Pneumocephalus as result of nonsurgical peri-implantitis treatment with an air-polishing device for submucosal debridement-A case report

Subcutaneous emphysema secondary to autogenous bone grafting: a case report

BACKGROUND

Subcutaneous emphysema, a rare complication after dental procedures, involves localized tissue swelling caused by air trapped within subcutaneous tissues. Its occurrence following autogenous bone grafting is extremely rare, with limited cases reported.

CASE PRESENTATION

This article describes delayed subcutaneous emphysema following autogenous bone grafting at both the donor site and the recipient site. The patient presented facial and labial swelling. Symptoms, clinical findings, and postoperative CBCT confirmed subcutaneous emphysema.

CONCLUSIONS

This case report highlights the rare occurrence of subcutaneous emphysema following autogenous bone grafting, with simultaneous involvement of donor and recipient sites. It emphasizes the need for heightened clinical awareness, timely diagnosis, and appropriate preventive measures to reduce the risk of SE in bone augmentation procedures.

BSP Implementation of prevention and treatment of peri-implant diseases - The EFP S3 level clinical practice guideline

OBJECTIVES

to adapt the supranational European Federation of Periodontology (EFP) Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline for UK healthcare environment, taking into account a broad range of views from stakeholders and patients.

SOURCES

This UK version, based on the supranational EFP guideline [1] published in the Journal of Clinical Periodontology, was developed using S3-level methodology, combining assessment of formal evidence from 13 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 55 clinical recommendations for the Prevention and Treatment of Peri-implant Diseases, based on the classification for periodontal and peri‑implant diseases and conditions [2].

METHODOLOGY

The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework, following the S3-process, the underlying evidence was updated and a representative guideline group of 111 delegates from 26 stakeholder organisations was assembled into four working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly.

RESULTS AND CONCLUSION

Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline for the Prevention and Treatment of Peri-implant Diseases was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the UK healthcare community including the public.

CLINICAL SIGNIFICANCE

The S3-level-guidelines combine evaluation of formal evidence, grading of recommendations and synthesis with clinical expertise of a broad range of stakeholders. The international S3-level-guideline was implemented for direct clinical applicability in the UK healthcare system, facilitating a consistent, interdisciplinary, evidence-based approach with public involvement for the prevention and treatment of peri‑implant diseases.

Guided biofilm therapy versus conventional protocol-clinical outcomes in non-surgical periodontal therapy

BACKGROUND

The aim of the randomized controlled clinical trial study was to evaluate the effectiveness in reducing pathologically increased pocket probing depths (PPD > 3 mm) using the Guided Biofilm Therapy (GBT) protocol (adapted to the clinical conditions in non-surgical periodontal therapy (NSPT): staining, air-polishing, ultrasonic scaler, air-polishing) compared to conventional instrumentation (staining, hand curettes/sonic scaler, polishing with rotary instruments) both by less experienced practitioners (dental students).

METHODS

All patients were treated according to a split-mouth design under supervision as diseased teeth of quadrants I/III and II/IV randomly assigned to GBT or conventional treatment. In addition to the treatment time, periodontal parameters such as PPD and bleeding on probing (BOP) before NSPT (T0) and after NSPT (T1: 5 ± 2 months after T0) were documented by two calibrated and blinded examiners (Ethics vote/ Trial-register: Kiel-D509-18/ DRKS00026041).

RESULTS

Data of 60 patients were analyzed (stage III/IV: n = 36/ n = 24; grade A/ B/ C: n = 1/ n = 31/ n = 28). At T1, a PPD reduction of all diseased tooth surfaces was observed in 57.0% of the GBT group and 58.7% of the control group (p = 0.067). The target endpoint (PPD ≤ 4 mm without BOP) was achieved in 11.5% for GBT (conventional treatment: 11.2%; p = 0.714). With the exception for number of sites with BOP, which was at T1 15.9% in the GBT group and 14.3% in the control group (p < 0.05) no significant differences between the outcomes of the study were found. At 30.3(28.3) min, the treatment time was significantly shorter in GBT than in the control group at 34.6(24.5) min (p < 0.001).

CONCLUSIONS

With both protocols (GBT/ conventional instrumentation) comparably good clinical treatment results can be achieve in NSPT in stage III-IV periodontitis patients.

TRIAL REGISTRATION

The study was registered before the start of the study and can be found under the number DRKS00026041 in the German Clinical Trials Register. The registration date was 19/08/2021.

Air powder waterjet technology using erythritol or glycine powders in periodontal or peri-implant prophylaxis and therapy: A consensus report of an expert meeting

OBJECTIVES

To attain a collective expert opinion on the use of air powder waterjet technology (APWT) with erythritol and glycine powders in the prophylaxis and therapy of periodontal and peri-implant diseases.

MATERIAL AND METHODS

In the first step, a modified one-round online Delphi survey including 44 five-point Likert scale questions was conducted among a group of 10 expert clinicians and researchers with thorough knowledge and experience in this topic. In the second step, the single questions and the survey results were discussed during a meeting, and consensus statements were formulated, respectively.

RESULTS

An agreement was reached on most items, especially opinions supporting glycine and erythritol powders as favorable with respect to efficiency, safety, and comfort. More scientific evidence is needed to support the improvement in clinical attachment on teeth and implants, especially when APWT with erythritol is used. In addition, APWT needs more long-term evaluation and studies in terms of microbiome/microbiological effects as well as effects on the inflammatory response on natural teeth and implants, also in light of a guided biofilm therapy concept.

CONCLUSIONS

In line with the expert opinions and supported by the evidence, it was concluded that the use of APWT with erythritol and glycine powders in nonsurgical periodontal and peri-implant therapy and prophylaxis is patient compliant and efficient.

The efficacy of subgingival air polishing and subgingival debridement in periodontal support therapy: a meta-analysis

OBJECTIVE

To assess whether there is sufficient evidence of a difference in efficacy between subgingival air polishing (SubAP) and subgingival debridement as periodontal support treatment. The systematic review protocol was registered in the PROSPERO database under no. CRD42020213042.

METHODS

A comprehensive search was conducted using eight online databases to develop straightforward clinical questions and search strategies, from their inception to 27 January 2023. The references of identified reports were also retrieved for inclusion in the analysis. The risk-of-bias of the included studies was evaluated using the Revised Cochrane Risk-of-Bias tool (RoB 2). A meta-analysis was performed on five clinical indicators using the Stata 16 software.

RESULTS

Twelve randomized controlled trials were ultimately included, and most included studies had varying degrees of risk-of-bias. The results of the meta-analysis indicated that there was no significant difference between SubAP and subgingival scaling in terms of improving probing depth (PD), clinical attachment loss (CAL), plaque index (PLI), and bleeding on probing% (BOP%). The results of the visual analogue scale score analysis indicated that SubAP produced less discomfort than did subgingival scaling.

DISCUSSION

SubAP can provide better treatment comfort than subgingival debridement. There was no significant difference in the efficacy of the two modalities in improving PD, CAL, and BOP% in supportive periodontal therapy.

CONCLUSION

Currently, evidence for assessing the difference in the efficacy of SubAP and subgingival debridement in improving the PLI is insufficient, and further high-quality clinical studies are needed.

Effect of supragingival air polishing on subgingival periodontitis microbiota

Background

Supragingival air polishing of teeth effectively removes dental plaque and extrinsic stain on coronal tooth surfaces, but its impact on specific periodontal pathogens in adjacent subgingival biofilms is not known. This study assessed the microbiological effect of supragingival air polishing on the subgingival microbiota of individuals with severe periodontitis.

Methods

Supragingival air polishing with a sodium bicarbonatebased powder was performed on 15 adult test subjects, with the nozzle of the air polishing device aimed apically at a 45° angle onto tooth surfaces immediately coronal to the entrance of periodontal pockets. Supragingival prophylaxis paste polishing, using a slow-speed handpiece, was carried out on 13 adult control subjects. Subgingival specimens were collected from a single 5 mm to 7 mm periodontal pocket with bleeding on probing in each of the study participants before and immediately after supragingival polishing procedures. Viable bacterial counts and selected putative periodontal pathogens (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia/nigrescens, Fusobacterium nucleatum, Parvimonas micra, Campylobacter species) were quantified by microbial culture, and motile morphotypes (spirochetes and motile rods) by phase-contrast microscopy.

Results

Statistically significant decreases were detected after supragingival air polishing in total viable counts (84.9% decrease), in P. intermedia/nigrescens, F. nucleatum, Campylobacter species, total proportions of red/orange complex periodontal pathogens (82.3% decrease), and in motile morphotypes (85.3% decrease). No statistically significant subgingival microbiological changes occurred with supragingival prophylaxis paste polishing.

Conclusion

Supragingival air polishing of teeth, but not supragingival prophylaxis paste polishing, may serve as a useful therapeutic adjunct to disrupt and help remove pathogenic biofilms in deep periodontal pockets.