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Background Methods Results Conclusion Key Points Plain Language Summary Betel leaf chewing habit has been studied extensively, as it has been an ancient practice in many Asian countries. Although betel leaf has been reported to have potential beneficial properties, it has also been shown to have a strong association with oral diseases, including periodontitis. This case series addresses the presentation of periodontitis among betel quid users, to help clinicians identify and manage such patients when they are encountered in settings outside the countries and territories where betel quid use is common.Four patients of Asian ethnicity were referred to The Ohio State University College of Dentistry Graduate Periodontology clinic for periodontal treatment. Targeted questioning resulted in all four patients reporting a past and current betel leaf chewing habit, established at a young age, typically in a family setting, and long before their immigration from their native country.All four patients exhibited similar reddish‐brown staining on the teeth and generalized radiographic bone loss. Notably, the patients disclosed the betel chewing habit only after different vernacular names for betel quid were used during questioning, which complicated history taking. Severe periodontitis (stage III/IV, grade C) was diagnosed in all four patients, who were given appropriate periodontal treatment plans.Betel leaf chewing, prevalent in many Asian countries, is associated with periodontitis and may present with extensive tooth staining. Oral healthcare providers should consider this cultural habit and pursue thorough assessment and history taking for their patients originating from countries where the habit is common practice. Clinicians should be aware of the clinical presentation and oral findings in betel quid users. Given the increasing diversity of the patient pool that clinicians are encountering, knowledge of vernacular names for betel quid usage can prove valuable in history taking. A protocol for betel quid cessation should be incorporated into the management strategy for these patients in clinical practice. Clinicians should be aware of the clinical presentation and oral findings in betel quid users.Given the increasing diversity of the patient pool that clinicians are encountering, knowledge of vernacular names for betel quid usage can prove valuable in history taking.A protocol for betel quid cessation should be incorporated into the management strategy for these patients in clinical practice.Betel quid (paan) chewing is a widespread cultural habit, especially in Asia. The chewing of betel quid, whether alone or with tobacco, has been strongly associated with periodontitis and other oral conditions, such as leukoplakia, oral cancer, and oral submucous fibrosis. This report illustrates the typical presentation of periodontitis patients who habitually chew betel quid, highlights the associated clinical features, such as reddish‐brown tooth staining and severe bone loss, and underlines the challenge of obtaining a complete history because of the very many vernacular names used for betel quid in different countries and the fact that for many of the patients, this is considered a routine cultural tradition. It is unusual to encounter patients chewing betel quid in this country because the practice is not common. However, immigrants from countries where betel quid chewing is commonplace may continue the habit after they move to the United States. Oral healthcare providers should be aware of this possibility and elicit the relevant information from the patients. This will help practitioners to properly address this underlying factor and to provide appropriate care to these patients, including cessation advice and support, and establishment of routine oral screenings and regular periodontal maintenance. [ABSTRACT FROM AUTHOR]

Background: This randomized controlled trial was aimed to evaluate the combined efficacy of injectable platelet‐rich fibrin (i‐PRF) and scaling and root planing (SRP) in type 2 diabetes mellitus subjects having periodontitis. Methods: Twenty‐six Stage III, grade C periodontitis subjects (HbA1c > 7) were recruited in this split‐mouth study. Following SRP, the test sites received subgingival application of i‐PRF, while the control sites received saline. Plaque index, bleeding on probing, modified gingival index, probing pocket depth (PPD) and clinical attachment level (CAL) were measured at baseline, 3 and 6 months. Results: Twenty‐three participants completed the course of research. The Friedman test followed by Dunn's post hoc test, revealed significant improvement in all the clinical parameters from baseline to 3 and 6 months in both the study groups (p ≤ 0.05). The mean PPD and CAL decreased from 6.30 ± 1.25 and 7.48 ± 1.75 at baseline to 3.48 ± 1.34 and 4.39 ± 1.67 at 6 months in control sites and from 6.57 ± 1.56 and 7.61 ± 1.69 to 3.39 ± 1.23 and 4.26 ± 1.81 at 6 months in test sites (p ≤ 0.0001). Intergroup analysis found no statistical significant differences in the evaluated parameters across all time intervals (p > 0.05) Conclusion: The results indicated that the adjunctive application of i‐PRF to SRP provided similar benefits as saline and SRP in diabetes mellitus subjects. Key points: Question: To find the combined efficacy of injectable platelet‐rich fibrin (i‐PRF) along with scaling and root planing (SRP) in the management of periodontal pockets of Stage III and Grade C periodontitis patients having Type 2 Diabetes Mellitus (T2DM).Finding: All of the treated sites showed satisfactory healing. Both the treatment modalities (i‐PRF + SRP and Saline + SRP) were effective in the treatment of periodontal pockets. At 3 and 6 months, there were no significant differences in periodontal parameters between groups.Meaning: The application of i‐PRF as an adjunct to SRP provided similar benefits as saline and SRP in improving clinical parameters in subjects with stage III and grade C periodontitis patients having T2DM (HbA1C > 7). [ABSTRACT FROM AUTHOR]

Background: This 6‐month randomized split‐mouth and placebo‐controlled clinical trial aimed to evaluate the clinical and radiographic efficacy of adjunctive use of 0.05% zoledronate (ZLN) gel as local drug delivery to scaling and root planing (SRP) in stage III, grade B periodontitis patients with and without controlled type‐2 diabetes mellitus (DM). Methods: A total of 120 infrabony sites were divided into two groups: Group‐1 (non‐diabetic periodontitis) and Group‐2 (periodontitis + DM). A total of 60 sites in each group were randomized to receive treatment with SRP + placebo gel (control) or SRP + 0.05% ZLN gel (test). Plaque index (PI), modified sulcus bleeding index (mSBI), pocket probing depth (PPD), and relative attachment levels (RAL) were assessed at baseline, 3 and 6 months, and digital intraoral periapical and cone‐beam computed tomography imaging were used to measure the linear and percentage reduction of intrabony defect depth (DD, DDR%) after 6 months. Results: Group‐1 showed significant reduction in PI (0.56 ± 0.15 and 0.52 ± 0.19 from 0.67 ± 0.17), mSBI (0.7 ± 0.60 and 0.47 ± 0.57 from 0.9 ± 0.48), PPD (4.6 ± 0.85 and 3.43 ± 0.63 from 6.5 ± 1.04) and gain in RAL (7.03 ± 0.85 and 5.93 ± 0.69 from 8.9 ± 1.09) in the ZLN‐treated sites than the placebo sites and also from Group‐2 sites after 3 and 6 months, respectively. A significant reduction in DD of 28.79% in Group‐1 and 22.20% in Group‐2 at ZLN sites was seen compared to placebo sites of both groups. Conclusion: ZLN gel applied subgingivally in infrabony pockets resulted in significant clinical improvements evident by probing depth reduction and gain in attachment levels along with radiographic evidence of more bone fill seen in non‐diabetic patients compared to diabetic periodontitis patients. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Key points Plain language summary Periodontitis is one of the most prevalent oral diseases with significant implications for systemic health. This study aims to explore themes influencing successful long‐term outcomes in periodontal treatment through a historical lens, focusing on various factors influencing the longevity of periodontal health and dentition stability.Utilizing an inductive qualitative thematic analysis approach, this study utilized a retrospective chart review of 19 patient records spanning, on average, 40 years.Four major themes contributing to periodontal stability were identified: (1) adequate patient plaque control; (2) regular periodontal maintenance; (3) collaboration between hygienists and periodontists; and (4) the application of various periodontist/dentist‐performed procedures.Current findings underscore the importance of these factors in preserving patients’ periodontal health by emphasizing conservative treatment approaches in the maintenance and retention of the natural dentition. Adequate patient plaque control is essential for maintaining a patient's periodontal health and dentition long‐term. A regular periodontal maintenance schedule should be assigned and modified as necessary for each individual patient's care. Collaborative care with hygienist colleagues and ensuring there are flexible treatment options for patients can lead to successful treatment outcomes when hygiene alone is not sufficient. Adequate patient plaque control is essential for maintaining a patient's periodontal health and dentition long‐term.A regular periodontal maintenance schedule should be assigned and modified as necessary for each individual patient's care.Collaborative care with hygienist colleagues and ensuring there are flexible treatment options for patients can lead to successful treatment outcomes when hygiene alone is not sufficient.Periodontitis is a widespread oral disease with significant systemic health implications. This study examined patient records to identify factors contributing to long‐term periodontal stability and maintenance of teeth. By analyzing 19 patient charts over an average of 40 years using a qualitative approach, four key themes were identified in successful patient treatments: effective patient plaque control, regular periodontal maintenance, collaboration between dental hygienists and periodontists, and the addition of other approaches by periodontists and dentists when necessary. The study underscores the importance of these factors in preserving periodontal health and retaining natural teeth with conservative treatment approaches. This research highlights the critical role of sustained, multifaceted dental care and professional collaboration in achieving successful long‐term oral and systemic health outcomes. [ABSTRACT FROM AUTHOR]

Background: Necrotizing periodontitis (NP) is a rare form of periodontal disease. It can manifest in immunocompromised patients and present as painful and rapidly progressing destruction with necrotic and ulcerated periodontal tissues. This case report describes a rare case of severe NP in human immunodeficiency virus (HIV)‐positive patient including medical management and periodontal treatment. Methods: A 28‐year‐old male presented to the periodontal clinic with chief complaint of severe oral pain leading to loss of chewing ability, spontaneous gingival bleeding, generalized gingival recession, tooth mobility, and dentinal hypersensitivity. Clinical and radiographic examination revealed generalized tissue necrosis with severe periodontal destruction, extensive bleeding, spontaneous suppuration, and heavy biofilm. Results: Medical history was positive for perinatal HIV infection, which was treated and patient was asymptomatic until he discontinued antiviral medications nine years ago. Following initial examination, patient was referred to the Infectious disease clinic and multidisciplinary management was initiated with comprehensive management of primary disease including systemic antiviral, antibiotic, and antifungal therapy to establish immunocompetence compatible with providing mechanical nonsurgical periodontal treatment. Conclusions: This case report highlights a severe and generalized form of NP in an HIV patient due to the cessation of antiviral therapy. Favorable course of interdisciplinary medical and periodontal therapy resulted in significant improvement in patient's systemic, oral, and periodontal health. [ABSTRACT FROM AUTHOR]

Background: With the entire papilla preservation (EPP) technique, it is possible to perform regenerative therapy without incisions in the interdental papilla and to reduce the risk of papillary rupture. However, one limitation of the EPP is the sole access from the buccal side. Here, we present a case of periodontitis treated by the combination regenerative therapy employing the Double‐sided (buccal‐palatal) EPP (DEPP) technique, which adds a palatal vertical incision to the EPP. Methods: A patient with 1–2 wall intrabony defects received the regenerative therapy using recombinant human fibroblast growth factor (rhFGF)‐2 and carbonate apatite (CO3Ap). Using the DEPP technique, vertical incisions at buccal and palatal aspects were placed to gain adequate access to the 1–2 wall intrabony defects between #11 and #12 without incision in the interdental papilla. After debridement, rhFGF‐2 and CO3Ap were applied to the defect. Periodontal clinical parameters and radiographic images were evaluated at the first visit, following initial periodontal therapy (baseline), 6, 9, and 12 months postoperatively. Results: Wound healing was uneventful. Scarring of the incision lines was minimal. At 12 months postoperatively, probing depth reduction was 4 mm, clinical attachment gain was 4 mm, and gingival recession was not observed. An improvement in radiopacity in the previous bone defect was observed. Conclusion: The DEPP is an innovative technique that allows approaching from both the buccal and palatal sides while ensuring flap extensibility without compromising the interdental papilla. This report suggests that the combination of regenerative therapy with the DEPP may be promising in the treatment of intrabony defects. Key points: Why is this case new information?The DEPP allows a direct visual approach to a 1–2 wall intrabony defect extending from the buccal to palatal sides, and increases flap extensibility, without compromising the papilla. What are the keys to the successful management of this case?Assessment of three‐dimensional bone defect morphology is required. Computed tomography images are very useful. The flap elevation just under the interdental papilla should be carefully performed with a small excavator to avoid damage to the interdental papilla. What are the primary limitations to success in this case?Despite the addition of a palatal incision, it was not possible to obtain complete flexibility of the palatal gingiva. Caution must be taken in a case in which the distance between the interdental papilla is narrow. Even if the interdental papilla is ruptured during the operation, recovery is possible by continuing the operation and suturing the rupture at the end. [ABSTRACT FROM AUTHOR]

Background: Successful periodontal therapy can lead to poor esthetic results, especially in the anterior region, for which there are treatment options such as direct composite or indirect veneer restorations. Until now, there are no data describing the long‐term results of veneer restorations in periodontally treated patients. The aim of this retrospective study was to evaluate the outcome of anterior porcelain veneer restorations in periodontally compromised and noncompromised patients. Methods: Periodontally healthy and periodontally compromised patients, who had received anterior veneer restorations at least 5 years ago, were invited to a follow‐up examination. Groups were divided according to their periodontal diagnosis (periodontally healthy, stage I/II, stage III/IV). Tooth loss, veneer loss, biologic parameters, and complication rates were examined. Also, veneers were evaluated according to modified United States Public Health Service criteria. Results: A total of 68 patients with 312 veneers were examined with a mean follow‐up time of 8 years. Veneered teeth in patients with periodontitis stage III/IV showed no difference regarding tooth‐specific, overall, and functional veneer survival when compared to periodontally healthy patients (Kaplan–Meier analyses). In Cox regression analysis, follow‐up time had an impact on complications and veneer loss, whereas periodontal diagnosis showed no significant influence on the survival of restorations. Comparative tests showed that patients with severe periodontitis at baseline have slightly lower veneer survival rates after 8 years and slightly higher complication rates after 13 years. Conclusion: Long‐term results and complication rates of veneer restorations in periodontally compromised patients are comparable to periodontally healthy patients over a mean follow‐up of 8 years. [ABSTRACT FROM AUTHOR]

Background: Pathological root resorption affects permanent teeth and is usually triggered by infectious‐inflammatory stimuli and/or dental trauma. Periodontitis and traumatic occlusion have been reported as possible causative factors of root resorptions, whilst the impact of systemic diseases is less well understood. This case highlights the need for consideration of multiple risk factors, especially when presenting in combination. Methods and Results: A 62‐year‐old South Asian female presented with unstable Stage IV Grade C periodontitis, poor oral hygiene and multiple autoimmune conditions including oral lichen planus. Clinical and radiographic examination revealed multiple advanced apical and external root resorptions of the patient's molars associated with periapical bone loss, despite of a minimally restored dental status. Conclusion: A likely etiology of this patient's multiple root resorptions is the presence of unstable periodontitis with periodontal‐endodontic lesions, exacerbated by a dysbalanced immune response to infectious agents. Appropriate monitoring and managing of such patients can prevent or limit the pathological process of inflammatory root resorption. Key points: Why is this case new information?This is the first report documenting advanced multiple external inflammatory root resorptions in a periodontitis patient with oral and systemic co‐morbidities. What are the keys to successful management of this case?Early diagnosis, prevention and intervention to limit periodontal inflammation, endodontic infection and occlusal trauma. What are the primary limitations to success in this case?Late diagnosis of multiple root resorptions, palliative periodontal treatment due to poor oral hygiene compliance, and poorly controlled systemic inflammation favoring the persistence of a dysregulated immune response to the oral microbiota. [ABSTRACT FROM AUTHOR]

Background: Probiotics are viable microorganisms, which if delivered in appropriate dose can provide health benefits. Lactobacillus reuteri (DM17938+ATCC PTA 5289) has been recommended as a safe choice for probiotics. The objective of this study is to compare the improvement in the periodontal parameters amongst smokers with generalized periodontitis with Stage III, Grade C treated with nonsurgical periodontal treatment (NSPT) to which either an antibiotics or probiotics were given as an adjuvant. Methods: Sixty smokers with Stage III, Grade C generalized periodontitis were randomized in two groups after taking informed consent. Periodontal parameters including bleeding on probing (BOP), probing depth (PD), attachment loss (AL), gingival index (GI), and plaque index (PI) were recorded. Group 1 received (after NSPT and oral hygiene instructions) amoxicillin and metronidazole for 7 days and a placebo for probiotics for 30 days. Group 2 was provided (after NSPT and oral hygiene instructions) with one tablet of Lactobacillus reuteri probiotics (2 × 108 CFU) twice daily for 30 days and placebo antibiotics for 7 days. The periodontal parameters were recorded again at 1‐ and 3‐month follow‐ups as outcome variables. Mean, standard deviation, and confidence interval were reported using SPSS 20.0. Results: A statistically significant clinical improvement in the PD, BOP, PI, and GI were observed in both the groups at 3‐month follow‐up. However, the AL remained unchanged in both the groups. Conclusions: Administration of probiotics and antibiotics along with NSPT yield statistically significant differences in PD and BOP from baseline to 3‐month follow‐up. However, between the group differences were not statistically significant for the periodontal parameters (AL, PD, and BOP). [ABSTRACT FROM AUTHOR]

Background: Reports from a large‐scale, prospective, masked, randomized controlled clinical trial demonstrated gain in attachment level, linear bone gain, and percentage bone fill in infrabony defects treated with recombinant human platelet‐derived growth factor‐BB (rhPDGF‐BB) and β‐tricalcium phosphate (β‐TCP) at 6 months. A follow up to that trial at 24 months showed the results were stable in terms of gain in clinical parameters, and assessment of selective cases demonstrated stability at 5 years. The cases presented in this report provide clinical applications to support the use of this biologic in complex infrabony defects. An infrabony defect is described as a periodontal pocket with its base apical to the crest of the alveolar bone. Infrabony defects may have one, two, or three bony walls creating challenges in management. Methods: Two complex infrabony defect cases are presented in this report: one using rhPDGF‐BB with β‐TCP and the other using rhPDGF‐BB with freeze‐dried bone allograft (FDBA) and a resorbable barrier membrane. The techniques are described with results showing long‐term follow up and reentry at 8 and 14 years (respectively). Results: Both cases demonstrate significant gains in clinical attachment levels as well as bone‐like fill as observed radiographically and at reentry. Conclusions: These case reports of combining rhPDGF‐BB with β‐TCP or with FDBA and a barrier membrane support the literature showing improvement in attachment levels and demonstrating bone fill in complex infrabony defects. The results can be maintained long term. [ABSTRACT FROM AUTHOR]

Background: The purpose of this review was aimed at providing the rationale supported with a series of cases to apply biologics to enhance orchestrating the healing process at implant removal sites. Summary: Implant removal is commonly applied on a daily basis, in particular, in cases that exhibit esthetic failures linked to inadequate implant position or in cases of advanced peri‐implantitis. Implant removal sites differ substantially from tooth extraction sockets. Implants are ankylosed within the alveolar bone, which therefore have neither mechanoreception nor the elasticity provided by periodontal ligament fibers. As a result, the bone‐to‐implant contact must be disrupted by means of using a reverse‐torque device to minimize trauma. It is possible that the surrounding bone provides limited vascularity, which may interfere with the healing and bone forming process within the socket. Therefore, the use of biologics may enhance this healing and accelerate bone formation in sites where implants are removed due to hopeless functional or esthetic prognoses. Conclusion: The use of biologics, in particular autologous blood‐derived products, may enhance and boost the healing process to potentiate bone availability at a later stage during implant placement. [ABSTRACT FROM AUTHOR]

Introduction: Necrotizing periodontitis (NP) is an atypical and painful form of periodontal disease, it is described by a promptly progress of ulceration and destruction of periodontal tissues; the NP is commonly linked to HIV‐positive patients. The aim of this report is to present a rare case of severe necrotizing ulcerative periodontitis treated non‐surgically. Case Presentation: A 28‐year‐old dark skin female patient was referred to a dentistry college with the main complaint of spontaneous gingival bleeding and enlargement, oral pain during deglutition and dental hypersensitivity. Clinical and radiographic examination revealed generalized severe periodontal destruction, extensive bleeding, increased biofilm presence and spontaneous suppuration. Medical exams were requested, red and white blood cells were evaluated and among those exams an enzyme‐linked immunosorbent assay for HIV‐1 antibodies, the result reveled reagent to HIV‐1. The diagnosis of NP was assigned based on periodontal parameters such as necrosis and ulceration of the coronal portion of interdental papillae and gingival margin. Treatment established was scaling and root planning plus antibiotics. At 3 months of treatment the clinical and periodontal condition were stable. Conclusion: This case report highlights a severe and generalized form of NP, where periodontal non‐surgical associated with antimicrobials resulted in elimination of the gingival enlargement, necrosis and ulceration of the coronal portion of interdental papillae and significant improvement of periodontal parameters. [ABSTRACT FROM AUTHOR]

Introduction: Maturity onset diabetes of the young (MODY) is a rare form of diabetes mellitus resulting from single nucleotide polymorphisms. There is a lack of evidence describing their periodontal condition and the management of these patients. The objective of this case report is to present the 6‐month outcomes following non‐surgical periodontal treatment of a patient diagnosed with MODY 5, the Renal Cyst and Diabetes Syndrome. Case Presentation: This case report describes the periodontal presentation and non‐surgical management of a 21‐year‐old patient, diagnosed with hyperglycemia (HbA1c >14%) and stage 4 chronic kidney disease. She presented with generalized severe chronic periodontitis and multiple periodontal abscesses. She was treated with quadrant debridement with adjunctive systemic amoxicillin and metronidazole and 0.2% chlorhexidine mouth rinse. Significant improvement was observed after treatment, remaining stable 6‐month post‐treatment, with only two sites with probing depths ≥5 mm. This was consistent with a reduction of the periodontal inflamed surface area from 3165 to 500 mm2. HbA1c was also reduced to 8.7% 6 months after treatment. Conclusions: MODY patients presenting with periodontitis can be successfully treated non‐surgically, concurrent with diabetic management. [ABSTRACT FROM AUTHOR]

Introduction: How to best classify the Stage III and IV periodontitis cases that share common features of the most severe clinical attachment loss and the most severe radiographic bone loss? Case Presentation: Two patients presented features of generalized periodontitis, with severe probing depth and clinical attachment loss that would meet inclusion in both Stage III and IV. The cases retained all teeth but were further complicated by teeth drifting and secondary occlusal trauma. Appropriate disease classification required clinical judgement and led to the final classification of Stage III, Grade C for both cases. Conclusion: Patient‐based clinical judgement, aiming for long‐term preservation of natural dentition, drives the final assignment of staging when the case falls in the "gray zone" that focuses on major differences in Stage III and IV periodontitis. [ABSTRACT FROM AUTHOR]

Focused Clinical Question: After a quick overview on the original principles of guided periodontal regeneration (GTR), the aim of this paper focuses on the advantages of minimally invasive surgical techniques for periodontal regeneration/reconstruction. The specific clinical question to answer is: Are there new clinical parameters useful to choose the best minimal invasive surgery approach for each periodontal defect? An update of the decision trees is to propose after highlighting some clinical parameters deemed relevant for the choice of the most suitable minimally invasive surgical approach and which therefore are considered by us having a place in the new decision trees. Summary: Starting from the paper of Evian dated 1985 until that of Aslan in 2017, we have analyzed the minimal periodontal surgical techniques proposed for the periodontal regeneration. In addition to the parameters set in the various flowcharts, we have highlighted the following additional parameters: papilla height loss; supra bone component of the defect; Δ Bone Sounding; width of keratinized tissue. Conclusion: The decision‐making chart improved with the new clinically relevant factors may serve as a useful guideline for dentists, but to definitively validate it, further studies need to be developed in the future. In order to clarify the proposed flow chart, the authors present two different clinical cases. [ABSTRACT FROM AUTHOR]

Introduction: Staging and grading for chronic periodontal disease, as described in 2018, is designed to focus on key distinctions with the recognition that there is a subset of individuals who are on a different clinical trajectory of disease. The staging and grading framework aids the clinician in generating a periodontal diagnosis, however, some cases fall into gray zones in which the simple diagnostic parameters make it challenging to categorize the patient. These cases do not present with clear clinical findings and medical and dental histories that fit within the simple guidelines defined in the staging and grading tables and subsequent algorithms. Case Presentation: Two cases are presented and demonstrate typical clinical scenarios that fall into gray zones when it comes to differentiating whether the patient will respond predictably to standard principles of care. Case 1 presents a scenario in which the patient's early history suggests the potential for disease progression and increases the likelihood that the patient may develop a need for complex rehabilitation due to periodontal breakdown. Clinical judgment was used to evaluate whether the patient remained at elevated risk and the potential implications for disease progression. Case 1 was diagnosed with generalized Stage III, Grade B. The initial presentation of Case 2 had a higher severity and complexity and therefore was diagnosed with generalized Stage IV, Grade C. The need for complex rehabilitation in Case 2, however, was not primarily due to periodontitis. Conclusion: Decision guidelines and algorithms help in establishing a standardized diagnosis, however cases that fall into gray zones require clinical judgment to establish the most appropriate diagnosis to guide a treatment plan that is personalized based on current knowledge. [ABSTRACT FROM AUTHOR]

Focused Clinical Question: What are the fundamental debates and questions related to the newly developed two‐vector system for classification of periodontal diseases that have emerged as to how to accurately assign, stage, and grade periodontitis cases? The aim of the present manuscript is to demonstrate the essential thought processes that are needed in utilizing the new periodontitis classification system to diagnose two gray zone cases. Summary: Clinical case 1 includes an 83‐year‐old male diagnosed with periodontitis and classified as Stage III Generalized Grade B periodontitis, while clinical case 2, a 73‐year‐old male was classified as presenting Stage IV Generalized Grade B periodontitis. Although clinical and radiographic evaluations revealed similarities between the cases, the thought process that includes clinical judgment is described to guide a more accurate diagnosis following the guidelines of the new classification system. Conclusion: The two cases demonstrated here offer an opportunity for clinicians to recognize the essential role of sound clinical judgment in certain cases when applying the new periodontal disease classification system and also clarify questions emerging from implementing this classification system. [ABSTRACT FROM AUTHOR]

Introduction: Dermatomyositis is an uncommon inflammatory disease marked by muscle and joint weakness with skin rash. Dermatomyositis affects adults and children, with higher prevalence for females aged 40 to 60 years. Most common oral lesions include mucosal edema, erythema, and telangiectasia. Case Presentation: A 51‐year‐old white female with an unremarkable medical history presented for periodontal evaluation in 2010. She reported a 6‐month history of gingival inflammation and skin irritation on her hands and a rash on the center of her chest and forehead. Other complaints included fatigue, hot flashes, decreased appetite, and weight loss. Periodontal examination revealed generalized acute marginal erythema, with localized slight incipient bone loss. Oral hygiene was deemed good to fair. Oral hygiene instructions were reviewed and a prescription for chlorhexidine gluconate was given. The patient was then referred to an allergist and dermatologist where a diagnosis of dermatomyositis was made. After the initial diagnosis, localized scaling and root planing was performed using local anesthetic. The patient was managed medically using prednisone, mycophenolate mofetil, and methotrexate and a 3‐month periodontal maintenance recall interval. The patient remained stable over an 8‐year period. Conclusions: Dermatomyositis is an uncommon inflammatory disease that requires medical and dental teams for proper diagnosis and management. Although the condition is chronic in nature with no definitive cure, signs, and symptoms can be managed with steroids and immunosuppressants to delay progression of the disease and improve quality of life for the patient. [ABSTRACT FROM AUTHOR]

Introduction: Glycogen storage diseases (GSD) are genetic metabolic disorders of glycogen metabolism. There are >15 types based on the enzyme deficiency and the affected organ. Glycogen storage disease Type Ib is the only type associated with neutropenia and periodontitis. This type is caused by a deficiency of glucose‐6‐phosphate (G6P) translocase which prevents the transport of G6P across the endoplasmic reticulum. As a result, glycogen cannot be metabolized into glucose with its subsequent accumulation in tissues. The affected organs involved in Type Ib are the liver, kidney, and intestine. Case Presentation: A 5‐year‐old Jordanian boy from a consanguineous family referred to the periodontal clinic in February 2014 with an established diagnosis of GSD‐Ib. The systemic manifestations include hepatomegaly, hypoglycemia, hyperprolactenemia, inflammatory bowel disease, osteoporosis, and neutropenia. Oral manifestations include severe gingival inflammation and recurrent oral ulceration disease. Conclusions: The clinical signs and symptoms of periodontal disease in GSD Type Ib are similar to those found in patients diagnosed with neutropenia. Future studies are needed to clarify whether severe generalized inflammation of the gingiva in children is part of the GSD Type Ib or is a separate entity caused by neutrophil dysfunction. [ABSTRACT FROM AUTHOR]

Focused Clinical Question: How can a clinician simply and quickly perform a periodontal screening and make a proper periodontal diagnosis using the 2018 proposed new periodontal classification? Summary: The 2018 periodontal classification has been released, however, it is challenging for clinicians especially for the dental students to apply the published information in practice. A diagnostic flowchart was created for three of the most common periodontal conditions: health, gingivitis, and periodontitis. Additionally, flowcharts were proposed for the diagnosis of periodontitis severity and risk of progression by staging and grading. Probing depth was the first clinical parameter to categorize the type of diseases. Subsequently, bleeding on probing, radiographic bone loss/clinical attachment loss, and history of periodontal treatment were further added for making a proper diagnosis. Three clinical cases were given to demonstrate the use of the simplified proposed flowcharts. Conclusions: The proposed diagnostic flowcharts are the user‐friendly tool to assist clinicians to perform an initial screening and diagnosis based on the 2018 newly proposed periodontal disease classification. [ABSTRACT FROM AUTHOR]

Introduction: The peripheral giant cell granuloma (PGCG) is associated with periodontal bony lesions in several situations and excision results in a soft papilla defect and an intrabony defect without soft tissue protection. Case Presentation: A PGCG associated with loss of periodontal support is described. Following the lesion excision, a specific flap design outlining a surgical papilla in the adjacent area was proposed. The aim of this flap design was to obtain an optimal condition for periodontal regeneration, to treat the lesion excision associated with soft tissue defect, and to avoid a second surgical area. Complete periodontal defect resolution without soft tissue contraction or lesion recurrence was obtained at 2‐year follow‐up. Conclusion: Early diagnosis and treatment are essential to prevent greater loss of periodontal attachment. [ABSTRACT FROM AUTHOR]

Focused Clinical Question: What are the key considerations for effective delivery of oral hygiene home care to best manage or prevent periodontal diseases? Background: Plaque control is critical for the management of periodontal diseases, but not all patients demonstrate the same risk for disease progression and challenges differ based upon clinical findings. This report seeks to present evidence‐based oral hygiene recommendations for a variety of common periodontal diseases. Summary: Accurate diagnosis, risk assessment, and individualized delivery of oral hygiene instruction is necessary to ensure that patients can provide adequate home care to promote health and maintain the benefits of periodontal therapy. Conclusions: Oral hygiene techniques and recommendations should vary based upon patients' clinical presentation and risk assessment. Utilization of evidence‐based strategies to deliver personalized care will allow for optimal wellness for patients. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to clinically evaluate an autogenous tooth graft (ATG) as a novel bone graft material in the treatment of Class II furcation defects. ATG is prepared at chairside from a freshly extracted tooth to be used immediately for bone regeneration. It has an advantage over the autogenous and other bone graft materials as it is non‐immunogenic, inexpensive, easily available, and lacks donor‐site morbidity. Case Presentation: This study was conducted on three middle‐aged (35 to 55 years) male patients, who had at least one mandibular molar with Class II furcation involvement (a total of 5 sites) and one tooth that required extraction because of poor prognosis and was not endodontically treated. At 9 and 12 months, the mean reductions in horizontal probing depth were (1.40 ± 0.57 mm) and (1.52 ± 0.59 mm), respectively, and the mean gains in linear bone‐fill were (3.90 ± 0.15 mm) and (5.33 ± 0.10 mm), respectively. Conclusions: Within the limitation of this study, ATG exhibited ideal properties for alveolar bone regeneration. In addition, this study outlines the chairside method to prepare a graft and highlights the improvement in clinical and radiographic parameters at 9 and 12 months. [ABSTRACT FROM AUTHOR]

Introduction: Patient‐, site‐, and procedure‐related factors important for successful periodontal regeneration have been defined in the periodontics literature by insightful clinician‐researchers. Prevention of bacterial contamination of the surgical site through careful wound closure and meticulous postoperative care is a critical procedure‐related factor necessary for periodontal regeneration. Dense polytetrafluoroethylene (dPTFE) is a nonresorbable barrier material that may protect bone replacement grafts (BRG) against bacterial contamination for a short period during early wound healing if membrane exposure occurs. Case Presentation: A 35‐year‐old African American female with a deep/narrow infrabony periodontal defect and Hamp degree I furcation involvement at tooth #14 (mesial) underwent combination BRG/guided tissue regeneration (GTR) using a mineralized/demineralized freeze‐dried bone allograft and a dPTFE barrier membrane. Favorable clinical and radiographic outcomes were noted nine months following the procedure. Conclusions: Two reports evaluating clinical parameters following use of dPTFE membranes for GTR appear in the literature. The present case provides clinical and radiographic outcome assessments following combination BRG/GTR using a dPTFE membrane. This material may be of interest for periodontal regeneration due to an ability to temporarily limit bacterial influence if membrane exposure occurs. [ABSTRACT FROM AUTHOR]

Introduction: Periodontal regeneration of hopeless teeth represents a major concern for clinicians, especially when these teeth are associated with the esthetic zone. Case Presentation: The case presented describes a non‐incised papillae surgical approach (NIPSA) to improve regenerative parameters in hopeless teeth. After treatment of a mandibular right canine with severe periodontal bone loss, clinical attachment loss to the apex, minimal keratinized tissue, and Class III mobility, there were important clinical improvements with no marginal soft tissue shrinkage and minimal morbidity for the patient. Conclusion: NIPSA represents a promising minimally invasive technique even in hopeless teeth, facilitating the treatment of deep intrabony defects associated with high risk of soft tissue collapse and post‐surgical soft tissue shrinkage. [ABSTRACT FROM AUTHOR]

Introduction: Aggressive periodontitis (AgP) is a form of periodontitis characterized by rapid attachment loss in otherwise healthy individuals. Although different treatment options have been explored for management of the disease, control of disease progression and subsequent regeneration of the attachment apparatus are considered the ideal treatment objectives. Limited evidence is available with respect to the efficacy of different regenerative materials in the treatment of AgP. Case Presentation: The present case report describes periodontal regeneration techniques and 6‐month outcomes in bilateral intrabony non‐contained defects around mandibular first molars in a 21‐year‐old patient diagnosed with localized AgP (LAgP). Periodontal lesions were treated with regenerative therapy with enamel matrix derivative (EMD) and allograft on the right side and allograft with bioabsorbable collagen membrane without EMD on the left side. Treatment yielded favorable clinical outcomes in terms of probing depth reduction, clinical attachment level gain, minimal gingival inflammation, and radiographic bone fill. Radiographic bone fill was observed after 6 months, suggesting possible periodontal regeneration. Conclusion: Both regeneration techniques used in this clinical report (guided tissue regeneration involving allograft and bioabsorbable membrane versus EMD combined with allograft without a barrier membrane) resulted in favorable outcomes in the treatment of deep (≥7 mm) non‐contained intrabony defects in LAgP. [ABSTRACT FROM AUTHOR]

Introduction: Alveolar bone resorption, a consequence of tooth extraction in infected sites, can substantially jeopardize the outcome of dental implant placement. This report describes a new therapeutic approach in a patient with severe dental‐periodontal infection based on laser and light‐emitting diode (LED) sources for decontamination, anti‐inflammation, and repair/regeneration of soft and hard tissues, and simultaneous placement of implants and biomaterials. Case Presentation: A 55‐year‐old white male with a history of chronic periodontitis presented with destructive dental‐periodontal infection and extended loss of alveolar bone, requiring removal of tooth #11. The patient underwent irradiation with diode (λ 810 and 635 nm) and erbium:yttrium‐aluminum‐garnet lasers and LED (λ 405 nm) for soft and hard tissue decontamination, anti‐inflammation, and biostimulation; grafting of biomaterials for osseoinduction; and simultaneous placement of ultrashort locking taper implants for prosthetic reconstruction. Conclusions: Within the limitations of this single case report, this method gave satisfactory clinical and esthetic results during a 3‐year follow up. This method allowed faster and better healing, rapid prosthetic restoration, and no need for local or systemic antibiotics, with obvious advantages in terms of reduction of discomfort for the patient, number of surgical sessions, and costs. [ABSTRACT FROM AUTHOR]

Introduction: Aggressive periodontitis (AgP), according to the diagnostic criteria set by the American Academy of Periodontology, is an infrequent periodontal disease. However, certain cases originally diagnosed as AgP due to young age and the involvement of first molars, when not responding to therapy, can diagnostically involve more severe systemic conditions such as the rare disorder Langerhans cell histiocytosis (LCH). Case Presentation: A 25‐year‐old white male, with no known systemic diseases, was referred to the Postgraduate Clinic of the Department of Periodontology and Implant Biology, Dental School, Aristotle University of Thessaloniki, Thessaloniki, Greece. Clinical and radiographic examination and comparison with a previous evaluation revealed a rapidly progressive lesion involving the molar region in all quadrants, although the patient had been treated by a periodontist during the last 2 years. Molars were extracted and biopsies taken, which demonstrated morphologic and immunohistochemical characteristics leading to the diagnosis of LCH. The patient was referred to a hematology clinic, where he received a comprehensive examination and chemotherapy. The patient did not further comply with his proposed medical treatment and therefore 2 years later appeared with a progressing lesion in the molar area. He was re‐treated by further extractions and closure of a sinus perforation. He was persuaded to continue the treatment plan and received supportive periodontal treatment every 3 months. Regular medical and periodontal checkups show that his condition remains stable during the last 5 years. Conclusion: Periodontists should be aware of rare systemic conditions mimicking AgP and immediately refer the patient accordingly. [ABSTRACT FROM AUTHOR]