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

Background/Aim: Hujoel & Moulton previously questioned the reported quality of split-mouth studies. Since then, there has been little enquiry into the methodology of this study design. The aim was to conduct a systematic review of the reported methodology of clinical studies using a split-mouth design published in dental journals over a 1-year period (2004). Material and Methods: An extension of the CONSORT guidelines for cluster-randomized designs was used to evaluate quality. We evaluated the methods used and quality of reporting split-mouth studies. Results: Thirty-four studies were eligible for this review. The results showed that many papers lack essential qualities of good reporting, e.g. five of 34 papers gave the rationale for choosing a split-mouth design, 19 of 34 (56%) used appropriate analytical statistical methods and only one of 34 presented an appropriate sample size calculation. Of the five studies that used survival analysis, none of them used a paired approach. Conclusions: Despite some progress in statistical analysis, if the reporting of studies represents the actual methodology of the trial, this review has identified important aspects of split-mouth study design and analysis that would benefit from development. [ABSTRACT FROM AUTHOR]

Abstract Objective: The purpose of this study was to perform a systematic review of the literature and to evaluate, in patients with chronic periodontitis, what the effect is of subgingival debridement (SGD), in terms of bleeding on probing, pocket depth and probing attachment level. Material and methods: An electronic search of the Cochrane Oral Health Group specialized register and MEDLINE were performed using specific search terms to identify studies assessing in patients with chronic periodontitis the effect of subgingival debridement with regard to clinical outcomes. This was performed on titles registered up to 2001. The only papers included were those which utilized data based on the patient as unit of observation. Results: The searches identified 702 abstracts. Titles and abstracts were independently screened by two reviewers (G.A.W. & M.F.T.) to identify publications that met specific inclusion criteria. The agreement between the two reviewers was assessed. The kappa score for agreement was 0.80. Review of these abstracts resulted in 114 publications for detailed review. Finally, 26 papers which met the criteria of eligibility were independently selected by the two reviewers. The kappa score for agreement on this decision was 0.92. Disagreement regarding inclusion of both abstracts and full papers was resolved by discussion between the reviewers. No randomized controlled trials (RCT) could be retrieved that were specifically designed to answer the question formulated at the outset of this systematic review. From the 10 controlled studies, four provide a definitive ‘yes’ that SGD is effective with regard to clinical outcomes. In the one study where subgingival debridement was not supported by oral hygiene instruction, the paper provided a definitive ‘no’. The weighted mean of attachment gain of SGD in pockets initially ≥5 mm was 0.64 mm as compared with 0.37 mm for supragingival plaque control only (SPC). The reduction of pocket depth was 0.59 mm and 1.18 mm for SPC and SGD, respectively. Of the 18 papers that provided only information on the effect of treatment as compared with the baseline values, eight showed SGD to be beneficial with regard to clinical attachment level change while the remaining 10 provided no such an analysis. The weighted mean of this effect was a 0.74-mm gain of attachment as a result of treatment in pockets initially ≥ 4 mm. Conclusions: In patients with chronic periodontitis, subgingival debridement (in conjunction with supragingival plaque control) is an effective treatment in reducing probing pocket depth and improving the clinical attachment level. In fact it is more effective than supragingival plaque control alone. [ABSTRACT FROM AUTHOR]

Background: It is thought that infrabony defect morphology affects the outcome of periodontal regenerative surgery. However, this has not been systematically investigated. Aims: To investigate how well defect morphology is described in papers reporting regenerative therapy of periodontal infrabony defects and to investigate its effect on clinical and radiographic outcomes. Materials and Methods: A search was conducted in 3 electronic databases for publications reporting clinical and radiographic outcomes of periodontal intra‐bony defects after regenerative therapy, divided by defect morphology. Results: The initial search resulted in 4487 papers, reduced to 143 after first and second screening. Fifteen of these publications were suitable for a fixed‐effects meta‐analysis. Initial defect depth was found to influence radiographic bone gain 12 months post‐surgery, while narrower angles and increased number of walls influenced both radiographic bone gain and clinical attachment level (CAL) gain at 12 months. These associations seemed to occur irrespective of biomaterials used. Risk of bias ranged from low to high. Conclusion: Deeper defects with narrower angles and increased number of walls exhibit improved CAL and radiographic bone gain at 12 months post‐regenerative surgery. More data are needed about other aspects of defect morphology such as extension to buccal/lingual surfaces. [ABSTRACT FROM AUTHOR]

Objective To perform an overview of literature search strategies in systematic reviews ( SRs) published in periodontology and implant dentistry. Materials and Methods Two electronic databases (PubMed and Cochrane Database of SRs) were searched, independently and in duplicate, for SRs with meta-analyses on interventions, with the last search performed on 11 November 2012. Manual searches of the reference lists of included SRs and 10 specialty dental journals were conducted. Methodological issues of the search strategies of included SRs were assessed with Cochrane collaboration guidelines and AMSTAR recommendations. The search strategies employed in Cochrane and paper-based SRs were compared. Results A total of 146 SRs with meta-analyses were included, including 19 Cochrane and 127 paper-based SRs. Some issues, such as 'the use of keywords,' were reported in most of the SRs (86%). Other issues, such as 'search of grey literature' and 'language restriction,' were not fully reported (34% and 50% respectively). The quality of search strategy reporting in Cochrane SRs was better than that of paper-based SRs for seven of the eight criteria assessed. Conclusion There is room for improving the quality of reporting of search strategies in SRs in periodontology and implant dentistry, particularly in SRs published in paper-based journals. [ABSTRACT FROM AUTHOR]

Aim: To study in humans with peri‐implant mucositis the efficacy of (Q1) mechanical/physical instrumentation over oral hygiene instructions alone; (Q2) any single mode of mechanical/physical instrumentation over others; (Q3) combinations of mechanical/physical instrumentation over single modes; and (Q4) repetitions of mechanical/physical instrumentation over single administration. Materials and Methods: Randomized clinical trials (RCTs) fulfilling specific inclusion criteria established to answer the four PICOS questions were included. A single search strategy encompassing the four questions was applied to four electronic databases. Two review authors independently screened the titles and abstracts, carried out full‐text analysis, extracted the data from the published reports and performed the risk of bias assessment through the RoB2 tool of the Cochrane Collaboration. In case of disagreement, a third review author took the final decision. Treatment success (i.e., absence of bleeding on probing [BoP]), BoP extent and BoP severity were considered as the implant‐level outcomes of critical importance for the present review. Results: A total of five papers reporting on five RCTs, involving 364 participants and 383 implants, were included. Overall, treatment success rates after mechanical/physical instrumentation ranged from 30.9% to 34.5% at 3 months and from 8.3% to 16.7% at 6 months. Reduction in BoP extent was 19.4%–28.6% at 3 months, 27.2%–30.5% at 6 months and 31.8%–35.1% at 12 months. Reduction in BoP severity was 0.3–0.5 at 3 months and 0.6–0.8 at 6 months. Q2 was addressed in two RCTs, which reported no differences between glycine powder air‐polishing and ultrasonic cleaning, as well as between chitosan rotating brush and titanium curettes. Q3 was addressed by three RCTs, which showed no added effect of glycine powder air‐polishing over the use of ultrasonic and of diode laser over ultrasonic/curettes. No RCTs were identified that answered Q1 and Q4. Conclusions: Several mechanical/physical instrumentation procedures including curettes, ultrasonics, lasers, rotating brushes and air‐polishing are documented; however, a beneficial effect over oral hygiene instructions alone or superiority over other procedures could not be demonstrated. Moreover, it remains unclear whether combinations of different procedures or their repetition over time may provide additional benefits. (CRD42022324382) [ABSTRACT FROM AUTHOR]

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

Aim: To evaluate outcome measures and methods of assessment in clinical studies on bone augmentation/preservation procedures for the placement of dental implants. Materials and Methods: A systematic search was performed on three databases from January 2011 to April 2021 to identify clinical studies reporting on any type of bone augmentation/preservation procedure. The outcomes that have been used to assess efficacy or performance in each study were registered and assigned to different domains (group of outcomes). The review followed the Preferred Reporting Items for Systematic Review and Meta‐Analyses statement. Results: Seven‐hundred and eighty‐three publications were included. Only 81.8% of the papers had a clear definition of their primary outcome. The rate of complications (59.3%), implant survival (58.2%), 3D radiographic bone gain/change (30%), marginal bone level (MBL; 29%), and histological outcomes (25.5%) were the most frequently reported outcome domains. The most commonly used primary outcome was 3D radiographic bone gain/change (25.8%), followed by implant survival (13.0%). Patient‐reported outcome measures (PROMs) were reported in 15.7% of studies. Differences in the reported outcomes were observed among different types of bone preservation/augmentation interventions (i.e., alveolar ridge preservation, immediate implants, horizontal and/or vertical ridge augmentation, and sinus floor augmentation). Conclusion: Within the past decade, great heterogeneity was observed among the outcomes considered in studies evaluating bone preservation/augmentation procedures. Three‐dimensional radiographic bone gain/change was the most routinely reported main outcome variable, while PROMs were rarely reported. [ABSTRACT FROM AUTHOR]

Background: It is unclear whether patients with specific subgingival microbiological profiles benefit more from adjunctive systemic antibiotics. Aims: To answer the question: "What is the clinical benefit in periodontitis patients taking adjunctive systemic antimicrobials to non‐surgical therapy, depending on pre‐treatment detection of periodontopathogenic bacteria?" Materials and methods: A search was conducted in four electronic databases for randomized controlled trials reporting clinical outcomes following adjunctive antibiotic therapy for patients divided by baseline microbiological profiles. Results: The initial search resulted in 643 papers, reduced to five after screening and author contact. Four of these studies were suitable for a fixed effects two‐stage individual participant data meta‐analysis adjusted for baseline data. Collectively, adjunctive amoxicillin and metronidazole yielded superior clinical results (measured as reduction of PPDs) compared to placebo. No significant differences were detected for the effect of adjunctive antibiotics by the detection of Aggregatibacter actinomycetemcomitans on PPDs ≥ 5 mm (WMD = 1.16, 95% CI [−5.37, 7.68], I2 = 37.8%) or other clinical outcomes. All included studies had low risk of bias. Conclusion: There is no evidence to suggest that baseline detection of periodontopathogenic bacteria should be used as criterion for prescribing adjunctive antibiotics, although only limited information on microbial data and specific antimicrobials was available for analysis. [ABSTRACT FROM AUTHOR]

Introduction: An evidence synthesis approach compiling biological/laboratory data is effective in advancing health‐related knowledge. However, this approach is still underused in the oral health field. Methods: This commentary discusses the opportunities and challenges of systematic and scoping reviews of laboratory data in dentistry. Special focus is on the potential of these reviews to elucidate etiological and treatment concepts of oral diseases, such as periodontitis and peri‐implantitis. Results: The following difficulties associated with such studies are discussed: (i) selection of ideal study design, (ii) assessment of "risk of bias" and definition of "certainty of evidence", (iii) evidence assembly and summary, and (iv) the paper review process. Discussion: Despite those challenges, high‐quality reviews integrating laboratory data may generate relevant scientific information and help identify new avenues for future investigations. Experts in different oral health topics should build a process capable of helping researchers assemble and interpret these types of data. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim: To determine the accuracy of biomarker combinations in gingival crevicular fluid (GCF) and saliva through meta‐analysis to diagnose periodontitis in systemically healthy subjects. Methods: Studies on combining two or more biomarkers providing a binary classification table, sensitivity/specificity values or group sizes in subjects diagnosed with periodontitis were included. The search was performed in August 2022 through PUBMED, EMBASE, Cochrane, LILACS, SCOPUS and Web of Science. The methodological quality of the articles selected was evaluated using the QUADAS‐2 checklist. Hierarchical summary receiver operating characteristic modelling was employed to perform the meta‐analyses (CRD42020175021). Results: Twenty‐one combinations in GCF and 47 in saliva were evaluated. Meta‐analyses were possible for six salivary combinations (median sensitivity/specificity values): IL‐6 with MMP‐8 (86.2%/80.5%); IL‐1β with IL‐6 (83.0%/83.7%); IL‐1β with MMP‐8 (82.7%/80.8%); MIP‐1α with MMP‐8 (71.0%/75.6%); IL‐1β, IL‐6 and MMP‐8 (81.8%/84.3%); and IL‐1β, IL‐6, MIP‐1α and MMP‐8 (76.6%/79.7%). Conclusions: Two‐biomarker combinations in oral fluids show high diagnostic accuracy for periodontitis, which is not substantially improved by incorporating more biomarkers. In saliva, the dual combinations of IL‐1β, IL‐6 and MMP‐8 have an excellent ability to detect periodontitis and a good capacity to detect non‐periodontitis. Because of the limited number of biomarker combinations evaluated, further research is required to corroborate these observations. [ABSTRACT FROM AUTHOR]

Focused question Based on evidence as presented in systematic reviews what is the efficacy and safety of available homecare toothbrush regimens for mechanical plaque removal on plaque and gingivitis in adults? Material & Methods Three Internet sources were used (up to and including August 2014) to search for appropriate papers that satisfied the study purpose. Plaque scores and gingivitis scores were considered to be the primary parameter of interest. Safety was considered an important facet in relation to efficacy. Data and conclusions as presented in the selected papers were extracted. The potential risk of bias was estimated and the emerging evidence was graded. Results Independent screening of 176 unique reviews resulted in 10 published and eligible systematic reviews. They were categorized into one review evaluating the effect of an oral hygiene instruction with a toothbrush on plaque and gingivitis scores, five evaluating the efficacy of manual and power toothbrushes and three reviews evaluating toothbrush safety and one evaluating toothbrush contamination. Conclusion Tooth brushing is effective in reducing levels of dental plaque. With respect to gingivitis power toothbrushes have a benefit over manual toothbrushes. The greatest body of evidence was available for oscillating-rotating brushes. Tooth brushing generally can be considered safe for the teeth and their investing tissues. [ABSTRACT FROM AUTHOR]

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- Pub Med, 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'. [ABSTRACT FROM AUTHOR]

Focused question What is the effect of mechanical inter-dental plaque removal in addition to toothbrushing, on managing gingivitis using various formats of inter-dental self-care in adults based on evidence gathered from existing systematic reviews? Material & Methods Three Internet sources were searched by a strategy designed to include systematic reviews on inter-dental cleaning devices. Plaque and gingivitis scores were the primary parameters of interest. Characteristics of selected papers were extracted. The potential risk of bias was estimated and the acquired evidence was graded. Results Screening of 395 papers resulted in six systematic reviews. Two papers evaluated the efficacy of dental floss, two of inter-dental brushes ( IDB), one of woodsticks and one of the oral irrigator. Weak evidence of unclear or small magnitude was retrieved that supported dental floss, woodsticks and the oral irrigator to reduce gingivitis in addition to toothbrushing. No concomitant evidence for an effect on plaque emerged. There is moderate evidence that IDBs in combination with toothbrushing reduce both plaque and gingivitis. Conclusion Evidence suggests that inter-dental cleaning with IDBs is the most effective method for inter-dental plaque removal. The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal. All investigated devices for inter-dental self-care seem to support the management of gingivitis, however, to a varying extend. [ABSTRACT FROM AUTHOR]

Objectives: Diabetes mellitus and periodontitis are complex chronic diseases with an established bidirectional relationship. This systematic review evaluated in subjects with professionally diagnosed periodontitis the prevalence and odds of having diabetes. Methods: The MEDLINE-PubMed, CENTRAL and EMBASE databases were searched. Prevalence of diabetes mellitus among subjects with periodontitis was extracted or if possible calculated. Results: From the 803 titles and abstracts that came out of the search, 27 papers met the initial criteria. Prevalence of diabetes was 13.1% among subjects with periodontitis and 9.6% among subjects without periodontitis. Based on subanalysis, for subjects with periodontitis, the prevalence of diabetes was 6.2% when diabetes was self-reported, compared to 17.3% when diabetes was clinically assessed. The highest prevalence of diabetes among subjects with periodontitis was observed in studies originating from Asian countries (17.2%, n = 18,002) and the lowest in studies describing populations from Europe (4.3%, n = 7,858). The overall odds ratio for patients with diabetes to be among subjects with periodontitis as compared to those without periodontitis was 2.27 (95% CI [1.90;2.72]). A substantial variability in the definitions of periodontitis, combination of self-reported and clinically assessed diabetes, lack of confounding for diabetes control in included studies introduces estimation bias. Conclusions: The overall prevalence and odds of having diabetes are higher within periodontitis populations compared to people without periodontitis. Self-reported diabetes underestimates the prevalence when compared to this condition assessed clinically. Geographical differences were observed: the highest diabetes prevalence among subjects with periodontitis was observed in studies conducted in Asia and the lowest in studies originating from Europe. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the risk factors / predictors of tooth loss in patients with periodontitis who underwent periodontal therapy and long‐term periodontal maintenance (PM). Material and Methods: PubMed, CENTRAL, EMBASE, Web of Science, LILACS and Scholar were searched up to and including September 2020. Studies limited to periodontitis patients who underwent active periodontal therapy (APT) and followed a regular PM programme with 5 years follow‐up minimum were eligible for inclusion in this review. Studies were included if they reported data on tooth loss during PM. Random effects meta‐analyses of number of tooth loss per patient per year were conducted. Results: Thirty‐six papers regarding thirty‐three studies were included in this review, with three prospective 30 retrospective trials. Subgroup meta‐analysis showed no differences between prospective and retrospective studies, with an average of 0.1 tooth loss per year per patient (p < 0.001). Maxillary and molar teeth were more susceptible to be extracted during long‐term PM. Baseline characteristics (smoking, diabetes mellitus, cardiovascular disease, being male and teeth with furcation lesions) showed no significance as predictor of tooth loss through meta‐regression. The percentage of tooth loss due to periodontal reasons ranged from 0.45% to 14.4%. The individual outcomes in each study evidenced different patient‐related factors (age and smoking) and tooth‐related factors (i.e. tooth type and location) were associated with tooth loss during PM. Conclusion: The majority of patients undergoing long‐term PM have not lost teeth. On average, long‐term PM effectively causes the loss of 1 tooth per patient every 10 years. Additional prospective trials may confirm these results. [ABSTRACT FROM AUTHOR]

Aim The objectives of this review were as follows: What are characteristics used to define various forms of periodontal biotypes? What are their anatomic dimensions in relation to the definition? In addition, what is the association between these various characteristics in relation to the periodontal biotypes? Furthermore, what is the prevalence of various forms of periodontal biotypes in the population? Material and Methods The PubMed- MEDLINE, the Cochrane- CENTRAL and EMBASE databases were searched through up and till June 2013 to identify any appropriate studies regarding the aim. Appropriate studies were those reporting characteristics of various forms of periodontal biotype and its dimensions. These characteristics were gingival thickness ( GT), gingival morphotype ( GM), tooth dimensions ( TD), keratinized tissue ( KT) and bone morphotype ( BM). Results and Conclusions The search yielded 2581 unique papers, after selection resulted in 12 publications that met the eligibility criteria. In general, the available definitions are found to be unclear and sometimes inconsistent. However, based on the available literature, the three biotypes thin scalloped, thick flat and thick scalloped seem a comprehensive categorization in defining periodontal biotypes in the population. The dental, gingival and osseous dimensions have a weak to moderate association. Only between gingival thickness, keratinized tissue and bone morphotype uniform positive associations are found. [ABSTRACT FROM AUTHOR]

Focused question What is the adjunctive effect of a diode laser (DL) following non-surgical periodontal debridement ( SRP) during the initial phase of periodontal therapy on the clinical parameters of periodontal inflammation. Material and Methods The MEDLINE-PubMed, Cochrane-Central Register of Controlled Trials and EMBASE databases were searched up to September 2013. Probing pocket depth ( PPD) and clinical attachment loss ( CAL) were selected as outcome variables. Also plaque scores ( PS), bleeding scores ( BS) and the Gingival Index ( GI) were considered outcome measures. Data were extracted and a meta-analysis (MA) was performed where appropriate. Results Independent screening of 416 unique papers resulted in nine eligible publications. The MA evaluating PPD, CAL and PS showed no significant effect. The only significance favouring adjunctive use of the DL was observed for the outcome parameters GI and BS. Conclusion The collective evidence regarding adjunctive use of the DL with SRP indicates that the combined treatment provides an effect comparable to that of SRP alone. That is for PPD and CAL. The body of evidence considering the adjunctive use of the DL is judged to be 'moderate' for changes in PPD and CAL. With respect to BS, the results showed a small but significant effect favouring the DL, however, the clinical relevance of this difference remains a question. This systematic review questions the adjunctive use of DL with traditional mechanical modalities of periodontal therapy in patients with periodontitis. [ABSTRACT FROM AUTHOR]

Aim To establish the added effect of a chemotherapeutic cooling solution in an ultrasonic device on clinical parameters of periodontal inflammation following non-surgical periodontal therapy. Methods The MEDLINE-PubMed, Cochrane- CENTRAL, and the EMBASE databases were searched. Probing pocket depth ( PPD) and clinical attachment level ( CAL) and their changes were selected as outcome variables. Subgroup analyses were performed according to the following active ingredients: essential oils ( EO), povidone-iodine ( PVP), and chlorhexidine ( CHX). Results Screening of 100 unique papers resulted in 14 eligible publications, including 16 comparisons. The meta-analysis ( MA) showed that when the ultrasonic cooling solution had adjuvant chemotherapeutic properties, the difference of means (DiffM) for end value PPD-0.12 (95% CI: −0.42; 0.18) and for CAL the DiffM+-0.13 (95% CI: −0.39; 0.14). None of these were statistically significant, and the findings were supported by the overall descriptive analysis. Subgroup analysis only revealed a small effect for PVP on the difference (DiffM = −0.23, 95% CI: −0.43; −0.02) with respect to CAL ( p = 0.03). Conclusions The collective evidence indicates that overall, no additional effects were observed. There is a 'very weak' recommendation based on the sub-analysis showing that in conjunction with PVP, a very small gain in CAL may be expected. For the use of CHX or EO, the added effect can be considered to be 'zero.' Therefore, the strength and direction of the recommendation emerging from this review is against their use. [ABSTRACT FROM AUTHOR]

Objective To perform a systematic critical appraisal of the methodological quality of systematic reviews on the effect of a history of periodontitis on dental implant loss. Materials & Methods PubMed, the Cochrane database for systematic reviews, the DARE, Biosis Preview, CINAHL, Web of Science, and LILACS electronic databases were searched on 16th June 2012, independently and in duplicate, for systematic reviews and meta-analyses related to dental implants for patients with and without a history of periodontitis. Manual searching of the reference lists of included papers was also conducted. The methodological quality of these systematic reviews was assessed by use of the AMSTAR and R- AMSTAR checklists. Before quality assessment was initiated, the reviewers were calibrated until they achieved excellent agreement. Results Sixty-eight papers were initially retrieved. Of these, nine systematic reviews and three meta-analyses were included. Some domains, for example, 'characteristics of the included studies' were satisfied in both checklists. In contrast, domains such as 'comprehensive literature search' and 'assessment of likelihood of publication bias' were rarely met. Conclusion Much methodological variability was encountered in the selected reviews. To furnish readers with a more comprehensive assessment of the evidence, authors should observe higher standards when conducting and reporting their reviews. [ABSTRACT FROM AUTHOR]

Aim The purpose of this systematic review was to investigate whether a mineral trioxide aggregate ( MTA) restoration of an endodontic-periodontal communication leads to regeneration of the adjacent periodontal tissues. Methodology The databases MEDLINE-PubMed, Cochrane- CENTRAL, and EMBASE were searched, up to July 2012. In vivo studies that reported on the histological response of the periodontium to MTA were selected. Results The screening of 98 title-abstracts, full-text reading, and hand searches in literature lists yielded 24 papers. All of them involved animals. There were no studies reporting on human histology. Study protocols presented heterogeneity regarding treated lesions, intervention, and reported outcomes. The histological results of the animal studies showed minimal inflammatory reactions, bone healing, periodontal ligament presence, and consistent cementum formation. Time lapse after mixing, bacterial contamination, root canal disinfection, and inflammation influenced MTA's cementoconductive properties. Conclusions Within the limitations of the selected papers concerning inhomogeneous study protocols and low methodological quality scores, their findings were consistent with regard to MTA's biocompatibility and cementogenic ability. Experimental animal studies show that MTA can promote healing towards regeneration. There is now a distinct need to examine the clinical performance of MTA in well-controlled prospective human cohort studies. [ABSTRACT FROM AUTHOR]

Purpose It has been stated that midfacial recession is common following immediate implant treatment ( IIT). The objective of this systematic review was to assess the frequency of advanced recession (>1 mm) following single IIT. Material and methods An electronic search in Pubmed, Web of Science and the Cochrane Oral Health Group Specialized Trials Register database was performed using a search algorithm. Reference lists of relevant articles were also scrutinized to identify prospective studies on ≥10 implants installed in patients with an intact buccal bone wall and followed for ≥12 months. Study eligibility and quality were independently assessed by two investigators. Primary outcome variables were advanced inter-proximal and midfacial recession defined as soft tissue loss surpassing 1 mm between the pre- or postoperative status and the final re-assessment. Results Thirteen of 171 papers were selected. Inter-examiner agreement on eligibility ( κ = 0.879; p < 0.001) and quality ( κ = 0.788; p < 0.001) was high. Advanced inter-proximal recession was described in 0-27% of the cases. However, these data were only based on two studies. Mean inter-proximal recession was frequently reported (11/13) and was <1 mm in all studies suggesting limited risk for advanced inter-proximal recession. Advanced midfacial recession was described in 0-64% of the cases. Again, few papers provided such information (4/13). Only one of these studies demonstrated high risk for advanced midfacial recession (>10%). This could be attributed to the fact that implants had not been restored with an immediate implant crown, which seems of pivotal importance given the results of a randomized controlled trial reporting on the preserving effect of immediate provisionalization on midfacial mucosa level. There is limited evidence to support an increased risk for midfacial recession following flap surgery and in patients with a thin-scalloped gingival biotype. The impact of implant-specific parameters on inter-proximal and midfacial soft tissue level seems conflicting. Conclusions Soft tissue recession may be expected following IIT and multiple factors seem to contribute to the phenomenon. Taking into account the paucity of papers, patients with an intact buccal bone wall and thick gingival biotype, treated by means of flapless surgery and an immediate implant crown may demonstrate limited risk for advanced midfacial recession (<10%). Proper risk assessment addressing diagnostic, surgical and restorative aspects is mandatory to avoid compromised outcome of IIT. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim: Elevated plasma C-reactive protein (CRP) is regarded as a risk predictor for cardiovascular diseases. This systematic review explored the robustness of observations that CRP is elevated in periodontitis. Similarly, the effect of periodontal therapy on CRP levels was investigated. Material and Methods: Selection of publications was based on: (1) cross-sectional (case–control) studies; (2) longitudinal (treatment) studies; (3) high-sensitivity CRP measurement; (4) median and/or mean (±SD) values presented; and (5) subjects with no systemic disorders. Results: Screening of the initially 448 identified studies and reference checking resulted in 18 suitable papers. The majority of the studies showed that CRP levels are higher in patients than in controls. Often, studies showed that patients had CRP levels >2.1 mg/l. A meta-analysis of 10 cross-sectional studies showed that the weighted mean difference (WMD) of CRP between patients and controls was 1.56 mg/l ( p<0.00001). Evidence from available treatment studies ( n=6) showed lower levels of CRP after periodontal therapy. Eligible treatment studies in a meta-analysis demonstrated a WMD of reductions of CRP after therapy of 0.50 mg/L (95% CI 0.08–0.93) ( p=0.02). Conclusions: There is strong evidence from cross-sectional studies that plasma CRP in periodontitis is elevated compared with controls. There is modest evidence on the effect of periodontal therapy in lowering the levels of CRP. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract Objectives: The purpose of this study was to determine to what extent the presence or absence of periodontal pathogens can distinguish between subjects with chronic and aggressive periodontitis. Material and Methods: A systematic review of cross sectional and longitudinal studies providing microbiological data both from patients with chronic periodontitis (ChP) and aggressive periodontitis (AgP) at a subject level. Strict inclusion criteria were applied. The presence or absence of five microorganisms was selected as primary study parameters: Actinobacillus actinomycetemcomitans (AA), Porphyromonas gingivalis (PG), Prevotella intermedia (PI), Bacteroides forsythus (BF), and Campylobacter rectus (CR). Results: The presence or absence of AA could be evaluated in 11 papers. In seven papers the presence or absence of PG could be analysed. Subject specific data on PI were available from six studies. Two studies could be used regarding the presence or absence of BF, and two regarding CR. Sensitivity and specificity of every microbiological test were individually calculated for each selected study, assuming that the clinical diagnosis of AgP or ChP was the true status the tests attempted to detect. AgP was considered to be the condition of interest and ChP was considered equivalent to ‘non-AgP’. Receiver Operator Characteristic (ROC) diagrams were constructed using these data. ROC diagrams indicated the limited discriminatory ability of all of the test parameters to identify subjects with AgP. An additional assessment showed that the highly leukotoxic variant of AA was uniquely associated with patients suffering from aggressive periodontitis. However, in a high proportion of patients diagnosed with AgP the presence of this variant could not be detected. Conclusion: The presence or absence of AA, PG, PI, BF or CR could not discriminate between subjects with AgP from those with ChP. [ABSTRACT FROM AUTHOR]

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

Aim: The aim of this network meta‐analysis (NMA) was to compare the efficacy of different oral hygiene products for chemical biofilm control, in 6‐month home‐use, randomized clinical trials (RCTs), in terms of changes in gingival index (GI). Material and Methods: Six‐month RCTs assessing GI were identified and screened for inclusion. Relevant information was extracted, and quality and potential risk of bias were estimated. Mean differences between baseline and end were calculated to obtain standardized mean differences (SMDs). NMA protocols were applied to assess direct and indirect comparisons among products using Löe & Silness GI, modified GI and gingival severity index. Results: Fifty‐three papers were included, 19 studies for mouth rinses, 32 for dentifrices, comprising data from 5,775 and 2,682 subjects, respectively. When ranking treatments, similar results were observed for all tested dentifrices, with the lowest effect observed for sanguinarine and baking soda. For mouth rinses, essential oils, triclosan–copolymer, chlorhexidine (at concentrations ≥ 0.10%) and cetylpyridinium chloride (>0.05%) demonstrated the greatest effect. Conclusion: Although NMA revealed significant differences when comparing placebo versus some active agents, when comparing among active agents, no differences were found for dentifrices, while mouth rinses containing essential oils showed the greatest effect on GI scores. [ABSTRACT FROM AUTHOR]

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

Abstract: 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. [ABSTRACT FROM AUTHOR]

Aim Several papers have considered the potential relationship between periodontitis and lipid parameters. The present systematic review, meta-analysis and meta-regression studies focused on investigating whether serum lipid parameter levels were elevated in patients with periodontal disease ( PD; without altered systemic conditions) in comparison with periodontally healthy subjects. Materials and Methods Eligible studies were those with data about serum lipid parameter levels in non-smoking subjects with and without chronic periodontitis, who are generally healthy and not taking any medication for dyslipidaemia. Mean differences and 95% confidence intervals for total cholesterol, triglycerides, low-density lipoprotein ( LDL) cholesterol and high-density lipoprotein ( HDL) cholesterol were obtained from all the selected studies. Results A total of 19 publications were included for meta-analysis. Participants with chronic periodontitis presented significantly higher serum levels of LDL and triglycerides ( p = .003 and p < .0001, respectively). The total cholesterol was higher in the PD group, but without significant difference in comparison with healthy participants. Significantly ( p = .0005) lower HDL serum levels were found in patients with chronic periodontitis than in healthy subjects. Conclusions Even considering the limitations of this meta-analysis, it is suggested that PD is significantly associated with reduction in HDL and elevation of LDL and triglyceride concentrations. This analysis supports the rationale that periodontal disease is associated with lipid metabolic control. [ABSTRACT FROM AUTHOR]

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

Aim: To analyse the efficacy of non‐surgical therapy (NST) in terms of pocket closure (PC) and changes in percentage and number of pockets. Materials and Methods: Three databases (PubMed, EMBASE, and Scopus) were searched up to January 2020. Prospective studies with a minimum follow‐up of 12 months and presenting data in terms of PC or number or percentage of pocket depths (PDs) before and after NST on systemically healthy patients were included. Random‐effect meta‐analyses were performed. Results: After screening 4610 titles and abstracts, 27 studies were included. Of these, 63.9% of PC was reported by one study. The percentage of PDs ≤3 mm changed from 39.06% to 64.11% with a weighted mean difference (WMD) of 26.14% (p <.001). This accounted for a relative increase of healthy sites of 64.13%. The mean percentage of PD ≥5 mm was 28.23% and 11.71% before and after treatment, respectively, with a WMD of 15.50% (p <.001). The WMD in the number of PDs ≥5 mm before and after treatment was 24.42 (p =.036). The mean number of residual PPD ≥5 after NST was 14.13. Conclusions: NST is able to eradicate the majority of the pockets. However, residual pockets after NST may remain and should be considered cautiously for further treatment planning. [ABSTRACT FROM AUTHOR]

Abstract Background: Scaling and root planing (SRP) are the bases of non-surgical therapy in the treatment of periodontitis. However, results from this therapy are often unpredictable and dependable from many different factors. Objectives: The aim of this systematic review was to evaluate the effectiveness of the adjunctive use of systemic antimicrobials with scaling and root planing (SRP) vs. SRP alone in the treatment of chronic (CP) or aggressive periodontitis (AgP). Search strategy: Use of computerized databases, namely MEDLINE, the Cochrane Oral Health Group Specialty Trials Register and EMBASE; reference lists from relevant articles were hand-searched; and a hand-search of selected journals until April 2001. Selection criteria: Studies were selected if they were designed as controlled clinical trials in which systemically healthy patients with either AgP or CP were treated with SRP plus systemic antimicrobials in comparison with SRP alone or with placebo, for a minimum of 6 months. Main outcome measures were clinical attachment level (CAL) change and probing pocket depth (PPD) change. Data collection and analysis: Two reviewers extracted independently information regarding quality and study characteristics, in duplicate. Kappa scores determined their agreement. Main results were collected and grouped by drug, disease and PPD category. For the quantitative data synthesis, the data was pooled (when mean differences and standard errors were available), and either a Fixed Effects or Random Effects meta-analysis was used for the analysis. Results: After an initial selection, 158 papers were identified by the manual and electronic searches; 25 papers were eligible for inclusion. Their quality assessment showed that randomization and allocation concealment methods were seldom reported and blindness was usually not defined clearly. In general, selected studies showed high variability and lack of relevant information for an adequate assessment. Overall, SRP plus systemic antimicrobial groups demonstrated better results in CAL and PPD change than SRP alone or with placebo groups. Only limited meta-analyses could be performed, due to the difficulties in pooling the studies and the lack of appropriate data. This analysis showed a statistically significant additional benefit for spiramycin (PPD change) and amoxicillin/metronidazole (CAL change) in deep pockets. Conclusion: Systemic antimicrobials in conjunction with SRP, can offer an additional benefit over SRP alone in the treatment of periodontitis, in terms of CAL and PPD change, and reduced risk of additional CAL loss. However, differences in study methodology and lack of data precluded an adequate and complete pooling of data for a more comprehensive analyses. It was difficult to establish definitive conclusions, although patients with deep pockets, progressive or ‘active’ disease, or specific microbiological profile, can benefit more from this adjunctive therapy. [ABSTRACT FROM AUTHOR]

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

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

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

Aim The aim of this study was to assess the effect of systemic antibiotic therapy on the treatment of aggressive periodontitis (AgP). Methods This study was conducted and reported in accordance with the PRISMA statement. The MEDLINE, EMBASE and CENTRAL databases were searched up to June 2014 for randomized clinical trials comparing the treatment of subjects with AgP with either scaling and root planing ( SRP) alone or associated with systemic antibiotics. Bayesian network meta-analysis was prepared using the Bayesian random-effects hierarchical models and the outcomes reported at 6-month post-treatment. Results Out of 350 papers identified, 14 studies were eligible. Greater gain in clinical attachment ( CA) (mean difference [ MD]: 1.08 mm; p < 0.0001) and reduction in probing depth ( PD) ( MD: 1.05 mm; p < 0.00001) were observed for SRP + metronidazole (Mtz), and for SRP + Mtz + amoxicillin (Amx) ( MD: 0.45 mm, MD: 0.53 mm, respectively; p < 0.00001) than SRP alone/placebo. Bayesian network meta-analysis showed additional benefits in CA gain and PD reduction when SRP was associated with systemic antibiotics. Conclusions SRP plus systemic antibiotics led to an additional clinical effect compared with SRP alone in the treatment of AgP. Of the antibiotic protocols available for inclusion into the Bayesian network meta-analysis, Mtz and Mtz/Amx provided to the most beneficial outcomes. [ABSTRACT FROM AUTHOR]

Aim: The present systematic review and meta‐analysis was performed to investigate if there was a significantly enhanced risk of dental implant failure due to the increased number of cigarettes smoked per day. Materials and Methods: Four databases, including PubMed, Embase, Web of Science and Scopus, were searched until January, 2019. The search terms "dental implant, oral implant, smoking, smoker, tobacco, nicotine and non‐smoker" were used in combination to identify the publications providing data for dental implant failures related to the smoking habit. Publications were excluded if the quantity of cigarettes consumed per day was not reported. Fixed‐ or random‐effects meta‐analyses were used to pool the estimates of relative risk (RR) with 95% confidence intervals (CI). Results: Having additional information supplied by the authors, 23 articles were selected for final analysis. The meta‐analyses based on implant‐ and patient‐related data showed a significant increase in the RR of implant failure in patients who smoked >20 cigarettes per day compared with non‐smokers (implant based: p =.001; RR: 2.45; CI: 1.42–4.22 and patient based: p <.001; RR: 4; CI: 2.72–5.89). Conclusion: The risk of implant failure was elevated with an increase in the number of cigarettes smoked per day. [ABSTRACT FROM AUTHOR]

Background and objectives There is still debate regarding potential relationships between maternal periodontitis during pregnancy and adverse pregnancy outcomes. The aim of this systematic review was to synthesize the available epidemiological evidence on this association. Data sources Combined electronic and hand search of MEDLINE, EMBASE, WEB OF SCIENCE and Cochrane Central Register databases. Study eligibility criteria Original publications reporting data from cross-sectional, case-control or prospective cohort epidemiological studies on the association between periodontal status and preterm birth, low birthweight (LBW) or pre-eclampsia. The search was not limited to publications in English. All selected studies provided data based on professional assessments of periodontal status, and outcome variables, including preterm birth (<37 weeks gestation), LBW (<2500 g), gestational age, small for gestational age, birthweight, pregnancy loss or miscarriage, or pre-eclampsia. Participants Pregnant women with or without periodontal disease, and with or without adverse pregnancy outcomes, assessed either during pregnancy or postpartum. No intervention studies were included. Study appraisal and synthesis methods - Publications were assessed based on predefined screening criteria including type of periodontal assessment, consistency in the timing of the periodontal assessment with respect to gestational age, examiner masking and consideration of additional exposures and confounders. Results Maternal periodontitis is modestly but significantly associated with LBW and preterm birth, but the use of a categorical or a continuous exposure definition of periodontitis appears to impact the findings: Although significant associations emerge from case-control and cross-sectional studies using periodontitis 'case definitions,' these were substantially attenuated in studies assessing periodontitis as a continuous variable. Data from prospective studies followed a similar pattern, but associations were generally weaker. Maternal periodontitis was significantly associated with pre-eclampsia. Limitations There is a high degree of variability in study populations, recruitment and assessment, as well as differences in how data are recorded and handled. As a result, studies included in meta-analyses show a high degree of heterogeneity. Conclusions and implications of key findings Maternal periodontitis is modestly but independently associated with adverse pregnancy outcomes, but the findings are impacted by periodontitis case definitions. It is suggested that future studies employ both continuous and categorical assessments of periodontal status. Further use of the composite outcome preterm LBW is not encouraged. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Major challenges in periodontology include understanding the pathophysiology, the interplay between various components of the host response, parallels with other diseases and identifying biomarkers of the disease. Four reviews were compiled with the aim of better understanding: (1) the role of polymorphic nuclear leucocytes (PMNs), i.e. neutrophils; (2) the function of cytokine networks in the host response; (3) whether parallels exist with rheumatoid arthritis (RA); and (4) whether useful biomarkers currently exist to help in the management of periodontal disease. Based on the focused questions, electronic and manual searches were conducted for human, animal and cellular studies on the above topics. Papers fulfilling the inclusion criteria were selected and reviews were written and reviewed and corrected before the academy meeting to produce consensus statements. The following consensus statements were produced. PMNs are important in the pathophysiology of periodontal disease but there is limited evidence on their much quoted destructive potential. Cytokine networks are enormously complex and we are really at the beginning of understanding their role in the disease process. RA has both similarities and marked differences to periodontal disease although the existing utilization of anti-cytokine therapies and other molecules in its treatment may have importance in periodontal disease therapy. Biomarkers for periodontal disease have yet to be completely defined but the ratio of receptor activator of NF- κB ligand to osteoprotegerin appears to be a biomarker test with utility for detecting bone destruction. [ABSTRACT FROM AUTHOR]

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. 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. 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 [ABSTRACT FROM AUTHOR]

Abstract Systematic reviews have become widely used for evaluating evidence across all fields of biomedicine. The objective of a systematic review is to provide a comprehensive and contemporary appraisal of research using transparent methods whilst aiming to minimize bias. In essence, research methodology is employed in the conduct of the review. Such reviews are therefore fundamentally different from traditional ‘narrative’ review articles in their purpose and in their potential to aid clinical decision-making. This paper is a guide to the rationale and nature of systematic reviews and will provide a background to understanding their use in clinical practice. [ABSTRACT FROM AUTHOR]

Aim: To systematically appraise the available evidence on vertical ridge augmentation (VRA) techniques and estimate a treatment‐based ranking on the incidence of complications as well as their clinical effectiveness. Materials and Methods: Searches were conducted in six databases to identify randomized clinical trials comparing VRA techniques up to November 2022. The incidence of complications (primary) and of early, major, surgical and intra‐operative complications, vertical bone gain (VBG), marginal bone loss, need for additional grafting, implant success/survival, and patient‐reported outcome measures (secondary) were chosen as outcomes. Direct and indirect effects and treatment ranking were estimated using Bayesian pair‐wise and network meta‐analysis (NMA) models. Results: Thirty‐two trials (761 participants and 943 defects) were included. Five NMA models involving nine treatment groups were created: onlay, inlay, dense‐polytetrafluoroethylene, expanded‐polytetrafluoroethylene, titanium, resorbable membranes, distraction osteogenesis, tissue expansion and short implants. Compared with short implants, statistically significant higher odds ratios of healing complications were confirmed for all groups except those with resorbable membranes (odds ratio 5.4, 95% credible interval 0.92–29.14). The latter group, however, ranked last in clinical VBG. Conclusions: VRA techniques achieving greater VBG are also associated with higher incidence of healing complications. Guided bone regeneration techniques using non‐resorbable membranes yield the most favourable results in relation to VBG and complications. [ABSTRACT FROM AUTHOR]

Background: Periodontitis worsens the hyperglycaemia in patients with type 2 diabetes mellitus (T2DM). Subgingival instrumentation, with or without surgical access, is the gold‐standard treatment for periodontitis. The aim was to summarize the evidence on the effect of subgingival instrumentation (with or without open flap) on the reduction of glycosylated haemoglobin (HbA1c). Methods: Nine electronic databases were searched up to 15 February 2023. Twelve randomized controlled trials with at least 6 months of follow‐up were included. Studies using systemic or local‐delivery antimicrobial therapies were excluded. Meta‐analyses were performed using the random‐effects model. The sources of heterogeneity were assessed by applying linear meta‐regression. Risk of bias was assessed by RoB 2, and certainty of evidence by GRADE. Results: Eleven studies were included in the quantitative analyses (1374 patients). Subgingival instrumentation resulted in 0.29% lower HbA1c (95% confidence interval: 0.10–0.47; p =.03) compared with non‐active treatment. Discussion: None of the 12 studies were assessed as having low risk of bias. The percentage of females and the time of diabetes diagnosis significantly explained the high level of heterogeneity. Subgingival periodontal therapy results in a significant and clinically relevant improvement in glycaemic control over 6 months in patients with T2DM and periodontitis. The grade of evidence was moderate. [ABSTRACT FROM AUTHOR]

Aim: To answer the following PICOS question: "In patients with peri‐implantitis, what is the efficacy of surgical therapy with adjunctive systemic or local antimicrobials, in comparison with surgical therapy alone, in terms of pocket probing depth reduction, as assessed in randomized controlled trials (RCTs) with at least 6 months of follow‐up?" Materials and Methods: A systematic literature search was conducted. Reduction in mean probing pocket depth (PPD) was the primary outcome. Secondary clinical outcomes were changes in suppuration (%), changes in bleeding on probing (BOP) (%), marginal bone level changes (mm), disease resolution (%), and implant/prosthesis loss (%). Patient‐reported outcome measures, possible adverse effects, and oral‐health‐related quality of life were also extracted if such data were available. Results: Four RCTs assessing the use of locally (two RCTs) and systemically (two RCTs) administered antimicrobial adjuncts to surgical treatment of peri‐implantitis, with 6–36‐month follow‐up, were included. Because of the substantial heterogeneity of interventions between the studies, meta‐analysis could not be performed. A reduction in the mean PPD was observed following all the involved surgical treatments, irrespective of the addition of antimicrobials. Except for the effect of systemic antimicrobials on marginal bone level changes and local antimicrobials on BOP, the effect of systemic and local antimicrobials was equivocal for all secondary outcome measures. Conclusions: Based on the limited available evidence, the adjunctive use of the currently tested systemic or local antimicrobials during surgical therapy, in comparison with surgical therapy alone, in patients with peri‐implantitis does not seem to improve the clinical efficacy. With regard the use of systemic antimicrobials, only 50% of the cases showed disease resolution after 1 year. There is a lack of studies that consider the sole use of local antimicrobials. Therefore, their true effect remains unclear. [ABSTRACT FROM AUTHOR]

Aim: The aim of this systematic review was to evaluate the efficacy of patient‐performed or administered adjunctive measures to non‐surgical peri‐implantitis therapy in terms of probing depth (PD) and/or bleeding on probing (BoP) reductions. Materials and Methods: Randomized and controlled clinical trials with at least 6 months of follow‐up were searched in three databases. Secondary outcomes included implant loss, disease resolution, recurrence of peri‐implantitis, need of re‐treatment, changes in marginal bone levels, patient‐reported outcomes and adverse effects. Results: Of 567 titles, 10 publications, reporting 9 investigations, were included. Three types of adjunctive measures were found (local/systemic antimicrobials and probiotics). Four studies evaluated the effects of local antimicrobials (i.e., minocycline microspheres, chlorhexidine chips or a metronidazole + amoxicillin gel), three studies evaluated systemic antimicrobials (either amoxicillin + metronidazole or metronidazole alone) and two studies evaluated probiotics (Lactobacillus reuteri strains). The addition of local antimicrobials led to modest improvements in PD reduction. Systemic antimicrobials showed significantly greater reductions in PD and BoP, especially at initially deep sites (PD > 6 mm). Due to the large heterogeneity among included studies, no meta‐analyses were performed. Conclusions: Different adjunctive measures in the non‐surgical treatment of peri‐implantitis have different impact in terms of PD and BoP reductions. Improved PD reductions result after the use of systemic antimicrobials, and to a lesser extent, after the use of local antimicrobials. [ABSTRACT FROM AUTHOR]

Aim: To answer the following PICOS question: "In adult patients with peri‐implantitis, what is the efficacy of surgical therapy with chemical surface decontamination of implant surfaces in comparison with surgical therapy alone or surgery with placebo decontamination, on probing pocket depth (PD) reduction and bleeding on probing (BoP)/suppuration on probing (SoP), in randomized controlled clinical trials (RCTs) and non‐RCTs with at least 6 months of follow‐up?" Materials and Methods: Six databases were searched from their inception up to 20 May 2022. Data on clinical outcome variables were pooled and analysed using mean differences (MDs), risk ratios (RRs), or risk differences (RDs) as appropriate, 95% confidence intervals (CIs), and prediction intervals (PIs) in the case of significant heterogeneity. Primary outcomes were determined as changes in PD and BoP/SoP. Secondary outcomes were radiographic marginal bone loss (MBL), implant loss, and disease resolution. PROSPERO registration number: CRD42022325603. Results: Six RCTs—two with moderate, three with high, and one with low risk of bias (RoB)—were included. These studies test the adjunctive effect of photodynamic therapy (PDT), chlorhexidine (CHX), and administration of local antibiotics (LAbs) during surgery on the clinical outcome. In a single 12‐month study, the adjunctive use of local antibiotics showed a clinically relevant reduction of PD [MD = 1.44; 95%CI (0.40 to −2.48)] and MBL [MD = 1.21; 95%CI (0.44–1.98); one trial, 32 participants]. PDT showed a small but significant reduction in BoP [MD = 7.41%; 95%CI (0.81–14.00); p = 0.028; two trials; 42 participants]. Treatment with CHX resulted in no significant changes in PD, BoP, or MBL compared to placebo (saline solution). None of the interventions affected disease resolution and implant loss. Certainty of the evidence was very low for all outcome measures assessed. Conclusions: Within the limitations of this systematic review and the meta‐analysis, adjunctive use of chemicals such as PDT, CHX, and LAbs for surface decontamination during surgery of peri‐implantitis cannot be recommended as superior to standard debridement procedures (mechanical debridement with or without saline). [ABSTRACT FROM AUTHOR]