Probing pocket depth reduction after non-surgical periodontal therapy: Tooth-related factors

Factors influencing pocket closure in surgically-treated intraosseous defects. A retrospective analysis

OBJECTIVES

to evaluate the association between patient- and local- factors and pocket closure (i.e., probing depth, PD, ≤4 mm) following surgical treatment of intraosseous defects with the Single Flap Approach (SFA).

MATERIALS & METHODS

a retrospective analysis of data from previous studies was conducted on 101 defects treated with SFA alone or in combination with enamel matrix derivative with/without a bovine-derived xenograft. Pocket closure at 12 months was the primary outcome. Age, sex, smoking status, baseline PD, tooth type, depth of the supraosseous component, radiographic depth of the intraosseous component, defect angle, defect morphology, treatment modality were considered as candidate determinants in a bivariate logistic regression analysis. Backward stepwise regression was used to identify the optimal set of factors significantly associated with pocket closure.

RESULTS

12-month pocket closure occurred in 74.3% of cases. The probability of pocket closure was significantly associated with baseline PD (OR = 0.741, 95%CI: 0.565-0.973; p = 0.031) and defect morphology, with defects classified as "mainly 1-wall" and "mainly 3-wall" showing greater odds for pocket closure compared to "mainly 2-wall" defects (OR = 7.125, p = 0.006; and OR = 5.225, p = 0.006, respectively).

CONCLUSIONS

When performed according to the SFA, regenerative surgical procedures are associated with high probability of pocket closure at 12 months. Intraosseous lesions with deeper pre-surgery PD and/or prevalent 2-wall morphology have lower probability to be closed.

CLINICAL RELEVANCE

Data from the present study may be of use to the clinician who wants to optimize the odds for pocket closure at a deep intraosseous lesion that is being approached according to the SFA.

Treating Periodontitis Strictly Non-Surgically-A Retrospective Long-Term Analysis of Tooth Loss During Supportive Periodontal Care

Background/Objectives: Retrospective analysis of long-term periodontal tooth loss (PTL) during supportive periodontal care (SPC) in patients with Stage III/IV periodontitis who received strictly non-surgical periodontal treatment. Methods: Fully documented medical documentation of SPC > 5 years was analyzed at T0 (baseline), T1 (after Steps 1/2), and during SPC (T2). PTL, periodontal pocket depth (PD), bleeding on probing (BOP), tooth mobility (TM), furcation involvement (FI), and frequency of SPC were recorded. Each parameter was tested for significance in a bivariate analysis, before a multilevel logistic regression analysis was performed to identify possible factors with an impact on PTL during SPC. Results: A total of 51 women/64 men (T1 mean age 55.4 ± 10.3 yrs) were surveilled after 9.0 ± 2.4 yrs; 2647 teeth were included. On average, patients attended 10.6 ± 3.8 SPC sessions between T1 and T2; 77 patients (67%) attended at least 1/year. At T1, 68 teeth were lost; 6.1% of the remaining teeth showed FI, and 13.8% showed TM. During SPC, the PTL range was 118 (1.03 ± 1.21/patient). TM, FI, mean PD, and Stage IV periodontitis proved to be statistically significantly associated with increased PTL. Conclusions: PTL was low in this cohort. Nevertheless, at T1, it may be beneficial to focus on stopping TM by splinting the mobile teeth and reducing the PD or treating FI appropriately, understanding that these precise applications of surgical procedures could positively affect long-term tooth retention.

Prevalence and characteristics of periodontal surgery procedures in postgraduate periodontic clinics: an epidemiological analysis

BACKGROUND

Periodontal diseases include gingivitis, periodontitis, and peri-implant disease. There are different ways to treat these diseases, such as surgical and non-surgical periodontal treatments like gingivectomy, open flap debridement, and crown lengthening.

Laser Technology in Periodontal Treatment: Benefits, Risks, and Future Directions-A Mini Review

Background/Objectives: The efficacy and safety of laser therapy in periodontal treatment are comprehensively reviewed in this study, focusing on efficacy, safety, patient experiences, and cost-effectiveness. Methods: This review encompasses a literature survey, analyzing studies from 2010 to 2024, and a search was conducted in January 2024 across various electronic databases, including PubMed, SCOPUS, EMBASE, COCHRANE library, and Science Direct. The search utilized Mesh terms/keywords such as "Laser therapy", "Periodontal disease", "Efficacy", and "Safety." Results: Out of the initial 884 articles identified, 98 were selected based on their titles and abstracts. After evaluating the full texts and applying the inclusion and exclusion criteria, 16 articles were chosen for the review, meeting the study's criteria. Conclusions: This review identifies gaps in current research and points to emerging trends and potential future advancements in laser therapy, emphasizing the need for standardized protocols, long-term studies, and technological innovations to enhance treatment efficacy and accessibility.

The Effect of Subgingival Curcumin Gel With and Without Photodynamic Therapy as Adjunctive Periodontal Treatment in Type 2 Diabetes Mellitus Patients: A Split-Mouth Clinical and Microbiological Study

Background: The study aimed to determine the quantity of periodontopathic and total bacteria on subgingival plaque from patients with periodontitis and uncontrolled diabetes and to compare adjunctive periodontal therapy using topical Curcuma longa extract gel with and without photodynamic treatment using blue light-emitting diodes (LEDs). Clinical periodontal parameters such as probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were assessed to evaluate the efficacy of the treatments. Methods: Thirty patients with diabetes mellitus (DM), a history of poor glycemic control, and chronic periodontitis were enrolled in this clinical and microbiological split-mouth study. After conventional periodontal treatment, scaling, and root planing, the most severe sites on the premolar or molar teeth with periodontal pockets measuring ≥5 mm were selected and randomly divided into two groups: the C. longa extract gel group (with a concentration of 25 µg/g) and the photodynamic group (C. longa extract gel 25 µg/g irradiated with blue light energy density = 16.8 J/cm2 for 120 s). All teeth were examined for clinical periodontal parameters data (PD, CAL, plaque index [PI], and BOP) and microbiological data (Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans, and total bacteria), measured using TaqMan Multiplex real-time polymerase chain reaction, at weeks 0, 1, 2, and 12. The Mann-Whitney U test was utilized to compare clinical outcomes between groups, while the Wilcoxon Signed Rank test at a 95% confidence level was employed to analyze the amount of periodontal pathogens within the same group. Results: After the 12-week follow-up period, significant improvements were observed in all clinical parameters across both groups. However, the reduction in both CAL and BOP was significantly higher in the photodynamic group compared to the curcumin gel alone group, indicating enhanced periodontal health outcomes in the former. Microbiologically, both groups exhibited a decrease in total bacterial count and a reduction in periodontopathic bacteria. Importantly, the photodynamic group demonstrated a significant decrease in F. nucleatum and P. intermedia counts, key pathogens associated with periodontal disease progression. This suggests that photodynamic therapy (PDT), when used with curcumin gel, not only improves clinical parameters but also promotes a favorable shift in the periodontal microbial profile. Conclusion: Our findings highlight that PDT with curcumin gel as a photosensitizer (PS) is more effective than curcumin gel alone in achieving clinical attachment gain, reducing gingival inflammation, and suppressing specific periodontal pathogens. This combined therapy approach holds promise for managing periodontal disease by addressing both clinical symptoms and microbial factors.

Effectiveness of nonsurgical re-instrumentation: Tooth-related factors

BACKGROUND

To investigate tooth-related factors that influence pocket closure (PC) and the reduction of pocket probing depths (PPD) after nonsurgical re-instrumentation (NSRI) as part of step 3 therapy.

METHODS

A total of 480 patients (10,807 teeth) presenting with residual pockets 6.33 ± 3.79 months after steps 1 and 2 of periodontal therapy were included and retrospectively analyzed before and 5.93 ± 4.31 months after NSRI. Reduction of PPD and PC rates following NSRI were associated with tooth-related factors, namely tooth type, arch, number of roots, furcation involvement (FI), pulp vitality, mobility, type of restoration, presence of plaque, and bleeding on probing (BOP), using mixed-effects regression models.

RESULTS

NSRI reduced periodontal pockets persisting after initial cause-related therapy by (mean ± SD) 1.32 ± 1.79 mm in PPD, and PC rate was 40%. Moderate pockets (4-5 mm) responded better to NSRI than deep pockets (≥ 6 mm) in terms of PC (51% vs. 16%). Both PPD reduction and PC rates of deep residual pockets were significantly influenced by tooth type, arch, number of roots, and presence of BOP.

CONCLUSION

Tooth type, arch, number of roots, and presence of BOP at re-evaluation (before NSRI) had a significant and clinically relevant influence on NSRI as part of step 3 therapy. Considering these factors, particularly for deep residual pockets, may allow more tailored re-intervention.

PLAIN LANGUAGE SUMMARY

The present study aimed to investigate the influence of tooth-related factors on the outcome of repeated nonsurgical therapy of periodontitis. Therefore, 480 patients (10,807 teeth) presenting with clinical symptoms of persistent periodontitis after initial therapy were administered repeated nonsurgical therapy and retrospectively analyzed. Therapy outcomes were associated with tooth-related factors, namely tooth type, tooth location (maxilla/mandible), number of roots, involvement of the root furcation area in multi-rooted teeth, pulp vitality, mobility, restoration, presence of plaque and bleeding upon periodontal probing, using mixed-effects models. The results revealed that repeated nonsurgical therapy was effective in reducing inflammation and clinical signs of disease, with moderate residual periodontal defects responding better than deep defects. Healing of deep defects after repeated nonsurgical therapy; however, was significantly influenced by the factors: tooth type, location, number of roots, and bleeding on probing. Considering these factors, particularly in deep residual defects which are commonly suggested to be treated surgically, may allow less invasiveness and thus a more tailored re-intervention.

Do all individuals benefit equally from non-surgical periodontal therapy? Secondary analyses of systematic review data

AIMS

This study aimed to assess the variability and treatment effect heterogeneity in response to non-surgical periodontal therapy (NSPT).

METHODS

Data from randomized controlled trials included in two recent systematic reviews on the effect of NSPT on mean clinical attachment loss (CAL), mean probing pocket depth (PPD), percentage of sites with bleeding on probing (%BOP), PPD ≤3 mm (%PD ≤3 mm), and C-reactive protein levels (CRP) at 3-12-month follow-up among adults with systemic diseases or conditions were used. In these trials, the control arms received no treatment, hygiene advice, or supragingival scaling. The Bayesian meta-regression models were utilized to assess the variability ratios between NSPT and control groups.

RESULTS

Data from 36 trials on mean PPD, 32 trials on mean CAL, eight trials on %PD ≤3 mm, 31 trials on %BOP and 19 trials on CRP were used. Variability in mean CAL and CRP was approximately 10% higher in the NSPT arms than in the control arms, hinting that there may be room for treatment effect heterogeneity. Instead, variability in mean PPD, %BOP, and %PD ≤3 mm was lower in the NSPT arms than in the control arms.

CONCLUSION

Potential treatment effect heterogeneity in response to NSPT was observed for CRP and mean CAL. However, substantial measurement error in CAL and natural variation in CRP may contribute to these findings. Conversely, treatment effect heterogeneity appears less pronounced for mean PPD, %BOP, and %PD ≤3 mm, potentially due to greater treatment effects in patients with more severe periodontitis and reduced measurement error in these parameters.

The association between periodontal microbial biomarkers and primary therapy outcome

OBJECTIVE

This study aims to analyse the association between the baseline microbial load of selected periodontopathogenic bacteria collected from gingival crevicular fluid (GCF) and the primary outcome of steps I and II therapy.

MATERIALS AND METHODS

222 patients with stage III periodontitis were included into this retrospective analysis that received steps 1 and 2 periodontal therapy without adjunctive systemic antibiotics. Baseline GCF samples were quantitatively analysed using ELISA-based kits for levels of periodontopathogens (Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans (Aa), Prevotella intermedia (Pi), Fusobacterium nucleatum (Fn), Treponema denticola (Td), and Tannerella forsythia (Tf)) and associated with the primary therapy outcome using a "treat-to-target" therapy endpoint (TE) defined as ≤ 4 sites with PD ≥ 5 mm six months after therapy.

RESULTS

38.2% of the patients achieved TE. Patients failing to achieve TE revealed significantly increased levels of Pg, Fn, and Tf at baseline (Pg: p = 0.010, Fn: p = 0.008 Tf: p = 0.004). Multivariate binary logistic regression adjusted for sex, mean probing depth, diabetes, and current smoking status showed an independent relationship between Tf and the TE (aOR 2.570, p = 0.023).

CONCLUSION

Increased microbial load is associated with decreased responsiveness to therapy. The findings suggest that specifically baseline Tf levels are associated with poorer treatment outcomes and might improve the accuracy of periodontal diagnosis.

CLINICAL RELEVANCE

The findings of this study support the concept of a critical biomass that is sufficient to induce and maintain an immune response within the periodontal pocket, which ultimately leads to irreversible tissue destruction. However, calculating this level in advance may serve as an early indicator for intervention.

KEY FINDING

Baseline Tannerella forsythia levels are associated with poorer treatment outcome.

Interrupted time series analysis of chronic periodontitis-related procedures before and after the scaling reimbursement policy in Korea

AIM

To study the use of a quasi-experimental design to assess the effects of scaling reimbursement policies on the incidence of chronic-periodontitis procedures.

MATERIALS AND METHODS

Interrupted time series analysis was used to compare the effects before and after policy implementation using data on the number of periodontitis-related procedures from the Korean National Health Insurance Service-National Sample Cohort (n = 740,467) and the Health Screening Cohort (n = 337,904). Periodontitis-related procedures with diagnosis codes were categorized into basic (scaling or root planing), intermediate (subgingival curettage) and advanced (tooth extraction, periodontal flap surgery, bone grafting for alveolar bone defects or guided tissue regeneration). Subjects' demographics and comorbidities were considered. The incidence rate of immediate changes and gradual effects before and after policy implementation was assessed.

RESULTS

Following the policy implementation from July 2013, an immediate increase was observed in total and basic procedures. No significant changes were noted in intermediate and advanced procedures initially. A decrease in the slope of intermediate procedures was observed in both databases. Advanced procedures showed varied trends, with no change in the National Sample Cohort but an increase in the Health Screening Cohort, particularly among subjects with comorbidities.

CONCLUSIONS

Following the new policy implementation, the number of intermediate procedures decreased while the number of advanced procedures increased, especially among patients with comorbidities. These findings offer valuable insights on policy evaluation.

Microbiological and Salivary Biomarkers Successfully Predict Site-Specific and Whole-Mouth Outcomes of Nonsurgical Periodontal Treatment

Background/Objectives: Nonsurgical periodontal treatment (NSPT) is the gold-standard technique for treating periodontitis. However, an individual's susceptibility or the inadequate removal of subgingival biofilms could lead to unfavorable responses to NSPT. This study aimed to assess the potential of salivary and microbiological biomarkers in predicting the site-specific and whole-mouth outcomes of NSPT. Methods: A total of 68 periodontitis patients exhibiting 1111 periodontal pockets 4 to 6 mm in depth completed the active phase of periodontal treatment. Clinical periodontal parameters, saliva, and subgingival biofilm samples were collected from each patient at baseline and three months after NSPT. A quantitative PCR assay was used to detect the presence of Fusobaterium nucleatum and Porphyromonas gingivalis in the biofilm samples. Salivary biomarkers including matrix metalloproteinase (MMP)-9, glutathione S-transferase (GST), and Annexin-1 were assayed both qualitatively (Western blot analysis) and quantitively (ELISA). Results: NSPT yielded significant improvements in all clinical parameters, including a reduction in bacterial load and decreased levels of MMP-9 together with increased concentrations of GST and Annexin-1. The binary logistic regression suggested that the overall accuracy of P. gingivalis identification, probing pocket depth, and interproximal sites was 71.1% in predicting successful site-specific outcomes. The salivary biomarker model yielded an overall accuracy of 79.4% in predicting whole-mouth outcomes following NSPT. Conclusions: At baseline, the presence of shallow periodontal pockets at interdental locations with a lower abundance of P. gingivalis is predictive of a favorable response to NSPT at the site level. Decreased salivary MMP-9 associated with increased GST and Annexin-1 levels can predict successful whole-mouth outcomes following NSPT.

Impact of Nonsurgical Periodontal Treatment of Periodontitis Stages 2 and 3 on Oral Health-Related Quality of Life

This study investigates the impact of nonsurgical periodontal treatment (NSPT) on oral health-related quality of life (OHRQoL) in patients with periodontitis stages (S)2 and S3, and the factors associated with the prediction of patient-reported outcomes. Periodontitis patients (n = 68) with moderately deep periodontal pockets were recruited. Responses to the Oral Health Impact Profile (OHIP)-14 questionnaire and clinical parameters including plaque index, bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment loss (CAL) were recorded. All patients received supra- and subgingival professional mechanical plaque removal. All clinical parameters and questionnaire responses were recorded again 3 months after NSPT. Clinical parameters and OHIP-14 scores for both stages of periodontitis were significantly improved 3 months after treatment. However, participants with periodontitis S3 had significantly higher total OHIP-14, physical pain, and functional limitation domains scores than periodontitis S2 cases. Baseline CAL, BOP, and the presence of PPD in anterior teeth were positively associated with increased OHIP-14 scores after NSPT. NSPT improved OHRQoL in participants with periodontitis S2 and S3. This was more pronounced in participants having periodontitis S3 than S2. Poorer OHRQoL could be anticipated in people having severe CAL, high BOP, and presence of pockets in the anterior teeth.

Six-Month Follow-Up of Periodontal Condition in Rheumatoid Arthritis and Ankylosing Spondylitis Arthritis Patients Undergoing Anti-Tumour Necrosis Factor-α Therapy

In our present study, we aimed to assess the effects of anti-TNF therapy on periodontal condition in a mixed cohort of patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Moreover, we wished to determine whether the baseline dental condition of these patients would affect response to biological therapy. A cohort of 24 arthritis patients was consecutively recruited before starting anti-TNFα therapy. After the dropout of six patients, we evaluated the dental status of 18 subjects at baseline and after 6 months of biological therapy. Clinical responder (R) and non-responder (NR) status was determined after 6 months of anti-TNF treatment. Plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), PPDmax, clinical attachment loss (CAL), and CALmax were determined. During the 6-month treatment period, six patients (3 RA and 3 AS) terminated the study prematurely as they did not respond to treatment (NR). Therefore, 18 patients were included in the full analysis. There were no major differences in PI, BOP, PPD, PPD max, CAL, and CALmax, among R and NR patients. TNF inhibition resulted in increased GI (0.65 ± 0.34 vs. 0.88 ± 0.30; p < 0.05), as well as decreased PPDmax (4 ± 1.94 vs. 2.72 ± 1.36; p < 0.05) and CALmax (5.22 ± 2.56 vs. 2.72 ± 1.36; p < 0.05) after 6 months. Eight patients had incomplete canal fillings or dead pulps and/or apical periodontitis; six in the R and two in the NR group. In our present study, anti-TNF therapy seemed to worsen the extent of gingival inflammation (GI); however our results also do not support the reduction of mean CPD and CAL as reported by others.