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AIM Tooth-level prognostic systems can be used for treatment planning and risk assessment. This retrospective longitudinal study aimed to evaluate the prognostic performance of 10 different tooth-level risk assessment systems in terms of their ability to predict periodontal-related tooth loss (TLP). MATERIALS AND METHODS Data were retrieved retrospectively from patients who received surgical and non-surgical periodontal treatment. Data on medical history and smoking status at baseline and the last maintenance visit were collected. Ten tooth-level prognostic systems were compared using both univariate and multivariate Cox proportional hazard regression models to analyse the prognostic capability of each system for predicting TLP risk. RESULTS One-hundred and forty-eight patients with 3787 teeth, followed-up for a mean period of 26.5 ± 7.4 years, were evaluated according to 10 different tooth-level prognostic systems, making up a total of 37,870 individual measurements. All compared prognostic systems were able to stratify the risk of TLP at baseline when different classes of association were compared. After controlling for maintenance, age, and gender, all systems exhibited excellent predictive capacity for TLP with no system scoring a Harrell's C-index less than 0.925. CONCLUSIONS All tooth-level prognostic systems displayed excellent predictive capability for TLP. Overall, the Miller and McEntire system may have shown the best discrimination and model fit, followed by the Nunn et al. system.

Background Clinicians predominantly use personal judgment for risk assessment. Periodontal risk assessment tools (PRATs) provide an effective and logical system to stratify patients based on their individual treatment needs. This retrospective longitudinal study aimed to validate the association of different risk categories of four PRATs (Staging and grading; Periodontal Risk Assessment (PRA); Periodontal Risk Calculator; and PerioRisk) with periodontal related tooth loss (TLP), and to compare their prognostic performance. Methods Data on medical history, smoking status, and clinical periodontal parameters were retrieved from patients who received surgical and non-surgical periodontal treatment. A comparison of the rate of TLP and non-periodontal related tooth loss (TLO) within the risk tool classes were performed by means of Kruskal-Wallis test followed by post-hoc comparison with the Bonferroni test. Both univariate and multivariate Cox Proportional hazard regression models were built to analyze the prognostic significance for each single risk assessment tool class on TLP. Results A total of 167 patients with 4321 teeth followed up for a mean period of 26 years were assigned to four PRATs. PerioRisk class 5 had a hazard ratio of 18.43, Stage 4 had a hazard ratio of 7.99, and PRA class 3 had a hazard ratio of 6.13 compared with class/stage I. With respect to prognostic performance, PerioRisk tool demonstrated the best discrimination and model fit followed by PRA. Conclusion All PRATs displayed very good predictive capability of TLP. PerioRisk showed the best discrimination and model fit, followed by PRA.

Bleeding on probing (BOP) is regarded as an indispensable diagnostic tool for evaluating periodontal disease activity; however, its role in peri-implant disease is more intricate. Much of the confusion about the interpretation originates from drawing parallels between periodontal and peri-implant conditions. BOP can originate from two forms of probing in implants: traumatic or pathologic induction. This, in addition to the dichotomous scale of BOP can complicate diagnosis. The objective of this commentary is to discuss the following: 1) the value of BOP as a diagnostic tool for peri-implant diseases; 2) the reasons it should be distinct from value for diagnosing periodontal and peri-implant diseases; and 3) the current best evidence on how to implement it in daily clinical practice. A comprehensive bleeding index is proposed for evaluating and monitoring peri-implant conditions. BOP should be used in addition to other parameters such as visual signs of inflammation, probing depth, and progressive bone loss before a peri-implant diagnosis is established.

The aim of this randomized clinical trial was to compare a flapless technique of alveolar ridge preservation (ARP) to a flap technique to determine if preserving the periosteal blood supply would limit loss of crestal ridge width and height.Twenty-four patients were randomly assigned to receive ARP using either a flapless or flap technique. Sockets were grafted with demineralized bone matrix and mineralized particulate allograft then covered with a barrier in both groups. Re-entry was performed at 4 months to obtain samples for histological analysis and subsequent implant placement.Ridge width of the flapless group at the crest decreased from 8.3 ± 1.3 mm to 7.0 ± 1.9 mm for a mean loss of 1.3 ± 0.9 mm (p0.05), whereas the flap group decreased from 8.5 ± 1.5 mm to 7.5 ± 1.5 mm for a mean loss of 1.0 ± 1.1 mm (p0.05). The mean midbuccal vertical change for the flap group was a loss of 0.9 ± 1.3 mm (p0.05) versus 0.5 ± 0.9 mm (p0.05) for the flapless group. There was no statistically significant difference between the groups. Histologically, flapless ARP revealed more vital mineralized tissue (44 ± 10%) compared to the flap group (p0.05). In the flapless group, the occlusal soft tissue was significantly thicker than in the flap group at the 4-month re-entry (p0.05).Crestal ridge width, height, and percentage of vital mineralized bone following treatment with a flapless ARP technique, was not significantly different from a flap technique.

Aim To develop and internally validate a nomogram built on a multivariate prediction model including parameters from the new classification of periodontal diseases, able to predict, at baseline, the occurrence of tooth loss due to periodontal reason (TLP). Materials and methods A total of 315 individuals diagnosed with periodontal disease and receiving a minimum of one annual supportive periodontal therapy visit were included in the study. Patients were staged and graded based upon baseline data. The population was divided into a development (254 patients) and a validation (61 patients) cohort to allow subsequent temporal validation of the model. According to the TLP at the 10-year follow-up, patients were categorized as "low tooth loss" (≤ 1 TLP) or "high tooth loss" (≥ 2 TLP). Bootstrap internal validation was performed on the whole data set to calculate an optimism-corrected estimate of performance. Results The generated nomogram showed a strong predictive capability (AUC = 0.81) and good calibration with an intercept = 0 and slope = 1. These findings were confirmed by internal validation using bootstrapping (average bootstrap AUC = 0.83). Conclusions The clinical implementation of the present nomogram guides the prediction of patients with high risk of disease progression and subsequent tooth loss for personalized care.

Alveolar ridge preservation (ARP) procedures have become one of the most commonly performed surgical procedures in dentistry, due to increased demand for dental implant therapy. Previous studies have repeatedly shown a naturally healed socket could lose up to 50% of its buccolingual width, which in turn would negatively impact the future implant placement. ARP procedures have been shown to consistently reduce the amount of post-extraction horizontal and vertical bone loss; however, it is still not conclusive which biomaterial or technique is the most superior. The purpose of this article is to review current evidence on various ARP procedures. The electronic database search was limited to the past 3 years (publication dates between January 1, 2017, and February 29, 2020) and to human clinical studies (including controlled clinical trials and randomized controlled trials) investigating dimensional changes in alveolar sockets after various ARP techniques with outcomes measured from 3 to 6 months postoperatively. A total of 31 articles were reviewed, with approximately half of the selected studies using bovine (14) bone substitutes. Other biomaterials used in the studies included porcine bone substitutes, allografts (both freeze-dried and solvent-dehydrated), alloplasts (biphasic calcium phosphate, β-tricalcium phosphate, and hydroxyapatite), biologics (platelet-rich fibrin and recombinant bone morphogenetic protein-2), collagen and high-density polytetrafluoroethylene membranes, and micro-titanium stent. Collagenated deproteinized bovine bone matrix (DBBM-C) was the most studied biomaterial in the past 3 years. Most studies showed DBBM-C plus barrier membranes resulted in comparable clinical and radiographic outcomes with DBBM and allografts. Consistent with previous studies, most of the ARP procedures reviewed in this article demonstrated effective reduction of alveolar ridge dimensional changes. Based on the selected articles and recent systematic reviews and meta-analysis, ARP procedure using bovine and porcine xenografts, as well as allografts, in conjunction with either collagen membranes or high-density polytetrafluoroethylene membranes gives similar results and should be considered when indicated.

Twenty-six patients with a horizontal ridge defect were entered into this 4-month randomized, controlled, blinded clinical trial to compare a cancellous block allograft to a demineralized bone matrix (DBM) allograft for ridge augmentation. Six patients were excluded from the study, leaving 20 for data interpretation. Both groups had a xenograft overlay and a collagen membrane. For the Block group there was a significant gain of 4.8 ± 1.9 mm (P = .00002; 95% confidence interval [CI]: 3.49 to 6.21), while the DBM group gained 4.6 ± 2.4 mm (P = .0002; 95% CI: 2.88 to 6.36). Vertical change was minimal for both groups (P > .05). The Block group had a mean of 40% vital bone while the DBM group had 35%.

Twenty patients completed this randomized, controlled, blinded clinical trial comparing ridge preservation with a bioabsorbable polylactic acid membrane (PLA group) compared to an acellular dermal matrix membrane guided bone regeneration (ADMG group). An intrasocket corticocancellous allograft plus a facial overlay xenograft was used for both groups. Final crestal ridge width was significantly greater for the ADMG group (P < .05). Soft tissue thickness, conversely, was thicker for the PLA group. Vertical ridge height change increased significantly for the midbuccal site of the ADMG group. Histologic evaluation showed high percentages of vital bone for both groups.

Twenty-four patients completed this randomized, controlled, blinded clinical trial comparing ridge preservation with a membrane (acellular dermal matrix graft [ADMG]) vs no membrane on buccal overlay graft technique. An intrasocket corticocancellous allograft with a facial overlay xenograft was used for both groups, and an ADMG was used as a membrane with guided bone regeneration in the ADMG group (control group). In the No Membrane group (test group), ADMG was used to cover only the occlusal surface for graft containment, with no membrane on the buccal overlay graft. Final crestal ridge width and vertical ridge height had no significant difference between groups (P > .05). Facial contour was preserved for the ADMG group compared to No Membrane group. Histologic examination showed a high percentage of vital bone for both groups with no significant difference between groups.

Twenty patients were randomly assigned to receive either a platform-switched or platform-matched implant to replace a single maxillary anterior tooth. Primary outcome variables were the implant interproximal bone loss, facial recession, and papilla fill at 12 months. The platform-switched group showed crestal bone loss of 0.1 ± 0.3 (mesial) and 0 mm (distal) while the platform-matched group showed losses of 0.6 ± 0.5 mm (mesial) and 0.7 ± 0.7 mm (distal) (P < .05). Facial recessions for the platform-switched and platform-matched groups were 0.1 ± 0.3 mm and 0.4 ± 0.8 mm, respectively.

Background A new classification of periodontal diseases aimed to identify periodontal disease based on a multidimensional staging and grading system has been recently proposed. However, up to date, its prognostic predictive capability has not been investigated. The aim of this study was to assess if parameters included in the new classification were predictive of tooth loss after a long-term follow-up (>10 years) in patients with periodontitis. Methods Patients presented with periodontitis at the University of Michigan between January 1966 and January 2004 were screened and categorized according to the new classification of periodontitis. Number/Reasons of teeth loss in patients who underwent at least one session/year of maintenance during the entire follow-up period were extracted and used to analyze the prognostic capabilities of variables (staging, grading, and Extent) included in the new classification. Results A total number of 292 patients with a mean follow-up of 289.7 ± 79.6 months were included. 31 (10.6%) patients were classified as Stage 1, 85 (29.1%) as Stage 2, 146 (50%) as Stage 3, and 30 (10.3%) as Stage 4. For grading, 34 (11.7%) were classified as Grade A, 193 (66.1%) as Grade B, and 65 (22.2%) as Grade C. Results of multilevel Cox regression analyses revealed a statistically significant association between stage (HR:3.73 between Stage 4 and Stage 1) and grade (HR: 4.83 between Grade C and Grade A) at baseline and periodontal related tooth loss, whereas no differences were detected for the extent of periodontitis. Conclusion This study provides the initial evidence regarding the predictive ability of the new classification of periodontitis. Patients in either Stage 4 or Grade C showed a significantly higher periodontal-related tooth loss.

The selection of surgical techniques and grafting materials is undoubtedly a critical component in the treatment of gingival recession defects. In order to provide top quality care, dental professionals are always in pursuit of treatment modality that provides maximal efficacy and predictability with minimal patient morbidity. The subepithelial connective tissue graft procedure, the gold standard, has been consistently proven to show excellent root coverage, but limited palatal tissue availability and potential morbidity associated with the harvesting process push dental practitioners to seek an alternative. The same holds true for peri-implant tissues—while autogenous grafts have served our purpose well, alternatives that can achieve similar results while avoiding a second intraoral wound (the donor sites) are preferred. The purpose of this review of recent studies is to evaluate the effectiveness and predictability of allografts and xenografts for root coverage procedures and around dental implants. The electronic database search was limited to the past 5 years and to the studies addressing root coverage procedures in the Miller class I and II gingival recession (even though the 2017 International Workshop suggested a new classification, the majority of research projects use the classic Miller classification). Search was also made for studies addressing soft tissue treatment around implants that were published during the same period. A total of 30 human clinical trials involving allografts (mainly acellular dermal matrix and placental membranes) and xenografts (porcine-derived collagen matrix) for treatment of gingival recession and a total of 19 clinical studies using allografts and xenografts to improve soft tissue quality around implants were selected. Based on the selected studies, acellular dermal matrix in combination with various flap designs appears to produce results similar to autogenous grafts in terms of mean root coverage and width of keratinized tissue. Other grafting materials, while less effective compared to autogenous grafts, still show some promise especially in patient-centered outcomes. For soft tissue quality improvement around implant sites, allografts and xenografts in general provide satisfactory clinical results. Multicenter, randomized clinical studies with large numbers of individuals and long-term outcomes may provide the most realistic answer for this topic.

Background A new periodontitis classification was recently introduced involving multidimensional staging and grading. The Study's aim was to assess if individuals well-trained in periodontics consistently used the new classification for patients with severe periodontitis. The secondary goal was to identify "gray zones" related to classifications. Methods Participants (raters) individually classified 10 pre-selected severe periodontitis cases using the 2017 World Workshop classification. An internet case-based study was conducted after inviting members from American Academy of Periodontology and European Federation of Periodontology. Gold-standard diagnoses were determined by five experts who developed the new periodontitis classification. Inter-reliability agreement among raters was assessed using Fleiss Kappa index with the jackknife method for linearly-weighted Kappa calculations. McNemar´s test was used to determine symmetry between raters and gold-standard panel. Results 103 raters participated and classified 9 clinical cases. Fleiss' Kappa values showed moderate inter-examiner consistency among raters for stage (K value: 0.49; 95%CI:0.19-0.79), grade (K value 0.50; 95%CI:0.30-0.70) and extent (K value: 0.51; 95%CI:0.23-0.77). When analyzed as composite (stage, grade, extent) a moderate inter-reliability was present among raters, k = 0.479 (K value: 0.47; 95%CI: 0.442 - 0.515). Agreement between raters and gold-standard panel was staging 76.6%; grading 82%; and extent 84.8%. In 6 of 9 cases 77-99% of raters consistently agreed with gold-standard panel, and other 3 cases had gray zone factors that reduced rater consistency. Conclusion Clinicians trained in the 2017 World Workshop periodontitis classification demonstrated moderate concordance in classifying 9 severe periodontitis cases, and in 6 of 9 cases raters consistently agreed with the gold-standard panel. This article is protected by copyright. All rights reserved.

Background The British Society of Periodontology (BSP) implemented a simplified version of the 2017 World Workshop Classification (WWC) on Staging and Grading of periodontitis, for use in UK clinical practice. The aim of this study was to assess the long-term (>10 years) prognostic capability of BSP's implementation (BSP-i) compared to the 2017 WWC, using periodontal-related tooth loss (TLP) as a disease outcome. Methods Data on medical history, smoking status, and clinical periodontal parameters were retrieved from 270 patients who received non-surgical and surgical periodontal therapy from 1966 to 2007. Each patient received a baseline diagnosis according to the 2017 WWC and the BSP-i guidelines for implementation. Univariate multilevel Cox regression frailty models were performed to analyze the association between variables with TLP. A post-hoc comparison with Bonferroni correction was performed to analyze interclass comparisons. The prognostic performance of both systems was analyzed using Harrell's C index. Results The prognostic performance of both systems was very similar (0.922 for the 2017 WWC and 0.925 for the BSP-i). The singular prognostic performance of BSP Stage was slightly higher than that of 2017 WWC Stage (0.9212 vs 0.9188), while the 2017 WWC Grade showed a slightly better performance than BSP Grade (0.9175 vs 0.9155). BSP-i's Extent performed better than the 2017 WWC Extent (0.9203 vs 0.9098), however in the 2017 WWC Extent, the class "localized" was associated with a better prognosis than "generalized." Conclusion The overall prognostic performance of the two systems was excellent, with both systems having a Harrell's C index score of more than 0.92. This article is protected by copyright. All rights reserved.

Soft tissue augmentation procedures are becoming more popular these days. Different soft tissue graft harvesting approaches have been proposed. Nonetheless, the location of the donor site (whether anterior-, lateral-, superficial-, deep-palate or the maxillary tuberosity) can affect the graft shape and its composition. Soft tissue grafts from the maxillary tuberosity are rich in connective tissue fibers, with minimal presence of fatty or glandular components. Clinical, histological, and molecular evidence shows that a soft tissue graft obtained from the maxillary tuberosity has unique properties. In addition, harvesting from this area presents minimal risk for intra- or postoperative complications, leading to reduced patient morbidity. The aim of this commentary is to discuss the advantages and disadvantages of harvesting a soft tissue graft from the tuberosity and to compare it with the traditional palatal graft, while highlighting functional, esthetic, and patient-related outcomes.

This editorial provides clarifications on the application of the Stage and Grade classification of periodontitis. In particular it describes: (1) how to apply the extent criterion to the defined Stage of the disease; and (2) how to calculate tooth loss because of periodontitis in Stage III and IV cases presenting with evidently hopeless (irrational to treat) teeth with a clinical definition of such teeth.

Biologically guided implant therapy is based on the new periodontitis classification system recently released by the American Academy of Periodontology and the European Federation of Periodontology that uses staging and grading for the diagnosis of periodontitis. This paper proposes that periodontitis staging and grading should be used in dental implant therapy as a means to ensure maximum conservation of teeth and maximum preservation of alveolar bone. These biologic principles should guide the treatment planning process and supersede a mechanically based, restoratively driven rationale that should be secondary to the biologic principles of conservation and preservation but part of the collaborative treatment planning process. And treatment alternatives throughout the patient's lifetime should be provided for in case of prosthesis loss due to peri-implantitis. The use of grading will help with recognition of systemic aspects that can have a negative impact.

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

A new periodontitis classification scheme has been adopted, in which forms of the disease previously recognized as "chronic" or "aggressive" are now grouped under a single category ("periodontitis") and are further characterized based on a multi-dimensional staging and grading system. Staging is largely dependent upon the severity of disease at presentation as well as on the complexity of disease management, while grading provides supplemental information about biological features of the disease including a history-based analysis of the rate of periodontitis progression; assessment of the risk for further progression; analysis of possible poor outcomes of treatment; and assessment of the risk that the disease or its treatment may negatively affect the general health of the patient. Necrotizing periodontal diseases, whose characteristic clinical phenotype includes typical features (papilla necrosis, bleeding, and pain) and are associated with host immune response impairments, remain a distinct periodontitis category. Endodontic-periodontal lesions, defined by a pathological communication between the pulpal and periodontal tissues at a given tooth, occur in either an acute or a chronic form, and are classified according to signs and symptoms that have direct impact on their prognosis and treatment. Periodontal abscesses are defined as acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus, rapid tissue destruction and are associated with risk for systemic dissemination.

The demand for root coverage in multiple gingival recession defects has increased in recent years. Compared to isolated recession, multiple gingival recession defects are much more challenging due to various limiting factors and require more sophisticated surgical techniques. This review aims to address recent progress in the management of multiple recession defects. The subepithelial connective tissue graft (SCTG) procedure, while effective, is limited due to tissue availability and patient preference to avoid a donor harvest site. Different surgical techniques and biological materials have been studied in an attempt to find ideal alternatives. Based on the studies reviewed, the SCTG procedure still remains the gold standard in terms of percent root coverage. Acellular dermal matrix allograft in conjunction with different flap designs has shown comparable, satisfactory results up to 1 year postoperatively. Other materials such as porcine collagen matrix and enamel matrix derivative also show some promise. Well-designed studies with long-term outcomes are still needed.

Purpose The primary aim of this randomized, controlled, blinded, clinical trial was to compare a mix of particulate allograft and harvested autogenous particles (Autogenous) to an osteoinductive demineralized bone matrix (DBM) allograft on clinical and histologic outcomes for horizontal ridge augmentation procedure. Materials and methods Fourteen patients with a horizontal ridge defect with at least 1 adjacent tooth were entered into this study. The test group of 7 subjects received corticocancellous particulate allograft (Mineross) mixed with autogenous bone chips (70:30) harvested using a bone scraper (SafeScraper TWIST). Seven subjects in the control group received DBM (Optecure-CCC). Both groups had a corticocancellous particulate allograft overlay and an acellular dermis membrane (ADMG) (AlloDerm GBR) to cover the grafts. Results For the Autogenous group, there was a gain of 3.5 ± 1.4 mm while the DBM group gained 3.8 ± 1.6 mm (P 0.05). The Autogenous group had a mean of 35% vital bone while the DBM had 39% (P > 0.05). Conclusions Both treatments provided similar gain of ridge width and minimal loss of ridge height. The autogenous bone chips did not provide any additional benefit when compared with allograft alone that had lot verified osteoinductive activity.

This paper was prepared by the Research, Science and Therapy Committee of the American Academy of Periodontology. It is intended to provide information for the dental profession and other interested parties. The purpose of this paper is to provide a general overview of oral reconstructive and corrective procedures used in periodontal therapy. It is not intended to be a comprehensive review of this subject.

The primary aim of this randomized, controlled, blinded clinical trial was to compare the effect of a resorbable collagen membrane (CM group) versus a nonresorbable high-density polytetrafluoroethylene membrane (PTFE group) on the clinical and histologic outcomes of a ridge preservation procedure.All 24 sites received an intrasocket cancellous allograft and a buccal overlay bovine derived xenograft.The change in horizontal crestal ridge width was -1.4 ± 1.2 mm for the CM group, whereas the PTFE group lost -2.2 ± 1.5 mm, which was not statistically significant between groups (P0.05). Vertical ridge height change was -1.2 ± 1.5 for the CM group, whereas the PTFE group lost -0.5 ± 1.6, which was not significantly different between groups (P0.05). The percent vital bone was similar and not significantly different between groups. Primary closure was not obtained and the exposed membrane portion over the socket opening healed with keratinized tissue.The choice of a resorbable versus a nonresorbable barrier membrane did not affect the clinical or the histologic outcome of ridge preservation treatment.

Background A panel of experts convened by the American Dental Association Council on Scientific Affairs presents an evidence-based clinical practice guideline on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts. Methods The authors developed this clinical practice guideline according to the American Dental Association's evidence-based guideline development methodology. This guideline is founded on a systematic review of the evidence that included 72 research articles providing clinical attachment level data on trials of at least 6 months' duration and published in English through July 2014. The strength of each recommendation ( strong , in favor , weak , expert opinion for , expert opinion against , and against ) is based on an assessment of the level of certainty in the evidence for the treatment's benefit in combination with an assessment of the balance between the magnitude of the benefit and the potential for adverse effects. Practical Implications and Conclusions For patients with chronic periodontitis, SRP showed a moderate benefit, and the benefits were judged to outweigh potential adverse effects. The authors voted in favor of SRP as the initial nonsurgical treatment for chronic periodontitis. Although systemic subantimicrobial-dose doxycycline and systemic antimicrobials showed similar magnitudes of benefits as adjunctive therapies to SRP, they were recommended at different strengths ( in favor for systemic subantimicrobial-dose doxycycline and weak for systemic antimicrobials) because of the higher potential for adverse effects with higher doses of antimicrobials. The strengths of 2 other recommendations are weak : chlorhexidine chips and photodynamic therapy with a diode laser. Recommendations for the other local antimicrobials (doxycycline hyclate gel and minocycline microspheres) were expert opinion for . Recommendations for the nonsurgical use of other lasers as SRP adjuncts were limited to expert opinion against because there was uncertainty regarding their clinical benefits and benefit-to-adverse effects balance. Note that expert opinion for does not imply endorsement but instead signifies that evidence is lacking and the level of certainty in the evidence is low.

The purpose of this article is to present a surgical and restorative protocol for the replacement of missing teeth in the esthetic zone. The ABC protocol consists of digitally guided implantation, autogenous bone graft (A), followed by bovine bone xenograft (B) and connective tissue graft (C). Autogenous bone is placed in contact with the implant surface to induce osseointegration; bovine bone xenograft is then applied to augment the ridge dimension and provide long-term stability. Connective tissue is used to provide additional volume. The ABC biomaterial sequence offers favorable hard and soft tissue dimensions and immediate provisional restoration predictably leads to an esthetically pleasing definitive prosthesis.

Periodontitis is a ubiquitous and irreversible inflammatory condition and represents a significant public health burden. Severe periodontitis affects over 11% of adults, is a major cause of tooth loss impacting negatively upon speech, nutrition, quality of life and self-esteem, and has systemic inflammatory consequences. Periodontitis is preventable and treatment leads to reduced rates of tooth loss and improved quality of life. However, successful treatment necessitates behaviour change in patients to address lifestyle risk factors (e.g. smoking) and, most importantly, to attain and sustain high standards of daily plaque removal, lifelong. While mechanical plaque removal remains the bedrock of successful periodontal disease management, in high-risk patients it appears that the critical threshold for plaque accumulation to trigger periodontitis is low, and such patients may benefit from adjunctive agents for primary prevention of periodontitis.AimThe aims of this working group were to systematically review the evidence for primary prevention of periodontitis by preventing gingivitis via four approaches: 1) the efficacy of mechanical self-administered plaque control regimes; 2) the efficacy of self-administered inter-dental mechanical plaque control; 3) the efficacy of adjunctive chemical plaque control; and 4) anti-inflammatory (sole or adjunctive) approaches.MethodsTwo meta-reviews (mechanical plaque removal) and two traditional systematic reviews (chemical plaque control/anti-inflammatory agents) formed the basis of this consensus.ResultsData support the belief that professionally administered plaque control significantly improves gingival inflammation and lowers plaque scores, with some evidence that reinforcement of oral hygiene provides further benefit. Re-chargeable power toothbrushes provide small but statistically significant additional reductions in gingival inflammation and plaque levels. Flossing cannot be recommended other than for sites of gingival and periodontal health, where inter-dental brushes (IDBs) will not pass through the interproximal area without trauma. Otherwise, IDBs are the device of choice for interproximal plaque removal. Use of local or systemic anti-inflammatory agents in the management of gingivitis has no robust evidence base. We support the almost universal recommendations that all people should brush their teeth twice a day for at least 2 min. with fluoridated dentifrice. Expert opinion is that for periodontitis patients 2 min. is likely to be insufficient, especially when considering the need for additional use of inter-dental cleaning devices. In patients with gingivitis once daily inter-dental cleaning is recommended and the adjunctive use of chemical plaque control agents offers advantages in this group.

Focused Clinical Question: What are the indications and clinical applications for gingival augmentation procedures, and what factors guide the choice among treatment options in specific situations? Summary: Although there is still controversy regarding whether there needs to be a minimum amount of attached gingiva to maintain the stability of the gingival margin, prospective and retrospective studies have shown that, in the presence of suboptimal plaque control and clinical inflammation, attachment loss and gingival recession (GR) may result unless a minimum amount of keratinized tissue (KT) and attached gingiva are present. Treatment of mucogingival deformities requires gingival augmentation procedures that address both a functional and esthetic component for the patient. Although free gingival grafts (FGGs) are considered the gold standard for treatment of GR defects to obtain root coverage, augmentation of KT and attached gingiva may be accomplished by FGG or other autogenous grafting options, including the free connective tissue graft, the lateral pedicle graft, and the double papilla technique. In addition, the modified apically repositioned flap can be considered in some instances. Alternatives to autogenous graft tissue include acellular dermal matrix, extracellular matrix membrane, bilayer collagen matrix, and living cellular construct. Conclusions: Understanding the clinical importance of the presence of a minimum amount of attached gingiva in patients with suboptimal hygiene is an important first step in addressing the condition. Patient education to address plaque control and counseling to quit smoking in patients who are smokers help enhance the success of these mucogingival surgical procedures. An analysis of patient-specific factors will help with the appropriate choice of surgical procedures aimed at augmenting the dimension of KT/attached gingival tissue. Evidence supporting the treatment decisions described in this practical application is summarized in the companion papers from the American Academy of Periodontology Regeneration Workshop (Kim and Neiva, J Periodontol 2015;86(Suppl.):S56-S72; Scheyer et al., J Periodontol 2015;86(Suppl.):S73-S76).

The aim of this study was to evaluate the efficacy of the anti-inflammatory effects of propolis on the systemic and local effects on experimental periodontitis and diabetes. Fifty-six Wistar rats were divided into seven groups: (1) negative-control (NC), (2) periodontitis (P), (3) diabetes (D), (4) diabetes+periodontitis (DP), (5) periodontitis+propolis (P-Pro), (6) diabetes+propolis (D-Pro), and (7) diabetes+periodontitis+propolis (DP-Pro). Periodontitis was induced by ligature placement and diabetes was induced by streptozotocin injection. Propolis (Pro) was administrated by oral gavage (100 mg/kg/day). On day 21, plasma was obtained for analysis and alveolar bone level was evaluated using histomorphometric analysis. Compared to NC the final blood glucose levels for D-Pro was not significantly different (P=.052), however, D, DP, and DP-Pro were significantly different. There were no statistically significant differences in blood glucose concentrations between P and P-Pro, between D and D-Pro, and between DP and DP-Pro. All groups showed significantly more alveolar bone loss compared with NC. A significant difference in bone loss was found between P and P-Pro, and DP and DP-Pro, however there was no difference between D and D-Pro. Plasma interleukin 1beta (IL-1 beta), tumor necrosis factor-alpha (TNF-alpha), and matrix metalloproteinase-8 (MMP-8) levels were not significantly different among groups. In conclusion, propolis reduced fasting blood glucose levels in diabetes. In addition, propolis might be beneficial as an adjunct treatment of diabetes associated periodontitis and periodontitis without diabetes.

Background: Soft tissue grafting for the purposes of increasing the width of keratinized tissue (KT) is an important aspect of periodontal treatment. A systematic review was analyzed, focusing on non-root coverage tissue grafts. The references were updated to reflect the current literature. Methods: To formulate the consensus report, group members submitted any new literature related to the topic that met criteria fitting the systematic review, and this information was reviewed for inclusion in this report. A consensus report was developed to summarize the findings from the systematic review and to guide clinicians in their treatment decision-making process. Results: Forty-six articles met the criteria for inclusion in the final analysis, and two articles were added that were used to formulate this consensus report. A list of eight clinically relevant questions was posed, and consensus statements were developed. Conclusions: The evidence suggests that a minimum amount of KT is not needed to prevent attachment loss (AL) when optimal plaque control is present. However, if plaque control is suboptimal, a minimum of 2 mm of KT is needed. The standard procedure to predictably gain KT is the autogenous gingival graft. There is limited evidence for alternative treatment options. However, additional research may offer promising results in certain clinical scenarios. Clinical Recommendations: Before patient treatment, the clinician should evaluate etiology, including the role of inflammation and various types of trauma that contribute to AL. The best outcome procedure (autograft) and alternative options should be reviewed with the patient during appropriate informed consent. Proper assessment of the outcome should be included during supportive periodontal care. J Periodontol 2015;86(Suppl.):S73-S76.

Background The effect of membrane exposure on guided bone regeneration (GBR) for lateral ridge augmentation has been poorly addressed. This case-controlled study aimed to investigate potential effect of membrane exposure lateral ridge augmentation and subsequent implant placement. Methods A total of 14 patients that did receive lateral ridge augmentation procedure using allogeneic cancellous graft particulate in combination with an alloplastic bioresorbable matrix barrier were retrospectively selected for this study. Bone width was measured at the crest with a digital caliper before bone augmentation and at the reopening for implant placement 4 months later for all patients. Cases where primary flap closure was achieved and the barrier did not expose throughout the time until implant placement were assigned to the control group (n = 7). Cases where primary closure could not be achieved or a barrier exposure happened within the first week following the initial surgery were assigned to the test group. Results The measured alveolar ridge width before surgery as well as after GBR procedure were not statistically significant different between the two groups (p > 0.05). Both groups showed a significant (p

Introduction: Localized gingival fibrous lesions (GFLs) can be esthetically disfiguring and may be associated with specific local, systemic, or unknown factors. Treatment of GFLs includes wide excision of the lesion, followed by the often difficult task of restoring soft-tissue function and esthetics. This case report describes the use of acellular dermal matrix (ADM) for wound coverage after lesion removal.Case Presentation: A 50-year-old African-American female presented with a very large, facially located, GFL between teeth #10 and #11. She reported that a similar lesion had been removed twice before this recurrence. No local irritants were noted that might be associated with this type of lesion. The lesion was excised, including periosteum, leaving a large area of denuded bone that was covered with ADM. This resulted in regeneration of the gingiva and provided an excellent esthetic outcome for the patient.Conclusions: There was no evidence of recurrence of the lesion in the first 15 months. The etiolo...

Introduction: Growth factors may play a prominent role in wound healing. Concentrating these mediators and applying them to healing osseous or soft tissue may accelerate the process and improve the quality of the healing tissues. Methods of collecting and concentrating autologous platelets have been developed. Platelet-rich plasma (PRP) is a technique that concentrates platelets and releases their growth factors when applied to healing tissues. There are some positive data about the effects of PRP on hard- and soft-tissue healing, but there is also some literature that shows minimal or no effect. Fibrin sealants undergo a different preparation procedure than PRP and tend to concentrate fibrinogen rather than platelets. They can be applied to either hard or soft tissue. Studies of these agents are also conflicting and some show positive results, whereas others show minimal effect. A third technique is plasma-rich growth factors (PRGFs). Like PRP, this preparation concentrates platelets but differs from PRP...

The primary aim of this randomized, controlled, masked clinical trial was to compare the percentage of root coverage obtained with a coronally positioned flap plus acellular dermal matrix (ADM) allograft to that of a tunnel technique plus ADM 4 months post-surgically.Twenty-four subjects with one site withor =3 mm Miller Class I or II recession were treated and followed for 4 months. Twelve patients received a coronally positioned flap plus ADM and were considered the positive control group (CPF). The test group consisted of 12 subjects treated with a coronally positioned tunnel technique plus ADM (TUN). Subjects were randomly selected by a coin toss to receive the test or control treatment.The mean facial recession defect at the initial examination for the TUN group was 3.1 +/- 0.3 mm; this was reduced to 0.7 +/- 0.9 mm at the 4-month examination for a gain of 2.4 +/- 1.0 mm or 78% defect coverage (P0.05). The mean facial recession defect at the initial examination for the CPF group was 3.4 +/- 0.8 mm; it was reduced to 0.2 +/- 0.3 mm at the 4-month examination for a gain of 3.2 +/- 0.9 mm or 95% defect coverage (P0.05). There was no statistically significant difference between groups (P0.05).The coronally positioned flap plus ADM produced a defect coverage of 95%, whereas the tunnel technique plus ADM produced only 78% coverage. This difference was considered clinically significant but was not statistically significant.

Objectives The objective of this study was to examine the prevalence of carotid area calcifications retrospectively detected on digital panoramic radiographs of pretreatment cancer subjects, and to correlate the finding of such calcifications with radiographic evidence of periodontal bone loss in the same subjects. Study design Digital panoramic radiographs of 201 subjects were evaluated for calcifications projected in the carotid artery bifurcation area as well as for alveolar bone loss as a result of periodontal disease. Inclusion criteria were unobscured carotid artery bifurcation regions bilaterally and sufficient index teeth present with a definable cemento-enamel junction and alveolar crest. Radiographs were independently observed for carotid area calcifications and for periodontal status. Image enhancements permitted for detection of calcifications projected in the carotid area included window/level, inverse, and emboss. Periodontal measurements were made on index teeth using proprietary imaging software and a mouse-driven measurement algorithm. A 3-factor analysis of variance was performed with 3 between-subjects comparisons. Percentage of bone loss was the dependent variable. Independent variables were age, subject sex, and the presence or absence of carotid area calcifications. Results Differences measured in percentage of bone loss between sexes were not statistically significant. While bone loss did increase with age, comparison of the mean bone loss of each age category revealed no statistical significance. There was a highly significant correlation between carotid artery area calcifications visible on panoramic radiographs and percent alveolar bone loss. Radiographs showing unilateral and bilateral calcifications had a mean percent bone loss of 24.2% ± 12.6% and 25.7% ± 13.0% respectively, compared to those with no calcification at 10.4% ± 9.9%. Conclusions Nearly 1 in 4 subjects in this study evidenced calcifications projected in the carotid bifurcation region. The finding of such calcifications was significantly related to the calculated percentage of alveolar bone loss.

Tooth extraction typically leads to loss of ridge width and height. The primary aim of this 6-month randomized, controlled, blinded, clinical study was to determine whether ridge preservation would prevent post-extraction resorptive changes as assessed by clinical and histologic parameters.Twenty-four patients, 10 males and 14 females, aged 28 to 76 (mean 51.5 +/- 13.6), requiring a non-molar extraction and delayed implant placement were randomly selected to receive either extraction alone (EXT) or ridge preservation (RP) using tetracycline hydrated freeze-dried bone allograft (FDBA) and a collagen membrane. A replaced flap, which did not completely cover the sockets, was used. Following extraction, horizontal and vertical ridge dimensions were determined using a modified digital caliper and an acrylic stent, respectively. Prior to implant placement, a 2.7 x 6.0 mm trephine core was obtained and preserved in formalin for histologic analysis.The width of the RP group decreased from 9.2 +/- 1.2 mm to 8.0 +/- 1.4 mm (P0.05), while the width of the EXT group decreased from 9.1 +/- 1.0 mm to 6.4 +/- 2.2 mm (P0.05), a difference of 1.6 mm. Both the EXT and RP groups lost ridge width, although an improved result was obtained in the RP group. Most of the resorption occurred from the buccal; maxillary sites lost more width than mandibular sites. The vertical change for the RP group was a gain of 1.3 +/- 2.0 mm versus a loss of 0.9 +/- 1.6 mm for the EXT group (P0.05), a height difference of 2.2 mm. Histologic analysis revealed more bone in the RP group: about 65 +/- 10% versus 54 +/- 12% in the EXT group. The RP group included both vital bone (28%) and non-vital (37%) FDBA fragments.Ridge preservation using FDBA and a collagen membrane improved ridge height and width dimensions when compared to extraction alone. These dimensions may be more suitable for implant placement, especially in areas where loss of ridge height would compromise the esthetic result. The quantity of bone observed on histologic analysis was slightly greater in preservation sites, although these sites included both vital and non-vital bone. The most predictable maintenance of ridge width, height, and position was achieved when a ridge preservation procedure was employed.

Conventional periodontal therapy consists of mechanical scaling and root planing, and surgical treatment. This is still the mainstay of periodontal treatment. Adjunctive antimicrobial treatments, both systemic and local delivery, are becoming more sophisticated and useful in the treatment of recurrent periodontitis. Also very promising are adjunctive treatments that modulate the host response and decrease levels of destructive pro-inflammatory cytokines or matrix metalloproteinases. Smoking is a major risk factor for periodontitis and has a profound impact on the progression of periodontal bone and attachment loss. In the interest of improved periodontal health patients should be encouraged to stop smoking. Finally bacterial endotoxins that stimulate the release of pro-inflammatory cytokines can have systemic effects and may lead to pre-term, low birthweight babies, and cardiovascular diseases such as atherosclerosis, myocardial infarction and stroke. Health professionals need to be cognisant of the effect dental health can have on systemic diseases and refer for treatment when appropriate to ensure that optimum oral and systemic health is achieved for their patients.

Focused Clinical Question: What are the indications and clinical applications for gingival augmentation procedures, and what factors guide the choice among treatment options in specific situations? Summary: Although there is still controversy regarding whether there needs to be a minimum amount of attached gingiva to maintain the stability of the gingival margin, prospective and retrospective studies have shown that, in the presence of suboptimal plaque control and clinical inflammation, attachment loss and gingival recession (GR) may result unless a minimum amount of keratinized tissue (KT) and attached gingiva are present. Treatment of mucogingival deformities requires gingival augmentation procedures that address both a functional and esthetic component for the patient. Although free gingival grafts (FGGs) are considered the gold standard for treatment of GR defects to obtain root coverage, augmentation of KT and attached gingiva may be accomplished by FGG or other autogenous grafting options, including the free connective tissue graft, the lateral pedicle graft, and the double papilla technique. In addition, the modified apically repositioned flap can be considered in some instances. Alternatives to autogenous graft tissue include acellular dermal matrix, extracellular matrix membrane, bilayer collagen matrix, and living cellular construct. Conclusions: Understanding the clinical importance of the presence of a minimum amount of attached gingiva in patients with suboptimal hygiene is an important first step in addressing the condition. Patient education to address plaque control and counseling to quit smoking in patients who are smokers help enhance the success of these mucogingival surgical procedures. An analysis of patient-specific factors will help with the appropriate choice of surgical procedures aimed at augmenting the dimension of KT/attached gingival tissue. Evidence supporting the treatment decisions described in this practical application is summarized in the companion papers from the American Academy of Periodontology Regeneration Workshop (Kim and Neiva, J Periodontol 2015;86(Suppl.):S56-S72; Scheyer et al., J Periodontol 2015;86(Suppl.):S73-S76).

The aim of this 9-month reentry study was to compare the regenerative healing using porous (P) and non-porous (NP) teflon barrier membranes plus demineralized freeze dried bone allografts (DFDBA) in Class II buccal/lingual furcation defects.Twenty-four patients, 13 males and 11 females, ages 38 to 75 (mean 54 +/- 10), were included in this study. Each patient had adult periodontitis and one Class II furcation defect measuringor = 3 mm open horizontal probing depth. Twelve patients were randomly selected to receive the NP treatment and 12 received the P membrane. All defects received a DFDBA graft. Measurements were performed by a masked examiner.No statistically significant differences (P0.05) were found between NP and P groups at any time with respect to any open or closed measure. Improvement in mean open horizontal probing depth was significant for both the NP (2.33 +/- 0.78 mm) and P (2.75 +/- 0.75 mm) groups. Mean clinical attachment level gains at 9 months were significant for both NP (1.50 +/- 1.62 mm) and P (2.50 +/- 2.11 mm) groups. Seventeen of 24 defects had an intrabony component andor = 50% fill was obtained in 100% of these defects.The results of this 9-month reentry study comparing the use of porous and non-porous barrier membranes with a DFDBA graft indicate that there were no statistically significant differences between groups. Both groups showed a statistically significant improvement following the treatment of Class II furcation defects in humans.

Background: The purposes of this article are to: 1) propose a new method of reporting root coverage data; 2) compare existing root coverage techniques using the proposed data analysis method; and 3) discuss additional refinements to root coverage data analysis. Past studies have equated percent defect coverage with root coverage. This gives deceptive information about the magnitude of the residual recession defect. Defect coverage of 67% could actually amount to 92% root coverage. Methods: The use of mean root lengths will permit the determination of true root coverage data. This should be reported in addition to defect coverage data. Also including frequency data will provide a better assessment of the predictability of the surgical techniques. Results: A comparison table of root coverage studies demonstrates that the connective tissue graft is the most effective and predictable method that has been tested. Conclusions: Further refinements to data analysis may help researchers identify the determinants o...

Data are presented from a multi-center, prospective, longitudinal, clinical trial comparing four different treatments for periodontitis, (1) the LANAP™ protocol utilizing a FR pulsed-Nd:YAG laser; (2) flap surgery using the Modified Widman technique (MWF); (3) traditional scaling and root planing (SRP); and (4) coronal debridement (CD). Each treatment was randomized to a different quadrant. Fifty-one (54) subjects were recruited at five centers that included both private practice and university-based investigators. At 6-months and 12 months post-treatment the LANAP™ protocol and MWF yielded equivalent results based on changes in probing depths. The major difference observed between the two procedures was that patients reported significantly greater comfort following the LANAP™ procedure than following the MWF (P

Patients often undergo a number of dental procedures that may cause bleeding. Usually these procedures can be performed with little risk to the patient. However, patients on medications such as warfarin (Coumadin) have an altered ability to control, bleeding and may develop bleeding problems subsequent to treatment. Once this potential problem has been recognized, measures can be taken to minimize the risks. Patients on warfarin are on specific medication protocols and often exhibit episodes of hyperanticoagulation. The purpose of this study was to assess patients on warfarin protocols for episodes of hyperanticoagulation. Sixty-two patients undergoing anticoagulation therapy with warfarin were assessed for episodes of hyperanticoagulation with the prothrombin test. Based on these results, it can be concluded that patients taking warfarin had an approximately 42% chance of at least one episode of hyperanticoagulation. No specific warfarin protocol demonstrated any statistical significance for an increased chance of hyperanticoagulation.

Previous studies of ridge preservation showed a loss of ≈18% or 1.5 mm of crestal ridge width in spite of treatment. The primary aim of this randomized, controlled, masked clinical trial is to compare a socket graft to the same treatment plus a buccal overlay graft, both with a polylactide membrane, to determine if loss of ridge width can be prevented by use of an overlay graft.Twelve patients who served as positive controls received an intrasocket mineralized cancellous allograft (socket group), and 12 patients received the same socket graft procedure plus buccal overlay cancellous xenograft (overlay group). Horizontal ridge dimensions were measured with a digital caliper, and vertical ridge changes were measured from a stent. Before implant placement, at 4 months, a trephine core was obtained for histologic analysis.The mean horizontal ridge width at the crest for the socket group decreased from 8.7 ± 1.0 to 7.1 ± 1.5 mm for a mean loss of 1.6 ± 0.8 mm (P0.05), whereas the same measurement for the overlay group decreased from 8.4 ± 1.4 to 8.1 ± 1.4 mm for a mean loss of 0.3 ± 0.9 mm (P0.05). The overlay group was significantly different from the socket group (P0.05). Histologic analysis revealed that the socket group had 35% ± 16% vital bone, and the overlay group had 40% ± 16% (P0.05).The overlay treatment significantly prevented loss of ridge width and preserved or augmented the buccal contour. The socket and overlay groups healed with a high percentage of vital bone.

AIMS The primary aim of this study was to evaluate the 1-year crestal bone loss and success rate of an immediately placed single-stage implant placed and restored by novice operators. A secondary aim was to determine the patient's assessment of the appearance of the final restoration. METHODS Fifty-one patients received a tooth extraction and placement of at least 1 immediate implant by a Graduate Periodontics resident. Clinical and radiographic measurements were taken at the surgical, 4-month, and 1-year follow-up visits. After at least 3 months healing, dental students restored the implants with either a crown or an overdenture. Patient satisfaction was assessed using 5 categories: excellent, very good, good, fair, or poor. RESULTS Sixty-two immediate implants were placed. The success rate was 100% at the 12-month visit and was subclassified as grade 3 because of the mean first year bone loss of 1.3 +/- 1.0 mm. Using the 2008 classification of Misch et al, 42 implants were classified as success optimum health, 19 as survival satisfactory health, and 1 as survival compromised health. Radiographic bone loss was stratified by implant platform position relative to the alveolar crest and changed from time 0 to time 12 by -1.0 +/- 1.2 mm for the supracrestal group (n = 25, P < 0.05), -1.5 +/- 0.9 mm for the crestal group (n = 31, P < 0.05), and -1.3 +/- 1.2 mm for the subcrestal group (n = 6, P < 0.05). The supracrestal group had significantly less bone loss than either the crestal or the subcrestal group (P < 0.05). The appearance of the final restoration at 1 year was rated excellent by 82% of patients, very good by 16%, and good by 2%. CONCLUSIONS Immediate implant placement by novice operators using routine dental school procedures was a highly predictable procedure as indicated by the 100% success rate at 12 months. Most patients rated the restoration appearance as excellent.

The primary aim of this randomized, controlled, blinded clinical pilot study was to compare the percentage of recession defect coverage obtained with a coronally positioned tunnel (CPT) plus an acellular dermal matrix allograft (ADM) to that of a CPT plus ADM and platelet-rich plasma (CPT/PRP) 4 months post-surgically.Eighteen patients with Miller Class I or II recessionor=3 mm at one site were treated and followed for 4 months. Nine patients received a CPT plus ADM and were considered the positive control group. The test group consisted of nine patients treated with a CPT plus ADM and PRP. Patients were randomly selected by a coin toss to receive the test or positive control treatment.The mean recession at the initial examination for the CPT group was 3.6 +/- 1.0 mm, which was reduced to 1.0 +/- 1.0 mm at the 4-month examination for a gain of 2.6 +/- 1.5 mm or 70% defect coverage (P0.05). The mean recession at the initial examination for the CPT/PRP group was 3.3 +/- 0.7 mm, which was reduced to 0.4 +/- 0.7 mm at the 4-month examination for a gain of 2.9 +/- 0.5 mm or 90% defect coverage (P0.05). There were no statistically significant differences between the groups (P0.05).The CPT plus ADM and PRP produced defect coverage of 90%, whereas the CPT with ADM produced only 70% defect coverage. This difference was not statistically significant, but it may be clinically significant.

The purpose of this study was to compare the effectiveness of a tricalcium phosphate, plaster of paris, and doxycycline composite graft to surgical debridement alone in the treatment of Class II and Class III furcation defects. Fifteen patients with adult periodontitis and at least two mandibular molars with Class II or III furcation defects were selected. A total of 40 sites were treated: 26 were Class II defects and 14 were Class III. Following initial therapy one site was randomly selected to receive the composite graft while the remaining site served as the surgically debrided control. Osseous healing was evaluated by direct measurements from an acrylic stent at the time of graft surgery and at the 6-month reentry. Following surgery each patient was placed on doxycycline 100mg/day for 10 days. The absence of clinical inflammation and infection during the healing process provided additional substantiation of the biocompatibility of the grafting materials. Results after 6 months indicated that sites treated with the composite graft had improved defect fill, defect resolution, probing depths, and clinical attachment levels when compared to the surgically debrided controls. Defect fill was 3.7 times greater in grafted sites and these sites were 4.0 times more likely to have 50% or greater defect fill. The effect of grafting was more pronounced in Class III defects where horizontal defect fill and gain of clinical attachment was achieved only in grafted sites. The plaster of paris functioned well as a binder, preventing particle scatter and facilitating graft retention. Additionally the plaster served as a vehicle to carry and retain the doxycycline at the treated site. These short-term results point to the potential of a composite graft containing tricalcium phosphate, plaster of paris, and doxycycline in promoting healing of furcation lesions.