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Background and Objectives: The aim of this in vitro study was to evaluate the combined effect of a 2% chlorhexidine aqueous solution and a universal adhesive system applied in self-etch and etch-and-rinse strategies on the composite resin–dentin interface. Materials and Methods: Class V cavities were prepared on the facial and lingual surfaces of forty caries-free molars extracted for orthodontic reasons. The samples were randomly divided into two groups corresponding to the used etching protocol: I—etch-and-rinse; II—self-etch. In each tooth, one cavity was assigned for the control subgroups -IA (n = 20) and IIA (n = 20)—adhesive only, and the opposite cavity was pretreated with a 2% chlorhexidine solution—Gluco CHeX Cerkamed—subgroups IB (n = 20) and IIB (n = 20). Both sets of groups were restored using a universal adhesive system (Single Bond Universal Adhesive, 3M-ESPE) and a bulk-fill composite resin (Filtek One Bulk Fill Restorative, 3M-ESPE). The roots and the pulp tissue were then removed, and a needle connected to a perfusor with 100 mL saline solution was used for pulp pressure simulation with a hydrostatic pressure of 20 cm H2O. Cariogenic attack was simulated using a demineralizing solution for 3 days at a constant temperature of 25 °C. The teeth were then sectioned in a facial-lingual direction and the microleakages at the occlusal and cervical margins were registered and scored using an optical Carl-Zeiss AXIO Imager A1m microscope (Carl-Zeiss). The composite resin–dentin interface was analyzed using a SEM Vega Tescan LMH II. Statistical analysis was performed using the Kruskal–Wallis test with a significance level of p < 0.05. Results: Microleakage evaluation showed no significant differences among the study groups (p > 0.05). In subgroup IA, significant differences were recorded between occlusal and cervical margins (p < 0.05). Conclusions: Application of chlorhexidine on tooth substrate before using a universal bonding system in total etch or self-etch mode has no influence on the adhesive interface in the condition of cariogenic attack. The thickness of the adhesive resin layer seems to be less uniform when using chlorhexidine, but the morphological differences at the adhesive interface have no influence on the sealing capacity of the universal bonding system, regardless of the etching strategy.

Periodontal disease represents an inflammatory disease of the tissues supporting the maintenance and functionality of the teeth on the dental arches. The main cause of periodontitis consists in periodontal dysbiosis, which will trigger an inflammatory response, progressively leading to periodontal tissue breakdown. Scaling and root planing represent the gold standard in treating periodontal diseases but, as it was already established, these measures are unable to completely eliminate the subgingival bacterial plaque. Therefore, new adjunctive therapies have emerged, involving systemic and local delivery of various antimicrobial products. This chapter aims to provide current knowledge on the local application of different periodontal supplementary therapies. The chapter focuses on local forms of antimicrobials, such as irrigations, gels or controlled release systems but also on laser/LED-assisted periodontal pocket photodynamic antibacterial therapy (PDT), along with various photosensitizers. Moreover, we present data from current guidelines regarding the recommendations for the main locally delivered antimicrobials.

Gingival recession is one of the most frequent undesirable conditions of the periodontal tissues, affecting a significant number of adult individuals worldwide. Gingival recessions can be the result of many etiological factors and occur, due to different factors acting simultaneously. Plaque-induced recession, can be recovered by surgical root coverage procedures, if it does not advance to the interdental papillae, while the periodontitis-related recession is harder to be restored. The most common traumatic etiologic factor, and one of the most common etiologic factors in general, is brushing-induced trauma. Another factor that can, in specific occasions, lead to gingival recession, is occlusal trauma. In general, abnormal occlusion is not a causative factor for recession. The reason is that there is no scientific evidence proving this relationship and that, after surgical treatment of the recession without fixing the pathological occlusion, there is no recurrence. Orthodontic patients have increased probability to form gingival recessions and, hence, orthodontic therapy is a major predisposing factor, especially at the area of mandibular incisors. Furthermore, prosthetic treatment is an iatrogenic predisposing factor of gingival recessions, due to trauma, either during impression taking, or during abutment preparation. Yet, there are some cases of gingival recessions that are not caused by the etiologic factors described above and, therefore, they are considered recessions of unknown etiology. These lesions are manifested as bright red inflammation of the tissue, surrounding the clinically visible roots. Gingival recessions are difficult to treat especially whenever the etiology is not clear. For a favorable prognosis is essential to identify specifically the etiological factors and correct them prior the surgical treatment.

Orthodontic treatment can successfully align pathologically migrated teeth leading to improved periodontal stability in patients with periodontal disease. Periodontal-orthodontic approaches have gained increasing attention in recent years. A considerable number of adult patients with periodontal disease are interested in orthodontics in order to improve the alignment of their teeth. However, the severity of periodontal disease and dental incongruence or demographic factors cannot be indicative of these. Elderly patients were significantly more frequently interested in orthodontic treatment. Most study participants were not provided with information on orthodontic treatment options for adults. Very importantly, this group of patients must be aware of the need to stabilize their periodontal condition, to maintain high standards of oral hygiene, before any orthodontic intervention. Therefore, practitioners need to be aware of the patient’s need, deliver patient-centered and provide them with relevant information and, if necessary, plan interdisciplinary treatment.

The coronavirus 2019 (COVID-19) disease has long-term effects, known as post-COVID conditions (PCC) or long-COVID. Post-COVID-19 syndrome is defined by signs and symptoms that occur during or after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection which persist for more than 12 weeks and cannot be supported by an alternative diagnosis. The cardiovascular damage caused by COVID-19 in the severe forms of the disease is induced by severe systemic inflammation, considered to be one of the causes of myocardial lesions, with increased levels of circulating cytokines and toxic response mediators. We have focused on conditions that can induce long-COVID-19, or multisystem inflammatory syndrome in adults or children (MIS-C/MIS-A), with an emphasis on endocrinological and metabolic disorders. Although described less frequently in children than in adults, long-COVID syndrome should not be confused with MIS-C, which is an acute condition characterized by multisystem involvement and paraclinical evidence of inflammation in a pediatric patient who tested positive for SARS-CoV-2. At the same time, we mention that the MIS-A symptoms remit within a few weeks, while the duration of long-COVID is measured in months. Long-COVID syndrome, along with its complications, MIS-A and MIS-C, represents an important challenge in the medical community. Underlying comorbidities can expose both COVID-19 adult and pediatric patients to a higher risk of negative outcomes not only during, but in the aftermath of the SARS-CoV-2 infection as well.

Even though periodontitis is considered an infectious disease, there are a number of factors that distinguish it from other infectious diseases: it is not the result of infection with an individual pathogen, but rather the consequence of a modified microbial community interaction with the host organism [...]

The influence of orthodontic treatment on periodontitis-susceptible patients is a subject of interest. Dental malposition caused by periodontal disease are often observed in this type of patients. Also, these patients often are undergoing orthodontic treatment in order to restore the esthetics and functions of the dental and periodontal apparatus. Thus, it is important to question and verify in what conditions and parameters the orthodontic treatment improves the status of the periodontium. This review analyses several studies concerning this important topic and highlights the parameters that influence the outcome of orthodontic treatment.

The aim of this study was to evaluate the influence of smoking on salivary RANKL and OPG levels in patients with generalized, stage III, grade B periodontitis. Material and methods: The salivary concentrations of RANKL and OPG were determined for 18 patients, aged between 23 and 50 years old, of which 8 were smokers, all presenting with a form of generalized, stage III, grade B periodontitis. Results: smokers had higher salivary levels of RANKL (p=0,0009) and a higher RANKL/OPG ratio (p=0,019), compared to non-smokers. OPG salivary levels did not differ much between smokers and non-smokers. Conclusions: Smoking has a higher impact on RANKL than on OPG salivary levels, for patients with generalized, stage III, grade B, periodontitis.

The term “periodontal disease” is properly assigned to gingivitis and periodontitis. Generally, gingivitis is a condition of the epithelial and connective tissues located in the immediate vicinity and subcolletal area of the tooth. From the etiopathogenic point of view, gingivitis is the result of the immediate exposure of the aggressive microbial factor through bacterial plaque, physical, chemical, thermal or other traumas such as irradiation, smoking. Cortisol induces metabolic processes antagonistic to insulin, especially during times of hunger and sustained stress. Cortisol influences the immune and inflammatory defense system. Selected articles involving psychosocial stress, anxiety, and depression directly related to periodontal disease reached the following conclusions: psychological stress highlighted by increased salivary cortisol levels influences periodontal disease by exacerbating it and increasing loss of attachment. at probing, potentiation of probing bleeding; the increased index of anxiety is correlated with the increased level of salivary cortisol and chronic periodontitis

Periodontal treatment of tissue defects which comprises guided tissue regeneration and mucosal plastic surgery still remains nowadays a challenge in the dental office due to the lack of absolute predictability. New treatment techniques and biomaterials have emerged in order to counteract the different risks generated by the periodontal surgical methods. 3D and 4D printing technologies offer new possibilities in terms of patient-tailored materials, with lower complications and trauma and with the promise of a more accurate treatment plan and success.

Lasers are used in oral surgery and periodontology liberally nowadays, however, solid therapeutic protocols are still lacking in some medical areas. An epulis is defined clinically as hyperplasia of the gingival tissues, usually situated in the proximity of the interdental papilla, however it may also occur in the edentulous ridges. Regarding the origin of this particular lesion the periodontun and the periosteum are considered principal components. In this case report we present an orthodontic patient with a recurrent fibrous epulis that was treated by ablation with a diode laser (940nm). This particular method was chosen due to the reduced treatment time and diminished intrasurgical bleeding. Furthermore, an improved gingival healing compared with classical scalpel blade surgical treatment was observed. We demonstrated that diode lasers are particularly useful tools in orthodontic patients that are predisposed to gingival hyperplasia and this treatment method has supplementary advantages compared to the classical scalpel regarding the presence and intensity of pain and postoperative discomfort

RAGE has historically been studied in periodontitis associated with diabetes. Activation of RAGE generates pro-inflammatory signals through its interaction with glycated molecules present in the serum and tissues of diabetic patients. This process is described as the AGE / RAGE axis. A body of evidence tends to show the involvement of this same receptor in the pathophysiology of periodontitis alone (not associated with diabetes). At the tissue level, RAGE is overexpressed in sites affected by periodontitis concomitantly with its AGER1 antagonist, limiting its inflammatory action. Finally, the serum concentration of the cleaved soluble forms of RAGE is reduced in periodontal patients and is negatively correlated with the clinical parameters of periodontitis. The pathophysiology of periodontitis seems to have an impact on the concentration of this antioxidant biomarker. The variation in the serum concentration of RAGE is associated with many systemic pathologies.

SARS-CoV-2 was first discovered in December 2019 as the etiologic agent of a serious respiratory illness later called COVID-19 or coronavirus disease 2019. The first COVID-19 case was reported in Wuhan, China and since then, has reached a pandemic level, spreading all over the world and multiplying faster than any other respiratory disease known until now in modern times, with more than 85 million confirmed cases and almost 2 million deaths, according to the latest information from the World Health Organization (WHO). Periodontal disease is one of the most common diseases of the oral cavity that has systemic implications in the overall health homeostasis. It is an inflammatory disease that involves a series of dysbiotic events caused by periodontopathogenic microflora that causes destruction of the periodontal tissues locally, and an exacerbated proinflammatory status systemically. Diabetes mellitus, metabolic syndrome and obesity, hypertension, cardiovascular disease, chronic kidney disease, chronic obstructive pulmonary disease and autoimmune diseases have been identified as risk factors for both periodontitis and severe Covid-19 infections. These diseases have similar inflammatory pathways that are involved in the progression of these conditions, thus, it is fair to assume a pathological common link.

The silent nature of osteoporosis makes it difficult to diagnose. Therefore, all healthcare professionals should participate in the identification of patients suffering from this disease. Dental x-rays can be considered a minimally invasive and convenient method in identifying osteoporosis. The repercussions of osteopenia / osteoporosis on the periodontium appear to be proven. Periodontal parameters (clinical loss of attachment, probing depth, gingival index, and bleeding on probing) show signs of greater tissue degradation. The relationship between periodontal disease and osteoporosis appears to be linked by the risk factors they share and by the mechanism of bone loss. The inflammatory nature of these two pathologies has been demonstrated, which could highlight a pathogenic link between them. The literature does not currently suggest any specific conduct or protocol in assessing the risk of low bone density and in the management of these patients. But osteopenic / osteeporotic patients require special attention and medical dental care.

Antibiotics represent an important adjunctive method in the complex and effective periodontal therapy. Moreover, beside the curative effects of antibiotics, antibiotic prophylaxis needs to be taken into account when particular cases of infectious risk patients need to be correctly approached. An important criterion in the antibiotic prohylaxis selection includes the physiopathological state of the patient: his general state of health, his immune status, his medical-surgical history, his comorbidities and his current medications. All this in order not to carry out contraindicated associations and to avoid the potentiation of undesirable effects. Compliance with these selection criteria maximizes therapeutic efficacy while limiting individual risks (hypersensitivity, adverse effects) but also collective risks with respect to the emergence of bacterial resistance. In summary, antibiotic therapy must be justified with the best efficacy, the best possible tolerance and at a reasonable cost. In addition, the methods of compliance and the duration of the treatment can direct towards preferred molecules.

The postmenopausal period, due to low hormonal concentrations, can exert a negative influence on both periodontitis and osteoporosis evolution. The present study aimed to identify potential clinical and microbiological benefic effects of locally delivered minocycline microspheres (Arestin®) in post-menopausal female patients with moderate and severe periodontitis. Probing depth, clinical attachment levels and bleeding on probing index, along with BANA tests for Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola, were performed before and at 3 months after a combined treatment of scaling, root planing (SRP), and Arestin® placed in deep periodontal pockets. The association between SRP and Arestin® exerted significant improvements in terms of clinical periodontal parameters, as well as significant reductions in the red complex bacteria detection.

The direct involvement of herpesviruses in the evolution of periodontitis can change the concepts of pathogenesis and disease management. A double periodontal infection of herpesviruses and pathogenic bacteria tends to be associated with more severe periodontitis than a periodontal infection involving only bacteria. Classical techniques in viral diagnosis use cell culture or antigenemia. These diagnostic techniques have been largely replaced by DNA and / or RNA-based tests, which possess superior technical performance and cost advantages. False-negative and false-positive PCR results are an inherent concern. Poor design of the PCR test, without optimization or validation of the PCR methodology, may lead to inaccurate findings and incompatible with those of other studies. The concept of viral infections of the diseased periodontium may introduce a new level of understanding of the importance of preventing and controlling periodontal disease for medical purposes

This study highlights the importance of regular periodontal control in orthodontics. Fix orthodontic treatment impairs a good hygiene and could lead to several complications. Materials and methods. In this study enrolled 20 subjects that met the inclusion and exclusion criteria. The informed consent was signed by all the patients. Results and Discussion. Bleeding on probing and hygiene were assessed before the placement of fixed orthodontic appliances and after. Comparing the values, we found that BOP values increased after placement of fixed orthodontic appliances. Hygiene was not found to be in an optimal level. Conclusions. The results found emphasize the need of regular periodontal control in order to detect and prevent any periodontal issues that could influence the periodontal status.

Oral infections and periodontal disease may be exacerbated during chemotherapy and represent an important risk due to the neutropenia that many of the patients develop during treatment. The main objectives of oral care during immunosuppression periods are maintaining the oral health status, evaluating and treating any side effects that may occur during chemotherapy and patient education regarding the importance of maintaining good oral hygiene in minimalizing the risk of oral complications and discomfort during the chemotherapy treatment. The aim of this study is to revise the means of treatment and prevention of the adverse effects of chemotherapy in oncology patients.

Diabetes is a systemic disease with a number of major complications that can adversely affect quality of life. The disease is characterized by an increased susceptibility to infection, poor wound healing and increased morbidity and mortality associated with the evolution of the disease. Periodontal disease has been reported as the sixth complication of diabetes, along with neuropathy, nephropathy, retinopathy, and micro and macrovascular damage. Diabetes not only increases the risk and prevalence of periodontal disease, but also increases the progression of periodontal destruction. Both periodontal disease and diabetes have major inflammatory components. Not only is diabetes a risk factor for periodontitis, but periodontitis could also have a negative effect on glycaemic control.

The number of patients undergoing hormone replacement therapy (HRT) to counterbalance hormonal changes is increasing. Patients follow HRT not only to avoid climatic symptoms but also to protect themselves from cardiovascular disease and osteoporosis. HRT is an option for women who need drug therapy to reduce the risk of osteoporosis, including women at high risk of fracture for the next 5-10 years. Oestrogen supplementation can modulate the periodontal destruction rate through mechanisms involving inhibition of matrix metalloproteinases (MMP-8 and MMP-13) and cytokines involved in bone resorption

Periodontal disease and Crohn’s disease both represent inflammatory conditions. Therefore, a relationship between the pathophysiological mechanisms of these two diseases has been proposed. The manifestations of Crohn’s disease on periodontal level could surpass the oral ulcerations. The presence of gingival inflammation in patients with active digestive disease appears to be greater than when the disease is inactive. Moreover, even the clinical periodontal attachment loss could be more severe in these patients, with deep manifestations on cytokine level.

The relationship between periodontitis and systemic diseases is an important part of clinical periodontal research, which has been growing steadily. Even though the etiologies of periodontal disease and rheumatoid arthritis (RA) differ, these pathologies have many common features, both being multifactorial diseases characterized by localized chronic inflammatory reactions, which are fuelled by an analogous set of cytokines (among many, the most prominent being Tumour Necrosis Factor (TNF), Interleukin (IL) 6 and 17), leading to high systemic circulating concentrations of inflammatory markers such as C-reactive protein (CRP). It was not until the discovery of peptidylarginine deiminase (PAD) mediated citrullination of proteins by Porphyromonas gingivalis that the link between the two diseases was purely speculative. This citrullination initiates a series of events which culminate in the production of anti-citrullinated protein antibodies (ACPA) and, finally, in the clinical manifestation of rheumatoid arthritis. Another common denominator is the bone destruction caused by proinflammatory cytokines secreted by T 17 helper cells (TH17) which is the pathological hallmark of both diseases. Other notable common areas are shared risk factors such as environmental and genetic risk factors. Regarding treatment, neither pathologies have a definitive cure, however, several strategies are employed, some of which are common, such as diet and lifestyle changes, and immunomodulating medication applied locally or systemically.

The present resorbable and non-absorbable membranes act as a physical barrier to prevent the fall of the connective and epithelial tissue in defect, favouring the regeneration of periodontal tissues. These conventional membranes have many structural, mechanical and biofunctional limitations. It is clear that the “ideal” membrane for use in periodontal regenerative therapy has not yet been developed. Based on a biomaterial-based approach, it was assumed that a biologically designed and functionally sized nanofibre material closely mimicking native ECM could succeed as the next generation of GTR / GBR membranes for periodontal tissue engineering.

Biofilms that colonize tooth surfaces and epithelial cells lining the periodontal pocket ⁄ gingival sulcus (subgingival dental plaques) are among the most complex biofilms that exist in nature. Photodynamic therapy has been suggested as an alternative to chemical antimicrobial agents to eliminate subgingival species and treat periodontitis. Antimicrobial photodynamic therapy seems to be a unique and interesting therapeutic approach towards the treatment of periodontitis and peri-implantitis. The results of a number of in vitro studies clearly demonstrate the effective and efficient bactericidal effect of antimicrobial photodynamic therapy. Antimicrobial photodynamic therapy may hold promise as a substitute for currently available chemotherapy in the treatment of periodontal and peri-implant diseases.

Defining periodontal health is very important in establishing a common reference point for evaluating periodontal disease and determining significant treatment outcomes. Health can be evaluated both histologically and clinically and should be considered in the context of a preventive starting point and a therapeutic end point. Periodontal health should not only be considered in the context of bacterial plaque / bacteria levels and control but should embrace a holistic analysis and assessment of all factors responsible for disease onset, as well as the restoration and maintenance of health. The term impeccable clinical health is a rare but realistic entity, resulting in no loss of attachment, no bleeding at probing (BoP), no probing depth >3 mm, and no redness, clinical oedema or purulent discharge. We must recognize that this condition is associated with immune physiological surveillance, rather than with pathological inflammation.

Understanding the interaction between endodontic and periodontal lesions is of crucial importance to the clinician because of the challenges commonly encountered in the evaluation, diagnosis, treatment and prognosis of these combined diseases. Among the risk factors for the occurrence and development of endo-periodontal lesions are: incorrect endodontic treatment, lack of coronary seal in coronary restorations, occlusal trauma, radicular resorption of infectious or non-infectious nature, peripheral perforations within the endodontic treatment or dental malformations. The treatment and prognosis of endo-periodontal lesions varies depending on the etiology, pathogenesis and the correct recognition of each specific condition.

Periodontal health may be used to evaluate the success of orthodontic treatment. Orthodontic treatment ensures proper alignment of the teeth and improves the occlusal and jaw relationship. This improves the quality of life, contributing to oral and general health. Orthodontic treatment has benefits, but also risks and complications. Oral hygiene instruction and periodontal therapy are also indicated for child and adolescent orthodontic patients. This review highlights three most important periodontal complications of the orthodontic treatment and it assesses the necessity of the periodical periodontal controls and treatments before, during and after the orthodontic treatment.

The present research proposes an assessment of the localized inflammatory burden but also at the systemic level by quantitating the pro-inflammatory molecules (IL1-a, IL1-b, IL2, IL12, IFN-g, TNF-a) with endo-periodontal lesions. The study was performed on a group of 146 subjects who, following clinical and radiological examinations, were divided into five groups: healthy endo-periodontal patients, patients with periodontitis, patients with moderate periodontitis, patients with severe periodontitis and patients presenting combined endo-periodontal lesions. IL1-a, IL1-b, IL2, IL12, IFN-g, TNF-a were analysed in crevicular fluid by ELISA and serum by fluorescence flowcytometry. IL1-a and IL1-b showed serum and crevicular fluid values significantly higher than the healthy subjects. Values for IL2, IL12, TNF-a and IFN-g measured in crevicular fluid were higher for groups II, III, IV, and V compared to the group of healthy endo-periodontal subjects. IL2 showed significantly higher serum values for groups III, IV and V than group I. Serum IL12 values were significantly higher than healthy periodontal subjects only for patients with severe periodontitis and endo-periodontal syndrome. Following serum determinations of proinflammatory molecules, patients with endo-periodontal lesions demonstrated significantly higher values even in subjects with severe periodontitis; these data indicate a much higher risk for these patients to develop and maintain systemic maladies, as is the role local inflammation can play over the general inflammatory status of the patient.

Periodontal disease (PD) and cardiovascular disease (CVD) are highly prevalent in the modern community. Both pathologies are chronic inflammatory disorders, which are influenced by multiple risk factors. In part, these factors such as age, smoking, and diabetes overlap between PD and CVD. Epidemiological studies suggest that PD is strongly associated with increased CVD risk. Biochemical and physiological analyses involving in vitro experiments, animal models, and clinical studies provided evidence for the substantial impact of periodontal pathogens, their virulence factors, and bacterial endotoxins on all general pathogenic CVD mechanisms such as endothelial dysfunction, systemic inflammation, oxidative stress, foam cell formation, lipid accumulation, vascular remodeling, and atherothrombosis.

Traumatizing forces may act on an individual tooth or on groups of teeth in premature contact relationship; they may occur in conjunction with parafunctions such as clenching and bruxism, or in conjunction with loss or migration of premolar and molar teeth with an accompanying, gradually developing spread of the anterior teeth of the maxilla etc. The local, regional and systemic effects of bruxism include tooth wear, excessive stress on periodontal ligaments and alveolar bone, temporomandibular joint effects and even effects on the nervous central system.

Bacterial plaque represents the main causing factor for the periodontal impairment. The etiological treatment includes measures of scaling and root planing but, in certain cases, these measures prove to be insufficient. Often, incorporation of an appropriate chemotherapeutic agent in conjunction with mechanical instrumentation provides an additional antimicrobial effect offering increased opportunity to control disease. The aim of this review is to provide an insight on the main locally delivered chemotherapeutic agents.

Chemotherapy presents a wide variety of side effects alongside the desired antineoplasic, affecting the entire organism through direct and indirect pathways. Both of these are due to the known effect of chemotherapy agents on cells with a high turn-over rate like marrow cells, mucosal cells, hair follicles. In the oral cavity the side effects that occur are due to both the immunosuppression and direct affection of mucosal cells that line the entire oral cavity. The aim of this review is to offer an update on the data present in literature regarding the side effects of chemotherapy within the oral cavity.

The inflammatory response of the host in periodontitis is the phenomenon that underlies the onset and evolution of periodontal destructive phenomena. A number of systemic factors, such as diabetes mellitus (DM), can negatively affect the patient with periodontitis, just as the periodontal disease can aggravate the status of the DM patient. Host response modulation therapy involves the use of anti-inflammatory and anti-oxidant products aimed at resolving inflammation, stopping destructive processes, and promoting periodontal healing, all important aspects in patients with high tissue loss rates, such as diabetic patients. This paper reviews the data available in the literature on the relationship between DM and periodontitis, the main substances modulating the inflammatory response (nonsteroidal anti-inflammatory drugs, sub-antimicrobial doses of doxycycline, or omega-3 fatty acids and their products, specialized pro-resolving mediators), as well as their application in diabetic patients.

The aim of this study was to investigate the effects of adjunctive periodontal therapy of 5 mg/mL indocyanine green irradiation by an 810 nm diode laser (aPDT), supplementary to scaling and root planing (SRP) in patients with periodontitis and type II diabetes mellitus (DM) compared to the SRP alone, on periodontal clinical parameters and glycated hemoglobin A1c (HbA1c). The study was conducted on 49 subjects with type II DM and periodontitis, divided into two groups: the SRP group (n = 25), who followed SRP alone, and the SRP + aPDT group (n = 24), who followed SRP and four weekly sessions of indocyanine green irradiation by an 810 nm diode laser. Plaque Index (PI), Bleeding on Probing Index (BOP), probing depth (PD), clinical attachment loss (CAL) and HbA1c were investigated at baseline and after 6 months. At 6 months, both SRP alone and SRP + aPDT generated significant reductions in all the investigated parameters; SRP + aPDT produced more significant reductions for BOP, PD and CAL (p < 0.001) but not for PI and HbA1c, than SRP alone. aPDT with indocyanine green therapy was well tolerated, with two subjects reporting slight discomfort. Therefore, aPDT with indocyanine green might represent a good adjunctive periodontal treatment option for SRP in patients with type II DM and periodontitis.

Fixed prosthodontic dental restorations can potentially affect the periodontal tissues and vice versa, the periodontium can influence the longevity and esthetic appearance of dental restorations. We proposed an investigation on total bacterial load, specific periodontal pathogens, and periodontal clinical parameters in patients with dental fixed prosthesis and different degrees of periodontal tissue loss that followed photoactivation therapy (PDT) adjunctive to scaling and root planing. The study was conducted on 160 subjects, which were randomly assigned to scaling and root planing (SRP) alone (52 subjects, 256 sites), SRP and chlorhexidine rinsing (58 subjects, 276 sites), and SRP plus PDT (50 subjects, 318 sites). Periodontal parameters (plaque index, bleeding on probing, probing depth, and clinical attachment loss), followed by total bacterial load and specific periodontal pathogens (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola) were examined in each patient at baseline, one and six months after. PDT exerted significant improvements both in clinical and microbiological load after one month, and these results were maintained 6 months after when compared to chlorhexidine rinsing or SRP alone, especially in severe periodontitis cases. Photoactivation therapy as an adjunctive periodontal therapeutic method was efficient in offering supplementary periodontal improvements in the clinical and microbiological parameters of patients with fixed dental prosthesis, particularly in severe periodontitis cases.

Periodontal disease is an infectious and inflammatory disease with a high incidence in the global population and an extremely complex etiopathogenesis. Osteoporosis is one of the systemic diseases that can affect the integrity of periodontal tissues. Osteoporosis, as a skeletal disease, causes a reduction in bone mass and microarchitectural changes in the bone. Discussions about the connection between the two diseases affecting the bone began in 1960, but, contrary to the high number of studies, discoveries are still being made regarding the pathophysiological mechanisms that link the two diseases. The chapter proposes a systematized description of data on the influence of osteoporotic disease on the periodontal structures, therapeutic methods to address the patient with periodontal disease and osteoporosis and data on the potential influence of conventional and adjunctive periodontal treatment on systemic parameters in patients with osteoporosis.

Scaling and root planing represent the gold standard in the treatment of periodontal disease, but these therapeutic methods cannot eliminate the remaining periodontopathogenic bacteria in cement, tubules, and periodontal soft tissue. Thus, a number of additional therapeutic means have been adopted, including local and systemic antibiotic therapy, as well as the use of photodynamic therapy techniques. Recently, special attention has been paid to potential phytotherapeutic means in the treatment of periodontal disease. In this review, we aim to present the effects generated by the extract of Curcuma longa, the various forms of application of turmeric as an additional therapeutic means, as well as the aspects related to its biotolerance.