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Background The global burden of periodontal diseases remains high. Population growth trends, changes in risk factors and improved tooth retention will increase the socio-economic burden of periodontitis that is responsible for 3,5 million years lived with disability, 54 billion USD/year in lost productivity and a major portion of the 442 billion USD/year cost for oral diseases. Methods In the context of the Milan World Exhibition 2015 “Feeding the Planet, Energy for Life”, a green paper was developed and offered for global consultation by the European Federation of Periodontology. The final draft was endorsed by professional organizations around the world and is presented to stakeholders as a call for global action. Results Specific actions for the public, policymakers, educators, and professional organizations have been identified in the areas of prevention, detection and care. These actions align public interest and knowledge, need for self-care, professional intervention and policies to the best scientific evidence to proactively promote periodontal health and effectively manage the global burden of periodontal diseases, in accordance with WHO/UN priorities and strategies for tackling common non-communicable diseases (NCDs) via the Common Risk Factor Approach. Conclusions A strong and coherent body of evidence allows identification of actionable preventive, diagnostic and therapeutic strategies to effectively promote periodontal health and general wellbeing, and better manage the socio-economic consequences. Action requires consideration of the specific national scenarios. This article is protected by copyright. All rights reserved.

Aim: Position paper on endpoints of active periodontal therapy for designing treatment guidelines. The question was as follows: How are, for an individual patient, commonly applied periodontal probing measures—recorded after active periodontal therapy—related to (a) stability of clinical attachment level, (b) tooth survival, (c) need for re-treatment or (d) oral health-related quality of life. Methods: A literature search was conducted in Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily . Results: A total of 94 papers were retrieved. From the literature search, it was found that periodontitis patients with a low proportion of deep residual pockets after active periodontal therapy are more likely to have stability of clinical attachment level over a follow-up time of ≥1 year. Other supporting literature confirms this finding and additionally reports, at the patient level, that probing pocket depths ≥6 mm and bleeding on probing scores ≥30% are risks for tooth loss. There is lack of evidence that periodontal probing measures after completion of active periodontal treatment are tangible to the patient. Conclusions: Based on literature and biological plausibility, it is reasonable to state that periodontitis patients with a low proportion of residual periodontal pockets and little inflammation are more likely to have stability of clinical attachment levels and less tooth loss over time. Guidelines for periodontal therapy should take into consideration (a) long-term tangible patient outcomes, (b) that shallow pockets (≤4 mm) without bleeding on probing in patients with

Aim To assess, using a structured review, the quality of reporting (design and outcome assessment) of risk factor research using the STROBE statements. The outcome was implant loss, and the risk factors assessed were smoking, diabetes and periodontitis. Materials and Methods Literature search was performed individually for each of the risk factors and the outcome using three sets of database: (a) MEDLINE, (b) references derived from relevant reviews and (c) references derived from identified manuscripts. Only case–control and cohort studies were included and assessed using the STROBE statements. Results A total of 104 papers were retrieved, three of which were found to be cohort studies (one in the diabetes and two in the periodontitis review) and none was a case–control study. A total of 101 of 104 papers were case series or cross-sectional study. Conclusions Risk factor research in implant dentistry is mostly comprised of case series studies. These are used to generate hypotheses, but are the wrong tool to test these hypotheses. In the near future, well-designed observational studies are needed and should be reported according to the proposed checklist.

Aim To conduct an evidence-based review of patient-reported outcome measures (PROMs) in dental implant research among dentate patients so as to gain an understanding of the use of such measures, and the potential evidence that can be gleaned from such studies. Material and Methods A structured literature search was carried out in the MEDLINE database. Patient-related end-points in dental implant research were categorized with respect to type of outcome and reviewed. Results The initial search identified 3397 publications; full texts were obtained for 133 papers, and ultimately 31 ‘effective papers’. PROMs were primarily concerned with assessment of patient satisfaction/preference (71%, 22). A range of prosthetic treatments associated with dental implants were identified. Few studies were prospective studies that included pre-treatment assessments. There was a lack of standardization in the assessment of patient-related outcomes. Conclusions There is an increasing use of PROMs in dental implant research among dentate patients for a range of prosthetic treatments. For the most part studies have been concerned with the assessment of patient satisfaction/preference but fail to employ standardized outcome assessment methods, which hampers understanding of the benefit of dental implant therapy from patients’ perspectives.

Copyright C Munksgaard 2000 J Clin Periodontol 2000; 27: 715–721 Printed in Denmark . All rights reserved ISSN 0303-6979 Review article Treatment of dentine hypersensitivity by lasers: a review Yuichi Kimura 1 , Petra Wilder-Smith 2 , Kazuo Yonaga 1 and Koukichi Matsumoto 1 Department of Endodontics, Showa University School of Dentistry, Japan; Beckman Laser Institute and Medical Clinic, University of California, Irvine, USA Kimura Y, Wilder-Smith P, Yonaga K, Matsumoto K: Treatment of dentine hyper- sensitivity by lasers: a review. J Clin Periodontol 2000; 27: 715–721. C Munks- gaard, 2000. Abstract Background, aims: Since the development of the ruby laser by Maiman in 1960, a variety of papers on potential applications for lasers in dentistry have been pub- lished. The purpose of this paper is to summarise laser applications for the treat- ment of dentine hypersensitivity. The effects of laser on pulp tissue and prob- lems on laser treatment are also reviewed. This article reviews the role of lasers for the treatment of dentine hypersensitivity since 1985, summarises many re- search reports from the last decade, and surmises what the future may hold for lasers in this treatment. Method: To date, 4 kinds of lasers have been used for the treatment of dentine hypersensitivity, and the effectiveness ranged from 5.2 to 100%, which was depend- ent on the laser type and parameters used. The mechanism involved in laser treatment of dentine hypersensitivity are relatively unknown. Results: These require clarification to result in safely effective treatment optimiza- tion. In general, the efficiency for the treatment of dentine hypersensitivity using lasers is higher than other methods, but in severe cases, it is less effective. Conclusion: It is necessary to consider the severity of dentine hypersensitivity before laser use. Dentine hypersensitivity is characterized by short, sharp pain arising from ex- posed dentine in response to stimuli typ- ically thermal, evaporative, tactile, os- motic or chemical and which cannot be ascribed to any other form of dental de- fect or pathology (Holland et al. 1997). Dentinal hypersensitivity can arise through incorrect tooth brushing, gingi- val recession, inappropriate diet, and be- cause of other factors (Dowell & Addy 1983, Matsumoto 1988, Schuurs et al. 1995). It is claimed that 14.3% of all pa- tients have some degree of sensitivity (Dowell & Addy 1983), and a range of therapies have been devised to alleviate this condition (Addy & Dowell 1983, McFall 1986). The sensation of pain is generally accepted to be associated with patent dentinal tubules not covered by smear layer terminating on the root sur- face. Stimulus transmission across den- tine in hypersensitive teeth may be me- diated by a hydrodynamic mechanism (Bra¨nnstro¨m et al. 1967, Bra¨nnstro¨m & Astro¨m 1972, Dowell & Addy 1983, Absi et al. 1987). Grossman (1935) suggested a number of requirements for treatment of this condition; these still hold true to- day. Therapy should be non-irritant to the pulp; relatively painless on appli- cation; easily carried out; rapid in ac- tion; effective for a long period; without staining effects; consistently effective. To date, most of the therapies have failed to satisfy one or more of these criteria, but some authors report that lasers may now provide reliable and reproducible treat- ment (Matsumoto et al. 1985a, b, Renton-Harper & Midda 1992). Since the ruby laser was developed by Maiman (1960), researchers have inves- Key words: dental; laser treatment; laser therapy use; dentinal hypersensitivity; tooth Accepted for publication 3 November 1999 tigated laser applications in dentistry. Laser is a device which transforms light of various frequencies into a chromatic radiation in the visible, infrared, and ultraviolet regions with all the waves in phase capable of mobilizing immense heat and power when focused at close range. The word ‘‘laser’’ is an acronym derived from Light Amplification by the Stimulated Emission of Radiation. Stern & Sognnaes (1964) and Goldman et al. (1964) were the first investigate the potential uses of the ruby laser in den- tistry. They began their laser studies on hard dental tissues by investigating the possible use of a ruby laser to reduce subsurface demineralization. Indeed, they did find a reduction in per- meability, to acid demineralization, of enamel after laser irradiation. After ini- tial experiments with the ruby laser, cli

Objective This review searched for a relationship between susceptibility to periodontitis and peri-implantitis, with implant outcome as the primary outcome variable and supportive periodontal therapy (SPT) and implant surface roughness as confounding factors. Material and methods It is based on a MEDLINE search up to June 2006. Only 16 fulfilled the selection criteria. The heterogeneity of the studies (e.g. periodontal status, SPT, prosthetic design, ...) rendered a meta-analysis impossible. The impact of a history of periodontitis on early implant loss was negligible. Only five papers reported sub-data for patients with different degrees of periodontitis. Four out of five papers indicate a higher incidence of late implant loss and/or marginal bone loss in patients with a history of periodontitis. This difference was most obvious for very rough implants (three papers), and/or when SPT was not organized (one paper). Other confounding factors were often neglected. Another 10 papers only reported the outcome of implants in patients with a history of periodontitis. In case of SPT and when avoiding roughened surfaces, late implant loss remained below 3%, and marginal bone loss remained low. Conclusions These results seem to indicate that periodontally compromised patients can be successfully treated with minimally/moderately rough implants, in the presence of SPT.

Objectives: The aims of this paper are to review and compare existing techniques for creation of interdental/interimplant papillae, to address factors that may influence its appearance and to present an approach that authors developed that could help clinicians to manage and recreate the interproximal papillae. Methods: Papers related to interdental and interimplant papillae published over the last 30 years were selected and analyzed. Results: Thorough treatment planning is essential for maintenance of the height of the interproximal papillae following tooth removal. The key for achieving an esthetically pleasing outcome is the clinicians’ ability of properly managing/creating interdental/ interimplant papillae. Bone support is the foundation for any soft tissue existence, techniques such as socket augmentation, orthodontic extrusion, guided bone regeneration, onlay graft and distraction osteogenesis are often used for this purpose. Soft tissue grafts as well as esthetic mimic restorations can also be used to enhance the esthetic outcomes. Conclusions: An esthetic triangle is developed to address the foundations that are essential for maintaining/creating papilla. These include adequate bone volume, proper soft tissue thickness as well as esthetic appearing restorations.

AIM: To answer the following PICOS question: in adult patients with periodontitis, which is the efficacy of adjunctive locally delivered antimicrobials, in comparison with subgingival debridement alone or plus a placebo, in terms of probing pocket depth (PPD) reduction, in randomized clinical trials with at least 6 months of follow-up. MATERIAL AND METHODS: A systematic search was conducted: 59 papers, reporting 50 different studies, were included. Data on clinical outcome variables changes were pooled and analysed using weighted mean differences (WMDs) and 95% confidence intervals (CI), and prediction intervals (PI), in case of significant heterogeneity. RESULTS: Statistically significant differences were observed, in 6- to 9-month studies, for PPD (WMD = 0.365, 95% CI [0.262; 0.468], PI [-0.29; 1.01]) and clinical attachment level (CAL) (WMD = 0.263, 95% CI [0.123; 0.403], PI [-0.43; 0.96]). For long-term studies, significant differences were observed for PPD (WMD = 0.190, 95% CI [0.059; 0.321]), but not for CAL. For adverse events, no differences were observed. Results were affected by study design (split-mouth versus parallel studies) and assessment (full- or partial-mouth), as well as by the formulation tested. CONCLUSIONS: The use adjunctive locally delivered antimicrobials in periodontitis therapy results in statistically significant benefits in clinical outcomes, without relevant side effects. ispartof: JOURNAL OF CLINICAL PERIODONTOLOGY vol:47 pages:239-256 ispartof: location:United States status: published

Aim To analyse, by means of a meta-analytical approach, the diagnostic accuracy of molecular biomarkers in gingival crevicular fluid (GCF) for the detection of periodontitis in systemically healthy subjects. Material and methods Studies on GCF molecular biomarkers providing a binary classification table (or sensitivity and specificity values and group sample sizes) in individuals with clinically diagnosed periodontitis were considered eligible. The search was performed using six electronic databases. The methodological quality of studies was assessed through the tool Quality Assessment of Diagnostic Studies. Meta-analyses were performed using the Hierarchical Summary Receiver Operating Characteristic, which adjusts classification data using random effects logistic regression. Results The included papers identified 36 potential biomarkers for the detection of periodontitis and for four of them meta-analyses were performed. The median sensitivity and specificity were for MMP8, 76.7% and 92.0%; for elastase, 74.6% and 81.1%; for cathepsin, 72.8% and 67.3%, respectively. The worst estimates of sensitivity and specificity were for trypsin (71.3% and 66.1%, respectively). Conclusions MMP8 showed good sensitivity and excellent specificity, which resulted in this biomarker being clinically the most useful or effective for the diagnosis of periodontitis in systemically healthy subjects, regardless of smoking condition.

Background Authors were assigned the task to develop case definitions for periodontitis in the context of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. The aim of this manuscript is to review evidence and rationale for a revision of the current classification, to provide a framework for case definition that fully implicates state-of-the-art knowledge and can be adapted as new evidence emerges, and to suggest a case definition system that can be implemented in clinical practice, research and epidemiologic surveillance. Methods Evidence gathered in four commissioned reviews was analyzed and interpreted with special emphasis to changes with regards to the understanding available prior to the 1999 classification. Authors analyzed case definition systems employed for a variety of chronic diseases and identified key criteria for a classification/case definition of periodontitis. Results The manuscript discusses the merits of a periodontitis case definition system based on Staging and Grading and proposes a case definition framework. Stage I to IV of periodontitis is defined based on severity (primarily periodontal breakdown with reference to root length and periodontitis-associated tooth loss), complexity of management (pocket depth, infrabony defects, furcation involvement, tooth hypermobility, masticatory dysfunction) and additionally described as extent (localized or generalized). Grade of periodontitis is estimated with direct or indirect evidence of progression rate in three categories: slow, moderate and rapid progression (Grade A-C). Risk factor analysis is used as grade modifier. Conclusions The paper describes a simple matrix based on stage and grade to appropriately define periodontitis in an individual patient. The proposed case definition extends beyond description based on severity to include characterization of biological features of the disease and represents a first step towards adoption of precision medicine concepts to the management of periodontitis. It also provides the necessary framework for introduction of biomarkers in diagnosis and prognosis.

OBJECTIVES This narrative review was prepared for the 2017 World Workshop of the American Academy of Periodontology and European Federation of Periodontology to address key questions related to the clinical condition of peri-implant mucositis, including: 1) the definition of peri-implant mucositis, 2) conversion of peri-implant health to the biofilm-induced peri-implant mucositis lesion, 3) reversibility of peri-implant mucositis, 4) the long-standing peri-implant mucositis lesion, 5) similarities and differences between peri-implant mucositis at implants and gingivitis at teeth, and 6) risk indicators/factors for peri-implant mucositis. METHODS A literature search of MEDLINE (PubMed) and The Cochrane Library up to and including July 31, 2016, was carried out using the search strategy (peri-implant[All Fields] AND ("mucositis"[MeSH Terms] OR "mucositis"[All Fields])) OR (periimplant[All Fields] AND mucosits[All Fields]). Prospective, retrospective, and cross-sectional studies and review papers that focused on risk factors/indicators for peri-implant mucositis as well as experimental peri-implant mucositis studies in animals and humans were included. FINDINGS Peri-implant mucositis is an inflammatory lesion of the soft tissues surrounding an endosseous implant in the absence of loss of supporting bone or continuing marginal bone loss. A cause-and-effect relationship between experimental accumulation of bacterial biofilms around titanium dental implants and the development of an inflammatory response has been demonstrated. The experimental peri-implant mucositis lesion is characterized by an inflammatory cell infiltrate present within the connective tissue lateral to the barrier epithelium. In long-standing peri-implant mucositis, the inflammatory cell infiltrate is larger in size than in the early (3-week) experimental peri-implant mucositis lesion. Biofilm-induced peri-implant mucositis is reversible at the host biomarker level once biofilm control is reinstituted. Reversal of the clinical signs of inflammation may take longer than 3 weeks. Factors identified as risk indicators for peri-implant mucositis include biofilm accumulation, smoking, and radiation. Further evidence is required for potential risk factors, including diabetes, lack of keratinized mucosa, and presence of excess luting cement. CONCLUSIONS Peri-implant mucositis is caused by biofilm accumulation which disrupts the host-microbe homeostasis at the implant-mucosa interface, resulting in an inflammatory lesion. Peri-implant mucositis is a reversible condition at the host biomarker level. Therefore, the clinical implication is that optimal biofilm removal is a prerequisite for the prevention and management of peri-implant mucositis. An understanding of peri-implant mucositis is important because it is considered a precursor for peri-implantitis.

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.

Aim Since there is limited study to assist in an evidenced-based decision whether to extract or preserve a structurally compromised tooth, the aim of this retrospective study was to investigate the long-term survival rate of tooth preservation after crown lengthening procedure (CLP) and restorative treatments. Methods Electronic and paper chart of patients received CLP in our graduate clinic from 1990 to 2015 were reviewed. Statistical analysis was done using Cox regression analysis and Kaplan-Meier estimator. Results A total of 766 coded charts were initially collected. Four hundred and fourteen cases were included in the final analysis. The Kaplan-Meier estimate shows a cumulative survival rate of 88.3% in 5 years, 78.4% in 10 years and 68.1% in 15 years. In terms of reasons for failure, restorative problem such as recurrent decays was the main issue (35.2%), followed by fracture (29.6%), endodontic complications (23.9%) and periodontal breakdown (11.3%). Conclusions Within the limitation of this study, structurally compromised teeth have a reasonable long-term survival rate close to 80% after 10 years in a teaching institute. Patients with high fracture or caries risk may pose a higher chance of failure. Objective information should be presented to the patient to arrive at an evidence-based decision.

AIM: Aim was to systematically review behavioural aspects in the prevention and control of dental caries and periodontal diseases at individual and population level.MATERIAL & METHODS: With regard to caries, MEDLINE/PubMed was searched on three subheadings focusing on early childhood, proximal and root caries. For periodontal diseases, a meta-review on systematic reviews was performed; thus, the search strategy included specific interventions to change behaviour in order to perform a meta-review on systematic reviews. After extraction of data and conclusions, the potential risk of bias was estimated and the emerging evidence was graded.RESULTS: Regarding early childhood, proximal and root caries, 28, 6 and 0 papers, respectively, could be included, which predominantly reported on cohort studies. Regarding periodontal diseases, five systematic reviews were included. High evidence of mostly high magnitude was retrieved for behavioural interventions in early childhood caries (ECC), weak evidence for a small effect in proximal caries and an unclear effect of specific informational/motivational programmes on prevention of periodontal diseases and no evidence of root caries.CONCLUSION: Early childhood caries can be successfully prevented by population-based preventive programmes via aiming at the change in behaviour. The effect of individual specific motivational/informational interventions has not yet been clearly demonstrated neither for the prevention of caries nor for periodontal diseases.

Background There is a lack of consensus on measures to assess implant performance in clinical research. Objectives To investigate the outcomes measures and reference groups employed to evaluate and compare implant success and failure. Data Sources MEDLINE (OVID) and Web of Science with searching reference lists of included papers. Study Eligibility Criteria Inclusion: root form, titanium implants in dentate or edentulous individuals. Longitudinal studies reporting survival or success outcomes on at least 20 participants ≥ mean 5 years. Study Appraisal and Synthesis Methods Descriptive statistics. Results Two-hundred and sixteen studies were included. Implant survival was the most commonly reported primary outcome (60%) with success at 15.7%. Success constituted a wide variety of measures with little consistency. A percentage of 98.6% of studies employed the implant as the unit of analysis with little consideration of clustering within patients. The status of periodontal and general heath of study groups was unclear for more than 80% studies. The proportion of studies comprising randomized trials or using appropriate analytical methods increased from 1980 to 2011. Limitations Considers only English language and there was no author contact. Conclusion In view of the disparate outcome measures employed to assess dental implant performance, agreement is needed both on a core set of implant outcomes and their statistical management.

Objective The aim was to assess the quality of reporting of experimental research in implant dentistry by a critical evaluation of study design, outcome assessments and model validation. Material & Methods An online search was performed using the MEDLINE. Experimental studies performed in both animals and humans were included. A’stratified random sample of the included studies was extracted and used for quantitative and qualitative analyses. Modified versions of the ARRIVE guidelines were used for quality assessment. Results A total of 982 papers were eligible and used for quantitative analyses. A’stratified random sample of 193 publications was extracted. The dog model was the most used experimental model whereas experimental studies on humans were few. Intra-oral experimental sites dominated in human, monkey, dog and mini-pig studies. Extra oral sites dominated in rabbit, rodent and goat/sheep studies. Studies on the pathogenesis and treatment of peri-implant diseases were few. Conclusion Different animal models, experimental protocols and methods of analysis have been used to address different areas of experimental research in implant dentistry. Standardized designs for investigations within this type of experimental research seem to be lacking. Furthermore, in many of these studies there were limitations in reporting on methodology and statistical methods.

IntroductionPeriodontal diseases are the pathological manifestation of the host response against the bacterial challenge from the dental biofilm at the tooth/gingival interface. The remit of this working group was to update the existing knowledge on the infectious nature of periodontal diseases.Material and MethodsThe literature was systematically searched and critically reviewed. Four manuscripts were produced in specific topics identified as key areas to understand the importance of the microorganisms in the etio-pathogenesis of periodontal diseases.Results/ConclusionsThe results and conclusions of the review process are presented in the following papers, together with the group consensus statements aiming to answer the following questions: (1) Has the use of molecular methods for the characterization of the human oral microbiome changed our understanding of the role of bacteria in the pathogenesis of periodontal disease process? (2) Are the periodontal microbial complexes associated with specific cell and tissue responses? (3) How is the development of dental biofilms influenced by the host? (4) What can we learn about biofilm/host interactions from the study of inflammatory bowel disease? This consensus report provides answers to these questions with the most updated information on periodontal microbiology.

Culshaw S, McInnes IB, Liew FY: What can the periodontal community learn from the pathophysiology of rheumatoid arthritis? J Clin Periodontol 2011; 38 (Suppl. 11): 106–113. doi: 10.1111/j.1600-051X.2010.01669.x Abstract Aim: The aim of this paper is to provide a narrative review of the aetiopathogeneis and treatments of rheumatoid arthritis (RA), focusing on aspects that may share commonality with periodontitis. Results: A myriad of cell types, cytokines and pathways have been investigated in both periodontitis and RA. Chronic inflammatory diseases, including RA, psoriatic arthritis, ankylosing spondylitis and periodontitis are likely to share pathogenic mechanisms of inflammation-mediated solid tissue destruction. The aetiopathogenesis of these diseases has been extensively researched over the last several decades and advances in understanding have revolutionized arthritis therapeutics. Conclusion: The rational, targeted inhibition of mediators in RA has provided clinically useful therapeutics and shed light on mechanisms underpinning disease pathogenesis. RA should be considered a prototypic disease revealing how understanding disease pathogenesis may transform therapeutic options and patient outcomes.

Background: Periodontitis remains a major public health issue and current management approaches have failed to impact upon the most high-risk proportion of the population and those with the most severe disease. The objective of this session was to assess if and how, current understanding of periodontitis provides the opportunity to develop new preventive and therapeutic strategies. Materials and Methods: Based on the current understanding of the pathophysiology of periodontal diseases, the Workshop discussed the potential of antimicrobial peptides, probiotics, pro-resolving lipid mediators, and micronutritional approaches. Evidence-based position papers and expert discussions formed the basis of deliberations. Results and Discussion: Current preventive and treatment approaches are only partially effective, and this appears due to the therapeutic focus remaining primarily upon biofilm management rather than embracing a pivotal role for inflammation as a driver of biofilm composition as well as tissue damage. There is a need to develop new, more effective, and efficient preventive and treatment approaches for gingivitis and periodontitis, which embrace recent advances in understanding of host modulation and inflammation resolution, as well as direct management of the microbiota.

Van Dyke TE. Proresolving lipid mediators: potential for prevention and treatment of periodontitis. J Clin Periodontol 2011; 38 (Suppl. 11): 119–125. doi: 10.1111/j.1600-051X.2010.01662.x. Abstract Aim: Periodontitis is an inflammatory disease initiated by microbial biofilm. The host response to the biofilm destroys the periodontium mediated by an overly robust inflammatory response in susceptible individuals. Whether the excessive host response is genetic, epigenetic or mediated by environment is unknown. New pathways of resolution of inflammation have been discovered. Resolution of inflammation is an active, agonist-mediated, programmed return to tissue homeostasis. Materials and Methods: Various computer-based search engines were employed to identify papers relevant to resolution of inflammation. Results: Recent data suggest that chronic inflammatory periodontal disease may be a failure of resolution pathways as well as overexpression of proinflammatory pathways. In this review, the biology of resolution of inflammation will be examined in normal tissues and periodontal disease. Anti-inflammatory pharmacologic agents [non-steroidal anti-inflammatory drugs (NSAIDs)] have been shown to prevent and slow the progression of periodontitis in animals and humans. However, the side effect profile of NSAIDS or other inhibitors or receptor antagonists preclude their use in periodontal therapy. Conclusion: The isolation and characterization of proresolving lipid mediators that are receptor agonists has opened a new area of research for potential therapeutic agents for the management of inflammatory periodontitis.

Introduction Periodontal diseases are the pathological manifestation of the host response against the bacterial challenge from the dental biofilm at the tooth/gingival interface. The remit of this working group was to update the existing knowledge on the infectious nature of periodontal diseases. Material and Methods The literature was systematically searched and critically reviewed. Four manuscripts were produced in specific topics identified as key areas to understand the importance of the microorganisms in the etio-pathogenesis of periodontal diseases. Results/Conclusions The results and conclusions of the review process are presented in the following papers, together with the group consensus statements aiming to answer the following questions: (1) Has the use of molecular methods for the characterization of the human oral microbiome changed our understanding of the role of bacteria in the pathogenesis of periodontal disease process? (2) Are the periodontal microbial complexes associated with specific cell and tissue responses? (3) How is the development of dental biofilms influenced by the host? (4) What can we learn about biofilm/host interactions from the study of inflammatory bowel disease? This consensus report provides answers to these questions with the most updated information on periodontal microbiology.

P>AimTo test recolonization of periodontal lesions after full-mouth scaling and root planing (FM-SRP) or multiple session-SRP (MS-SRP) in a randomized clinical trial and whether FM-SRP and MS-SRP result in different clinical outcomes.Materials and MethodsThirty-nine subjects were randomly assigned to FM-SRP or MS-SRP groups. At baseline and after 3 months, probing pocket depth (PPD), plaque index (PlI) and bleeding on probing (BoP) were recorded. At baseline, immediately after treatment, after 1, 2, 7, 14 and 90 days, paper point samples from a single site from the maxillary right quadrant were collected for microbiological analysis of five putative pathogens by polymerase chain reaction.ResultsFM-SRP and MS-SRP resulted in significant reductions in PPD, BoP and PlI and the overall detection frequencies of the five species after 3 months without significant differences between treatments. Compared with MS-SRP, FM-SRP resulted in less recolonization of the five species, significantly for Treponema denticola, in the tested sites.ConclusionFM-SRP and MS-SRP result in overall clinically and microbiologically comparable outcomes where recolonization of periodontal lesions may be better prevented by FM-SRP.

Aim: To test recolonization of periodontal lesions after full-mouth scaling and root planing (FM-SRP) or multiple session-SRP (MS-SRP) in a randomized clinical trial and whether FM-SRP and MS-SRP result in different clinical outcomes. Materials and Methods: Thirty-nine subjects were randomly assigned to FM-SRP or MS-SRP groups. At baseline and after 3 months, probing pocket depth (PPD), plaque index (PlI) and bleeding on probing (BoP) were recorded. At baseline, immediately after treatment, after 1, 2, 7, 14 and 90 days, paper point samples from a single site from the maxillary right quadrant were collected for microbiological analysis of five putative pathogens by polymerase chain reaction. Results: FM-SRP and MS-SRP resulted in significant reductions in PPD, BoP and PlI and the overall detection frequencies of the five species after 3 months without significant differences between treatments. Compared with MS-SRP, FM-SRP resulted in less recolonization of the five species, significantly for Treponema denticola, in the tested sites. Conclusion: FM-SRP and MS-SRP result in overall clinically and microbiologically comparable outcomes where recolonization of periodontal lesions may be better prevented by FM-SRP.

Aims: The aim of this paper was to analyse the aetiology and characteristics of 2000 patients who visited a multidisciplinary bad breath clinic in Leuven, Belgium and to correlate organoleptic ratings with portable device measurements. Materials and Methods: The characteristics and aetiology of breath malodour of two thousand consecutive patients who visited a halitosis consultation were explored by means of a standard questionnaire and a clinical examination, including organoleptic scores provided by a trained and calibrated judge, and a portable bad breath detector (Halimeter®). Results: Most patients came without referral and had complaints for several years (mean: 7 years, SD: 8 years). For 76% of the patients, an oral cause was found [tongue coating (43%), gingivitis/periodontitis (11%) or a combination of the two (18%)]. Pseudo-halitosis/halitophobia was diagnosed in 16% of the cases; and ear, nose and throat/extra-oral causes were found in 4% of the patients. Most patients had an organoleptic score

FOCUSED QUESTION: What is the effect of a dentifrice (DF), a mouthwash (MW), tongue cleaning (TC), or any combination of these as adjunct to toothbrushing on intra-oral malodour and tongue coating as compared to toothbrushing alone in systemically healthy patients, when used for a minimum follow-up period of 2 weeks? MATERIAL AND METHODS: The MEDLINE-PubMed, Cochrane-CENTRAL and EMBASE databases were searched up to August 2014. Measurements of Volatile Sulphur Compounds and organoleptic scores of oral malodour were selected as outcome variables. Data were extracted and a descriptive analysis was performed. RESULTS: Independent screening of 1054 unique papers resulted in 12 eligible clinical trials with a medium-term (≥2 weeks) duration. The majority of studies provided a significant reduction in oral malodour when evaluating products with an active ingredient (incorporated into a DF or a MW) used adjunctively to toothbrushing. The added value of tongue cleaning over a MW was evaluated in one study. CONCLUSION: Due to very limited evidence, the potential effect of a specifically formulated dentifrice, a mouthwash or a tongue scraper for treating oral malodour is, in general, unclear. For mouthwashes containing the active ingredients chlorhexidine + cetylpyridinium chloride + zinc (CHX + CPC + Zn) and zinc chloride + cetylpyridinium chloride (ZnCl + CPC) most evidence was available. The strength of a recommendation to use these products was graded to be 'weak'. ispartof: Journal of Clinical Periodontology vol:42 issue:S16 pages:S303-S316 ispartof: location:SPAIN status: published

Background and aims Interleukin-17 (IL-17) is a T-cell-derived cytokine that may play an important role in the initiation or maintenance of the pro-inflammatory response and has recently been found to stimulate osteoclastic resorption. The purpose of the present study was to determine the presence of IL-17 in gingival crevicular fluid (GCF) samples and in the culture supernatants of gingival cells from patients with chronic periodontitis. Method GCF samples were collected during 30 s from two sites in 16 patients from periodontally affected sites (probing depth > or =5 mm, attachment loss > or =3 mm). The comparison with healthy controls was carried out by collecting GCF samples from eight healthy volunteers. GCF was collected using a paper strip and ELISA was performed to determine the total amount of IL-17. Supernatant cellular cultures of gingival cells were obtained from periodontal biopsies taken from 12 periodontitis patients and from eight healthy control subjects during the surgical removal of wisdom teeth. Spontaneous and phytohaemagglutinin (PHA)-stimulated levels of IL-17 were determined by ELISA. Results The total amount of cytokine IL-17 was significantly higher in the periodontitis group than the control group (45.9 versus 35.6 pg, p=0.005). Significantly higher GCF volume and amount of total proteins were obtained from periodontitis patients as compared with control subjects (0.98 versus 0.36 microl, p=0.0005; 0.12 versus 0.05 microg, p=0.0005, respectively). A higher concentration of IL-17 was detected in culture supernatants from periodontitis patients compared with healthy subjects, either without stimulation (36.28+/-8.39 versus 28.81+/-1.50 microg/ml, p=0.011) or with PHA stimulation (52.12+/-14.56 versus 39.00+/-4.90 microg/ml, p=0.012). Treatment with PHA induced a significant increase in the production of IL-17 in healthy subjects and periodontitis patients (p=0.001 and 0.003). Conclusions The total amount of cytokine IL-17 in GCF samples and in the culture supernatants of gingival cells are significantly increased in periodontal disease.

Background Periodontal diseases are among the most frequent diseases affecting children and adolescents. These include gingivitis, localized or generalized aggressive periodontitis (a.k.a., early onset periodontitis which includes generalized or localized prepubertal periodontitis and juvenile periodontitis) and periodontal diseases associated with systemic disorders. The best approach to managing periodontal diseases is prevention, followed by early detection and treatment. Methods This paper reviews the current literature concerning the most common periodontal diseases affecting children: chronic gingivitis (or dental plaque-induced gingival diseases) and early onset periodontitis (or aggressive periodontitis), including prepubertal and juvenile periodontitis. In addition, systemic diseases that affect the periodontium and oral lesions commonly found in young children are addressed. The prevalence, diagnostic characteristics, microbiology, host-related factors, and therapeutic management of each of these disease entities are thoroughly discussed.

In this paper, we review recent work on collagen degradation, 2 main routes of breakdown are described and their relevance during healthy and inflammatory conditions of the periodontium is discussed. Special attention is paid to the possible role of cytokines, in particular interleukin 1 (IL-1) and transforming growth factor beta (TGF-beta), on the modulation of collagen phagocytosis and metalloproteinase production. IL-1 has been shown to have a dual function in collagen digestion. It inhibits the intracellular phagocytic pathway, but at the same time, it strongly promotes extracellular digestion by inducing the release of collagenolytic enzymes like collagenase. TGF-beta has an opposite effect on both pathways and antagonizes IL-1. Collagenase is released in an inactive form, and a considerable fraction of the proenzyme may become incorporated in the extracellular matrix. This reservoir of latent enzyme can be activated (for instance by plasmin), leading to a sudden and extensive breakdown of the collagenous fibre meshwork. It is suggested that this phenomenon may also take place during progressive periodontitis and could explain an episodic nature of collagenolysis, clinically resulting in bursts of attachment loss (burst hypothesis).

Aim: To critically appraise recent research into associations between periodontal disease and systemic diseases and conditions specifically respiratory disease, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer. Methods: A MEDLINE literature search of papers published between 2002 and April 2012 was conducted. Studies that included periodontitis as an exposure were identified. Cross-sectional epidemiological investigations on large samples, prospective studies and systematic reviews formed the basis of the narrative review. A threshold set for the identification of periodontitis was used to identify those studies that contributed to the conclusions of the review. Results: Many of the investigations were cross-sectional secondary analyses of existing data sets in particular the NHANES studies. There were a small number of systematic reviews and prospective studies. There was substantial variability in the definitions of exposure to periodontitis. A small number of studies met the threshold set for periodontitis and supported associations; however, in some of the chronic diseases there were no such studies. There was strong evidence from randomized controlled trials that interventions, which improve oral hygiene have positive effects on the prevention of nosocomial pneumonias. Conclusions: There was substantial heterogeneity in the definitions used to identify periodontitis and very few studies met a stringent threshold for periodontitis. Published evidence supports modest associations between periodontitis and some, although not all, of the diseases and conditions reviewed. There is a need to reach a consensus on what constitutes periodontitis for future studies of putative associations with systemic diseases.

Background and Objectives The receptor activator of NF-κB ligand-osteoprotegerin (RANKL-OPG) bi-molecular system is the “bottle-neck” regulator of osteoclastogenesis and bone resorption, both in physiological and pathological conditions. This review aims to elaborate the current knowledge on RANKL and OPG in periodontal disease, and to evaluate their diagnostic and prognostic potential as biomarkers of the disease. Materials and Methods To pursue this aim, electronic and manual searches were performed for identifying clinical and in vivo studies on RANKL and OPG in gingival tissue, gingival crevicular fluid, saliva and blood. Smoking and diabetes mellitus were also considered for their potential effects. Results Papers fulfilling the inclusion criteria demonstrate that RANKL is up-regulated, whereas OPG is down-regulated in periodontitis, compared to periodontal health, resulting in an increased RANKL/OPG ratio. This ratio is further up-regulated in smokers and diabetics, and is not affected by conventional periodontal treatment. Conclusions The increased RANKL/OPG ratio may serve as a biomarker that denotes the occurrence of periodontitis, but may not necessarily predict on-going disease activity. Its steadily elevated levels post treatment may indicate that the molecular mechanisms of bone resorption are still active, holding an imminent risk for relapse of the disease. Additional adjunct treatment modalities that would “switch-off” the RANKL/OPG ratio may therefore be required.

The purpose of this paper is (1) to investigate the similarity of the amount, distribution, and, severity of periodontal disease of the within-patient experimental units, (2) to estimate the relative efficiencies of split-mouth designs when compared to whole-mouth designs, and (3) to discuss how stratification on initial pocket depth can result in large differences in the power of the test- statistics in the different disease categories. Periodontal disease characteristics are not always homogeneously distributed over the within-patient experimental units and this heterogeneity can reduce the efficiency of split-mouth designs. In particu- lar, if analyses are stratified on initial pocket depth, sites with an initial probing depth deeper than 6 mm may be small in number and asymmetrically distributed when compared to sites with an initial probing depth less than 6 mm. This may result in large differences of the power of the test statistics among the different disease categories and should lead to a careful interpretation of the statistical significance tests. When disease characteristics are symmetrically distributed over the within-patient experimental units and a sufficient number of sites is present per expenmental unit, the split-mouth design can provide moderate to large gains in relative efficiency. In the absence of a symmetric disease distribution, whole- inouth clinical trials may be preferable.

Aim: The aim of this systematic review was to produce the best available evidence and pool appropriate data to evaluate the effect of tooth brushing on the initiation and progression of non-inflammatory gingival recession. Material and Methods: A protocol was developed a priori for the question: "Do factors associated with tooth brushing predict the development and progression of non-inflammatory gingival recession in adults?" The search covered six electronic databases between January 1966 and July 2005. Hand searching included searches of the Journal of Clinical Periodontology, Journal of Periodontal Research and the Journal of Periodontology. Bibliographies of narrative reviews, conference proceedings and relevant texts known to the authors were also searched. Inclusion of titles, abstracts and ultimately full texts was based on consensus between three reviewers. Results: The full texts of 29 papers were read and 18 texts were eligible for inclusion. One abstract from EuroPerio 5 reported a randomized-controlled clinical trial [Level I evidence] in which the authors concluded that the toothbrushes significantly reduced recessions on buccal tooth surfaces over 18 months. Of the remaining 17 observational studies, two concluded that there appeared to be no relationship between tooth brushing frequency and gingival recession. Eight studies reported a positive association between tooth brushing frequency and recession. Other potential risk factors were duration of tooth brushing, brushing force, frequency of changing the toothbrush, brush (bristle) hardness and tooth brushing technique. None of the observational studies satisfied all the specified criteria for quality appraisal and a valid appraisal of the quality of the randomized-controlled trial was not possible. Conclusion: The data to support or refute the association between tooth brushing and gingival recession are inconclusive.

The purpose of this study was: to determine whether polishing standardized proximal root surfaces with dental floss, Superfloss, wood and plastic interdental cleaners, using a polishing paste, produces any significant change on root surface roughness; and to determine the effectiveness of different number of strokes in polishing. 80 tooth specimens were prepared, 10 in each of 8 sample groups. Each proximal root surface was standardized with 600A grit silicone carbide paper and polished with either waxed dental floss, Superfloss, wood or plastic interdental cleaners, using alkali aluminum silicate polishing paste. All specimens were mounted on a flossing machine and polished with 10 or 20 strokes. Before and after polishing, measurements were recorded with the Surfanalyzer 150 System to produce profile and average roughness tracings. Average maximum peak heights, mean number of peaks, and mean average roughness values were calculated from the tracings. The data were analyzed statistically by paired t-test and Student t-test. No significant mean differences were found between the number of strokes used. No significant differences were found for waxed dental floss in relation to the values analyzed. Significant differences were found for maximum peak heights for Superfloss following 20 strokes of polishing. However, no significant differences were found for Superfloss for mean number of peaks and average roughness. Significant differences were found for average roughness values, maximum peak heights, and mean number of peaks for the wood and plastic interdental cleaners. It was concluded that root surface roughness increased significantly with the use of wood and plastic interdental cleaners but not with waxed dental floss or Superfloss.

This paper is a review of current literature combined with clinical observations. Well-controlled maintenance care is a key consideration in the long-term prognosis of treated periodontitis patients. Periodic professional tooth cleaning every 3 to 4 months often is recommended. Furthermore, recent studies indicate a potential need for selected retreatment in problem areas, since minute residual accretions may be left behind during active therapy--even with "open" surgery. While efficient plaque control is essential for optimal results during the healing phase of periodontal therapy, periodic prophylaxis may prevent loss of clinical attachment over long periods of time even for patients with less than perfect oral hygiene.