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BackgroundGingivitis is a non-specific inflammatory lesion in response to the accumulation of oral biofilm and is a necessary precursor to periodontitis. Enhanced oral hygiene practices, including utilization of a dentifrice that could significantly improve plaque accumulation and gingival inflammation, is desirable to prevent and treat gingivitis and potentially prevent progression to periodontitis. This clinical study aimed to investigate the effect of a new stannous fluoride-containing dentifrice with 2.6% ethylenediamine tetra acetic acid (EDTA) as an anti-tartar agent to reduce plaque index and gingival index over a 3-month study period compared to other commercially-available fluoride-containing dentifrices.MethodsThis double-blind, randomized controlled clinical study evaluated plaque, gingival inflammation, and sulcular bleeding in patients using one of five commercially available fluoride-containing dentifrices The dentifrices tested contained: 0.454% stannous fluoride and 2.6% EDTA (D1), 0.24% sodium fluoride (C), and 0.454% stannous fluoride (D2-D4). One hundred fifty subjects participated over a 3-month period. Co-primary endpoints were improvements in plaque index (PI) and modified gingival index (mGI) from baseline values. No professional cleaning was performed during the study period.ResultsAll subjects in the study demonstrated statistically significant improvements in all measures of oral hygiene over the 3-month study period. Subjects using dentifrice 1 (D1) showed statistically significantly greater reductions in PI, mGI, and modified sulcular bleeding index (mSBI) compared with all other commercially-available dentifrices tested (p

BackgroundCompliance to periodontal maintenance therapy (PMT) is essential for long-term periodontal health. Between PMT visits, patients must maintain good oral hygiene. A dentifrice with demonstrable clinical benefits for use between PMT visits would be highly desirable. The aim of this clinical study was to investigate the effect of a novel dental gel on probing depths (PD) and inflammation when used as a home care dentifrice in Stage I and II periodontitis patients.MethodsThis double-blind clinical study randomized 65 subjects with Stage I and II periodontitis to the novel dental gel containing 2.6% EDTA, and a commercially available anti-gingivitis dentifrice with 0.454% stannous fluoride. Primary endpoint was PD at 6 months for those sites with baseline PD ≥ 4 mm and secondary endpoints included whole mouth mean scores of modified gingival index (MGI), modified sulcus bleeding index (mSBI) and plaque index (PI). No SRP was performed at baseline.ResultsSubjects using the novel dentifrice showed significant PD reductions of 1.18 mm (from 4.27 mm at baseline to 3.09 mm at 6 months) compared to 0.93 mm (from 4.23 mm at baseline to 3.30 mm at 6 months) shown for those using the positive control dentifrice. Difference between treatments at 6 months was 0.21 mm with P-value = 0.0126. Significant improvements in MGI (P = 0.0000), mSBI (P = 0.0000), and PI (P = 0.0102) were also observed in 6 months.ConclusionThe novel dentifrice showed significant reductions in PD and gingival inflammation over 6 months solely as a home care dentifrice without baseline SRP in Stage I and II periodontitis maintenance patients.

Objective:Overall aim of this prospective, randomized, positive controlled, double-blind in vivo study was to identify the effects of a test dental gel containing 2.6% edathamil with an added carrier and permeability enhancer vs. a positive control dentifrice on periodontal health measures in patients with Stage II and III periodontitis. Methods:In this prospective double-blinded, randomized study, 33 subjects were randomly assigned in a 1:1 ratio to brushing their teeth with either the test gel (LivFresh®, Livionex Dental Gel, Los Gatos, CA 95030) or the positive control toothpaste (Crest ProHealth®, P&G, Cincinnati, OH 45202).Full-mouth gingival index, modified sulcus bleeding index, and periodontal pocket probing depths were recorded for all teeth at baseline, and on days 90 and 180.Subjects brushed with the study material twice a day. Results:The test dental gel reduced gingival inflammation and bleeding, as well as periodontal pocket probing depths significantly more than a control dentifrice. Conclusions:In this pilot study in subjects with Stage II and III periodontitis, a test dental gel was found to improve gingival inflammation and bleeding, as well as periodontal pocket depths significantly better than a control dentifrice.

Background Methods Results Conclusion Key points Plain language summary Proliferative verrucous leukoplakia (PVL) is a rare and refractory form of oral leukoplakia. The etiology of PVL remains unknown. The lesion is characterized by a high rate of malignant transformation. There is no definitive treatment for PVL.This case study presents a patient diagnosed in 2000 with a localized hyperkeratinized/verrucous lesion involving the facial gingivae of teeth #6–#8. Over the next 24 years, the lesion was biopsied five times. Further, two attempts to ablate the lesion with a CO2 laser (10.6 µm wavelength) were performed. Both ablation treatments were unsuccessful as the lesion recurred and progressed to involve more areas of gingival tissue. To date, biopsy has not revealed transformation into verrucous or squamous cell carcinoma (SCCA).This case study demonstrates that two attempts at ablation of PVL using a CO2 laser had no short‐ or long‐term benefit. The patient eventually lost all maxillary teeth due to root caries and inability to maintain adequate oral hygiene. The PVL lesion currently involves the entire maxillary edentulous ridge, extending from the 2nd molar site to the opposite corresponding site. During the 24 years encompassed by this report, the patient has not experienced a malignant transformation.The results of CO2 laser ablation of the PVL lesion in this case provided no short‐ or long‐term benefit. Given the potential for a sinister outcome, PVL patients require frequent clinical evaluation and biopsy for early detection of a malignant transformation into oral verrucous or SCCA. Proliferative verrucous leukoplakia (PVL) is a clinical diagnosis and represents a refractory form of multifocal oral mucosal leukoplakia of unknown origin. Currently, there is no reliable and successful treatment for PVL. PVL may undergo transformation to a verrucous or squamous cell carcinoma, thereby necessitating frequent oral examination and biopsy of sinister‐appearing mucosal sites. Proliferative verrucous leukoplakia (PVL) is a clinical diagnosis and represents a refractory form of multifocal oral mucosal leukoplakia of unknown origin.Currently, there is no reliable and successful treatment for PVL.PVL may undergo transformation to a verrucous or squamous cell carcinoma, thereby necessitating frequent oral examination and biopsy of sinister‐appearing mucosal sites.Proliferative verrucous leukoplakia (PVL) is a rare disorder that affects the gum tissue around the teeth. PVL is a pre‐cancerous disorder for which the cause is unknown and there is no treatment that yields a consistently successful result. This case study presents a patient diagnosed in 2000 with PVL involving the facial gum tissue of the upper right cuspid, lateral, and central incisor teeth. Over the next 24 years, the lesion was biopsied five times and two attempts to irradicate the lesion with a CO2 laser were performed. All attempts at treatment were unsuccessful and the lesion slowly progressed to involve more areas of gum tissue. The last biopsy taken in February 2024 did not reveal any areas of developing cancer. During the 24 years covered in this report, the patient did not develop oral cancer. However, treatment with the CO2 laser afforded no measurable benefit. Given the potential for developing cancer of the gum tissues, PVL patients should receive frequent oral exams and periodic biopsies for the detection of early cancer. [ABSTRACT FROM AUTHOR]

Background: A previous case study reported periimplantitis and concomitant perigraftitis of a second implant placed at a site that had alveolar ridge preservation three decades earlier. Infection at the site persisted 4 months after implant removal by flapless implant reversal. A flap was subsequently reflected, the grafted bone was removed, and a second alveolar ridge preservation was performed with a freeze‐dried bone allograft. The publication reported infection resolved, and the site healed uneventfully. However, it is unknown if placement of another implant at the site would be successful. The purpose of this paper is to report on the findings at surgical reentry and outcome of the third implant. Methods: Eleven months after the second alveolar ridge preservation, the site was reentered. The bone graft was found to be partially soft tissue encapsulated. All encapsulated graft materials and soft tissue were removed. An implant was placed, and the alveolar defect was grafted with a demineralized bone allograft. Seventeen months after implant placement, a buccal free gingival graft was performed during which the crestal bone adjacent to the implant was found to be hard and corticated. The implant was deemed to be osseointegrated and restored after soft tissue healing. Results: Twenty‐five months after implant placement, the third implant remained functional and asymptomatic with the peri‐implant bone exhibiting normal trabeculation. Conclusions: Implant therapy can be successful following treatment and resolution of perigraftitis. Key points: Perigraftitis may play a contributing role in the biologic complications of implants that have been placed into grafted bone.Perigraftitis may be successfully resolved by completely removing all grafted bone.Once perigraftitis has been eliminated, an implant may be successfully placed. [ABSTRACT FROM AUTHOR]

The authors present a case concerning an adult male patient who developed multiple sites of root caries adjacent to the area where he habitually held a sugar‐free nicotine lozenge that contained mannitol and maltodextrin. The root caries occurred despite the patient's excellent oral hygiene, exemplary dietary habits, and clinically normal salivary flow. Between 1999 and 2008, he had only required two restorations to repair carious lesions. This patient had a 20+‐year habit of using smokeless tobacco before switching to a cessation aid nicotine lozenge in May of 2008. A full‐mouth series of radiographs taken in November 2009 revealed carious lesions on virtually every posterior tooth. The nicotine lozenge's principal ingredients were mannitol (75.7%) and maltodextrin. According to the United States' current Food and Drug Administration (FDA) guidelines, manufacturers can advertise these lozenges as sugar‐free. Thus, it is assumed by the public that these types of products are incapable of "causing a cavity." However, this case report presents evidence suggesting that frequent use of sugar‐free nicotine lozenges may be associated with dental caries. [ABSTRACT FROM AUTHOR]

The article explores the impact of inadequate calculus removal on periodontal therapy outcomes, based on the 2018 classification of periodontal disease. It also discusses the development of decision points and guidelines for periodontal therapy, the role of calculus in inflammation, and the need for rigorous reevaluation and advanced therapy in cases where calculus removal is incomplete.

Successful treatment of peri-implantitis requires decontamination of implant surfaces exposed to biofilms and byproducts of tissue inflammation. In this regard, dental lasers may provide a clinical benefit. While the inherent characteristics of specific laser wavelengths may damage titanium implant surfaces, in vitro and animal studies have shown that damage to the target surface can be avoided with the selection of appropriate laser parameters. In this in situ human study, five hopeless implants were irradiated, each by one of the following lasers: Nd:YAG (1,064 nm), Er,Cr:YSGG (2,780 nm), Er:YAG (2,940 nm), CO2 (9,300 nm), and CO2 (10,600 nm) at their recommended settings. All implants were then removed and examined under scanning electron microscopy for the presence of residual bacteria and to assess the extent of damage to the implant surface. An additional implant (implant no. six) was irradiated and evaluated by the Limulus Amebocyte Lysate test for the presence of residual lipopolysaccharide endotoxin. The results showed that while there were localized areas of heat-related damage to an implant surface following laser irradiation, residual bacteria were rarely noted. Additionally, the Limulus Amebocyte Lysate test indicated a nearly complete removal of endotoxin. With the use of appropriate settings, all current dental lasers can be utilized for implant surface decontamination in a human. [ABSTRACT FROM AUTHOR]

The article addresses periodontitis, a chronic inflammatory condition affecting about 42 Percent of Americans aged 30 to 75, which translates to approximately 80.8 million people. Topics discussed include the disease's significant risk factors for stroke, atherosclerosis, and Alzheimer's disease, the need for clinically-based treatment guidelines, and the evaluation of treatment outcomes.

The article discusses clinical decisions based on the 2018 Classification of Periodontal and Peri-implant Disease and Conditions. Topics include rationale for therapeutic decision points, clinical therapeutic decision points, and simplified diagnostic and treatment summary for different stages of periodontitis.

Purpose: It is well known that fluorosis may be manifested by abnormal mineralization in teeth. The Er:YAG laser has seen increasing use for treatment of root surfaces exposed to periodontitis. However, there is little information regarding the effects of the Er:YAG laser on root cementum of fluorosed teeth. Therefore, this in-vitro study aimed to evaluate and compare root surface changes following Er:YAG laser irradiation of fluorosed and nonfluorosed teeth. Materials and Methods: Thirty periodontally healthy fluorosed and nonfluorosed root specimens were irradiated using an Er:YAG laser (2.94 µm wavelength) at 140 mJ/pulse and 10 Hz under a surface-cooling water spray. Examination by SEM was performed to assess laser-induced ultrastructural changes in the root surfaces. Statistical analysis and dichotomous expression of root surface changes in each of the groups were performed for intra- and intergroup comparisons. Results: Specimens in both treatment groups exhibited evidence of mild thermally induced change, primarily surface melting. Other surface alterations noted in both treatment groups included surface etching, intermittent smear layer, exposure of collagen tufts, and open dentinal tubules. Intergroup comparisons using the dichotomous data indicated that except for melting of root surface, other undesirable morphological changes were found to be more common in nonfluorosed than fluorosed root specimens. Conclusion: Results of the present study suggest that undesirable morphological changes were similar for both the HF and HNF groups. The results also indicate that further in vitro studies are required, using a variety of lower energy settings, before clinical trials can be initiated that would evaluate the use of the Er:YAG laser for treatment of teeth with fluorosed root structure. Also, observation of etched root surfaces with smear layer after laser irradiation may necessitate additional chemical acid etching for composite restoration for treatment of root caries if indicated. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this initial study was to evaluate the effects of both a sonic and a mechanical toothbrush versus the effects of no treatment on depth of subgingival penetration of epithelial and tooth-associated bacteria. Methods and materials: Eight adult subjects exhibiting advanced chronic periodontitis with at least 3 single-rooted teeth that were in separate sextants with facial pockets ≥ 4 mm and ≤ 8 mm and that required extraction constituted the experimental sample. Teeth were either subjected to 15 seconds of brushing with a mechanical toothbrush or a sonic toothbrush or left untreated. The test tooth and the associated soft tissue wall of the periodontal pocket were removed as a single unit. Samples were processed and coded for blind examination by scanning electron microscopy. Distributional and morphologic characteristics of dominant bacteria with specific emphasis on spirochetes were evaluated for both epithelial- and tooth-associated plaque. Results: No differences were found in morphotypes or distributional and aggregational characteristics of epithelial-associated microbes in the 1- to 3-mm subgingival zone between the mechanical and sonic toothbrush-treated groups and the control group. Both toothbrush groups featured disruption of microbes that extended up to 1 mm subgingivally. Root surfaces on the sonic-treated samples appeared plaque-free at low magnification; however, at 4,700× a thin lair of mixed morphotypes and intact spirochetes was found supragingivally and slightly subgingivally. In comparison, mechanical brush samples featured incompletely removed plaque, both supragingivally and subgingivally, with intact spirochetes present on subgingival root surfaces. Conclusion: Results suggest similar effects for both sonic and mechanical toothbrushes on epithelial- and tooth-associated bacterial plaque in periodontal pockets and adjacent root surfaces that extend up to 1 mm subgingivally. Further, the presence of intact subgingival spirochetes suggests limited exposure to acoustical or mechanical energy from the toothbrushes evaluated. (Quintessence Int 2001; 32: 147-154) [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to conduct a postmortem examination of retrieved failed dental implants to identify design characteristics that may have contributed to premature loss. Method and materials: Forty-five failed implants retrieved from 40 patients with no significant risk factors for implant failure (eg, history of smoking or diabetes) were examined by scanning electron microscopy. All implants were placed by general dentists or periodontists in private practice and had functioned for an average of 4 years. Results: Several design features of currently used implants present plaque-retentive areas. Plaque accumulation occurred along the implant-transmucosal abutment interfaces, transmucosal abutment- prosthesis interfaces, implant-prosthesis interfaces, and on surfaces of the abutment, the implant, and the prosthesis. The size of the microgap between the various components, the degree of surface roughness of the restorations and abutments, the exposure of plasma-sprayed coatings and threaded surfaces of implants, and overcontouring of implant restorations contributed to plaque accumulation and provided an ¡deal environment for bacterial colonization. Conclusion: These implant features may be key precipitating or exacerbating factors in the development of pen-implant inflammation, predisposing patients to Implant failure. [ABSTRACT FROM AUTHOR]