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Objectives The aim of this longitudinal intervention study was to assess the impact of psychosocial stress and coping response strategies on the clinical outcomes in periodontitis patients treated with non-surgical periodontal therapy (NSPT). Materials and methods After the administration of psychological questionnaires, patients diagnosed with generalized stage III–IV periodontitis were categorized into different groups depending on their stress levels (10-item perceived stress level (PSS-10)) and coping response strategies (coping responses inventory (CRI)). Clinical data were collected 1 week before and 3 months after the completion of NSPT. Results Of the 90 patients included at baseline, 27 presented major and 63 minor stress levels, while 40 had avoidance and 50 approach coping behavior. All clinical parameters were similar at the baseline across different categories. At re-evaluation, full-mouth bleeding score (FMBS), mean probing pocket depth (PPD), and number of residual pathological pockets were significantly superior in groups with higher stress levels (p p =0.001, and p =0.020, respectively), while higher full-mouth plaque scores (FMPS) and FMBS were found in patients with avoidance coping strategies (p =0.009 and p Conclusion Psychosocial stress and avoidance coping strategy seem to negatively influence the clinical outcomes of NSPT at short term (NCT04739475; 9/1/2017). Practical implications Based on these findings, patients reflecting these psychological profiles should be considered at greater risk for poor NSPT response and may benefit from complementary stress management strategies.

To evaluate the association between Leisure-Time/Occupational Physical Activity (LTPA/OPA) and periodontitis in a nationally representative sample of the US population.Data from 10,679 adults were retrieved from the NHANES 2009-2014 database. Physical activity was assessed through the Global Physical Activity Questionnaire; accordingly, subjects were classified as performing either high or low LTPA/OPA. Periodontal status was assessed through a full-mouth periodontal examination, and subjects were classified according to the AAP/CDC criteria (no, mild, moderate, severe periodontitis). Simple and multiple regression analyses were applied to study the association between LTPA/OPA and periodontitis/severe periodontitis.Multiple regression analyses identified high LTPA as protective indicator for periodontitis (OR=0.81; 95% CI: 0.72, 0.92), while high OPA resulted as a significant risk indicator (OR=1.16; 95% CI: 1.04, 1.30). The combination of low LTPA/high OPA showed a cumulative independent association with periodontitis (OR=1.47; 95% CI: 1.26, 1.72). Moreover, both high LTPA (OR=0.72; 95% CI: 0.58, 0.90) and high OPA (OR=1.29; 95% CI: 1.09, 1.53) resulted independently associated with stronger estimates of severe periodontitis; the same was observed for the combination of low LTPA/high OPA (OR=1.66; 95% CI: 1.29, 2.15).Leisure-time and occupational physical activity demonstrated divergent associations with periodontitis.

There is increasing evidence on the connections between chronic oral inflammation/infection and the pathophysiological conditions of the gastrointestinal tract and accessory organs of digestion. The aim of this review is to provide a critical synthesis regarding the epidemiological, clinical, and in vivo associations between periodontitis and the most relevant diseases of the digestive system. An increasing body of dental and medical literature is supporting the gum-gut axis as a relevant mechanism to explain the associations between periodontitis and systemic diseases. Indeed, shared microbiological and immunological pathways have been identified between periodontitis and gut diseases, and translocation of oral bacteria to the lower parts of the digestive system has been postulated as a driver for peptic ulcers, inflammatory bowel disease, liver disease, and ultimately digestive cancers. For the upper digestive tract, epidemiologic association between periodontitis and gastroesophageal reflux disease or squamous cell carcinoma remains conflicting, despite oral keystone pathogens having been consistently found in esophageal and gastric cancer tissue biopsies. The oral cavity represents a reservoir for Helicobacter pylori, with periodontal therapy increasing the eradication and the non-recurrence rate of the infection. Regarding bowel diseases, gut dysbiosis is being progressively ascertained in close relation to periodontal infection, and periodontitis is being investigated among the risk indicators for colorectal cancer. Lastly, non-alcoholic fatty liver disease and cirrhosis were epidemiologically linked to periodontitis, while its association with pancreatic tumors represents one of the most intriguing fields of research in periomedicine.

As the whole world is epidemically aging, the burden of periodontitis and tooth loss is becoming a major health concern. Growing meta-epidemiological data implicate chronic systemic inflammation/infection due to periodontitis as an independent risk factor for aging-related diseases and mortality. However, because people age differently, chronological age is not a reliable marker of an individual’s functional status. Recent advances in geroscience have shown that various biomarker signatures of biological aging are longitudinally associated with declined physical function, morbidity, and mortality due to major age-related diseases, including periodontitis. Here, we emphasize novel research developments bidirectionally linking periodontitis to accelerated biological aging. Using a composite biomarker age estimator, a striking increase in periodontitis and tooth loss was observed in subjects whose biological age at baseline was higher than their chronological age. Moreover, significantly shortened telomeres were encountered in populations affected by severe periodontitis. Second, we elucidate the cellular and molecular pillars of the aging process at the periodontal level. Accumulating evidence suggests that cellular senescence, stem cell exhaustion, and immunoaging are hallmarks of biological aging implicated in the impairment of periodontal homeostasis and the pathophysiology of periodontitis. Indeed, persistent bacteria-derived lipopolysaccharide stimulation influences cellular senescence in osteocytes, driving alveolar bone resorption. Moreover, inflammaging status induced by chronic hyperglycemia elevates the burden of senescent cells in gingival tissues, impairing their barrier function. Lastly, we reviewed a recent breakthrough in senotherapy to directly target the mechanisms of aging at the periodontal level. Physical exercise and intermittent fasting, together with natural compounds, senolytic drugs, and cell therapy, are increasingly being evaluated to rejuvenate the oral cavity. Following these innovations in geroscience, further advancements could provide oral clinicians the chance to intercept biological aging when still “subclinical” and set interventions for halting or delaying the trajectory toward aging-related diseases while patients are still chronologically young.

Aim: The present multi-centre randomized clinical trial with 12 months of follow-up aimed at studying the added effect of sub-marginal instrumentation before surgical treatment of peri-implantitis. Materials and Methods: Forty-two patients diagnosed with peri-implantitis were recruited. After a behavioural intervention phase including oral hygiene instructions, patients were randomized to either receiving supra- and sub-marginal instrumentation on their affected implants (control group: 21 patients and 29 implants) or only supra-marginal instrumentation (test group: 21 patients and 24 implants), before undergoing surgery. Changes in the deepest probing pocket depth (PPD) with respect to baseline and a composite outcome of treatment success (no implant loss, no bone loss > 0.5 mm, no bleeding or suppuration on probing [BoP/SoP], and PPD ≤ 5 mm) at the 12-month examination were regarded as the primary outcomes of the trial. Results: At the 12-month examination, changes in the deepest PPD with respect to baseline amounted to ¬-2.96 mm in the control group and to -3.11 mm in the test one (MD = -0.16; SE = 0.56; p = .769), while 21.4% of the implants in the control group and 33.3% in the test group presented treatment success (OR = 1.83; SE = 1.15; p = .338). With the exception of a longer non-surgical treatment duration in the control group (differences in = -14.29 min; SE = 2.91; p < .001), no other secondary (e.g., soft-tissue recession, keratinized mucosa height, and bone level changes, as well as BoP, SoP, profuse bleeding and implant loss rates) or exploratory (i.e., early wound healing, aesthetics, surgical and total treatment duration, surgery difficulty, intra-operative bleeding, and adverse events) outcome demonstrated statistically significant differences between groups. Conclusions: The present multi-centre randomized clinical trial did not demonstrate an added effect of performing sub-marginal instrumentation 6 weeks before the surgical treatment of peri-implantitis. Larger clinical trials are however needed to confirm the present findings (Clinicaltrials.gov: NCT03620331).

To answer the following PICO question: "In patients requiring surgical treatment of peri-implantitis (P), is any implant surface decontamination protocol (I) superior to others (C) in terms of clinical and radiographic parameters (O)?"Randomized clinical trials (RCTs) comparing two or more decontamination protocols as part of the surgical treatment of peri-implantitis were included. Two authors independently searched for eligible studies, screened titles and abstracts, did full-text analysis, extracted data, and performed the risk-of-bias assessment. Whenever possible, results were summarized through random effects meta-analyses.Twenty-two manuscripts reporting on 16 RCTs were included, testing mechanical, chemical and physical decontamination protocols. All of them resulted in an improvement in clinical parameters; however, the superiority of specific protocols over others is mainly based on single RCTs. The use of titanium brushes and implantoplasty showed favorable results as single decontamination methods. Meta-analyses indicated a lack of added effect of Er:Yag laser on probing pocket depth (PPD) reduction (n = 2, WMD = -0.24 mm, 95% confidence interval [CI] [-1.10; 0.63], p = .59); while systemic antimicrobials (amoxicillin or azithromycin) showed an added effect on treatment success ([PPD ≤5 mm, no bleeding or suppuration, no progressive bone loss]; n = 2, RR = 1.84, 95% CI [1.17;2.91], p = .008), but not in terms of PPD reduction (n = 2, WMD = 0.93 mm, 95% CI [-0.69; 2.55], p = .26), even if with substantial heterogeneity.No single decontamination method demonstrated clear evidence of superiority compared to the others. Systemic antibiotics, but not Er:Yag laser, may provide short-term clinical benefits in terms of treatment success (CRD42020182303).

Objectives To extract the microbiological and immunological evidence underpinning the association between periodontitis and inflammatory bowel disease (IBD). Methods Relevant articles were sorted through a systematic search on PubMed, Embase, Scopus and Web of Science up to October 2020. Available evidence was grouped in three different clusters: a) studies that examined oral microbial alterations in IBD patients; b) studies that investigated intestinal dysbiosis in patients with periodontitis; and c) evidence for a shared immunological pattern between the two conditions. Results A total of 15 studies involving 1,171 patients were included. Oral microbiome, either subgingival or salivary, was consistently altered in patients with IBD compared to healthy subjects (a). Additionally, gut dysbiotic microbiota of IBD patients was colonized by pathobionts from oral origin, either via hematogenous or enteric route. Suffering from periodontitis is associated with lower alpha diversity in the gut microbiome (b). Lastly, both IBD and periodontitis are characterized by similar expression patterns of inflammatory cytokines at the gingival and gut levels, that are exacerbated when both diseases are present (c). Conclusions Periodontitis and IBD share common dysbiotic and immunological traits. Well-designed preclinical models and longitudinal cohort studies are required to better explore the causal pathways between the two conditions (PROSPERO CRD42020194379).

The purpose of the present review is to answer the following focused question: “What are the most relevant findings about the diagnosis and subsequent treatment of desquamative gingivitis (DG)?” Topical corticosteroids in the form of gel should be the first-line medical treatment and may be sufficient for some moderate or mild forms of DG. When patients continue to experience erosions and pain despite topical therapy, treatment with systemic therapy is indicated. A tailored plaque control program is effective in reducing gingival manifestations of DG in terms of related symptoms, plaque index, mucosal disease score, gingival crevicular fluid volume, matrix metalloproteinase (MMP)-1, and MMP-9. The painful symptoms and clinical features in gingiva are improved by non-traumatic oral hygiene procedures, but the underlying causes of DG cannot be eliminated by plaque control alone. Thus, the cooperation with dermatologists/oral pathologists is always required. New technologies for home oral hygiene may improve patients’ quality of life.

Aim To systemically review the available evidence on the clinical performance of osseous resective surgery (ORS) in the treatment of residual periodontal defects in terms of pocket elimination and biological costs in patients with chronic periodontitis. Materials and methods Three databases (PubMed, EMBASE and Cochrane) were searched up to January 2019. Clinical trials with a follow-up duration of at least 12 months after ORS with or without fibre retention technique were included. Quantitative synthesis was conducted with random-effect meta-analysis. Results Overall, 1,765 studies were retrieved, of which 53 full-text articles were screened by two reviewers. Finally, a total of three RCTs were included in the meta-analysis. Random-effect meta-analysis showed a weighted mean percentage of pocket elimination (final PD ≤ 4 mm) at 12 months of 98.3% (95% CI: 96.8; 99.7) with I2 of 26%. The weighted mean amount of resected bone was 0.87 mm (95% CI: 0.49; 1.25), and the weighted mean increase in gingival recession was 2.13 mm (95% CI: 1.49; 2.78) at 12 months. Conclusions ORS represents an effective surgical approach for the elimination of residual periodontal pockets in the short to medium term. Additional randomized controlled clinical trials with data on pocket elimination are warranted.

Recent evidence is supporting the notion of a microbiological and immunological continuum on the gum-gut axis in health and disease. Therefore, the purpose of this study was to assess the prevalence and risk indicators of periodontitis in patients with Crohn's disease (CD) or ulcerative colitis (UC) compared to age- and sex-matched controls without inflammatory bowel disease (IBD).A total of 180 IBD (117 CD, 60 UC, 3 IBD-unclassified) and 180 healthy controls were compared for their periodontitis diagnosis (Centers for Disease Control and Prevention/American Academy of Periodontology [CDC/AAP] case definition) and full-mouth periodontal parameters. In addition, explorative logistic regression models were performed.Significantly more patients with IBD had moderate/severe periodontitis (85.6% vs. 65.6%, p 0.001) and severe periodontitis (36.7% vs. 25.6%, p 0.001) than controls. Differences were higher in the 35-50 and 51-65 age groups, without significant changes between CD and UC. IBD subjects presented chances ∼3.5 higher of having moderate/severe periodontitis (p 0.001). Significant variables associated with periodontitis in the whole sample were older age, presence of IBD, and higher full-mouth plaque scores, whereas in the IBD group they were male sex, IBD-associated surgery, and IBD duration and localization (pancolitis). Positive risk indicators for IBD were periodontitis severity and higher bleeding scores, while smoking was negatively associated with UC.Relevant associations between IBD and periodontitis were found, being modified by CD and UC clinical characteristics. Preventive and therapeutic strategies involving the gum-gut axis should be enforced in IBD patients.

This retrospective study evaluated the effect of combined periodontal-orthodontic treatment in terms of clinical, radiographic, and patient-reported outcomes in 40 stage IV periodontitis patients with advanced attachment loss and pathologic migration of anterior teeth. Full-mouth periodontal parameters were recorded at baseline (after diagnosis; T0), at the end of active periodontal therapy (APT; T1), at completion of orthodontic tooth movement (OTM; T2), and at the last supportive periodontal care (SPC) visit (T3). Radiographic analysis was performed at T0, T2, and T3. A total of 115 teeth were lost during APT, including 5 molars at T2 (used as orthodontic anchorage) and 10 premolars at T3 (due to root fracture). All anterior migrated teeth were in function at T3 (mean duration: 9.5 years). Significant mean probing pocket depth reduction (1.5 ± 1.1 mm) and attachment level gain (0.9 ± 1.0 mm) were observed after APT, whereas OTM and SPC were associated with furthering small changes. The alveolar bone level at T3 was slightly increased from T0 values. Patient-reported outcome measurements significantly improved in terms of esthetics and masticatory function. OTM should be considered an essential part of the comprehensive treatment plan to change the prognosis of severely compromised teeth in stage IV periodontitis patients.

Objectives The present systematic review examined the available evidence on distinctive salivary ion profile in periodontitis compared to periodontal health and provided a qualitative assessment of the literature. Background Macro and trace elements are essential for cellular physiology, and their changes in biological fluids can be revelatory of an underlying pathological status. Methods Data from relevant studies identified from PubMed, Embase, and Scopus databases were retrieved to answer the following PECO question: "In systemically healthy individuals, are there any differences in any salivary macro or trace element concentration between periodontally healthy subjects (H) and patients with periodontitis (P)?" Quality of included studies was rated using a modified version of the QUADOMICS tool. A consistency analysis was performed to identify significantly discriminant chemical elements. Results After the screening of 873 titles, 13 studies were included reporting data on 22 different elements. Among them, levels of sodium and potassium were consistently and significantly higher in P compared to H. Conflicting results were found for all the other elements, despite concentration of calcium, copper, and manganese mostly increased in saliva of P. Levels of magnesium were found higher in P than in H in 2 studies but lower in 3. Zinc resulted significantly increased in saliva from H compared to P individuals in 2 studies, but one study reported opposite results. Four studies were considered as high quality, while reporting of operative protocols and statistical analysis was a major limitation for the others. Due to high methodologic heterogeneity, meta-analysis was not performed. Conclusions Levels of macro or trace elements were differentially identified in saliva across diverse periodontal conditions, having a major potential for investigation of oral homeostasis and for high-resolution periodontal diagnosis. Products of inflammatory physiologic cellular impairment, such as sodium and potassium, were the most consistently associated with periodontitis (PROSPERO CRD42021235744).

AIM To analyse the efficacy of non-surgical therapy (NST) in terms of pocket closure (PC) and changes in percentage and number of pockets. MATERIALS AND METHODS Three databases (PubMed, EMBASE, and Scopus) were searched up to January 2020. Prospective studies with a minimum follow-up of 12 months and presenting data in terms of PC or number or percentage of pocket depths (PDs) before and after NST on systemically healthy patients were included. Random-effect meta-analyses were performed. RESULTS After screening 4610 titles and abstracts, 27 studies were included. Of these, 63.9% of PC was reported by one study. The percentage of PDs ≤3 mm changed from 39.06% to 64.11% with a weighted mean difference (WMD) of 26.14% (p

Aims The aim of this study was to explore general dental practitioners' (GDP) attitude to periodontal furcation involvement (FI). Materials and methods An online survey focused on diagnosis and management of periodontal FI was circulated to general dental practitioners in 7 different countries. Results A total of 400 responses were collected. Nearly a fifth of participants reported rarely or never taking 6-point pocket charts. 65.8% of participants had access to a Nabers probe in their practice. When shown clinical pictures and radiographs of FI-involved molars, the majority of participants correctly diagnosed it. Although 47.1% of participants were very/extremely confident in detecting FI, only 8.9% felt very-extremely confident at treating it. Differences in responses were detected according to country and year of qualification, with a trend towards less interest in periodontal diagnosis and treatment in younger generations. Lack of knowledge of management/referral pathways (reported by 22.8%) and lack of correct equipment were considered the biggest barriers to FI management. Most participants (80.9%) were interested in learning more about FI, ideally face-to-face, followed by online tutorials. Conclusions Plans should be put in place to improve general dentists' knowledge and ability to manage FI, as this can have a significant public health impact.

The present case series evaluated three-dimensional volumetric bone tissue changes and new bone formation in severely resorbed extraction sockets augmented with Bio-Oss collagen and a covering collagen membrane in nine chronic periodontitis patients. Healing was by secondary intention. After 12 months of healing, the augmentation procedure appeared not only to compensate for bone remodeling but also appeared to repair a significant portion of the buccal wall. The mineralized tissue filled the 91.49% ± 6.77% of the maximum volume for regeneration. Overall, a mean of 49.6% new bone, 27.1% residual graft material, and 23.3% connective tissue were detected.

Metabolomic analysis of saliva proved its accuracy in discriminating patients with generalized chronic periodontitis (GCP) from healthy subjects by identifying specific molecular signatures of the disease. There is lack of investigations concerning the effect of periodontal treatment on individual metabolic fingerprints. Therefore, the aim of this study was to determine whether non-surgical periodontal therapy could change salivary metabolomic profile in GCP to one more similar to periodontal health.Unstimulated whole saliva of 32 controls and 19 GCP patients were obtained prior to and 3 months after conventional staged non-surgical periodontal therapy. Metabolic profiling was performed using Nuclear Magnetic Resonance (NMR) spectroscopy, followed by univariate and multivariate paired approaches to assess the changes introduced by the therapy.In GCP group, periodontal treatment led to an improvement in all clinical parameters (p 0.001). The accuracy of the multivariate model in discriminating the metabolomic profile of each GCP patient at two time points was 92.5%. Despite the almost perfect separation of the spectra in the metabolic space, the univariate analysis failed to identify significant variations in single metabolite content. The post-treatment metabolic profile of GCP patients could not be assimilated to that of healthy controls who exhibited different levels of lactate, pyruvate, valine, proline, tyrosine, and formate.Based on these data, NMR-spectroscopic analysis revealed that, despite significant changes in the overall metabolomic fingerprint after non-surgical therapy, GCP patients maintained a distinctive metabolic profile compared to healthy individuals.

This study assessed the periodontal conditions of type 2 diabetes (T2DM) patients attending an Outpatient Center in North Italy and explored the associations between metabolic control and periodontitis. Periodontal health of 104 T2DM patients (61 men and 43 women, mean age of 65.3 ± 10.1 years) was assessed according to CDC/AAP periodontitis case definitions and Periodontal Inflamed Surface Area (PISA) Index. Data on sociodemographic factors, lifestyle behaviors, laboratory tests, and glycated hemoglobin (HbA1c) levels were collected by interview and medical records. Poor glycemic control (HbA1c ≥ 7%), family history of T2DM, and C-reactive protein levels were predictors of severe periodontitis. An increase in HbA1c of 1% was associated with a rise in PISA of 89.6 mm2. On the other hand, predictors of poor glycemic control were severe periodontitis, waist circumference, unbalanced diet, and sedentary lifestyle. A rise in PISA of 10 mm2 increased the odds of having HbA1c ≥ 7% by 2%. There is a strong bidirectional connection between periodontitis and poor glycemic control. The inflammatory burden posed by periodontitis represents the strongest predictor of poor glycemic control.

BackgroundEfficient control of infection is essential to achieve desired outcomes in the surgical treatment of peri-implantitis lesions, although methods employed are largely heterogeneous.PurposeTo compare the impact of different decontamination protocols and adjunctive systemic antimicrobials on the outcomes of surgical treatment of peri-implantitis.Materials and methodsRandomized clinical trials (RCTs) on surgical treatment of peri-implantitis were selected through an electronic search on Medline, Embase, Scopus, and Central databases. Only studies comparing two or more anti-infective strategies were included. Following data extraction, two different sets of meta-analyses were performed. Firstly, overall impact of different implant surface decontamination methods was assessed by comparing baseline values with outcomes at 6-12 months. Secondly, pairwise comparisons evaluated the potential benefit of adjunctive systemic antimicrobials over placebo. Results were expressed as weighted mean effect (WME), weighed mean difference (WMD) or risk ratio (RR).ResultsSixteen RCTs were included. No pairwise comparisons were available for different surface decontamination methods. Use of curettes resulted in improved probing depth (PD) (WME = 2.13 mm), but the results in terms of marginal bone levels (MBL) and percentage of disease resolution were unsatisfactory. Moreover, the adjunctive benefit of systemic antimicrobials over placebo was evaluated in two studies, representing a total of 178 implants. Despite not being statistically significant, the meta-analyses identified a higher probability of disease resolution (RR = 1.50) for test procedures. In terms of overall outcome, systemic antimicrobials with open flap debridement resulted in improved MBL (WME = 0.44 mm), reduced PD (WME = 2.46 mm) and 51.4% of disease resolution.ConclusionsThere is not enough evidence to support adjunctive usage of systemic antimicrobials together with the surgical treatment of peri-implantitis. Moreover, higher consistency is required to prove the superiority of a surface decontamination protocol over another (PROSPERO CRD42020182303).SUMMARY BOXWhat is knownPeri-implantitis is a common biological complication occurring at dental implants, and surgery is usually required to obtain thorough peri-implant infection control.No systematic reviews with meta-analysis have assessed surface decontamination protocols for surgical treatment of peri-implantitis, as well as the adjunctive benefit of peri-operative systemic antimicrobials.What this study addsThis study offered the first evidence-based synthesis of randomized clinical trials regarding this relevant topic.Although protocol heterogeneity was high, a combination of mechanical and chemical implant surface decontamination is recommendable.Titanium brushes and local delivery of minocycline showed encouraging results; while the additional benefit of systemic antimicrobials needs to be further determined.

Early diagnosis of periodontitis by means of a rapid, accurate and non-invasive method is highly desirable to reduce the individual and epidemiological burden of this largely prevalent disease. The aims of the present systematic review were to examine potential salivary metabolic biomarkers and pathways associated to periodontitis, and to assess the accuracy of salivary untargeted metabolomics for the diagnosis of periodontal diseases. Relevant studies identified from MEDLINE (PubMed), Embase and Scopus databases were systematically examined for analytical protocols, metabolic biomarkers and results from the multivariate analysis (MVA). Pathway analysis was performed using the MetaboAnalyst online software and quality assessment by means of a modified version of the QUADOMICS tool. Twelve studies met the inclusion criteria, with sample sizes ranging from 19 to 130 subjects. Compared to periodontally healthy individuals, valine, phenylalanine, isoleucine, tyrosine and butyrate were found upregulated in periodontitis patients in most studies; while lactate, pyruvate and N-acetyl groups were the most significantly expressed in healthy individuals. Metabolic pathways that resulted dysregulated are mainly implicated in inflammation, oxidative stress, immune activation and bacterial energetic metabolism. The findings from MVA revealed that periodontitis is characterized by a specific metabolic signature in saliva, with coefficients of determination ranging from 0.52 to 0.99. This systematic review summarizes candidate metabolic biomarkers and pathways related to periodontitis, which may provide opportunities for the validation of diagnostic or predictive models and the discovery of novel targets for monitoring and treating such a disease (PROSPERO CRD42020188482).

Purpose The aim of this randomized clinical trial was to assess whether chemical cleansing using a sulfonic/sulfuric acid gel solution (HBX) as an adjunct to scaling and root planing (SRP) resulted in a decrease in residual plaque and calculus in deep periodontal pockets compared to SRP alone. Methods Fifty-six patients with 56 hopeless posterior teeth, scheduled for extraction due to severe periodontitis, were enrolled in this study. Each tooth was randomly assigned to 1 of the 2 experimental procedures. The test teeth were subjected to the irrigation of the subgingival area with HBX for 2 minutes, followed by SRP with hand and ultrasonic instruments for 14 minutes, and then extracted. The control teeth received only mechanical instrumentation before extraction. Residual biofilm was evaluated on photographs and measured as total area and percentage of root surface covered by remaining plaque (RP) or calculus (RC) after treatment. Results The initial pocket depth (PD) and total subgingival root surface area were similar between the 2 treatment groups. After treatment, the total subgingival root area covered by RP and RC was statistically significantly larger (P, Graphical Abstract

The present systematic review aimed to examine periodontitis-specific biomarkers in the gingival crevicular fluid (GCF) that could have a diagnostic relevance, and to provide a qualitative assessment of the current literature. Metabolites are reliable indicators of pathophysiological statuses, and their quantification in the GCF can provide an outlook of the changes associated with periodontitis and have diagnostic value. Relevant studies identified from PubMed, Embase, Cochrane Library, and Scopus databases were examined to answer the following PECO question: "In systemically healthy individuals, can concentration of specific metabolites in the GCF be used to discriminate subjects with healthy periodontium (H) or gingivitis from patients with periodontitis (P) and which is the diagnostic accuracy?" Quality of included studies was rated using a modified version of the QUADOMICS tool. Meta-analysis was conducted whenever possible. After the screening of 1,554 titles, 15 studies were selected, with sample size ranging from 30 to 93 subjects. Eleven studies performed targeted metabolomics analysis and provided data for 10 metabolites. Among the most consistent markers, malondialdehyde levels were found higher in the P group compared with H group (SMD = 2.86; 95% CI: 1.64, 4.08). Also, a significant increase of 8-hydroxy-deoxyguanosine, 4-hydroxynonenal, and neopterin was detected in periodontally diseased sites, while glutathione showed an inverse trend. When considering data from untargeted metabolomic analysis in four studies, more than 40 metabolites were found significantly discriminant, mainly related to amino acids and lipids degradation pathways. Notably, only one study reported measures of diagnostic accuracy. Several metabolites were differentially expressed in GCF of subjects across different periodontal conditions, having a major potential for investigating periodontal pathophysiology and for site-specific diagnosis. Oxidative stress-related molecules, such as malondialdehyde and 8-hydroxy-deoxyguanosine, were the most consistently associated to periodontitis (PROSPERO CRD42020188482).

Aim To systematically assess the clinical performance of different approaches for periodontal regeneration of intrabony defects in terms of pocket resolution compared to access surgery with papilla preservation techniques (PPTs). Material and methods Systematic literature searches were conducted on PubMed, EMBASE, and CENTRAL up to April 2020 to identify RCTs on regenerative treatment [guided tissue regeneration (GTR) or enamel matrix derivative (EMD) with or without biomaterials] of intrabony defects using PPTs. Results were expressed as weighted mean percentages (WMP) or risk ratios of pocket resolution at 12 months (considering both final PD ≤ 3 mm and ≤4 mm). Results A total of 12 RCTs were included. Based on a final PD ≤ 3 mm or PD ≤ 4 mm, the WMP of pocket resolution was 61.4% and 92.1%, respectively. EMD and GTR obtained comparable results. Pairwise meta-analysis identified a greater probability of achieving pocket resolution for GTR compared to PPTs. The number needed to treat for GTR to obtain one extra intrabony defect achieving PD ≤ 3 mm or PD ≤ 4 mm over PPTs was 2 and 4, respectively. Conclusion Regenerative surgery represents a viable approach to obtain final PD ≤ 4 mm in the short-term.

Pattern analysis of the salivary metabolic profile has been proven accurate in discriminating between generalized periodontitis (GP) patients and healthy individuals (HI), as this disease modifies the salivary concentrations of specific metabolites. Due to the scarcity of data from previous studies, this study aimed to evaluate if non-surgical periodontal therapy (NST) could affect the metabolomic profile in GP patients&rsquo, saliva and if it compares to that of HI. Unstimulated salivary samples were collected from 11 HI and 12 GP patients before and 3 months after NST. Nuclear Magnetic Resonance (NMR) spectroscopy, followed by a supervised multivariate statistical approach on entire saliva spectra and partial least square (PLS) discriminant analysis, were performed to obtain metabolic profiles. In the GP group, periodontal treatment improved all clinical parameters, but not all the diseased sites were eradicated. PLS revealed an accuracy of 100% in distinguishing between metabolic profiles of GP patients before and after NST. Orthogonal projection to latent structure was able to discriminate between the three groups of subjects with an accuracy of 85.6%. However, the post-NST metabolic profile of GP patients could not be completely assimilated to that of HI. Although NST may produce significant changes in the metabolic profile, GP patients maintained a distinctive fingerprint compared to HI.

BACKGROUND Limited information is available on the application of diode laser in the treatment of peri-implant diseases. The aim of this study was to investigate the clinical efficacy of the adjunctive application of diode laser in the non-surgical treatment of peri-implant mucositis during a 12-month follow-up period. METHODS The sample was composed of 73 systemically healthy patients with one implant diagnosed with peri-implant mucositis (bleeding on probing [BoP] with no loss of supporting bone). Implants were randomly assigned to mechanical debridement with hand and powered instruments and 980-nm diode laser application (test group, N.=38) or mechanical debridement alone (control group, N.=35). At the completion of active treatment patients were included in a periodontal maintenance program. Recalls were provided every three months in both treatment groups for reinforcement in oral hygiene instructions and professional implant cleaning with rubber cups. Baseline parameters were repeated at 3 and 12 months postoperatively. RESULTS Intragroup analysis showed that plaque index, BoP and probing depth presented statistically significant improvements when compared with baseline values (all P

This investigation was designed to evaluate the long-term effectiveness of human placental allograft in root coverage procedures in terms of clinical and esthetic outcomes. Thirteen patients with 28 maxillary or mandibular recession defects > 4 mm deep were reexamined at 6 months and 5 years postoperatively. Overall, mean percentage of root coverage decreased from 65.58% ± 16.45% to 49.75% ± 19.40% with a greater stability of the gingival margin in the mandible. At 5 years, 18 sites maintained at least 2 mm of keratinized tissue. Gingival color and texture blended well with adjacent soft tissue area in 78.6% of treated sites.

Background As there are few studies in Europe describing characteristics of breath malodor for large groups of patients, this retrospective study was designed to analyse the etiology of halitosis among patients attending a breath malodor center in Northern Italy. Methods Clinical records of 547 consecutive patients were reviewed and data on self-perceived halitosis, organoleptic scores, volatile sulphur compound (VSC) levels, and oral health condition were extracted and analysed. Results The prevalence of intra-oral halitosis was 90.7%. In 21 patients no objective signs of breath malodor could be found. Periodontitis and gingivitis were the main cause of bad breath in 33.9% of subjects and in combination with tongue coating in 55.2%. Only eight subjects have tongue coating as the only cause of halitosis. Ear, nose and throat (ENT)/extra-oral causes were found in 5.2% of the patients. VSC concentrations were lower in the psychogenic halitosis group, whereas no statistically significant differences were detected when comparing intra-oral and extra-oral halitosis except for (CH3)2S. Conclusions Psychogenic halitosis is a rare condition among subjects complaining of suffering from bad breath. The most prevalent cause of halitosis is intra-oral, in particular a combination of tongue coating and periodontal disease. Tongue coating is rarely the primary cause of oral malodor.

This retrospective study evaluated the long-term response of periodontal tissues and survival rate of teeth with advanced attachment loss and pathologic migration in 21 periodontitis patients treated with combined periodontal and orthodontic treatment. All anterior migrated teeth were in function at the end of 10 to 15 years of maintenance. Residual probing depths and clinical attachment levels improved after treatment and remained stable through the follow-up. A total of 55 hopeless teeth were lost during active therapy, as well as 6 molars over the course of the supportive periodontal therapy (for nonperiodontal reasons). In highly compliant patients, all migrated teeth with initial unfavorable prognosis showed long-term clinical stability.

BACKGROUND Recent findings about the differential gene expression signature of periodontal lesions have raised the hypothesis of distinctive biological phenotypes expressed by generalized chronic periodontitis (GCP) and generalized aggressive periodontitis (GAgP) patients. Therefore, this cross-sectional investigation was planned, primarily, to determine the ability of nuclear magnetic resonance (NMR) spectroscopic analysis of unstimulated whole saliva to discriminate GCP and GAgP disease-specific metabolomic fingerprint and, secondarily, to assess potential metabolites discriminating periodontitis patients from periodontally healthy individuals (HI). METHODS NMR-metabolomics spectra were acquired from salivary samples of patients with a clinical diagnosis of GCP (n = 33) or GAgP (n = 28) and from HI (n = 39). The clustering of HI, GCP, and GAgP patients was achieved by using a combination of the Principal Component Analysis and Canonical Correlation Analysis on the NMR profiles. RESULTS These analyses revealed a significant predictive accuracy discriminating HI from GCP, and discriminating HI from GAgP patients (both 81%). In contrast, the GAgP and GCP saliva samples seem to belong to the same metabolic space (60% predictive accuracy). Significantly lower levels (P

AIM The goal of this study was to evaluate if dental pulp stem cells (DPSCs) delivered into intrabony defects in a collagen scaffold would enhance the clinical and radiographic parameters of periodontal regeneration. MATERIALS AND METHODS In this randomized controlled trial, 29 chronic periodontitis patients presenting one deep intrabony defect and requiring extraction of one vital tooth were consecutively enrolled. Defects were randomly assigned to test or control treatments which both consisted of the use of minimally invasive surgical technique. The dental pulp of the extracted tooth was mechanically dissociated to obtain micrografts rich in autologous DPSCs. Test sites (n = 15) were filled with micrografts seeded onto collagen sponge, whereas control sites (n = 14) with collagen sponge alone. Clinical and radiographic parameters were recorded at baseline, 6 and 12 months postoperatively. RESULTS Test sites exhibited significantly more probing depth (PD) reduction (4.9 mm versus 3.4 mm), clinical attachment level (CAL) gain (4.5 versus 2.9 mm) and bone defect fill (3.9 versus 1.6 mm) than controls. Moreover, residual PD

The aim of this pilot in vitro study was to evaluate material wear and temperature variations after using conventional rotating bur and piezosurgical insert for osseous resective surgery in bovine bone blocks under physiologic irrigation. Wear evaluation was carried out by measuring cutting time, and wear mechanisms were analyzed by scanning electron microscopy. Time analysis showed greater material wear and higher heat production with the piezoelectric insert. However, temperatures remained below values of clinical concern even after a cutting time of 20 minutes. Conversely, bone surface appeared irregular in shape with bone debris and signs of thermal damage on the bur-drilled surface, probably due to the more traumatic action of the diamond-coated bur.

PURPOSE The primary aim of the study was to describe a novel technique to evaluate volumetric hard tissue dimensional changes after ridge augmentation procedures. The secondary aim was to apply this newly developed measuring method to compromised alveolar sockets grafted with a slowly resorbing biomaterial covered with a collagen membrane. MATERIALS AND METHODS Eleven patients (6 men and 5 women, mean age 52.7 ± 8.3 years) requiring extraction of one hopeless tooth for severe periodontitis in the maxillary anterior area were consecutively treated with a ridge augmentation procedure. All experimental sockets showed advanced buccal bone plate deficiency and were grafted with deproteinized bovine bone mineral with 10% collagen covered with a collagen membrane. Sockets healed by secondary intention. Three-dimensional volumetric alveolar bone changes were calculated by superimposing cone beam computed tomography scans obtained before and 12 months after the augmentation procedure. RESULTS After 12 months, the alveolar mineralized tissue filled 91.20% ± 7.96% of the maximum volume for regeneration. The augmentation procedure appeared not only to compensate for bone remodeling in most alveolar regions but also to repair a significant portion of the buccal wall. The most significant ridge width changes occurred 1 mm apical to the bone crest (2.33 ± 1.46 mm, P < .001). CONCLUSION Within present limitations, this radiographic measuring methodology can be a useful tool to evaluate changes in socket volume. A ridge preservation technique performed with collagenated bovine bone and a collagen membrane was able to improve ridge shape and dimensions in compromised alveolar sockets.

The present case series aimed to explore the potential clinical benefits of the application of dental pulp stem cells (DPSCs) in the regenerative treatment of deep intrabony defects. A total of 11 isolated intrabony defects in 11 chronic periodontitis patients were accessed with a minimally invasive flap and filled with DPSCs loaded on a collagen sponge. A tooth requiring extraction for impaction or malpositioning was used as an autologous source for DPSCs. An average clinical attachment level gain of 4.7 ± 1.5 mm associated with a residual mean probing depth (PD) of 3.2 ± 0.9 mm and remarkable stability of the gingival margin was observed at 1 year. Complete pocket closure (PD < 3 mm) was achieved in 63.6% of the experimental sites. Clinical outcomes were supported by the radiographic analysis showing a bone fill of 3.6 ± 1.9 mm.

AIM This systematic review aimed to answer the following focused questions: (a) "In patients with periodontitis, how effective are access flaps (AFs) as compared to subgingival debridement in attaining probing depth (PD) reduction?" and (b) "In patients with periodontitis, does the type of AF impact PD reduction?". MATERIAL AND METHODS Randomized clinical trials were searched in three databases. Besides PD, information concerning clinical attachment level (CAL) and other relevant outcomes was also collected. Meta-analyses were performed whenever possible and results were categorized based on the initial PD. RESULTS Thirty-six publications were included. AFs resulted in a significantly greater PD reduction in deep pockets (>6 mm or ≥6 mm), as compared to subgingival debridement, in short- (n = 4; weighted mean difference [WMD] = 0.67 mm; 95% confidence interval [CI] 0.37,0.97; p