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The regeneration of lost periodontal tissues due to periodontal disease remains a difficult clinical challenge. As clinicians, we look for procedures with improved predictability, beneficial impact on the treatment of periodontal disease, and in the long term – improvement of prognosis of the involved teeth. Various types of grafting materials with substantial research evidence reporting on their efficacy have been introduced in regenerative periodontal therapy based on their ability to facilitate the reconstruction of the lost supporting apparatus. Consequently, the periodontal regeneration of intrabony defects involves not only the experience and skills of the clinicians but also the selection of suitable regenerative material. The type of tissue filling in a periodontal defect after surgical treatment can only be precisely evaluated by histological means, and it is restricted to a few cases due to ethical reasons. Histologic studies have demonstrated regeneration potential for GTR, allografts, xenografts and growth factors. And since the periodontal regeneration includes the regrowth of alveolar bone, by using radiographs, changes of the alveolar crest may be used to monitor periodontal healing. Our case series present the radiographic evaluation of the bone fill of 6 vertical bone defects treated with Cerabone®. The xenograft Cerabone® is a 100% pure bone mineral of bovine origin that has been successfully applied in regenerative dentistry and has been in use for more than 15 years in various medical applications (e.g. craniofacial surgery, oncology and hand and spine surgery).

Introduction: It`s well known that the periodontitis is а complex disease initiated by bacteria, but modified by environmental factors and the host response. As any other chronic disease, the periodontal disease is influenced by the individual predisposition of the patient to develop the specific symptoms. The increasing number of studies in the area of the genetic factors and mechanisms of the patient to develop the specific condition is leading to the need for certain polymоrphism’s to be studied in details for the Bulgarian population. Aim: The recent study aims to identify the presence of SNP of IL-17F in the Bulgarian population. Materials and methods: In the study, 40 patients with periodontitis stage II, III and IV and 10 healthy control subjects were taking part. The age of the subjects varied between 23 and 75 with an average value of 46 years. Clinical and radiographic methods to establish the basic periodontal parameters were used. Laboratory methods were performed by means of Real-Time PCR for determination of SNP of Interleukin 17F (IL-17F) (-7488C/T rs_763780). The statistic data was processed with PCA – IBM SPSS Statistics Version 21. From all of the patients, informed consent was taken. Results: The recent study collected information about the dominating genotype when studying SNP of IL-17 F for patients with periodontitis. The presence of two genotypes was established – genotype TT (92%) and genotype CT (8%). We have established specific tendencies about the distribution of major parameter for diagnosis of periodontitis such as BoP and BL/Age in both groups. The individual host susceptibility can be used as a diagnostic parameter leading to the development of screening methods in order suspectable individuals to be found. Conclusion: The study has contributed to clarifying the genetic characteristic of the tested subject. The results confirmed the data from different studies that aim to research the genetic polymorphism of IL-17F in relation to periodontitis.

Introduction: Gingival inflammations relating to an increase in the quantity of dental plaque are most frequently seen in children and young adults. Their spread and severity increase with age and reach their peak during puberty. Aim - To study the main microorganisms of the subgingival microflora in children in puberty (10 – 14 years of age). Material and methods: 60 children aged 10-14 years subjected to monitoring- 30 without gingivitis (up to 25% PBI) and good oral hygiene and 30 children with plaque-induced gingivitis (over 50% PBI). A PCR – Real-Time method was used for identifying the main subgingival microorganisms and determining their quantities. Samples were taken with paper pins from the gingival sulcus of six teeth – three molars, two canines and one incisor (16, 13, 11, 26, 36, 43). Nine control strains were studied (a comprehensive sample). Samples were sent for research in standardized containers. Results: The results of this study show that the total quantity of subgingival microorganisms increases in the case of worsening oral hygiene and an increase in the quantity of dental biofilm. Six of the nine subgingival microorganisms tested were encountered in all children between the ages of 10 and 14. The remaining three species of microorganisms were isolated only from the children with gingivitis. Conclusion: During gingival inflammationshe subgingival microflora becomes more complex and from it can be isolated microorganisms from the red complex (P.gingivalis, T.denticola, T.forsythia).

SUMMARY Placement of dental implants in the posterior maxillary edentulous areas is often compromised by the limited volume of bone due to the anatomy of the maxillary sinuses. In such cases, the technique of Sinus Lift is indicated to provide a sufficient volume of hard tissue in order to achieve primary stability at implant placement. Simultaneous augmentation of the sinus floor and implant placement is severely limited by the amount of residual bone of the floor of the sinus. A clinical case of minimal residual bone at the bottom of the sinus is demonstrated. A sinus floor augmentation with bone block harvested from the mandibular symphysis is performed. The bone block is placed in the sinus after membrane elevation and fixed with a screw to the sinus floor. After fixation of the bone block in the sinus implant (10/4.1 mm TSV (Zimmer)) is placed in reconstructed bone with good primary stability. Healing occurs without complications and the third month X-ray showed normal density of bone around the implant. The technique is very sensitive to surgeon’s skills.

Periodontitis is an infectious disease concerning supporting tissues of the teeth. The primary etiological agent for disease development and progression is the subgingival biofilm, but recently it is known that host factors may modify the pathological process or may affect the severity and /or extent. The increasing levels of some specific pathogenic subgingival bacteria such as Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Fusobacterium nucleatum, Prevotella intermedia and others can result in periodontal destruction and possibly correlate with disease severity. Data from controlled studies show high prevalence of P. gingivalis, T. forsythia and Tr. denticola which represent the red complex (coexistence of these three species) in patients with moderate and severe chronic periodontitis. Parallel investigation of probing depth (PD) and clinical attachment level (CAL) with the microbiological testing may give a confirmation of relation between subgingival pathogenic bacteria and severity of periodontitis.

BACKGROUND: Successful prevention and treatment of periodontitis is contingent upon effective control of the periodontopathic microbiota. Periodontal pathogens reside in deep subgingival sites but also colonize supragingival plaque, tongue dorsum and other oral sites. Antimicrobial agents administered systemically or locally can help suppress periodontal pathogens in periodontal sites and in the entire mouth. MATERIALS AND METODS: Thirty patients with generalized severe chronic periodontitis with 567 periodontal pockets >5mm were included in the presented study. The mechanical periodontal treatment was performed with ultrasonic device P5 Newtron in four visits. Subgingival irrigation of the periodontal pockets in the right two quadrants (split-mouth study) were performed with 10% povidone-iodine solutions. Full mouth periodontal status evaluation was recorded again on the last visit. RESULTS: The results from this study show significant improvement of the clinical parameters of periodontitis in all treated patients and in almost all periodontal sites. In the regions treated with subgingival irrigation with 10% povidone-iodine solution superior reduction of the probing depth, more attachment gain and better reduction of the gingival inflammation were recorded in comparison with regions treated with SRP only. CONCLUSION: This study demonstrates positive effect of the subgingival irrigations with 10% povidoneiodine in cases of severe chronic periodontitis. This results are rationale for future studies on the effectiveness of the iodophore solutions in the treatment of the disease and on the clinical significance of the investigated treatment.

SUMMARY Clinical application of knowledge about risk factors and indicators associated with the loss of implants or periimplantitis requires additional studies to demonstrate the risk of peri-implant diseases. Identification of risk factors for periimplant mucositis and peri-implantitis will provide the clinician tools for determining the prognosis of the individual and the implant and better selection of patients for placement of implants. Progress in understanding the risk of periimplantitis at the individual level with a careful assessment of the risk level of an implant would be useful in the planning of implant treatment. The similarity in the etiology and pathogenesis of periodontal diseases and peri-implant infections requires an assessment of periodontal status and assessing the risk of progression of periodontitis in patients with a history of periodontal disease and implants. In the literature are few and conflicting data on the relationship of periodontal status of the patient and peri-implant diseases. It is likely that the presence of periodontal pockets, showing clinical signs of an infection and activity to be associated with inflammatory periimplant diseases. The study is focused on the discovery of a relationship between peri-implant mucositis and periimplantitis and activity (bleeding on probing - BoP) of patient’s periodontal disease. Statistically significant relationship was established between occurrence of active periodontal sites and inflammatory peri-implant diseases.

The main goal of the periodontal therapy is the regeneration of the affected periodontal structures and achievement of stable periodontal attachment. The contemporary statement regarding the effectiveness of the periodontal therapy is that healing results with more coronal level of the connective tissue attachment are associated with better long term stability.Aim: Evaluation of the effectiveness of treatment of severe chronic periodontitis with additional target antibiotic administration in comparison with the therapy with adjunctive antimicrobial combination amoxicillin+ metronidazole and conventional mechanical periodontal treatment regarding the mean clinical attachment gain, reduction of the attachment loss extent and the variations of the attachment level in sites with initial CAL from 1-2mm, from 3-4mm and above 5mm.Results: In all study groups mean clinical attachment gain has been achieved after the non-surgical periodontal therapy. In the group with target antibiotic administration the highest reduction of periodontal sites with CAL above 5mm is reported.

Introduction: Currently accepted understanding about the role of the host inflammatory response in the progression of destructive periodontal diseases is the basis of therapeutic approaches with NSAIDs. Reduced levels of IL-1 and PGE2 in crevicular fluid and gingival tissues are measured in patients with adjunctive host modulation therapy in comparison with conventional mechanical therapy alone in numerous studies. The healing in patients with this additional therapy demonstrates successful elimination of gingival inflammation with pocket depth reduction and attachment level improvement. Aim: To investigate the effectiveness of additional host modulation therapy with NSAID (Aulin) in patients with chronic periodontitis. Material and methods: The study involves 14 adult patients suffering moderate to advanced periodontitis, instructed for strict daily plaque control (including personal hygiene involving interdental brushes and dental floss) and antimicrobial mouth rinsing with 0.2% chlorhexidine (Corsodyl) and is treated with scaling and root planning. On the 5th day of the treatment the patients are put on adjunctive systemic administration of NSAID (Aulin) for 14 days, twice daily x100 mg. The efficiency of the therapy is measured at its 6th week with the same clinical parameters – PD, CAL, HI, and PBI. Results: The results of the treatment depict significant shift in the distribution of shallow and deep periodontal pockets. The shallow pockets (1-3mm) in the initial status of the patients are 23.8% from all measured pockets and at the end of the applied treatment this number rises up to 75.7%. The initial level of the deep periodontal pockets (≥5mm) is 9.8% and decreases to 0.5% after treatment. The quantity of pockets with moderate depth (35mm) decreases from 66.5% to 38.7% at the end of the evaluated treatment. Conclusion: Within the limits of this pilot study we may conclude that the additional host modulation therapy