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Aim: To assess the prevalence of severe periodontitis based on the population‐based CONSTANCES cohort using a validated self‐reported questionnaire. Materials and Methods: Individuals were selected from the adult population in France using a random sampling scheme. Analyses were restricted to those invited in 2013–2014 who completed the periodontal health questionnaire at the 2017 follow‐up. The risk of severe periodontitis was assessed using the periodontal screening score (PESS) and weighting coefficients were applied to provide representative results in the general French population. Results: The study included 19,859 participants (9204 men, mean age: 52.8 ± 12.6 years). Based on a PESS ≥ 5, 7106 participants were at risk of severe periodontitis, corresponding to a weighted prevalence of 31.6% (95% confidence interval: 30.6%–32.7%). This prevalence was higher among participants aged 55 and over, those with lower socio‐economic status as well as current smokers, e‐cigarette users and heavy drinkers. Among individuals at risk of severe periodontitis, only 18.8% (17.3%–20.4%) thought they had gum disease, although 50.5% (48.6%–52.5%) reported that their last dental visit was less than 6 months. Conclusions: The present survey indicates that (1) self‐reported severe periodontitis is highly prevalent with marked disparities between groups in the general French adult population, and (2) periodontitis could frequently be under‐diagnosed given the low awareness. [ABSTRACT FROM AUTHOR]

Objective To analyze the factors related to implant marginal bone resorption after implant restoration in elderly patients with severe periodontitis. Methods One hundred and ninety-five elderly patients with severe periodontitis who underwent implant restoration in Hospital of Stomatology of Jilin University from January 2017 to June 2021 were selected， and the implant marginal bone resorption was recorded after 12 months of follow-up. Patients with alveolar ridge resorption height >0.5 mm were included in the resorption group， and the rest were included in the non-resorption group. The general data of the non-resorption group and the resorption group were compared. The influencing factors of implant marginal bone resorption were analyzed by Logistic regression model. Results After 12 months of follow-up， 40.80% of the patients had implant marginal bone resorption. Logistic regression analysis showed that smoking （OR=3.080， 95% CI 1.494-6.349）， diabetes （OR=2.542， 95% CI 1.355-4.769）， missing teeth in the upper jaw （OR=3.951， 95% CI 1.800-8.671）， the angle between the long axis of the implant and the long axis of the crown （OR=2.000， 95% CI 1.066-3.752）， and poor peri-implant hygiene （OR=2.573， 95% CI 1.435-4.614） were risk factors for adverse marginal bone resorption around implants. In contrast， the thickness of the bone quality at the implantation site （OR=0.214， 95% CI 0.086-0.533） was a protective factor， with all P < 0.05. Conclusion Smoking， diabetes， missing teeth in the upper jaw， the angle between the long axis of the implant and the crown， poor peri-implant hygiene， and the bone quality at the implantation site affected the marginal bone resorption around implants in elderly patients.

Background/purpose: History of periodontitis is a well-documented risk indicator of peri-implantitis. However, the influence of severity of periodontitis is still unclear, especially for severe periodontitis. This study was aimed to investigate the prevalence of peri-implant disease and analyze the risk indicators in patients with treated severe periodontitis. Materials and methods: A total of 182 implants from 88 patients (44 males and 44 females) with severe periodontitis with a mean fellow-up period of 76.5 months were enrolled in this study. Patient and implant information, and periodontal and peri-implant conditions were collected to evaluate the prevalence of peri-implant disease and risk indicators. Results: The prevalence of peri-implantitis was 9.1% and 6.6% at the patient-level and implant-level. The prevalence of peri-implant mucositis was 76.1% and 51.1% at the patient-level and implant-level. Risk indicators of peri-implantitis included older age (OR: 1.132), poor proximal cleaning habits (OR: 14.218), implants in anterior area (OR: 10.36), poor periodontal disease control (OR: 12.76), high peri-implant plaque index (OR: 4.27), and keratinized tissue width (KTW)＜2 mm (OR: 19.203). Conclusion: Implants in patients with severe periodontitis after periodontal treatment and maintenance show a low prevalence (9.1%) of peri-implantitis and a relatively high prevalence (76.2%) of peri-implant mucositis. Patient age, peri-implant proximal cleaning habits, implant position, periodontal disease control, peri-implant plaque index, and KTW are associated with prevalence of peri-implantitis.

Objective: To explore the therapeutic effect of concentrated autologous growth factor combined with periodontal tissue regeneration on patients with severe periodontitis, as well as the effects of gingival thickness and immune factor levels. Methods: A prospective study was conducted on 58 patients with severe periodontitis admitted to our hospital from June 2019 to June 2020. They were divided into a matched group and an observation group using a random number table method, with 29 patients in each group. The matched group received periodontal tissue regeneration surgery; The observation group received periodontal tissue regeneration surgery combined with concentrated autologous growth factor treatment. Prior to treatment and 9 months Post-treatment, follow-up visits were conducted to compare the clinical efficacy of the two groups of patients, including gingival thickness, visual analog scale (VAS) scores, and the expression levels of interleukin-17(IL-17), interleukin-23(IL-23), and interleukin-17(IL-23) in gingival crevicular fluid and serum before and Post-treatment. Results: The total effective rate of 93.10% in the observation group was higher than 72.41% in the matched group (P<0.05); Pretherapy, there was no difference in gingival thickness and VAS score between the two groups of patients (P>0.05). Post-treatment, the gingival thickness of the two groups of patients increased, and the observation group was higher than the matched group, while the VAS score decreased. The observation group was lower than the matched group (P<0.05); Pretherapy, there was no difference in the comparison of gingival crevicular fluid IL-17, IL-23, and IL-10 between the two groups (P>0.05). Post-treatment, the expression of gingival crevicular fluid factor was different between the two groups of patients, and the observation group was different compared with the matched group (P<0.05); Pretherapy, there was no difference in serum IL-17, IL-23, and IL-10 comparison (P>0.05). Post-treatment, the serum factor expression between the two groups was different, and the observation group was different compared with the matched group (P<0.05). Conclusion: The combination of concentrated autologous growth factor and periodontal tissue regeneration has a significant therapeutic effect on severe periodontitis. It can increase the thickness of the patient's gingiva, reduce pain, improve the levels of immune factors in gingival crevicular fluid and serum, and reduce inflammatory reactions. It is worthy of clinical application and promotion. [ABSTRACT FROM AUTHOR]

Objective To analyze the factors related to implant marginal bone resorption after implant restoration in elderly patients with severe periodontitis. Methods One hundred and ninety-five elderly patients with severe periodontitis who underwent implant restoration in Hospital of Stomatology of Jilin University from January 2017 to June 2021 were selected, and the implant marginal bone resorption was recorded after 12 months of follow-up. Patients with alveolar ridge resorption height >0.5 mm were included in the resorption group, and the rest were included in the non-resorption group. The general data of the non-resorption group and the resorption group were compared. The influencing factors of implant marginal bone resorption were analyzed by Logistic regression model. Results After 12 months of follow-up, 40.80% of the patients had implant marginal bone resorption. Logistic regression analysis showed that smoking (OR=3.080, 95% CI 1.494-6.349), diabetes (OR=2.542, 95% CI 1.355-4.769), missing teeth in the upper jaw (OR=3.951, 95% CI 1.800-8.671), the angle between the long axis of the implant and the long axis of the crown (OR=2.000, 95% CI 1.066-3.752), and poor peri-implant hygiene (OR=2.573, 95% CI 1.435-4.614) were risk factors for adverse marginal bone resorption around implants. In contrast, the thickness of the bone quality at the implantation site (OR=0.214, 95% CI 0.086-0.533) was a protective factor, with all P < 0.05. Conclusion Smoking, diabetes, missing teeth in the upper jaw, the angle between the long axis of the implant and the crown, poor peri-implant hygiene, and the bone quality at the implantation site affected the marginal bone resorption around implants in elderly patients. [ABSTRACT FROM AUTHOR]

History of periodontitis is a well-documented risk indicator of peri-implantitis. However, the influence of severity of periodontitis is still unclear, especially for severe periodontitis. This study was aimed to investigate the prevalence of peri-implant disease and analyze the risk indicators in patients with treated severe periodontitis. A total of 182 implants from 88 patients (44 males and 44 females) with severe periodontitis with a mean fellow-up period of 76.5 months were enrolled in this study. Patient and implant information, and periodontal and peri-implant conditions were collected to evaluate the prevalence of peri-implant disease and risk indicators. The prevalence of peri-implantitis was 9.1% and 6.6% at the patient-level and implant-level. The prevalence of peri-implant mucositis was 76.1% and 51.1% at the patient-level and implant-level. Risk indicators of peri-implantitis included older age (OR: 1.132), poor proximal cleaning habits (OR: 14.218), implants in anterior area (OR: 10.36), poor periodontal disease control (OR: 12.76), high peri-implant plaque index (OR: 4.27), and keratinized tissue width (KTW)＜2 mm (OR: 19.203). Implants in patients with severe periodontitis after periodontal treatment and maintenance show a low prevalence (9.1%) of peri-implantitis and a relatively high prevalence (76.2%) of peri-implant mucositis. Patient age, peri-implant proximal cleaning habits, implant position, periodontal disease control, peri-implant plaque index, and KTW are associated with prevalence of peri-implantitis. [ABSTRACT FROM AUTHOR]

Background Periodontitis and atherosclerosis are both chronic inflammatory diseases with a high prevalence. Increasing evidence supports the independent association between severe periodontitis and atherosclerotic cardiovascular disease, in which oral microorganisms may play an important role. We aimed to evaluate the characteristic changes of salivary microbiome and metabolome in patients with carotid atherosclerosis (CAS) and periodontitis. Methods and Results The subjects were obtained from a cross‐sectional study that included 1933 participants aged 40 years or older from rural northeast China. The study enrolled 48 subjects with CAS and 48 controls without CAS matched by sex, age, body mass index, and prevalence of hypertension, diabetes, and dyslipidemia. We performed full‐length 16S rDNA gene sequencing and untargeted metabolomics of saliva samples from 96 subjects. We found that CAS was closely associated with an increased abundance of Streptococcus, Lactobacillus, and Cutibacterium. Furthermore, patients with CAS had higher prevalence of severe periodontitis than the control group. Notably, periodontal pathogens such as Tannerella and Anaeroglobus were not only associated with periodontitis but also enriched in patients with CAS, whereas periodontal health‐associated Neisseria was more abundant in those without CAS. We also identified 2 lipid metabolism pathways, including glycerophospholipid and sphingolipid metabolism, as associated with CAS. The levels of trimethylamine N‐oxide and inflammatory mediator leukotriene D4 were significantly higher in patients with CAS, whereas the levels of carnosine were significantly lower, than those in controls. Additionally, serum levels of inflammatory marker high‐sensitivity C‐reactive protein were significantly increased in CAS and positively correlated with the abundance of Anaeroglobus and leukotriene D4 in saliva. Conclusions Our study suggests that characteristic changes in salivary microbiota and metabolites are closely related to CAS, and periodontitis and associated microorganisms may be involved in the initiation and progression of CAS.

Objective: This study aimed to compare hard‐ and soft‐tissue changes after ridge preservation in periodontally compromised molar sockets with and without primary wound closure. Materials and Methods: Forty molars with severe periodontitis requiring extraction were included and allocated to two treatment modalities. After tooth extraction, the sockets were filled with deproteinized bovine bone mineral and covered with a bioabsorbable porcine collagen membrane. Primary wound closure was achieved in the control group, whereas the test group underwent minimally invasive open healing. The dimensions of the bone and soft tissue were recorded at baseline and 6 months. Results: Over 6 months, the control and test groups had similar mean ridge heights at the center of sockets of 8.59 ± 2.47 mm and 8.47 ± 2.51 mm, respectively. The total volume of the control group increased from 1070.17 to 1713.52 mm3 for a mean gain of 643.35 mm3, whereas that of the test group increased from 992.51 to 1514.05 mm3 for a mean gain of 521.54 mm3. Compared with the test group, the control group showed a statistically significant decrease in keratinized tissue width of 1.08 ± 1.63 mm. Conclusions: Bone dimensional changes following ridge preservation with and without primary wound closure were comparable. ARP without primary wound closure preserves more keratinized tissue than that with (Chinese Clinical Trial Registry: ChiCTR‐ONN‐16009433). [ABSTRACT FROM AUTHOR]

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Pathological migration is one of the chief complaints of patients-seeking dental treatment. It results in difficulty in mastication, speech, poor esthetic appearance, and decreased self-confidence. The prevalence ranges from 21.73% to 55.8% in patients having moderate-to-severe periodontitis. In this presentation, a 38-year-old adult male, systemically healthy, nonsmoking presented with the complaint of mobility and forward displacement of maxillary anterior tooth causing poor esthetic appearance and low self-esteem. He was treated with the interdisciplinary approach of periodontal and orthodontic intervention. Two-year posttreatment follow-up shows significant improvement in esthetics, periodontal status, and boosted the self-confidence of the patient and improved the oral health-related quality of life. This case emphasizes the importance of regenerative therapy and orthodontic movement for the treatment of periodontally compromised pathologically migrated tooth in adult patient. [ABSTRACT FROM AUTHOR]

Pathological migration is one of the chief complaints of patients-seeking dental treatment. It results in difficulty in mastication, speech, poor esthetic appearance, and decreased self-confidence. The prevalence ranges from 21.73% to 55.8% in patients having moderate-to-severe periodontitis. In this presentation, a 38-year-old adult male, systemically healthy, nonsmoking presented with the complaint of mobility and forward displacement of maxillary anterior tooth causing poor esthetic appearance and low self-esteem. He was treated with the interdisciplinary approach of periodontal and orthodontic intervention. Two-year posttreatment follow-up shows significant improvement in esthetics, periodontal status, and boosted the self-confidence of the patient and improved the oral health-related quality of life. This case emphasizes the importance of regenerative therapy and orthodontic movement for the treatment of periodontally compromised pathologically migrated tooth in adult patient.

Abstract Background Orthodontic treatment involves movement of teeth by compression and resorption of the alveolar bone using orthodontic forces. These movements are closely linked to the interactions between the teeth and the periodontal tissues that support them. Owing to an increase in adults seeking orthodontic treatment, orthodontists increasingly encounter patients with periodontal diseases, in whom orthodontic treatment is contraindicated. In rare cases, periodontitis may develop after treatment initiation. However, no approach for treating periodontitis after the initiation of orthodontic treatment has been established. Here, we present an approach for managing localized severe periodontitis manifesting after initiating orthodontic treatment. Case presentation A 32-year-old Japanese woman was referred to the Department of Dentistry and Oral Surgery by an orthodontist who observed symptoms of acute periodontitis in the maxillary molars that required periodontal examination and treatment. A detailed periodontal examination, including oral bacteriological examination, revealed localized severe periodontitis (stage III, grade B) in the maxillary left first and second molars and in the mandibular right second molar. After consultation with the orthodontist, the orthodontic treatment was suspended based on the results of the bacteriological examination to allow for periodontal treatment. Full-mouth disinfection was performed with adjunctive oral sitafloxacin. Periodontal and bacteriological examinations after treatment revealed regression of the localized periodontitis with bone regeneration. Thereafter, orthodontic treatment was resumed, and good progress was achieved. Conclusions Orthodontists should recognize the risk of acute severe periodontitis in young adults. Asymptomatic patients with localized severe periodontitis may clear a screening test before orthodontic treatment but develop acute symptoms with bone resorption during orthodontic treatment. Therefore, patients requiring orthodontic treatment should be examined by their family dentist or a periodontist to rule out periodontal issues that may impede orthodontic treatment. The patients should also be informed of age-related risks. Further, periodontists, family dentists, and orthodontists who treat adults should be informed about periodontitis and the need for interdisciplinary collaboration. In patients who develop periodontitis after orthodontic treatment initiation, temporary interruption of orthodontic treatment and aggressive periodontal intervention may facilitate recovery.

Abstract Background Changes in alveolar bone dimension after tooth extraction may affect placement of the subsequent implant, resulting in ridge deficiency that can adversely impact long-term implant stability or aesthetics. Alveolar ridge preservation (ARP) was effective in reducing the amount of ridge resorption following tooth extraction. There is sparse evidence regarding the benefit of ARP at periodontally compromised molar extraction sockets. This study will be a randomized trial to assess the soft tissue contour, radiographical, and histological changes of ARP at molar extraction sites in order to compare severe periodontitis cases with natural healing results and determine the most beneficial and least traumatic clinical treatment for such patients. Methods This research is designed as a two-group parallel randomized controlled trial. The total number of tooth extraction sites will be 70 after calculation with power analysis. Teeth will be randomly assigned to two groups with the test group conducting ridge preservation and the control group healing naturally. Periodontal examination, cone beam-computed tomography (CBCT) data, and stereolithographic (STL) files obtained by intraoral scanning will be collected through the follow-up period, and bone biopsy samples would be obtained during implant surgery. The primary outcomes are the vertical and horizontal change of alveolar ridge measured on CBCT images, soft tissue contour changes evaluated by superimposing the digital impressions, alterations of mucosa thickness (as measured by superimposing the CBCT data and STL files), histological features of implant sites and periodontal parameter changes. The secondary outcomes are patient-reported post-operative reaction and conditions of simultaneous bone graft or sinus lifting procedures during implantation. Discussion This study will provide information about hard and soft tissue dimension changes and histomorphology evaluation following ARP and natural healing in periodontally compromised molar sites, which may contribute to complement the missing information of ARP at periodontally compromised molar extraction sockets. Trial registration Chinese Clinical Trial Register (ChiCTR) ChiCTR2200056335. Registered on February 4, 2022, Version 1.0.

Objective: To explore the impacts of severe periodontitis on intestinal flora and expression of neuroinflammatory factors in rats with Alzheimer's disease (AD) model. Methods: SD rats were randomly grouped into blank control group (NC group), periodontitis group (P group), AD group and P+AD group, with 10 rats in each group. The NC group did not do any treatment. The rats in P group and AD group were respectively constructed with severe periodontitis model and AD model, while the rats in P+AD group were also constructed with severe periodontitis model and AD model. After 8 weeks, Morris water maze experiment was used to observe the spatial learning and memory ability of rats. The level of serum inflammatory factors including interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) were determined by enzyme-linked immunosorbent assay (ELISA) method. Hematoxylin-eosin (HE) staining was used to detect the pathological changes of hippocampus. Short chain fatty acids (SCFAs) and 16S rRNA gene were sequenced in feces. Results: The neurons in the NC group and P group were arranged neatly and compactly, without obvious cell vacuoles and necrosis. Neuronal degeneration and necrosis were observed in the hippocampus in the AD group and P+AD group, and the pyramidal cells in the hippocampus were arranged loosely and vacuolized. Compared with NC group, the escape latency, the levels of IL-1β, TNF-α, the relative abundances of Bacteroidetes, Proteobacteria, Streptococcus, Prevotella, Escherichia-Shigella in the AD group in- creased obviously (P<0.05), Stagnation time, times of platform crossing, the level of IL-10, the content of acetate, propionate, butyrate, the Shannon, Simpson, Chaol indexes, relative abundances of Firmicutes and Lactobacillus decreased obviously (P<0.05), there was no significant difference in the above indexes between NC group and P group (P>0.05). Compared with AD group and P group, the escape latency, the levels of IL-1β, TNF-α, the relative abundances of Bacteroidetes, Proteobacteria, Streptococcus, Prevotella, Escherichia-Shigella in the P+AD group increased obviously (P<0.05), Stagnation time, times of platform crossing, the level of IL-β the content of acetate, propionate, butyrate, the Shannon, Simpson, Chaol indexes, relative abundances of Firmicutes and Lactobacillus decreased obviously(P<0.05). Conclusions: Severe periodontitis can promote the disorder of intestinal flora and the expression of neuroinflammatory factors in rats with AD. [ABSTRACT FROM AUTHOR]

Background: Kidney transplant recipients (KTRs) represent a vulnerable group of patients who develop a number of comorbidities. Severe periodontitis (SP) is associated with the most common chronic systemic diseases including kidney diseases. The objective of this study was to explore the risk factors for SP in KTRs. Methods: In this study, KTRs were divided into those with or without periodontitis and in relation to the severity of periodontitis. A comprehensive medical and periodontal examination was performed and evaluated. Multivariate logistic regression was performed to examine possible risk factors for SP among KTRs. Results: A total of 100 KTRs were included in the analysis, of which 87% had periodontitis. Significant predictors of periodontitis were older age (OR = 1.07, 95% CI [1.01, 1.13], p = 0.016) and lower skeletal muscle mass (OR = 0.88, 95% CI [0.78, 0.99], p = 0.035). When examining periodontitis severity, predictors of SP (n = 21, 24%) were increased levels of uric acid (OR = 1.01, 95% CI [1.00, 1.02], p = 0.022) and dental plaque (OR = 1.04, 95% CI [1.01, 1.07], p = 0.013). In the subset analysis that included only KTRs with measured advanced glycation end products (AGE) (n = 47), 34% (n = 16) had SP. The predictors of SP were AGE (OR = 3.89, 95% CI [1.28, 11.82], p = 0.017) and dental plaque (OR = 1.07, 95% CI [1.01, 1.13], p = 0.028). Conclusions: KTRs with SP had significantly higher uric acid levels and AGE, which may contribute to the systemic health status of this patient population. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Periodontitis is a chronic inflammatory disease, in which destruction of the periodontium occurs. Not well-treated periodontitis causes teeth loss and problems regarding speech and appearance. OBJECTIVES: To evaluate the effectiveness of tooth particles as a graft material in the regeneration of periodontal vertical alveolar defects clinically and regeneration of bone defect experimentally. MATERIAL AND METHODS: A total of 21 patients with stage III severe periodontitis, aged 25 to 45 years, having periodontal vertical defects were selected for the study. They were randomly divided into 3 groups, in which splitmouth study design was used. In group 1, right side was treated by open flap debridement (OFD) alone, and left side with autogenous tooth graft particles. In group 2, control side treated by OFD, and left side using beta-tricalcium phosphate (ß-TCP) graft material. In group 3, left side was treated using autogenous tooth graft, and right side using ß-TCP graft. For the experimental part, a total of 21 rats had an intended surgical bony defect at diastema area, and were randomly divided into 3 groups. In group 1, defects were created without addition of any graft material. In group 2, defects were filled with ß-TCP graft material. In group 3, autogenous tooth particles were used. Clinical data, including plaque index (PI), gingival index (GI), periodontal probing depth (PPD), clinical attachment level (CAL), and radiographic parameters were recorded at baseline and 3 and 6 months post-surgically. For the experimental part, animals were sacrificed one month later. Tissue specimens were prepared for histological analysis. RESULTS: After 3 and 6 months post-treatment, there was an improvement in PI and GI in all the groups. Also PPD, CAL gain, and radiographic bone formation were significant for autogenous tooth-grafted sites and ß-TCP-grafted sites, with a significant improvement in PPD and CAL for tooth-grafted sites compared with ß-TCP-grafted sites. Histologically, the amount of new bone formation was higher in group 3 compared with group 1 and 2. CONCLUSIONS: It can be concluded that autogenous tooth particles can be considered as an effective and suitable bone graft material used in the treatment of intra-bony defects in patients with chronic severe periodontitis. [ABSTRACT FROM AUTHOR]

Background: Autogenous tooth bone graft material (AutoBT) has been advocated as a bone substitute when conducting alveolar ridge preservation. This study is aimed at using a radiomics approach in order to evaluate and testify whether AutoBT can stimulate bone growth during socket preservation in severe periodontal cases. Materials and Methods: For this study, 25 cases with severe periodontal diseases were selected. The patients' AutoBTs were inserted into the extraction sockets and covered with Bio-Gide® collagen membranes. 3D CBCT scans and 2D X-rays were taken of the patients before surgery and after 6 months post-surgery. For the retrospective radiomics analysis, the maxillary and mandibular images were compared in different groups. Maxillary bone height was analyzed at the buccal, middle, and palatal crest sites, while the mandibular bone height was compared at the buccal, center, and lingual crest sites. Results: In the maxilla, the alveolar height was increased by −2.15 ± 2.90 mm at the buccal crest; −2.45 ± 2.36 mm at the center of the socket, and −1.62 ± 3.19 mm at the palatal crest, while the height of the buccal crest was increased by 0.19 ± 3.52 mm, and the height at the center of the socket was increased by −0.70 ± 2.71 mm in the mandible. The three-dimensional radiomics analysis demonstrated significant bone growth in the local alveolar height and high density. Conclusion: Based on clinical radiomics analysis, AutoBT could be used as an alternative bone material in socket preservation after tooth extraction in patients with severe periodontitis. [ABSTRACT FROM AUTHOR]

Background: Severe periodontitis is one of the most prevalent diseases and a global public health problem due to its high incidence and prevalence. However, there are few studies on the burden of periodontitis in different regions of the world. Methods: We extracted data on the incidence, prevalence, and disability‐adjusted life years (DALYs) from the Global Burden of Disease study as severe periodontitis burden measures. We also explored the global burden of severe periodontitis according to 21 world regions and Socio‐Demographic Index (SDI) quintiles. The joinpoint model was used to analyze temporal trends of major regions from 1990 to 2019, and the age‐period‐cohort model was used to estimate age, period, and cohort trends in severe periodontitis. Results: Globally, the age‐standardized incidence rate (ASIR), age‐standardized prevalence rate (ASPR), and disability‐adjusted life years (DALYs) rate increased from 1990 to 2019 (percentage change: 5.77%, 7.78%, and 8.01%, respectively), with average annual percent changes of 0.2%, 0.3%, and 0.3%, respectively. The region with the highest DALY rate was western sub‐Saharan Africa with a value of 142.5 (95% uncertainty interval: 56.3, 303.7) per 100,000 in 2019. For the ASIR, ASPR, and DALY, the age effect of severe periodontitis showed an increase followed by a decrease, the period effect showed an upward trend, the cohort effect showed an overall decreasing trend, and the cohort relative risk for incidence for some SDI quintiles showed a slight increase in recent years. Conclusions: Oral health varies significantly across regions, and it is essential to address inequalities in oral health between countries. Effective measures to prevent severe periodontitis risk factors should also be taken in regions with low SDI. [ABSTRACT FROM AUTHOR]

Background: Orthodontic treatment involves movement of teeth by compression and resorption of the alveolar bone using orthodontic forces. These movements are closely linked to the interactions between the teeth and the periodontal tissues that support them. Owing to an increase in adults seeking orthodontic treatment, orthodontists increasingly encounter patients with periodontal diseases, in whom orthodontic treatment is contraindicated. In rare cases, periodontitis may develop after treatment initiation. However, no approach for treating periodontitis after the initiation of orthodontic treatment has been established. Here, we present an approach for managing localized severe periodontitis manifesting after initiating orthodontic treatment. Case presentation: A 32-year-old Japanese woman was referred to the Department of Dentistry and Oral Surgery by an orthodontist who observed symptoms of acute periodontitis in the maxillary molars that required periodontal examination and treatment. A detailed periodontal examination, including oral bacteriological examination, revealed localized severe periodontitis (stage III, grade B) in the maxillary left first and second molars and in the mandibular right second molar. After consultation with the orthodontist, the orthodontic treatment was suspended based on the results of the bacteriological examination to allow for periodontal treatment. Full-mouth disinfection was performed with adjunctive oral sitafloxacin. Periodontal and bacteriological examinations after treatment revealed regression of the localized periodontitis with bone regeneration. Thereafter, orthodontic treatment was resumed, and good progress was achieved. Conclusions: Orthodontists should recognize the risk of acute severe periodontitis in young adults. Asymptomatic patients with localized severe periodontitis may clear a screening test before orthodontic treatment but develop acute symptoms with bone resorption during orthodontic treatment. Therefore, patients requiring orthodontic treatment should be examined by their family dentist or a periodontist to rule out periodontal issues that may impede orthodontic treatment. The patients should also be informed of age-related risks. Further, periodontists, family dentists, and orthodontists who treat adults should be informed about periodontitis and the need for interdisciplinary collaboration. In patients who develop periodontitis after orthodontic treatment initiation, temporary interruption of orthodontic treatment and aggressive periodontal intervention may facilitate recovery. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this literature review and case report was to point out the relationship between Cowden Syndrome (CS) and severe periodontitis. CS is a rare autosomal dominant disorder characterised by skin and oral hamartomas, and is associated with an increased risk of cancer development.Case Report: The case of a 43-year old male patient affected by Cowden syndrome and presenting severe periodontitis was reported.Results: It can be suggested that the specific gingival morphology of the patient with CS might be a risk factor for the development of periodontal disease, as described in the present case report.Conclusion: Early diagnosis is crucial in patients affected by CS. The dentist may be the first to notice any atypical changes in the oral cavity and refer the patient for further examinations. Moreover, the mucosal and skin changes have a tendency to appear prior to the malignancies associated with the syndrome. This highlights the responsibility of the dentist in the early diagnosis of this progressive pathological syndrome. [ABSTRACT FROM AUTHOR]

Background: Changes in alveolar bone dimension after tooth extraction may affect placement of the subsequent implant, resulting in ridge deficiency that can adversely impact long-term implant stability or aesthetics. Alveolar ridge preservation (ARP) was effective in reducing the amount of ridge resorption following tooth extraction. There is sparse evidence regarding the benefit of ARP at periodontally compromised molar extraction sockets. This study will be a randomized trial to assess the soft tissue contour, radiographical, and histological changes of ARP at molar extraction sites in order to compare severe periodontitis cases with natural healing results and determine the most beneficial and least traumatic clinical treatment for such patients. Methods: This research is designed as a two-group parallel randomized controlled trial. The total number of tooth extraction sites will be 70 after calculation with power analysis. Teeth will be randomly assigned to two groups with the test group conducting ridge preservation and the control group healing naturally. Periodontal examination, cone beam-computed tomography (CBCT) data, and stereolithographic (STL) files obtained by intraoral scanning will be collected through the follow-up period, and bone biopsy samples would be obtained during implant surgery. The primary outcomes are the vertical and horizontal change of alveolar ridge measured on CBCT images, soft tissue contour changes evaluated by superimposing the digital impressions, alterations of mucosa thickness (as measured by superimposing the CBCT data and STL files), histological features of implant sites and periodontal parameter changes. The secondary outcomes are patient-reported post-operative reaction and conditions of simultaneous bone graft or sinus lifting procedures during implantation. Discussion: This study will provide information about hard and soft tissue dimension changes and histomorphology evaluation following ARP and natural healing in periodontally compromised molar sites, which may contribute to complement the missing information of ARP at periodontally compromised molar extraction sockets. Trial registration: Chinese Clinical Trial Register (ChiCTR) ChiCTR2200056335. Registered on February 4, 2022, Version 1.0. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to elucidate a putative association between severe periodontitis and the incidence of recurrent cardiovascular events in patients with cardiovascular disease (CVD) within 10 years after their initial hospitalisation., Methods: A cohort of 1002 stationary patients with angiographically proven CVD was included. They were examined regarding prevalence of severe periodontitis (≥ 30% of the teeth with proximal attachment loss of ≥ 5 mm), probing depth, clinical attachment loss, bleeding on probing, number of missing teeth and oral care habits. Recurrent events were summarised as combined end point (myocardial infarction, stroke/transitory ischemic attack, cardiovascular death and death caused by stroke). Survival analyses were carried out after a 10-year follow-up period. Hazard ratios (HRs) were adjusted for known cardiac risk factors using Cox regression., Results: The follow-up was completed by 792 patients. The overall incidence of the combined end point was 42.8%. Severe periodontitis was associated with recurrent cardiovascular events (adjusted hazard ratio [HR] = 1.26, 95% confidence interval [CI] 1.0-1.58 and Standard error [SE] 0.11), whereas both, tooth brushing more than once a day (adjusted HR = 0.74, 95% CI 0.57-0.97, SE 0.13) and performing interdental hygiene (adjusted HR = 0.71, 95% CI 0.52-0.99, SE 0.16) decreased this risk., Conclusions: Severe periodontitis is a putative risk factor for recurrent cardiovascular events., Trial Registration: ClinicalTrials.gov identifier: NCT01045070., (© 2024 The Author(s). Journal of Periodontal Research published by John Wiley & Sons Ltd.)

Objectives: To demonstrate the potential application of mixed reality (MR) holographic imaging technology in subgingival scaling and root planing (SRP) for patient with advanced periodontitis., Methods: This case series comprised the analysis of 1566 sites from 261 teeth of 10 patients with advanced periodontitis. Digital CBCT scans and intraoral scans of the patients were digitally acquired preoperatively and aligned to create a three-dimensional periodontal visualization model. Through rendering, interactive holographic images were displayed using MR. The surgeon first used MR images to communicate with the patients, and then facilitated SRP under their guidance. Probing pocket depth (PPD), clinical attachment loss (CAL), Plaque index (PI), and bleeding on probing (BOP) parameters were recorded at baseline and at 8-week postoperatively. Patient-reported outcome indicator questionnaires on self-efficacy were also collected., Results: PPD, CAL, PI, and BOP significantly decreased at 8-week following MR hologram-assisted SRP (p<0.001). For sites with PPD≥4 mm, PPD and CAL declined by 2.33±1.23 mm and 0.69±1.07 mm, respectively. PI significantly decreased from 1.94±0.61 to 0.82±0.58 (p < 0.001) and BOP sites decreased significantly from 84.11% to 40.25%. After receiving MR holograms for condition communication, most patients had a better perception of the effectiveness of SRP treatment and the benefits it brings. 80% of the subjects expressed their willingness to undergo MR-assisted periodontal treatment in the future., Conclusion: These results provide preliminary support for MR hologram-assisted digital SRP. With this technology, images of the gingiva and alveolar bone can be displayed in real time, accurately and three-dimensionally. This improves SRP effectiveness, diminishes complications, and enhances patients' confidence in the treatment., Clinical Significance: MR holographic imaging-based digital SRP is a clinically feasible and promising adjunctive periodontal treatment option. It may contribute to improved non-surgical treatment efficacy in patients with severe periodontitis., Competing Interests: Declaration of competing interest The authors declare there is no conflict of interests., (Copyright © 2024. Published by Elsevier Ltd.)

Abstract Background Aplastic anemia is an intractable disease characterized by pancytopenia, susceptibility to infection, and difficulty in achieving hemostasis. In patients with severe periodontal disease and aplastic anemia, spontaneous bleeding from the gingival tissue due to thrombocytopenia and during brushing is common, which may further exacerbate dental issues. Comprehensive periodontal treatment for patients with aplastic anemia is highly challenging and requires collaboration with a hematologist. Here, we discuss the case of a patient with aplastic anemia and severe periodontitis who was successfully treated in collaboration with our hematology department. Case presentation A 36-year-old Japanese woman with chief complaints of spontaneous gingival bleeding, pain, and increasing tooth mobility consulted our department. She had developed pancytopenia at age 11 years and was later diagnosed with aplastic anemia, making her susceptible to infection due to leukopenia. The results of the initial periodontal examination led to a diagnosis of severe generalized periodontitis (generalized stage IV grade C periodontitis) caused by leukopenia and poor oral hygiene. We adopted a comprehensive treatment plan, including invasive dental procedures. The patient exhibited no postoperative bleeding due to aplastic anemia-induced thrombocytopenia and experienced a good outcome. Conclusions Both physicians and dentists should be aware that immunocompromised patients with aplastic anemia are at risk of developing severe periodontitis with severe alveolar bone resorption if the condition is combined with poor oral hygiene. Even in the presence of aplastic anemia, patients with severe periodontitis can undergo comprehensive dental treatment, including dental extraction and periodontal surgery, if bleeding and susceptibility to infection are controlled. This requires the cooperation of the patient and hematologists and can ultimately contribute to improving the patient’s quality of life.

OBJECTIVE: To probe into the efficacy of photodynamic therapy combined with minocycline hydrochloride in the treatment of severe periodontitis and its effects on miIR193a and MCP-1 levels. METHODS: Totally 98 patients with severe periodontitis admitted into Kailuan General Hospital from Jun. 2019 to Jun. 2021 were selected and divided into observation group and control group via random number table, with 49 cases in each group. The control group was treated with minocycline hydrochloride, and the observation group was given photodynamic therapy combined with minocycline hydrochloride. After 4 weeks of treatment, the efficacy and incidences of adverse drug reactions, the periodontal index [plaque index (PLI), probing depth (PD), gingival index (GI) and bleeding of probing (BOP)], masticatory function ( masticatory efficiency, bite force), gingival crevicular fluid inflammation factors [ matrix metalloproteinase-7 (MMP-7), monocyte chemoattractant protein-1 (MCP-1), soluble intercellular adhesion molecule-1 (sICAM-1)], micro RNA-193a (miR-193a), bone resorption markers [osteocalcin (BGP ), osteoprotegerin (OPG), type I collagen cross-linked amino terminal peptide (NTX)], oral health impact scale 14 (OHIP-14) score were compared between two groups. RESULTS: The total effective rate of observation group was 95. 92% (47/49), which was higher than that of the control group (81. 63%, 40/49), with statistically significant difference (P <0. 05). After treatment, the GI, PLI, BOP and PD levels of both groups were decreased, and those of the observation group were lower than the control group; the masticatory efficiency and bite force of both groups were increased, and those of the observation group were higher than the control group, with statistically significant differences (P < 0. 05). After treatment, the MMP-7, MCP-1, sICAM-1 and NTX levels were decreased, and those of the observation group were lower than the control group; the miR-193a, BGP and OPG levels were increased, and those of the observation group were higher than the control group, with statistically significant differences (P<0. 05). After treatment, the OHIP-14 scores of both groups were decreased, and that of the observation group was lower than the control group, with statistically significant difference (P<0. 05); the differences in the comparison of incidences of adverse drug reactions including local swelling, local pain and local stimulation were not statistically significant between two groups (P > 0. 05). CONCLUSIONS: The efficacy of photodynamic therapy combined with minocycline hydrochloride in the treatment of severe periodontitis is remarkable, which can effectively improve periodontal index, relieve periodontal inflammation and bone resorption, contribute to the promotion of patients’ oral health and chewing function, with high safety. [ABSTRACT FROM AUTHOR]

Introduction, aim: Periodontitis, which is one of the most common diseases in the adult population, is almost as common cause of tooth loss in people over the age of 35 as it is due to tooth decay. The aim of this study was to evaluate the utility of new-generation sequencing methods as a tool for complex characterization of subgingival bacterial biofilm in patients with advanced periodontitis and for monitoring the dynamics of changes in the composition of subgingival bacterial biofilm during therapy. We assume that next-generation sequencing methods will provide a new quality of monitoring the course of treatment and offer periodontologists a tool for objective evaluation of the effectiveness of the chosen therapeutic procedure and choice of further treatment. Methods: The study included 43 patients with a diagnosis of advanced periodontitis. Patients were divided into two subgroups and treated with one of two standard approved methods - deep scaling and root planing only (subgroup A - 20 patients) and deep scaling and root planing supplemented with antibiotic therapy (subgroup B - 23 patients) - and their periodontal status was assessed by periodontal indices BOP (bleeding on probing), CAL (clinical attachment loss) a PPD (periodontal pocket depth) before treatment and two weeks, three months and 18 months after therapy. A set of four samples was taken from each deepest periodontal pocket at equal time intervals to determine the microbiome composition. Results: During treatment, there was a significant decrease in the periodontal indices PPD, BOP and CAL in both subgroups of patients. There was also a significant decrease in the periodontal risk index R/G during treatment. In addition, the subgroup of patients treated with deep scaling and root planing with antibiotics (subgroup B) had a significantly higher decrease in R/G index 14 days after treatment compared to subgroup A treated with deep scaling and root planing alone. Three months and 18 months after treatment, the periodontal risk index R/G values were similar in both subgroups of patients. Conclusion: Taxonomic characterization of the microbiome expressed in the form of R/G index allows to monitor dynamic changes during treatment, in contrast to mere monitoring of clinical parameters shows clear differences between groups with and without antibiotics at 14 days after deep scaling and root planing therapy. However, given the clinical parameters of the two groups, which do not differ significantly after three or 18 months, it is appropriate to carefully consider whether antibiotic support for deep scaling and root planing is beneficial, as there is a significant risk of developing and spreading resistance. The use of antibiotics in periodontology should be based on detailed clinical, microbiological and general medical examination.

Background: Autogenous tooth bone graft material (AutoBT) has been advocated as a bone substitute when conducting alveolar ridge preservation. This study is aimed at using a radiomics approach in order to evaluate and testify whether AutoBT can stimulate bone growth during socket preservation in severe periodontal cases. Materials and Methods: For this study, 25 cases with severe periodontal diseases were selected. The patients’ AutoBTs were inserted into the extraction sockets and covered with Bio-Gide® collagen membranes. 3D CBCT scans and 2D X-rays were taken of the patients before surgery and after 6 months post-surgery. For the retrospective radiomics analysis, the maxillary and mandibular images were compared in different groups. Maxillary bone height was analyzed at the buccal, middle, and palatal crest sites, while the mandibular bone height was compared at the buccal, center, and lingual crest sites. Results: In the maxilla, the alveolar height was increased by −2.15 ± 2.90 mm at the buccal crest; −2.45 ± 2.36 mm at the center of the socket, and −1.62 ± 3.19 mm at the palatal crest, while the height of the buccal crest was increased by 0.19 ± 3.52 mm, and the height at the center of the socket was increased by −0.70 ± 2.71 mm in the mandible. The three-dimensional radiomics analysis demonstrated significant bone growth in the local alveolar height and high density. Conclusion: Based on clinical radiomics analysis, AutoBT could be used as an alternative bone material in socket preservation after tooth extraction in patients with severe periodontitis.

Periodontal disease is a major public health problem. This study aimed to develop a nomogram using a self-reported periodontitis screening instrument in predicting severe periodontitis (SP), defined by the World Workshop on Classification of Periodontal and Peri-Implant Diseases and Conditions, and evaluate its utility in clinical setting. An Akaike information criterion selected multivariable model was developed to predict SP using a self-reported questionnaire, with a nomogram developed based on its regression coefficients. Discriminatory capability was evaluated by Receiver-operating characteristic curve. Ability to predict SP of individual patients was evaluated with bootstrapping. Decision curve analysis (DCA) was performed to evaluate its potential clinical utility by evaluating clinical net benefit at different thresholds. 58.1% of 155 participants were classified with SP. Older males without tertiary education, with 'loose teeth', 'bone loss' and 'mouth rinse use' had higher SP risk. The nomogram showed excellent discriminatory capability with Area under Curve of 0.83 (95% CI = (0.76, 0.89)), good calibration (intercept = 0.026) and slight overestimation of high risk and underestimation of low risk (slope = 0.834). DCA showed consistent clinical net benefit across the range of thresholds relative to assumption of 'no patient' or 'all patient' with SP. Our nomogram using a self-reported periodontitis instrument is useful in SP screening in English-speaking Singaporean adults. [ABSTRACT FROM AUTHOR]

Abstract The full‐mouth disinfection protocol implemented in this case can be integrated into established protocols for treating severe periodontitis in the context of a hematological malignancy, without any interference with the cancer treatment.

Context: The potential impact of severe periodontitis on glycemia in systemically healthy individuals is not clearly established. It was hypothesized that among individuals who were previously undiagnosed for diabetes mellitus, patients with severe periodontitis have impaired glycemia and insulin resistance. Aims: The aim of our study was to assess and compare glycemia in severe periodontitis patients and in individuals with clinically healthy periodontium. Materials and Methods: A cross-sectional analytical design was employed. From among individuals who were undiagnosed for diabetes mellitus, 37 patients with severe periodontitis and 37 individuals with healthy periodontium in the age group of 25–55 years were recruited for the study. The fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), and insulin resistance by the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) were assessed and compared between the two groups. Results: The mean FBS, HOMA-IR, and HbA1c were significantly higher for patients with severe periodontitis than those individuals with healthy periodontium. After adjustments for age, gender, and body mass index, patients with severe periodontitis had a statistically significant association with impaired glucose metabolism (HbA1c ≥5.7) (adjusted odds ratio [OR] of 9.56; 95% confidence interval [CI]: 1.819–46.08; P < 0.01). Furthermore, patients with severe periodontitis had significantly greater odds to develop impaired fasting glucose (adjusted OR of 7.489, 95% CI: 1.408–39.839; P < 0.01). Conclusions: The mean FBS, HbA1c, and HOMA-IR were significantly higher in severe periodontitis patients than in the control group. A higher proportion of patients presented with prediabetes, incident diabetes, and insulin resistance in the severe periodontitis group.

Severe periodontitis is challenging to treat. The aim of this study was to evaluate the efficacy of a combined Er:YAG laser (ERL) and Nd:YAG laser (NDL) in non-surgical treatment for severe periodontitis. One week after supragingival scaling, 32 systemically healthy patients with stage III or IV periodontitis were randomly divided into a control group (16 subjects) and a test group (16 subjects). The control group was treated by scaling and root planning (SRP) with ultrasonic equipment and manual instruments, and the test group was treated by SRP as well as ERL and NDL. Before treatment, the following clinical parameters were recorded at baseline: debris index (DI), probing depth (PD), clinical attachment level (CAL), and percentage of bleeding on probing (BOP %). Two months after therapy, the clinical parameters were recorded again, and the results between the groups were compared. All clinical parameters were significantly improved in both groups after therapy. For moderately deep periodontal pockets (4 mm ≤ PD ≤ 6 mm), the gains in CAL were greater in the test group (1.17 ± 1.47 mm) than in the control group (0.46 ± 2.78 mm), while no significant difference was found for PD reductions after therapy between the two groups. For deep periodontal pockets (PD > 6 mm), the differences in all of the clinical parameters were similar between the test group and the control group. In this short-term study, ERL and NDL radiation exhibited potential advantages in improving the clinical attachment level compared to conventional SRP in the non-surgical treatment of severe periodontitis. [ABSTRACT FROM AUTHOR]

Abstract Aim The aim of this study was to evaluate the association between periodontal parameters related with the periodontal disease severity and the presence and levels of anti-citrullinated protein antibodies (ACPAs) in rheumatoid arthritis (RA) patients. Materials and methods This cross-sectional study included 164 RA patients. Socio-demographics and RA disease characteristics, including ELISA-detected ACPA (anti-CCP-2), were recorded. Exposure was assessed by periodontal parameters: plaque index (PI), bleeding on probing (BoP), probing pocket depth, and clinical attachment levels (CAL). Presence and levels of ACPAs (outcome) and exposure variables were compared by both parametric and non-parametric tests and associations were evaluated by adjusted odds ratio (OR). Results A significant association was observed between the presence of anti-CCP antibodies and severity of periodontal outcomes such as the mean CAL (OR 1.483, p = 0.036), mean PI (OR 1.029, p = 0.012), and the number of pockets ≥ 5 mm (OR 1.021, p = 0.08). High anti-CCP antibodies levels were associated with mean CAL, mean PI, and number of pockets ≥ 5 mm with an OR of 1.593 (p = 0.043), 1.060 (p

Background: Periodontitis and atherosclerosis are both chronic inflammatory diseases with a high prevalence. Increasing evidence supports the independent association between severe periodontitis and atherosclerotic cardiovascular disease, in which oral microorganisms may play an important role. We aimed to evaluate the characteristic changes of salivary microbiome and metabolome in patients with carotid atherosclerosis (CAS) and periodontitis., Methods and Results: The subjects were obtained from a cross-sectional study that included 1933 participants aged 40 years or older from rural northeast China. The study enrolled 48 subjects with CAS and 48 controls without CAS matched by sex, age, body mass index, and prevalence of hypertension, diabetes, and dyslipidemia. We performed full-length 16S rDNA gene sequencing and untargeted metabolomics of saliva samples from 96 subjects. We found that CAS was closely associated with an increased abundance of Streptococcus , Lactobacillus , and Cutibacterium . Furthermore, patients with CAS had higher prevalence of severe periodontitis than the control group. Notably, periodontal pathogens such as Tannerella and Anaeroglobus were not only associated with periodontitis but also enriched in patients with CAS, whereas periodontal health-associated Neisseria was more abundant in those without CAS. We also identified 2 lipid metabolism pathways, including glycerophospholipid and sphingolipid metabolism, as associated with CAS. The levels of trimethylamine N -oxide and inflammatory mediator leukotriene D4 were significantly higher in patients with CAS, whereas the levels of carnosine were significantly lower, than those in controls. Additionally, serum levels of inflammatory marker high-sensitivity C-reactive protein were significantly increased in CAS and positively correlated with the abundance of Anaeroglobus and leukotriene D4 in saliva., Conclusions: Our study suggests that characteristic changes in salivary microbiota and metabolites are closely related to CAS, and periodontitis and associated microorganisms may be involved in the initiation and progression of CAS.

Background: Aplastic anemia is an intractable disease characterized by pancytopenia, susceptibility to infection, and difficulty in achieving hemostasis. In patients with severe periodontal disease and aplastic anemia, spontaneous bleeding from the gingival tissue due to thrombocytopenia and during brushing is common, which may further exacerbate dental issues. Comprehensive periodontal treatment for patients with aplastic anemia is highly challenging and requires collaboration with a hematologist. Here, we discuss the case of a patient with aplastic anemia and severe periodontitis who was successfully treated in collaboration with our hematology department.Case Presentation: A 36-year-old Japanese woman with chief complaints of spontaneous gingival bleeding, pain, and increasing tooth mobility consulted our department. She had developed pancytopenia at age 11 years and was later diagnosed with aplastic anemia, making her susceptible to infection due to leukopenia. The results of the initial periodontal examination led to a diagnosis of severe generalized periodontitis (generalized stage IV grade C periodontitis) caused by leukopenia and poor oral hygiene. We adopted a comprehensive treatment plan, including invasive dental procedures. The patient exhibited no postoperative bleeding due to aplastic anemia-induced thrombocytopenia and experienced a good outcome.Conclusions: Both physicians and dentists should be aware that immunocompromised patients with aplastic anemia are at risk of developing severe periodontitis with severe alveolar bone resorption if the condition is combined with poor oral hygiene. Even in the presence of aplastic anemia, patients with severe periodontitis can undergo comprehensive dental treatment, including dental extraction and periodontal surgery, if bleeding and susceptibility to infection are controlled. This requires the cooperation of the patient and hematologists and can ultimately contribute to improving the patient's quality of life. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the association between low bone mineral density (BMD) and severe periodontitis at the end of the second decade of life. Materials and methods: This population‐based study analysed 2032 youngers (18–19 years old) of the RPS cohort. BMD of lumbar spine (BMD‐LS) and of the whole body (BMD‐WB) were assessed by dual x‐ray emission densitometry. Low BMD‐LS (Z‐score ≤ −2) and low BMD‐WB (Z‐score ≤ −1.5) were correlated with severe periodontitis. The extent of periodontal disease was also evaluated as the following outcomes: proportions of teeth affected by clinical attachment loss ≥5 mm and probing depth ≥5 mm. Multivariate models by sex, education, family income, risk of alcohol dependence, smoking, plaque, bleeding index, and body mass index were estimated through logistic regression (binary outcomes) and Poisson regression (continuous outcomes). Results: The prevalence of severe periodontitis was 10.97%. Low BMD‐LS (odds ratio [OR] = 2.08, confidence interval [CI] = 1.12–3.85, p =.01) and low BMD‐WB (OR = 1.34, CI = 1.001–1.81, p =.04) were associated with severe periodontitis in the final multivariate models. Low BMD‐LS and BMD‐WB were also associated with a greater extent of periodontitis (p <.05). Conclusions: Low BMD was found to be associated with the severity and extent of periodontitis in adolescents. Adolescents at peak bone mass age presenting low BMD are more likely to be affected by severe periodontitis. [ABSTRACT FROM AUTHOR]

Aim: Up‐to‐date epidemiological studies on the global burden of severe periodontitis is scarce. This study aimed to present the latest estimates for prevalence of severe periodontitis from 1990 to 2019, by region, age, and level of socio‐demographic development. Materials and Methods: Estimates from the Global Burden of Disease study 2019 were used to investigate burden and trends of prevalence of severe periodontitis and its association with socio‐demographic development at global, regional, and national level. Decomposition analysis was performed to explore the contribution of demographic and epidemiological factors to the evolving burden of severe periodontitis. Results: In 2019, there were 1.1 billion (95% uncertainty interval: 0.8–1.4 billion) prevalent cases of severe periodontitis globally. From 1990 to 2019, age‐standardized prevalence rate of severe periodontitis increased by 8.44% (6.62%–10.59%) worldwide. Prevalence of severe periodontitis is higher among less developed countries/regions. Global population growth accounted for 67.9% of the increase in the number of prevalent cases of severe periodontitis from 1990 to 2019. Conclusions: The global burden of severe periodontitis has been substantial and increasing over the past three decades. Upstream policy changes are urgently needed to address the global public health challenge of severe periodontitis. [ABSTRACT FROM AUTHOR]

Context: The potential impact of severe periodontitis on glycemia in systemically healthy individuals is not clearly established. It was hypothesized that among individuals who were previously undiagnosed for diabetes mellitus, patients with severe periodontitis have impaired glycemia and insulin resistance. Aims: The aim of our study was to assess and compare glycemia in severe periodontitis patients and in individuals with clinically healthy periodontium. Materials and Methods: A cross-sectional analytical design was employed. From among individuals who were undiagnosed for diabetes mellitus, 37 patients with severe periodontitis and 37 individuals with healthy periodontium in the age group of 25–55 years were recruited for the study. The fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), and insulin resistance by the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) were assessed and compared between the two groups. Results: The mean FBS, HOMA-IR, and HbA1c were significantly higher for patients with severe periodontitis than those individuals with healthy periodontium. After adjustments for age, gender, and body mass index, patients with severe periodontitis had a statistically significant association with impaired glucose metabolism (HbA1c ≥5.7) (adjusted odds ratio [OR] of 9.56; 95% confidence interval [CI]: 1.819–46.08; P < 0.01). Furthermore, patients with severe periodontitis had significantly greater odds to develop impaired fasting glucose (adjusted OR of 7.489, 95% CI: 1.408–39.839; P < 0.01). Conclusions: The mean FBS, HbA1c, and HOMA-IR were significantly higher in severe periodontitis patients than in the control group. A higher proportion of patients presented with prediabetes, incident diabetes, and insulin resistance in the severe periodontitis group. [ABSTRACT FROM AUTHOR]

Introduction, aim: Periodontitis, which is one of the most common diseases in the adult population, is almost as common cause of tooth loss in people over the age of 35 as it is due to tooth decay. The aim of this study was to evaluate the utility of new-generation sequencing methods as a tool for complex characterization of subgingival bacterial biofilm in patients with advanced periodontitis and for monitoring the dynamics of changes in the composition of subgingival bacterial biofilm during therapy. We assume that next-generation sequencing methods will provide a new quality of monitoring the course of treatment and offer periodontologists a tool for objective evaluation of the effectiveness of the chosen therapeutic procedure and choice of further treatment. Methods: The study included 43 patients with a diagnosis of advanced periodontitis. Patients were divided into two subgroups and treated with one of two standard approved methods - deep scaling and root planing only (subgroup A - 20 patients) and deep scaling and root planing supplemented with antibiotic therapy (subgroup B - 23 patients) - and their periodontal status was assessed by periodontal indices BOP (bleeding on probing), CAL (clinical attachment loss) a PPD (periodontal pocket depth) before treatment and two weeks, three months and 18 months after therapy. A set of four samples was taken from each deepest periodontal pocket at equal time intervals to determine the microbiome composition. Results: During treatment, there was a significant decrease in the periodontal indices PPD, BOP and CAL in both subgroups of patients. There was also a significant decrease in the periodontal risk index R/G during treatment. In addition, the subgroup of patients treated with deep scaling and root planing with antibiotics (subgroup B) had a significantly higher decrease in R/G index 14 days after treatment compared to subgroup A treated with deep scaling and root planing alone. Three months and 18 months after treatment, the periodontal risk index R/G values were similar in both subgroups of patients. Conclusion: Taxonomic characterization of the microbiome expressed in the form of R/G index allows to monitor dynamic changes during treatment, in contrast to mere monitoring of clinical parameters shows clear differences between groups with and without antibiotics at 14 days after deep scaling and root planing therapy. However, given the clinical parameters of the two groups, which do not differ significantly after three or 18 months, it is appropriate to carefully consider whether antibiotic support for deep scaling and root planing is beneficial, as there is a significant risk of developing and spreading resistance. The use of antibiotics in periodontology should be based on detailed clinical, microbiological and general medical examination. [ABSTRACT FROM AUTHOR]

Background. The role of mast cells in periodontal tissue degradation has been established. These cells can be efficient in the etiology of periodontitis by participating in gingival homeostasis and releasing cytokines and enzymes, resulting in connective tissue matrix breakdown. Therefore, the aim of this study was to compare the mast cell counts between patients with moderate and severe periodontitis. Methods. This case‒control study was performed on 15 subjects with severe periodontitis and 15 subjects with moderate periodontitis, who needed periodontal surgical treatment. Incisional biopsies were provided during periodontal surgery. Afterward, the mean counts of mast cells were determined after toluidine blue staining of the samples. Finally, data were analyzed with SPSS. Results. The results of this study showed that mast cell counts in severe periodontitis cases were lower than those in moderate periodontitis. However, there were no statistically significant differences between the two groups (P=0.611). In addition, the mean mast cell counts in males and females did not show a statistically significant difference (P=0.231), although the count was higher in female subjects. Conclusion. Based on the results, no statistically significant differences were found in mast cell counts between subjects with severe periodontitis and those with moderate periodontitis.

Objective: The objective was to examine the association of having poor oral health-care access and low socioeconomic status on poor oral health outcomes such as gingivitis/periodontitis and severe periodontitis in United States (US) adults. Methods: A cross-sectional analysis of 4745 US adults 30 years and older from the National Health and Nutrition Examination Survey (NHANES) 2015–2016 was done. Poor oral health outcomes were determined by the response of the respondents to the questionnaire. Logistic and regression analyses were used to determine the association of having poor oral health-care access and low socioeconomic status on poor oral health outcomes. To take into account the complex survey sampling methods, all the analyses were weighted. Results: This research study found an increased association between limited dental health-care access and poor oral health outcomes such as gingivitis/periodontitis and severe periodontitis among US adults aged 30 years and older. The low socioeconomic status and severe periodontitis results of the unadjusted model of the regression analysis suggest that people who belong to the low socioeconomic group were less likely to have severe periodontitis than people who belong to the high socioeconomic group. In all the other regression models, low socioeconomic status did not have a significant association with poor oral health outcomes such as gingivitis/periodontitis and severe periodontitis. Conclusion: On analyzing the NHANES 2015–2016 data, an increased association between limited dental health-care access and poor oral health outcomes such as gingivitis/periodontitis and severe periodontitis was found in US adults aged 30 years and older. A decreased association was found for low socioeconomic status and severe periodontitis from the unadjusted model of the regression analysis. More research is needed to solve the issue of having poor oral health outcomes such as gingivitis and periodontitis due to not having enough access to dental health care among low-income US adults.

The full‐mouth disinfection protocol implemented in this case can be integrated into established protocols for treating severe periodontitis in the context of a hematological malignancy, without any interference with the cancer treatment. [ABSTRACT FROM AUTHOR]

Background: Periodontitis is associated with glycemic control in patients with diabetes. The purpose of this study was to determine if glycosylated hemoglobin is elevated in patients with severe periodontitis who are nondiabetic adults. Methods: A total of 60 patients were selected and were divide into test and control groups. The test group included 30 adults without diabetes but with severe periodontitis (more than 30% of the sites showing clinical attachment loss [CAL] ≥ 5 mm and bleeding on probing [BOP]), and the control group included 30 healthy adults (probing depth ≤ 4 mm, BOP ≤ 15%, and no CAL). Glycosylated hemoglobin (HbA1c) was assessed in the laboratory for these patients. Groups were compared using the t test, Mann-Whitney U test, chi-square test, and Pearson's correlation. Results: There was a slight increase in mean HbA1c scores in the test group (cases 5.76%, controls 5.63%, P = .071). Mean body mass index [BMI] among cases and controls were similar. On intragoup comparison among BMI subgroups of the test group, HbA1c levels in the overweight subroup were significantly higher compared to the normal BMI subgroup (overweight 5.89%, normal 5.68% ,P = .017). Among controls, values were similar. Intergroup comparison showed that among overweight patients, the test group showed a significant increase in the mean HbA1c value compared to controls (cases 5.89%, controls 5.65%, P = .016). Pearson's correlation comparing plaque scores and HbA1c values of the entire sample was positive and revealed significance at the level of 0.01. Conclusion: There was no clear-cut link between severe periodontitis and glycemic control in nondiabetic individuals. Severe periodontitis patients who were also overweight showed significantly higher HbA1c values compared to their normal counterparts. (doi: 10.3290/j.qi.a29144 [ABSTRACT FROM AUTHOR]

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Background: The aim of this study was to retrospectively assess bone volumes, healed ridge topography and possibility to plan prosthetically guided implants (PGI) at least 6 months after extraction or exfoliation of first molars as a consequence of terminal periodontitis (EEFMP). Materials and Methods: 45 subjects with stage III‐IV periodontitis providing 74 extraction sites (maxillary = 51 and mandibular = 23) were included. The degree of residual periodontal support on each root was assessed by combining periodontal and radiographic data. Digital planning of PGI with 4.8/4.1 mm diameter, 8 mm long, root‐form dental implant and need for bone augmentation (BA) were performed using CBCT with a radiographic stent. Possibility of standard implant placement (STANDARD) and need for simultaneous or staged BA were assessed. Results: Planning PGI placement was possible in all cases. For a 4.8 mm diameter implant, STANDARD was possible in 37.8% of the sites, 33.8% required BA at the time of implant placement, and 28.4% required staged BA before PGI. The use of 4.1 mm rather than 4.8 mm diameter implant allowed STANDARD in an additional 8.1% of cases that originally required simultaneous BA/osteotome sinus floor elevation (OSFE). The level of periodontal bone loss did not predict the complexity of implant placement, but significant differences were observed comparing maxillary with mandibular sites. Conclusion: PGI planning at sites with first molar loss due to terminal periodontitis is possible but poses great challenge to rehabilitation, often requiring advanced augmentation procedures and sinus augmentation. [ABSTRACT FROM AUTHOR]

The purpose of this study is to detect the serum peroxidase activity by using silicone dioxide nanoparticles in the severe periodontitis patients comparing them with healthy control. Clinical periodontal parameters (Plaque index, Gingival index, Bleeding on probing, Probing pocket depth and Clinical attachment loss) and serum were taken from 50 subjects; thirty patients were periodontitis divided according to new classification into (Stage III & VI) and 20 control healthy periodontium. Peroxidase activity was measured by colorimetric method with and without silicon dioxide nanoparticles. Results revealed that there was a significant differences in the activity of serum peroxidase with and without nanoparticles. There was a nonsignificant differences between serum peroxidase and clinical parameters except pocket depth; which was a significant difference(p values <0.05). In conclusion, serum peroxidase revealed an increase activity with the presence of silicone oxide nanoparticles in periodontitis group incomparable to healthy control group. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects of manual scaling, ultrasonic scaling, and Er: YAG laser irradiation of different pulse energies on the roughness and morphology of the root surface in the scaling and root planning (SRP) of periodontitis teeth, so as to provide references for Er: YAG laser application in periodontitis therapy. Methods Ninety premolars with severe periodontitis and 10 healthy premolars were included in this study. Experimental samples were divided into four groups according to different root surface treatment. In the group A, 10 healthy premolars comprised the control group without any treatment. In the group B, 10 teeth were manually scraped with Gracey scraper. In the group C, 10 teeth were treated with ultrasonic scaling. In the group D, samples treated with Er: YAG laser were divided into 7 subgroups according to different pulse energies (40 mJ/P, 60 mJ/P, 80 mJ/P, 100 mJ/P, 120 mJ/P, 140 mJ/P, and 160 mJ/P); with 10 teeth in each. The surface roughness was quantitatively analyzed by using a surface profilometer, and the surface morphology of the root was observed by scanning electron microscopy. Results The Ra values of groups A, B, C, D, E, F, G, H, I, and J were 4. 91±1.22, 4. 71±1. 70, 6. 67 ±2. 88, 6. 73 ±4. 28, 5.14 ±2.46, 7. 57 ±3. 53, 7. 46 ± 5. 89, 2. 92 ± 0. 77, 2. 72 ± 1. 06, and 2. 19 ± 0. 51, respectively, with statistically significant differences between the groups A, B, C, D, E, F, G, H, I and group J, between the groups A, B, C, D, E, F, G and groups H and I, and between the groups A, B, C, D, E and groups F and G, all P < 0. 05. The root surface of the teeth in the groups A to E was clean, rough, with a granular protrusion-like appearance, no smear layer, no exposed dentin tubules, and no carbonization of the tissues; the root surfaces of the groups F and G were rougher, with exposed dentin tubules; smear layer and debris were seen on the root surface of the teeth in groups H and I, and no dentin tubules were exposed; the root surface of group J was smooth and flat, with no smear layer. Conclusions Manual scaling, ultrasonic scaling, and Er: YAG laser all increase the surface roughness of the roots of teeth with severe periodontitis. Compared with the laser group, the root surface of the manual scaling and ultrasonic scaling group is smoother, but there is a smear layer, which is not conducive to the adhesion of the periodontal tissue; Er: YAG laser can remove the smear layer of the root surface to form a clean root surface, which is beneficial to the adhesion of the periodontal tissues, which is better than traditional manual and ultrasonic scaling; the root surface after Er: YAG laser treatment is rougher, and the average root surface roughness after 40-120 mJ/P pulse energies does not change much, the surface roughness produced by 140-160 mJ/P pulse energies increases obviously. Therefore, it is recommended that the pulse energy should be within 120 mJ/P for clinical application. [ABSTRACT FROM AUTHOR]

Periodontology is an infectious disease-based discipline. The etiopathology of progressive/severe periodontitis includes active herpesviruses, specific bacterial pathogens, and proinflammatory cytokines. Herpesviruses and periodontopathic bacteria may interact synergistically to produce periodontal breakdown, and periodontal herpesviruses may contribute to systemic diseases. The infectious agents of severe periodontitis reside in deep pockets, furcation lesions, and inflamed gingiva, sites inaccessible by conventional (purely mechanical) surgical or nonsurgical therapy but accessible by systemic antibiotic treatment. This brief overview presents an effective anti-infective treatment of severe periodontitis, which includes systemic chemotherapy/antibiotics against herpesviruses (valacyclovir [acyclovir]) and bacterial pathogens (amoxicillin + metronidazole or ciprofloxacin + metronidazole) plus common antiseptics (povidone-iodine and sodium hypochlorite) and select ultrasonic scaling. The proposed treatment can cause a marked reduction or elimination of major periodontal pathogens, is acceptably safe, and can be carried out in minimal time with minimal cost. [ABSTRACT FROM AUTHOR]

Aim: Periodontitis has been identified as a moderate but independent risk factor for cardiovascular (CV) disease and progression. The objective of this study (ClinicalTrials.gov Identifier: NCT01045070) was to assess subgingival colonization with selected periodontal pathogens on the occurrence of further adverse CV events in a cohort of CV patients. Methods: The prevalence of severe periodontitis including the detection of 11 periodontal pathogens (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, Treponema denticola, P. intermdia, Peptostreptococcus micros, Fusobacterium nucleatum, Campylobacter rectus, Eubacterium nodatum, Eikenella corrodens, Capnocytophaga sputigena, Capnocytophaga gingivalis, Capnocytophaga ochracea; HAIN‐Diagnostica®) was analysed in 1,002 CV patients The prognostic impact of periodontal pathogens for combined CV endpoint (stroke/TIA, myocardial infarction, CV death, death from stroke) was evaluated after a 3‐year follow‐up period. Hazard ratios (HRs) were adjusted for established CV risk factors applying Cox regression. Results: In the Kaplan–Meier analysis (log‐rank test: p <.001) and Cox regression (HR: 0.545, 95%‐CI: 0.387–0.773; p =.001), the decreased occurrence of E. corrodens was shown to be an independent predictor for adverse CV events after 3 years of follow‐up. Conclusions: The detection of E. corrodens was associated with a reduced risk of adverse CV events in patients with CV disease. The pathophysiological background underlying this association should be investigated in further studies. [ABSTRACT FROM AUTHOR]

Objectives: Salivary exosomes harbour numerous constituents associated with oral and systemic diseases. However, no reports addressed components of salivary exosomes in patients with periodontitis. Our study aims to explore salivary exosomal proteins in young adults with severe periodontitis (SP) and to analyse the relationships between different proteins. Materials and Methods: We collected saliva from 11 young adults with SP and 11 periodontally healthy subjects. After isolation of salivary exosomes, liquid chromatography–tandem mass spectrometry (LC‐MS/MS) was used to analyse proteins. Gene ontology analysis was performed based on GeneCodis, and interaction network analysis for unique salivary exosomal proteins was performed by STRING. Results: Twenty‐six proteins were identified only in the SP group, and 58 proteins were identified only in the healthy group. Gene ontology analysis revealed that innate immune response, cytolysis and complement activation were highly enriched in the SP group. Interaction network analysis showed that the correlations among immune‐related proteins (e.g. complement components and chemokine (C‐C motif) ligand 28) were significant in the SP group. C6 proteins expressed only in the SP group were evaluated by Western blotting. Conclusions: Salivary exosomes from periodontitis patients are enriched immune‐related proteins that might participate in the immune response during the development of periodontitis. [ABSTRACT FROM AUTHOR]