim was to assess two macronutrient interventions in a 2 × 2 factorial dietary design to determine their effects on oral health. Materials and Methods: Participants (65–75 years old) with a body mass index between 20 and 35 kg/m2 of a larger randomized control trial who consented to an oral health assessment were recruited. They had ad libitum access to one of four experimental diets (omnivorous higher fat or higher carbohydrate, semi‐vegetarian higher fat or higher carbohydrate) for 4 weeks. The periodontal examination included periodontal probing depth (PPD), clinical attachment level (CAL), and bleeding on probing. Oral plaque and gingival crevicular fluid (GCF) were collected before and after the intervention. Results: Between baseline and follow up, the number of sites with a CAL <5 mm (mean difference [MD] −5.11 ± 9.68, p =.039) increased and the GCF amount (MD −23.42 ± 39.42 Periotron Units [PU], p =.050) decreased for the semi‐vegetarian high‐fat diet. For the mean proportion of sites with PPD reduction of >1 mm and CAL gain of >1 mm, significant differences were calculated between the diets investigated. The clinical parameters were not associated with changes in the oral microbiota. Conclusions: The results of this study provided evidence that a semi‐vegetarian high‐fat diet provides benefits to clinical parameters of periodontal health. This study is registered in ClinicalTrials.gov (ACTRN12616001606471). [ABSTRACT FROM AUTHOR]

Aim: To compare the results of administration of hyaluronic acid (HA) gel to no gel administration following alveolar ridge preservation (ARP) in terms of changes in wound dimensions over time. Materials and Methods: Systemically healthy patients scheduled for ARP at one or two sites in the incisor, cuspid, or premolar area with at least one neighbouring tooth and >50% buccal bone present following extraction were included. ARP consisted of socket grafting with collagen‐enriched, deproteinized bovine bone mineral and socket sealing by means of a collagen matrix. Following surgical therapy, sites were randomly allocated to the control group (no gel application) or the test group (0.8% HA gel applied onto the collagen matrix three times per day for 7 days). Bucco‐lingual and mesio‐distal wound dimensions were registered at T0 (immediately post operation), T1 (1 week), and T2 (3 weeks). Patient‐reported outcomes, clinical outcomes, and hard and soft tissue changes were recorded up to 4 months (T3). Results: In the control group, 20 patients (7 males, 13 females; mean age 53.30) with 23 sites, and in the test group 18 patients (9 males, 9 females; mean age 52.56) with 23 sites, were included. There were no significant differences between the groups in the changes in wound dimensions from T0 to T2 (bucco‐lingual aspect: p =.340; mesio‐distal aspect: p =.883). Three sites (13%) in the control group and six (26%) in the test group demonstrated complete wound resolution at T2 (p =.259). HA failed to show any effect on the number of analgesics taken (p =.175), patient‐reported outcomes (p ≥.263), alveolitis (p =.136), socket healing (p ≥.424), soft tissue changes (p ≥.064), or mucosal scarring (p =.548). However, significantly more horizontal bone loss at the coronal aspect was found in the test group (p ≤.025). Conclusion: HA failed to promote wound resolution on a collagen matrix. This study was registered in ClinicalTrials.gov (NCT04467736). [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the effects of a 6‐week Mediterranean diet (MD) intervention on gingival inflammatory and anthropometric parameters of patients with gingivitis. Materials and methods: Forty‐two participants were allocated to MD group (MDG) or control group (CG). After a 2‐week equilibration period regarding dental care procedures, only MDG changed their diet to MD for 6 weeks, supported by a diet counselling. Gingival and anthropometric parameters were assessed at baseline (T0), Week 2 (T1, beginning of MD intervention), and Week 8 (T2). Adherence to MD was assessed by the Mediterranean Diet Adherence Screener (MEDAS); dietary behaviour was evaluated by the German Health Interview and Examination Survey for Adults Food Frequency Questionnaire (DEGS‐FFQ). Results: Plaque values remained constant in both groups. Inflammatory periodontal and anthropometric parameters decreased in the MDG only (gingival index: T1 1.51 ± 0.21, T2 1.49 ± 0.24; bleeding on probing: T1 51.00 ± 14.65, T2 39.93 ± 13.74; body weight: T1 79.01 ± 15.62, T2 77.29 ± 17.00; waist circumference: T1 84.41 ± 10.1, T2 83.17 ± 10.47 (p <.05). MEDAS revealed a sufficient diet adherence for MDG. Conclusion: Within this study, gingival inflammatory parameters were significantly reduced by MD, whereas plaque parameters remained constant. The diet counselling achieved sufficient adherence with beneficial changes in weight loss and waist circumference. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the radiological, clinical, and microbiological outcomes of implants with a hybrid surface macro‐design in patients with a history of periodontitis. Material and Methods: The study was designed as a 12‐month, parallel‐arm, randomized controlled trial where patients with a history of treated periodontitis in need of dental implants for single‐unit or short‐span prosthesis were randomly allocated to a test [implants with a machined titanium surface in the coronal collar (hybrid; HS)] or a control group [conventional implants with moderately rough surface up to the implant shoulder (RS)]. Patients were followed at 3, 6, and 12 months after loading with assessment of radiological, clinical, and microbiological outcomes, as well as patient‐related outcome measures (PROMs). Results: Forty patients were randomly assigned to either the RS group (n = 20) or the HS (n = 20) group. At 1 year, the mean marginal bone level changes were 0.22 [standard deviation (SD) 0.36] mm for the HS group and 0.22 (SD 0.29) mm for the RS group, with no significant differences between them (p =.961). Similarly, no significant differences in clinical, microbiological, or PROMs were observed between groups. Conclusions: HS implants demonstrated radiographic, clinical, and microbiological characteristics equal to RS implants in patients with a history of periodontitis. Clinical trial registration: ClinicalTrials.gov (identifier NCT05010382). [ABSTRACT FROM AUTHOR]

Aim: Analysis of distribution of p‐values of continuous differences between test and controls after randomization provides evidence of unintentional error, non‐random sampling, or data fabrication in randomized controlled trials (RCTs). We assessed evidence of highly unusual distributions of baseline characteristics of subjects enrolled in clinical trials in implant dentistry. Materials and methods: RCTs published between 2005 and 2020 were systematically searched in Pubmed, Embase, and Cochrane databases. Baseline patient data were extracted from full text articles by two independent assessors. The hypothesis of non‐random sampling was tested by comparing the expected and the observed distribution of the p‐values of differences between test and controls after randomization. Results: One‐thousand five‐hundred and thirty‐eight unique RCTs were identified, of which 409 (26.6%) did not report baseline characteristics of the population, and 671 (43.6%) reported data in forms other than mean and standard deviation and could not be used to assess their random sampling. Four‐hundred and fifty‐eight trials with 1449 baseline variables in the form of mean and standard deviation were assessed. The study observed an over‐representation of very small p‐values [<.001, 1.38%, 95% confidence interval (CI) 0.85–2.12 compared to the expected 0.10%, 95% CI 0.00–0.26]. No evidence of over‐representation of larger p‐values was observed. Unusual distributions were present in 2.38% of RCTs and more frequent in non‐registered trials, in studies supported by non‐industry funding, and in multi‐centre RCTs. Conclusions: The inability to assess random sampling due to insufficient reporting in 26.6% of trials requires attention. In trials reporting suitable baseline data, unusual distributions were uncommon, and no evidence of data fabrication was detected, but there was evidence of non‐random sampling. Continued efforts are necessary to ensure high integrity and trust in the evidence base of the field. [ABSTRACT FROM AUTHOR]

Aim: To study clinical, radiographic, and microbiological outcomes after non‐surgical therapy of peri‐implantitis with or without adjunctive systemic metronidazole. Materials and Methods: A randomized placebo‐controlled clinical trial was carried out in 32 subjects (62 implants) diagnosed with peri‐implantitis. Implants received a mechanical non‐surgical debridement session and systemic metronidazole or placebo. Clinical, radiographic, and microbiological outcomes were evaluated at baseline, 3, 6, and 12 months. Results: After 12 months, the test treatment resulted in significantly greater PPD reduction (2.53 vs. 1.02 mm) and CAL gain (2.14 vs. 0.53 mm) (p value <.05) in comparison with placebo. The test treatment also resulted in additional radiographic bone gain (2.33 vs. 1.13 mm) compared with placebo (p value <.05). There was a significantly greater decrease in Porphyromonas gingivalis, Tannerella forsythia, and Campylobacter rectus counts compared with the control group (p value <.05). At the end of follow‐up, 56.3% of patients met the success criteria in the test group and 25% in the control group. Conclusions: The use of systemic metronidazole as an adjunct to non‐surgical treatment of peri‐implantitis resulted in significant additional improvements in clinical, radiographic, and microbiological parameters after 12 months of follow‐up. This study is registered in ClinicalTrials.gov (NCT03564301). [ABSTRACT FROM AUTHOR]

Aim: To investigate potential effect of bias on magnitude of outcomes. Material and Methods: Randomized-controlled trials (RCTs) from the Cochrane Database of Systematic Reviews were searched. Methodological quality of RCTs was assessed in terms of allocation concealment and examiner masking. Meta-regression analyses were used to determine associations between the quality assessments and magnitude of treatment outcomes on probing depth and attachment level. Results: Thirty-five RCTs were identified from five systematic reviews. Adequate allocation concealment and examiner masking were found in 24% and 64% of trials respectively. There were no statistically significant differences in the magnitude of treatment outcomes comparing adequate versus inadequate or unclear allocation concealment, nor comparing adequate and inadequately examiner masked trials. However, a retrospective power calculation indicated 265 RCTs would be needed to demonstrate a statistically significant effect for the impact of bias on CAL as an outcome measure for a 0.5 mm exaggeration of mean difference between test and control. Conclusions: There is insufficient evidence to support or refute the theory that the bias from improper methods of allocation concealment and examiner masking affect the magnitude of clinical outcomes in periodontology trials. The pilot data provide a baseline for sample size calculations in future research. [ABSTRACT FROM AUTHOR]

Objectives: To systematically review the effectiveness of full-mouth treatment concepts for chronic periodontitis. Material and Methods: A search was conducted for randomized, controlled clinical trials including full-mouth scaling with (FMD) or without (FMS) the use of antiseptics and quadrant scaling (control). Data sources included COHG, CENTRAL, MEDLINE and EMBASE. Reviewers independently conducted data abstraction and quality assessment. The primary outcome was tooth loss; secondary outcomes were the reductions of PPD and BOP and a gain of CAL. Results: Of 216 identified abstracts, seven trials were included. Meta-analysis revealed a weighted mean difference (WMD) for the reduction of PPD between FMD and control of 0.53 mm [95% confidence interval (CI) (0.28, 0.77), p<0.0001] in moderately deep pockets of single-rooted teeth. The WMD for gain in CAL was 0.33 mm [95% CI (0.04, 0.63), p=0.03] in moderately deep pockets of single- and multi-rooted teeth. Comparing FMD and FMS, the WMD for the reduction of CAL amounted to 0.74 mm [95% CI (0.17, 1.31), p=0.01] in deep pockets of multi-rooted teeth in favour of FMS. For BOP a WMD –18.0% [95% CI (−34.30, −1.70), p=0.03] was calculated in deep pockets of single-rooted teeth in favour of FMD. Conclusions: In adults with chronic periodontitis only minor differences in treatment effects were observed between the treatment strategies. [ABSTRACT FROM AUTHOR]

Background: Outcome discrepancies between protocols and respective publications represent a concerning bias. The purpose of this study was to assess the prevalence of selective outcome reporting (SOR) in root coverage randomized clinical trials (RCTs). Methods: Published root coverage RCTs (July 2005 to March 2020) were included if a corresponding protocol could be identified in a public registry. Discrepancies between protocol and its correspondent publication(s) were compared regarding primary and secondary outcomes and other study characteristics. Associations between trial characteristics and SOR were evaluated. Results: Forty four studies (54 publications) were included. The majority of studies (77.3%) were retrospectively registered. SOR was frequent (40.9% of trials) and consisted of primary outcome downgrade (22.7%); secondary outcome upgrade (11.4%); new primary outcome introduced in publication (25%); protocol primary outcome omitted from publication (13.6%) and discrepancy in primary outcome timing (18.2%). SOR was unclear in 20.5% of studies and favoured statistical significance in 12 studies (27.3%). SOR was significantly associated with study significance (p < 0.001) and unclear outcome definition in the publication (p < 0.001). Only a third (32.8%) of primary outcomes were completely defined. Conclusions: The present study identified high prevalence of SOR in root coverage RCTs. [ABSTRACT FROM AUTHOR]

Aim: To investigate the potential benefit of enamel matrix derivative (EMD) as adjunct to re‐instrumentation of residual pockets persisting after steps 1 and 2 of periodontal therapy. Material and Methods: 44 adult patients participated in a multicentre feasibility randomized clinical trial with split‐mouth design. They had presented at re‐evaluation after initial non‐surgical periodontal therapy (steps 1 and 2 of periodontal therapy) for generalized periodontitis with at least 2 teeth with residual probing pocket depths (PPD) ≥5 and ≤8 mm, with bleeding on probing (BOP). Two teeth with similar PPD were randomized to receive re‐instrumentation either with (test) or without (control) adjunctive flapless administration of EMD. Differences in the changes of PPD and BOP from baseline to 6 and 12 months were analysed, and the frequencies of pocket closure (PPD ≤4 mm and no BOP) compared. Results: For the primary outcome "change of mean PPD after 6 months," a significant additional benefit of 0.79 ± 1.3 mm (p <.0001) could be observed for the test group. At 12 months, this difference could be maintained (0.85 ± 1.1 mm; p <.0001). The frequency of pocket closure in the test group was 69% at 6 and 80% at 12 months and significantly higher than in the control group with 34% and 42%, respectively (p <.01). Conclusions: The results of the present feasibility study indicate a benefit of adjunctive EMD during non‐surgical retreatment (step 3 of periodontal therapy) of residual deep pockets. [ABSTRACT FROM AUTHOR]

Objectives: To analyse the soft tissue morphology under healthy and experimental mucositis conditions comparing zirconia and titanium implants. Methods: Forty‐two patients with two adjacent missing teeth received one zirconia (Zr) and one titanium (Ti) implant, with the mesial and distal position randomized. At 3 months, half of the patients were instructed to continue (healthy; h) and the other half to omit (experimental mucositis; m) oral hygiene around the implants for 3 weeks. Clinical parameters were evaluated before and after the experimental phase, and a soft tissue biopsy was harvested. Mixed model analyses were performed to analyse the data. Results: The plaque control record increased significantly for the two mucositis groups, reaching 68.3 ± 31.9% (mean ± SD) for Zr‐m and 75.0 ± 29.4% for Ti‐m (p <.0001), being also significantly lower for Zr‐m than for Ti‐m. Bleeding on probing remained stable in group Zr‐m and amounted to 21.7 ± 23.6%, but increased significantly in group Ti‐m (p =.040), measuring 32.5 ± 27.8%. The number of inflammatory cells and the length of the junctional epithelium did not significantly differ between the groups. Conclusion: Both implants rendered similar outcomes under healthy conditions. Lower plaque and bleeding scores were detected for zirconia implants under experimental mucositis conditions. Histologically, only minimal differences were observed. [ABSTRACT FROM AUTHOR]

Objective: To verify whether ridge preservation is effective in the reduction of dimensional loss and in bone formation compared to spontaneous healing in extraction sockets of periodontally compromised teeth. Methods: Twenty‐six subjects requiring tooth extraction for stage III/IV periodontitis were randomly assigned to one of two interventions: alveolar ridge preservation using collagenated bovine bone mineral and a resorbable collagen membrane (test, RP) or spontaneous healing (control, SH). Six months later, postoperative cone‐beam computed tomography (CBCT) was performed to measure the linear and volumetric changes of the sockets compared to baseline scans. Biopsies were retrieved at the implant site for histomorphometric calculations. Nonparametric tests were applied for statistical analysis. Results: Significantly less shrinkage occurred in RP compared to SH, mainly in the crestal zone. The width loss difference between groups was 3.3 mm and 2.2 mm at 1 mm and 3 mm below the crest, respectively (p <.05). RP yielded a gain in socket height of 0.25 mm, whereas a loss of −0.39 mm was observed in SH (p <.05). The percentage of volume loss recorded in RP was also less than that recorded in SH (−26.53% vs −50.34, p <.05). Significantly less bone proportion was detected in biopsies from RP (30.1%) compared with SH (53.9%). A positive association between baseline bone loss and ridge shrinkage was found in SH but not in RP. Conclusion: Ridge preservation in extraction sockets of periodontally compromised teeth was effective in reducing the amount of ridge resorption. [ABSTRACT FROM AUTHOR]

Aim: To determine the effects of glycine powder air‐polishing (GPAP) as an adjunct to full‐mouth scaling and root planing (SRP) on clinical, inflammatory and microbiological outcomes in patients with untreated periodontitis. Materials and Methods: Forty‐one patients were randomly assigned to the control group A (SRP) and test groups B1 (subgingival GPAP right after SRP) and B2 (subgingival GPAP right before SRP). Clinical examinations and sample collections (saliva, subgingival plaque, serum and gingival crevicular fluid) were performed at assessment visits and before therapies at clinical visits of baseline, 6‐week and 3‐month. C‐reactive protein, IL‐6 and TNF‐α were assessed in serum and gingival crevicular fluid, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans and Fusobacterium nucleatum were measured in saliva and subgingival plaque. Results: Patients in control and test groups did not significantly differ by age, sex and disease severity at baseline. Participants in control and intervention groups had similar improvements in clinical parameters (PD, BOP, PLI and BI). All groups had a similar percentage of sites showing PD reduction of ≥2 mm between baseline and follow‐up visits, with a few exceptions. Reduced C‐reactive protein, IL‐6 and TNF‐α in serum were found after treatments. Conclusion: Full‐mouth SRP with and without GPAP resulted in largely similar clinical, inflammatory and microbiological outcomes in the care of untreated periodontitis. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effect of connective tissue graft (CTG) in terms of vertical mid‐facial soft tissue change when applied at the buccal aspect following single immediate implant placement (IIP). Materials and methods: Two independent reviewers conducted an electronic literature search in PubMed, Web of Science, EMBASE and Cochrane databases as well as a manual search to identify eligible clinical studies up to January 2020. Randomized controlled trials (RCTs) and non‐randomized controlled studies (NRSs) comparing IIP with CTG and without CTG over a mean follow‐up of at least 12 months were included for a qualitative analysis. Meta‐analyses were performed on data provided by RCTs. Results: Out of 1814 records, 5 RCTs and 3 NRSs reported on 409 (IIP + CTG: 246, IIP: 163) immediately installed implants with a mean follow‐up ranging from 12 to 108 months. Only 1 RCT showed low risk of bias. Meta‐analysis revealed a significant difference in terms of vertical mid‐facial soft tissue change between IIP + CTG and IIP pointing to 0.41 mm (95% CI [0.21; 0.61], p <.001) in favour of soft tissue grafting. This outcome was clinically relevant since the risk for ≥1 mm asymmetry in mid‐facial vertical soft tissue level was 12 times (RR 12.10, 95% CI [2.57; 56.91], p =.002) lower following IIP + CTG. Soft tissue grafting also resulted in a trend towards less bleeding on probing (MD 17%, 95% CI [−35%; 1%], p =.06). Meta‐analyses did not reveal significant differences in terms of pink aesthetic score, marginal bone level change and probing depth. Results were inconclusive for horizontal mid‐facial soft tissue change and papilla height change. Based on GRADE guidelines, a moderate recommendation for the use of a CTG following IIP can be made. Conclusion: CTG contributes to mid‐facial soft tissue stability following IIP. Therefore, CTG should be considered when elevated risk for mid‐facial recession is expected in the aesthetic zone (thin gingival biotype, <0.5 mm buccal bone thickness). [ABSTRACT FROM AUTHOR]

Aim: To compare the efficacy of two different therapies (amino acid glycine abrasive powder and a desiccant material) and their combination in the non‐surgical treatment of peri‐implantitis. Materials and Methods: This was an examiner‐blind randomized clinical trial, with 2‐factorial design with a follow‐up of 6 months. The combination of the two factors resulted in four interventions: (a) non‐surgical debridement alone (C); (b) non‐surgical debridement and a desiccant material (H); (c) non‐surgical debridement and glycine powder (G); and (d) non‐surgical debridement, desiccant material and glycine powder (HG). Results: Sixty‐four patients with peri‐implantitis were randomized, 16 for each intervention. After six months, two implants failed in the G intervention. Mean pocket depth reduction was higher in patients treated with the desiccant material (estimated difference: 0.5 mm; 95% CI from 0.1 to 0.9 mm, p =.0229) while there was no difference in the patients treated with glycine powder (estimated difference: 0.1 mm; 95% CI from −0.3 to 0.5 mm, p =.7333). VAS for pain during intervention and VAS for pain after one week were higher for patients treated with glycine powder (p =.0056 and p =.0339, respectively). The success criteria and other variables did not reveal differences between interventions. Conclusions: In this 6‐month follow‐up study, pocket reduction was more pronounced in patients using the desiccant material. Pain was higher in patients using glycine. All the interventions resulted in low success rate. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the presence and characteristics of spin (a distorted interpretation to make research findings seem favourable) in abstracts of randomized controlled trials (RCTs) in periodontology and oral implantology, and to explore its associated factors and influence on the subsequent literature. Materials and methods: PubMed was searched to identify recent RCTs in periodontology and oral implantology, whose primary outcome was non‐significant. Spin in abstracts was assessed and categorized according to pre‐determined spin strategies. The associations between study characteristics and the presence/severity of spin were analysed using multivariable logistic regressions. Results: 196 abstracts were included, 137 (69.9%) of which had spin. 57 (29.1%) abstracts had spin in the Results section, and 126 (64.3%) had spin in the Conclusion section. The main spin strategies in the Results and Conclusion sections were focusing on secondary outcomes (16.3%) and focusing on within‐group comparisons (28.6%), respectively. The presence of spin was associated with number of centres (OR = 0.28, 95% CI: 0.11–0.73; p =.009), while its severity was associated with topic (OR = 0.24, 95% CI: 0.08–0.70; p =.009). Conclusions: The frequency of spin is relatively high among published RCT abstracts in periodontology and oral implantology. Findings reported in these abstracts need to be interpreted with caution. [ABSTRACT FROM AUTHOR]

Aim: The aim of this randomized clinical trial was to compare clinical and volumetric outcomes of tunnel technique (TUN) with subepithelial connective tissue graft (CTG) versus coronally advanced flap (CAF) with enamel matrix derivate (EMD) 2 years after gingival recession (GR) treatment. Materials and methods: Twenty‐three patients contributed 45 Miller class I or II GR. At baseline and follow‐up examinations, study models were collected. Their three‐dimensional scans allowed precise computer‐assisted measurement of recession depth (REC), complete root coverage (CRC), percentage of root coverage (RC), pointwise (pTHK) and mean areal (aTHK) marginal soft tissue thickness. Clinical examination delivered probing depths (PPD) and height of keratinized tissue. Results: 24 months after surgery, digitally evaluated CRC was present in 60.0% of the TUN + CTG and 0.0% of the CAF + EMD‐treated sites (p <.0001), meaning a certain relapse of the gingival margin ragarding both approaches. RC amounted to 94.0% (TUN + CTG) and 57.3% (CAF + EMD), respectively (p <.0001). REC reduction (RECred) was significantly higher for TUN + CTG (1.81 ± 0.56 mm) than for CAF + EMD (0.90 ± 0.45 mm) (p <.0001). pTHK and aTHK values were significantly greater in the TUN + CTG group (1.41 ± 0.35 mm and 1.11 ± 0.26 mm) than in the CAF + EMD group (0.78 ± 0.32 mm and 0.60 ± 0.26 mm) (p <.0001). Statistical analysis detected positive correlations between THK and both RC and RECred (p <.001). Conclusions: Two years post‐operatively, CTG showed better clinical and volumetric outcomes than EMD. Increased THK values were associated with improved outcomes regarding RC and RECred. [ABSTRACT FROM AUTHOR]

Aims: To assess the long‐term clinical and radiographic results of implants placed using osteotome sinus floor elevation (OSFE) with or without bone grafting. Materials and methods: Forty‐five patients were randomly assigned into two groups: Group 1 (OSFE with deproteinized bovine bone mineral) and Group 2 (OSFE without grafting). The patients were recalled at 1, 3, 5 and 10 years after surgery. The implant survival, endo‐sinus bone gain (ESBG), marginal bone loss (MBL), peri‐implant bone height (PBH, distance from the most coronal level to the most apical level of bone‐to‐implant contact), prosthesis survival and hardware complications, and peri‐implant soft tissue conditions were assessed. Results: Forty patients attended the 10‐year examination. Mean residual bone height was 4.58 ± 1.28 mm. The 10‐year cumulative survival rate was 90.7% for Group 1 and 95.0% for Group 2. The PBH was 5.89 ± 1.24 mm for Group 1 and 5.74 ± 1.43 mm for Group 2 at 10 years. The ESBG of both groups remained stable after 3 years. Two‐thirds of the implants were free of hardware complications. No significant differences in MBL and peri‐implant tissue parameters were found. Conclusion: OSFE with or without grafting both yielded predictable clinical outcomes with similar PBH (ClinicalTrials.gov. NCT01619956). [ABSTRACT FROM AUTHOR]

Aim: To evaluate clinical and biochemical effects of adjunctive systemic folic acid (FA) intake with scaling and root planing (SRP) in periodontitis treatment. Materials and methods: Sixty periodontitis subjects (30 per group) were randomly assigned into study groups and treated with either SRP + placebo (SRP + P) or SRP + folic acid (SRP + F). In addition to clinical parameters (plaque index [PI], gingival index [GI], probing pocket depth [PPD], clinical attachment level [CAL] and gingival recession [GR]), gingival crevicular fluid (GCF) samples were obtained at baseline and post‐treatment (PT) periods (one (PT‐1), three (PT‐3) and six (PT‐6) months) for C‐reactive protein (CRP) and homocysteine (Hcy) evaluation. Results: Significant time‐dependent reduction was detected at all clinical parameters for both groups (p <.001). Compared to SRP + P, CAL was lower in SRP + F at PT‐1 (p =.004) and PT‐3 (p =.035), whereas GR was lower at only PT‐1 (p =.015). GCF volume and CRP did not show inter‐group differences, whereas Hcy was higher in SRP + F at PT‐3 (p =.044) and PT‐6 (p =.041). GCF volume and Hcy showed reduction after treatment in both groups (p <.001). Conclusion: Both modalities exhibited clinical improvement and change in biochemical parameters. Adjunctive systemic FA intake may be recommended adjunctive to periodontitis treatment to reveal better outcomes. However, its impact mechanisms should be further enlightened. [ABSTRACT FROM AUTHOR]

Aim: This study compared the clinical efficacy of the entire papilla preservation technique (EPP) alone and in combination with enamel matrix proteins plus bovine‐derived bone substitutes (EPP EMD + BS) in the treatment of isolated inter‐dental intrabony defects. Material and methods: Thirty patients, each with one isolated intrabony defect, were randomly assigned to EPP EMD + BS or EPP alone. Clinical outcomes were assessed 1‐year post‐surgery. Results: Early healing phase was uneventful in all cases, and 100% primary wound closure was maintained throughout the study period. Intragroup differences between baseline and 1‐year were statistically significant in both groups in terms of clinical attachment level (CAL) gain and probing depth (PD) reduction (p ≤.001). No statistically significant differences were detected in gingival recession (REC) (p >.05). No statistically significant differences were detected in terms of CAL gain (6.3 ± 2.5 mm vs. 5.83 ± 1.12 mm), PD reduction (6.5 ± 2.65 mm vs. 6.2 ± 1.33 mm) or increase in gingival recession (0.2 ± 0.25 mm vs. 0.36 ± 0.54 mm) between the groups treated with EPP EMD + BS or EPP alone. Conclusions: Application of EPP with and without regenerative biomaterials resulted in significant amounts of CAL gain and PD reduction, with negligible increase in gingival recession. Within the limits of the present study, it can be concluded that the addition of regenerative biomaterials does not improve the clinical outcomes of EPP alone. NCT03923465. [ABSTRACT FROM AUTHOR]

Objective: To compare the cleansing efficacy of waist‐shaped versus cylindric inter‐dental brushes in patients receiving supportive periodontal therapy. Materials and methods: After sample size estimation, 20 periodontal maintenance patients diagnosed with periodontitis stage 3 were recruited. Brushing efficacy of waist‐shaped and cylindric inter‐dental brushes was evaluated in a randomized‐controlled, examiner‐blinded, two‐period crossover study by assessment of the Turesky modification of Quigley‐Hein plaque index (T‐QHI) and the papillary bleeding index (PBI) at four sites per tooth. Results: Seventeen probands with 1,474 tooth sites finished the study. At baseline, median of overall T‐QHI scores was 1.4 (interquartile range 1.38–1.92). After 1 month, T‐QHI for waist‐shaped inter‐dental brushes was 1.24 (1.03–1.52); in 15 individuals, T‐QHI 0 was the grade most often measured. T‐QHI for cylindric brushes was 1.71 (1.18–2.29; p =.042), with T‐QHI 0 being the grade most often measured only in seven individuals. The odds ratio for establishing plaque‐free inter‐dental sites with waist‐shaped relative to cylindric brushes was 1.8 [95% CI 1.6–1.9] (p <.001; logistic regression analysis). There were no statistically significant differences between PBI levels of waist‐shaped and cylindric brushes. Conclusion: This study has demonstrated the superiority in cleansing efficacy of waist‐shaped over cylindric inter‐dental brushes in individuals receiving supportive periodontal treatment. [ABSTRACT FROM AUTHOR]

Aim: Our objective was to compare guided virtual surgery to conventional surgery in terms of angular deviation of single dental implants placed in the posterior mandible. Materials and Methods: Patients with bilateral homologous single teeth missing in the posterior mandible were eligible for this split‐mouth randomized clinical trial. Cone beam computed tomography (CBCT) was performed for virtual planning of implant position and manufacturing of the stereolithographic guides. One week after the surgery, a second CBCT scan was superimposed to the initial planning. Primary endpoint was the angular deviation between virtual and clinical implant position. Secondary endpoints were linear deviations and patient‐reported outcomes collected with a questionnaire. Results: Data from 12 patients were available for analysis. Angular deviation was significantly lower using stereolithographic guides as compared to conventional guides (2.2 ± 1.1° vs. 3.5 ± 1.6°, p =.042). Linear deviations were similar for both techniques in the coronal (2.34 ± 1.01 vs. 1.93 ± 0.95 mm) and apical (2.53 ± 1.11 vs. 2.19 ± 1.00 mm) dimensions (p ˃.05). The selection of the surgical technique had no significant impact on the patient‐reported outcomes. Conclusion: Our data suggest that the angular discrepancy between the virtual and the clinical implant position is slightly lower when using stereolithographic guides as compared to conventional guides. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to evaluate whether the use of a xenograft is not inferior to the use of xenograft and autogenous bone chips in treating dehiscences at implant placement. Materials and Methods: After implant placement, leaving a dehiscence, control sites were treated using a composite graft (autogenous bone chips and xenograft) and at the test sites 100% xenograft was used. Both sites were covered with a resorbable collagen membrane. Dehiscences were measured clinically at implant placement and at re‐entry. CBCT was taken immediately after implant placement and after 4 months. Results: In total, 28 GBR procedures were performed in 14 patients. On average, the change in vertical defect height was 2.07 mm (46.7%—test group) and 2.28 mm (50.9%—control group) (p >.05). The horizontal defect width at the implant shoulder change on average 1.85 mm (40.5%—test group) and 1.75 mm (40.9%—control group) (p >.05). On average, a loss in augmentation thickness of 0.45 mm (68.9%—test group) and 0.64 mm (55.5% control group) between implant placement and augmentation and abutment surgery was obtained at the implant shoulder. Conclusion: Both treatment modalities seem to work to a certain extent. At implant shoulder level, the augmentation thickness seems to be disappeared after the healing phase. (NCT03946020). [ABSTRACT FROM AUTHOR]

Aim: To examine the adjunctive effect of a Lactobacillus reuteri probiotic (ATCC PTA 5289 & DSM 17938) on the re‐instrumentation of residual pockets. Materials and Methods: This randomized, double‐blind, placebo‐controlled study included 39 previously non‐surgically treated periodontitis patients. A re‐instrumentation was carried out, and probiotic and/or placebo drops were applied according to the study protocoll. Patients afterwards received lozenges to use 2×/day for 12 weeks. Probing pocket depth (PPD), recession, bleeding on probing and plaque levels were analysed, next to the microbiological impact. Results: No effects of the probiotic drops could be found. However, after 24 weeks, the overall PPD in the probiotic lozenges group (2.64 ± 0.33 mm) was significantly lower compared to the control lozenges (2.92 ± 0.42 mm). This difference was even more pronounced in moderate (4–6 mm) and deep (≥7 mm) pockets. In the probiotic lozenges group, there were also significantly more pockets converting from ≥4 mm at baseline to ≤3 mm at 24 weeks (67 ± 18% versus 54 ± 17%) and less sites in need for surgery (4 ± 4% versus 8 ± 6%). However, the probiotic products did not influence the microbiological counts of the periodontopathogens. Conclusion: The adjunctive consumption of L. reuteri lozenges after re‐instrumentation improved the PPD reduction, without an impact on pocket colonization with periodontopathogens. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the long term root coverage outcomes of coronally advanced flap plus a connective tissue graft with (CAF + CTG) or without an epithelial collar (CAF + ECTG), and evaluate the adjacent treated sites included in the flap. Methods: Seventeen of the original 20 subjects included in the randomized clinical trial were available at 12 years (43 sites). Mean root coverage (mRC), keratinized tissue width (KTW), gingival thickness (GT) on the grafted and adjacent sites were evaluated and compared with baseline and 6 months. Result: There was a reduction in the mRC at all sites: 16.52% in the CAF + CTG (p > .05), 19.42% in the CAF + ECTG (p < .05) and 34.12% in the CAF‐alone (adjacent treated sites) group (p < .05). No significant differences were observed within the groups for changes in KTW, GT and clinical attachment level (CAL) (p > .05). Keratinized tissue width at baseline and at 6 months was found to be predictors for the stability of the gingival margin in the long term. Conclusions: CAF + CTG and CAF + ECTG were found equally efficacious in maintaining the levels of the gingival margin with a small amount of relapse over the period of 12 years while CAF‐alone sites showed a greater gingival recession (GR) reoccurrence. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this randomized clinical trial was to assess the aesthetical and clinical outcomes of acellular dermal matrix graft (ADMG) plus coronally advanced flap (CAF) with vertical incisions or the envelope flap in the treatment of thin phenotype, multiple‐recession defects. Material and Methods: Twenty‐two participants with 55 class recession type 1 (RT1) with a depth of ≥3 mm were investigated. Control group was treated with ADMG plus conventional CAF with vertical releasing incisions, whereas test group received the envelope flap with ADMG. Primary outcome variables were complete root coverage (CRC), root coverage aesthetic score and patient satisfaction. Results: Tooth‐based CRC was observed in 23 of the 28 recession defects in mCAF + ADMG group (82.1%), whereas in 19 of the 27 recession defects in CAF + ADMG group (70.37%), with no inter‐group difference (p > .05). CRC was observed in 9 of the 11 patients in mCAF + ADMG group (81.8%). On the other hand, in CAF + ADMG group, CRC was achieved in 8 of the 11 patients (72.7%). Results were similar between the groups (p > .05). Conclusions: Both techniques were successful in the management of multiple recessions; however, superior results regarding patient's satisfaction were achieved with mCAF + ADMG. [ABSTRACT FROM AUTHOR]

Introduction: There are mixed results regarding the aesthetic advantage of immediate provisionalization of dental implants. Therefore, this study aimed to compare facial mucosal level of single immediately placed implants with and without immediate provisionalization. Methods: Single implants were immediately placed to replace a hopeless maxillary anterior or premolar tooth in 40 subjects. Each implant was randomly assigned to receive a non‐occluding temporary crown or a healing abutment after implant placement. At 4 months, these implants were permanently restored and followed up for 12 months. Clinical and radiographic parameters were measured and compared. Results: The implant survival rate at 12 months in the test and control group was 90% and 100%, respectively. Mid‐facial mucosal marginal level and papilla height changes were minimal within groups, and no significant differences were found between the two groups. The amount of marginal bone remodelling was modest, with no significant difference between the two groups. Radiographic bone changes were not statistically different between the groups, except for the vertical crestal bone resorption. Conclusion: Immediate implant placement with or without provisionalization can achieve stable vertical soft tissue level for 12 months as compared to pre‐extraction level. However, immediate provisionalization was not able to improve the aesthetic outcome further. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the long‐term outcomes of Acellular Dermal Matrix (ADM) with Coronally Advanced Flap (CAF) or Tunnel technique (TUN) in the treatment of multiple adjacent gingival recessions (MAGRs). Material and methods: Nineteen of the original 24 patients contributing to a total number of 33 sites for CAF and 34 for TUN were available for the 12 years follow‐up examination. Recession depth, mean root coverage (mRC), keratinized tissue width (KTW), gingival thickness (GT) were evaluated and compared with baseline values and 6‐months results. Regression analysis was performed to identify factors related to the stability of the gingival margin. Results: A highly significant drop in mRC was observed for both groups from the 6 months timepoint to the 12 years recall (p < .001). While there were no statistically significant differences between the two groups in terms of Clinical Attachment Level (CAL), KTW, GT changes and Root Coverage Esthetic Score at each timepoint (p > .05). KTW ≥ 2 mm and GT ≥ 1.2 mm at 6‐months were two predictors for stability of the gingival margin (p = .03 and p = .01, respectively). Conclusions: A significant relapse of the gingival margin of MAGRs treated with CAF or TUN + ADM was observed after 12 years. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy of a 0.03% chlorhexidine and 0.05% cetylpyridinium chloride mouth rinse, as an adjunct to professionally and patient‐administered mechanical plaque removal, in the treatment of peri‐implant mucositis (PiM). Material and Methods: Patients displaying PiM in, at least, one implant were included in this randomized, double‐blinded, clinical trial. Subjects received professional prophylaxis (baseline and 6 months) and were instructed to regular oral hygiene practices and to rinse, twice daily, with the test or placebo mouth rinses, during one year. Clinical, radiographic and microbiological outcomes were evaluated at baseline, 6 and 12 months. Disease resolution was defined as absence of bleeding on probing (BOP). Data were analysed by repeated measures ANOVA, Student's t and chi‐square tests. Results: Fifty‐four patients were included and 46 attended the final visit (22 in control and 24 in test group). In the test group, there was a 24.49% greater reduction in BOP at the buccal sites (95% confidence interval [3.65–45.34%]; p = 0.002) than in controls. About 58.3% of test implants and 50% controls showed healthy peri‐implant tissues at final visit (p > 0.05). Conclusions: The use of the test mouth rinse demonstrated some adjunctive benefits in the treatment of PiM. Complete disease resolution could not be achieved in every case. [ABSTRACT FROM AUTHOR]

Aim: To compare the clinical outcomes of ≤6 mm extra‐short implants (test group) versus ≥10 mm long implants (control group), with and without bone augmentation procedures. Materials and Methods: A systemic literature search of randomized clinical trials was performed using the PubMed (MEDLINE) and EMBASE databases. A quantitative meta‐analysis was conducted to compare all the outcome variables. Meta‐regression analysis determined the effect of bone augmentation procedures and the influence of other clinical covariates on the results. Results: Eighteen studies comprising 1,612 implants (793 extra‐short and 820 long implants) were selected for the meta‐analysis. No statistically significant difference in the survival rate was observed at 1 and 3 years (p > 0.05). Extra‐short implants displayed less marginal bone loss (MBL) from both implant placement time points (1 and 3 years) and prosthetic placement (1 year), as well as less biological complications, surgical time and treatment cost (p < 0.05). Contrarily, a statistically significant small number of prosthetic complications were reported with long implants (p < 0.05). Conclusions: Placement of extra‐short implants (≤6 mm) presented as an equivalent option in the treatment of patients with an atrophic posterior arch up to 3‐year follow‐up. However, the long‐term effectiveness of extra‐short dental implants remains to be further studied. [ABSTRACT FROM AUTHOR]

Aim: This randomized placebo‐controlled clinical trial evaluated the effect of Bifidobacterium animalis subsp. lactis (B. lactis) HN019‐containing probiotic lozenges as adjuvant to scaling and root planing (SRP) in patients with generalized chronic periodontitis. Materials and Methods: Forty‐one chronic periodontitis patients were recruited and monitored clinically, immunologically, and microbiologically at baseline (before SRP) and 30 and 90 days after SRP. All patients were randomly assigned to a Test (SRP + Probiotic, n = 20) or Control (SRP + Placebo, n = 21) group. The probiotic lozenges were used twice a day for 30 days. The data were statistically analysed. Results: The Test group presented a decrease in probing pocket depth and a clinical attachment gain significantly higher than those of the Control group at 90 days. The Test group also demonstrated significantly fewer periodontal pathogens of red and orange complexes, as well as lower proinflammatory cytokine levels when compared to the Control group. Only the Test group showed an increase in the number of B. lactis HN019 DNA copies on subgingival biofilm at 30 and 90 days. Conclusion: The use of B. lactis HN019 as an adjunct to SRP promotes additional clinical, microbiological, and immunological benefits in the treatment of chronic periodontitis (NCT03408548). [ABSTRACT FROM AUTHOR]