A double-blind randomized clinical evaluation of enamel matrix derivative proteins for the treatment of proximal class-II furcation involvements

Objective: The aim of the present randomized, double‐blind study was to evaluate the clinical response of proximal furcations treated with enamel matrix derivative proteins (EMD). Material and Methods: Fifteen patients, each with a pair of contralateral class‐II proximal furcation involvements, presenting probing depths (PDs) 5 mm and bleeding on probing (BOP) were selected. The patients were randomly assigned to: control group (n=15) – open flap debridement (OFD)+24% ethylenediaminetetraacetic acid (EDTA) conditioning; test group (n=15) – OFD+24% EDTA conditioning+EMD application. Plaque index (PI), BOP, PD, gingival margin position (GMP), relative vertical and horizontal clinical attachment level (RVCAL and RHCAL), vertical and horizontal bone level (VBL and HBL) and furcation closure were evaluated immediately before and 2, 4 and 6 months after the surgeries. Results: At 6 months, the RVCAL gains of the control and test group were 0.39 ± 1.00 and 0.54 ± 0.95 mm, while the RHCAL gains were 1.21 ± 2.28 and 1.36 ± 1.26 mm (p>0.05). The VBL and HBL gains of the control group were 1.04 ± 1.12 and 1.00 ± 1.79 mm, and 0.82 ± 1.82 and 1.17 ± 1.38 mm for the test group (p>0.05). In addition, a statistical difference was observed in the number of the remaining class‐II furcations between the test and control groups (p<0.05) in this period. Conclusion: It may be concluded that the use of EMD in proximal furcations did not promote a superior reduction in PD or a gain in clinical and osseous attachment levels, but resulted in a higher rate of class‐II to class‐I furcation conversion.     

Anti-infective treatment of peri-implant mucositis: a randomised controlled clinical trial

Aim: To compare the effectiveness of two anti‐infective protocols for the treatment of peri‐implant mucositis. Materials and methods: Twenty‐nine patients with one implant diagnosed with peri‐implant mucositis (bleeding on probing [BOP] with no loss of supporting bone) were randomly assigned to a control or test group. Following an assessment of baseline parameters (probing depth, BOP, suppuration, presence of plaque), all patients received non‐surgical mechanical debridement at the implant sites and were instructed to brush around the implant twice daily using a gel provided for a period of 4 weeks. The test group (15 patients) received a chlorhexidine gel (0.5%), and the control group (14 patients) received a placebo gel. The study was performed double blind. After 4 weeks, patients were instructed to discontinue using the gel and to continue with routine oral hygiene at the implant sites. Baseline parameters were repeated at 1 and 3 months. Results: At 1 month, there was a statistically significant reduction in the mean number of sites with BOP and mean probing depth measurements at implants in both groups. There were also some statistically significant changes in these parameters from 1 to 3 months. However, there were no statistically significant differences between test and control groups. One month following treatment, 76% of implants had a reduction in BOP. Complete resolution of BOP at 3 months was achieved in 38% of the treated implants. The presence of a submucosal restoration margin resulted in significantly lower reductions in probing depth following treatment. Conclusions: Non‐surgical debridement and oral hygiene were effective in reducing peri‐implant mucositis, but did not always result in complete resolution of inflammation. Adjunctive chlorhexidine gel application did not enhance the results compared with mechanical cleansing alone. Implants with supramucosal restoration margins showed greater therapeutic improvement compared with those with submucosal restoration margins. To cite this article:
Heitz‐Mayfield LJA, Salvi GE, Botticelli D, Mombelli A, Faddy M, Lang NP, On Behalf of the Implant Complication Research Group (ICRG). Anti‐infective treatment of peri‐implant mucositis: a randomised controlled clinical trial.
Clin. Oral Impl. Res. 22 , 2011; 237–241.
doi: 10.1111/j.1600‐0501.2010.02078.x     

Clinical and microbiologic effects of commercially available dentifrice containing aloe vera: a randomized controlled clinical trial

Background: Certain plants used in folk medicine serve as a source of therapeutic agents that have antimicrobial and other multipotential effects. This prospective, randomized, placebo, and positively controlled clinical trial was designed to evaluate the clinical and microbiologic effects of a commercially available dentifrice containing aloe vera on the reduction of plaque and gingival inflammation in patients with gingivitis. Methods: Ninety patients diagnosed with chronic generalized gingivitis were selected and randomly divided into three groups: group 1, placebo toothpaste; group 2, toothpaste containing aloe vera; and group 3, toothpaste with polymer and fluoride containing triclosan. Clinical evaluation was undertaken using a gingival index, plaque was assessed using a modification of the Quigley‐Hein index, and microbiologic counts were assessed at baseline, 6 weeks, 12 weeks, and 24 weeks. A subjective evaluation was also undertaken by questionnaire. Results: Toothpaste containing aloe vera showed significant improvement in gingival and plaque index scores as well as microbiologic counts compared with placebo dentifrice. These improvements were comparable to those achieved with toothpaste containing triclosan. Conclusion: Toothpaste containing aloe vera may be a useful herbal formulation for chemical plaque control agents and improvement in plaque and gingival status.     

Clinical and microbiological effects of root debridement in periodontal furcation pockets

The aim of the present study was to investigate longitudinally over 52 weeks the clinical and microbiological effects of plaque control and root debridement at molar furcation sites. The results were compared with changes at non-molar sites. 24 non-molar sites and 31 grade II molar furcation sites with probing depth greater than or equal to 5.0 mm were monitored in 11 patients. Clinical measurements consisted of plaque scores, probing depths, and changes in probing attachment level. Microbiological monitoring was carried out with phase-contrast microscopy and anaerobic culturing. The debridement resulted in improvement in probing measurements and microbiological counts for both groups of sites. A slightly less favorable clinical response was noted for molar furcation sites. Higher post-operative microbiological counts were found throughout the 52-week observation period for molar furcation sites. Sites with probing attachment loss showed higher microbial counts and higher proportions of spirochetes, black pigmented colony forming units (CFU), and Bacteroides gingivalis CFU than sites with probing attachment gain. Individual site analysis, however, demonstrated marked variations of the microbiological counts at the different postoperative time points. In the few available sites undergoing probing attachment loss, no apparent association between target micro-organisms and periodontal deterioration was observed.     

Clarithromycin as an Adjunct to One‐Stage Full‐Mouth Ultrasonic Periodontal Debridement in Generalized Aggressive Periodontitis: A Randomized Controlled Clinical Trial

Background: The aim of the present study is to evaluate the periodontal clinical and microbiologic responses and possible adverse effects of clarithromycin (CLM) combined with periodontal mechanical therapy in the treatment of patients with generalized aggressive periodontitis. Methods: Forty patients were selected and randomly assigned into one of two groups: 1) CLM (n = 20): one‐stage full‐mouth ultrasonic debridement (FMUD) associated with CLM (500 mg, every 12 hours for 3 days); and 2) placebo (n = 20): FMUD associated with placebo pills. Clinical and microbiologic parameters were evaluated at baseline and 3 and 6 months postoperatively. Results: Both treatments presented statistically significant clinical and microbiologic improvements. However, the CLM group presented lower means of probing depth for pockets ≥7 mm at 6 months (4.0 ± 1.7 mm) compared with the placebo group (4.7 ± 1.3 mm) (P = 0.04). In addition, the CLM group also presented greater reduction of Porphyromonas gingivalis (Pg) DNA counts at 6 months (P = 0.0001). Conclusion: Results from this study suggest both treatments are effective; however, adjunct use of CLM to FMUD leads to better reduction of deep pockets and Pg at 6 months compared with FMUD alone.     

The combination of amoxicillin and metronidazole improves clinical and microbiologic results of one-stage, full-mouth, ultrasonic debridement in aggressive periodontitis treatment

Background: The aim of the present study is to assess clinical, microbiologic, and immunologic benefits of amoxicillin/metronidazole (AM) when performing full‐mouth ultrasonic debridement (FMUD) in generalized aggressive periodontitis (GAgP) treatment. Methods: Twenty‐four GAgP patients were divided into two groups: the FMUD group (n = 12), which received FMUD plus placebo, and the FMUD+AM group (n = 12), which received FMUD and 375 mg amoxicillin plus 250 mg metronidazole for 7 days. The following clinical outcomes were tested: plaque and bleeding on probing indices, pocket probing depth (PD), relative gingival margin position (GMP), and relative clinical attachment level (CAL). Total amount of Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans (Aa), Tannerella forsythia (Tf), and gingival crevicular fluid (GCF) concentration of interleukin (IL)‐10 and IL‐1β were also determined. All clinical, microbiologic, and immunologic parameters were assessed at baseline and at 3 and 6 months post‐therapy. The ANOVA/Tukey test was used for statistical analysis (α = 5%). Results: Amoxicillin/metronidazole used as an adjunct to the FMUD protocol added clinical and microbiologic benefits to GAgP treatment (P <0.05). FMUD+AM groups presented an additional PD reduction in initially deep PDs at the 3‐month follow‐up (3.99 ± 1.16 mm and 3.09 ± 0.78 mm for FMUD+AM and FMUD, respectively; P <0.05), a lower number of residual pockets at the 3‐ and 6‐month follow‐ups, and a statistical reduction in amounts of Aa (P <0.05). Analysis of Tf and Pg amounts, as well as IL‐10 and IL‐1β GCF concentrations failed to demonstrate a difference between the groups (P >0.05). Conclusion: It may be concluded that amoxicillin/metronidazole improves clinical and microbiologic results of FMUD in GAgP treatment.     

Non-surgical periodontal therapy affects metabolic control in diabetics: a randomized controlled clinical trial

Background: Periodontal diseases and diabetes are two common diseases with high prevalence. Many clinicians have accepted the relationship between these two diseases. Some investigators have reported that periodontal treatment may enhance the metabolic control of diabetes. The effects of non‐surgical periodontal treatment on metabolic control in people with type 2 diabetes mellitus (DM2) were examined. Methods: Forty patients with DM2 and chronic periodontitis [mean age = 50.29 years; mean glycated haemoglobin (HbA1c) = 8.72] were randomly assigned to two groups. The treatment group (n = 22) received full‐mouth scaling and root planing, whereas the control group (n = 18) received no periodontal treatment. Gingival index (GI), plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), fasting plasma glucose (FPG), HbA1c, total cholesterol (TC), triglyceride (TG) and cholesterol levels were recorded at baseline and compared to data collected three months later. Results: The groups did not differ in gender ratio, age or clinical parameters [PPD (p = 0.107), CAL (p = 0.888), PI (p = 0.180)] and biochemical markers at baseline [FPG (p = 0.429), HbA1c (p = 0.304), TG (p = 0.486), TC (p = 0.942), LDL (p = 0.856) and HDL (p = 0.881)]. FPG, HbA1c and clinical parameters differed between the treatment and control groups (p = 0.006, 0.003 and 0, respectively). From baseline to follow‐up (after three months), HbA1c levels decreased in the treated group (p = 0.003). In the same time period, FPG, GI, PPD and CAL increased in the control group (p = 0.016, 0.0, 0.0 and 0.004, respectively) but HbA1c did not change significantly. Conclusions: Non‐surgical periodontal therapy could improve metabolic control in diabetic patients.     

A randomized clinical trial of autologous platelet-rich plasma in the treatment of mandibular degree II furcation defects

Aim: A combined technique using a platelet-rich plasma (PRP)/bovine porous bone mineral/guided tissue regeneration membrane was found to be an effective modality for the treatment of mandibular grade II furcation defects. To elucidate the role played by each component, the present randomized, double-blind study is designed to evaluate the effectiveness of autologous PRP alone in the treatment of mandibular degree II furcation defects compared with open flap debridement (OFD).
Material and Methods: Using a split-mouth design, 40 mandibular degree II furcation defects were treated either with autologous PRP or OFD. Plaque index, sulcus bleeding index, vertical probing depth, relative vertical and horizontal clinical attachment level and gingival marginal level were recorded at baseline and 6 months post-operatively. Vertical and horizontal defect depths were also recorded using spiral computed tomography.
Results: A statistically significant difference was observed in all the clinical and radiographic parameters at the sites treated with PRP as compared with those with OFD. However, all the furcation defects retained their degree II status.
Conclusion: Despite a significant improvement, lack of complete closure of furcation defects implies a limited role of autologous PRP as a regenerative material in the treatment of furcation defects, necessitating further long-term studies.     

An evaluation of bioactive glass in the treatment of periodontal defects: a meta-analysis of randomized controlled clinical trials

Background: The regenerative surgical treatment of intrabony defects caused by periodontal disease has been examined in several systematic reviews and meta‐analyses. The use of bioactive glass (BG) as a graft material to treat intrabony defects has been reported, but all data have not been synthesized and compiled. Our objective was to systematically review the literature on the use of BG for the treatment of intrabony defects and to perform a meta‐analysis of its efficacy. Methods: A search of PubMed, EMBASE, and Cochrane Database of Systematic Reviews, as well as a manual search of recently published periodontology journals, were conducted to identify randomized controlled trials of the use of BG in the treatment of intrabony and furcation defects. Criteria included publication in English, follow‐up duration of ≥6 months, baseline and follow‐up measures of probing depth (PD) and clinical attachment levels (CAL) with 95% confidence intervals (CIs), and an appropriate control arm. Twenty‐five citations were identified, 15 of which were included in the final analysis. Data, including study methods and results, as well as CONSORT (Consolidated Standards of Reporting Trials) criteria, were extracted from eligible studies and cross‐checked by at least two reviewers. Results: Meta‐analyses of eligible studies were performed to ascertain summary effects for changes in PD and CAL among experimental and control groups, using the mean change plus standard deviation for each study. Pooled analyses showed that BG was superior to control for both measures: the mean (95% CIs) difference from baseline to follow‐up between BG and controls was 0.52 mm (0.27, 0.78, P <0.0001) in reduction for PD and 0.60 mm (0.18, 1.01, P = 0.005) in gain for CAL. Analyses of CAL revealed heterogeneity across studies (I² = 60.5%), although studies reporting PD measures were homogeneous (I² = 0.00%). CAL heterogeneity appeared secondary to active controls versus open flap debridement (OFD) alone and to defect‐type modifying BG treatment success. Per subgroup analyses, the benefit of BG over control treatment was highly significant only in studies comparing BG to OFD (P <0.0001), with mean difference change in CAL being 1.18 mm (95% CI = 0.74, 1.62 mm) between the BG and OFD group. Conclusion: Treatment of intrabony defects with BG imparts a significant improvement in both PD and CAL compared to both active controls and OFD.     

Impaired healing response of periodontal furcation defects following flap debridement surgery in smokers. A controlled clinical trial

OBJECTIVES: The purpose of the present parallel-design, controlled clinical trial was to evaluate the treatment outcome of periodontal furcation defects following flap debridement surgery (FDS) procedure in cigarette smokers compared to non-smokers. MATERIALS AND METHODS: After initial therapy, 31 systemically healthy subjects with moderate to advanced periodontitis, who presented at least one Class I or II molar furcation defect, were selected. Nineteen patients (mean age: 40.3 years, 15 males) were smokers (>or=10 cigarettes/day) and 12 patients (mean age: 44.8 years, 3 males) were non-smokers. Full-mouth plaque score (FMPS) and full-mouth bleeding score (FMBS), probing pocket depth (PPD), vertical clinical attachment level (v-CAL), and horizontal clinical attachment level (h-CAL) were assessed immediately before and 6 months following surgery. RESULTS: Overall, statistically significant v-CAL gain was observed in smokers (1.0 +/- 1.3 mm) and non-smokers (1.3+/-1.1 mm), the difference between groups being statistically significant (p=0.0003). In proximal furcation defects, v-CAL gain amounted to 2.3+/-0.7 mm in non-smokers as compared to 1.0+/-1.1 mm in smokers (p=0.0013). At 6 months postsurgery, non-smokers presented a greater h-CAL gain (1.3+/-1.1 mm) than smokers (0.6+/-1.0 mm), with a statistically significant difference between groups (p=0.0089). This trend was confirmed in both facial/lingual (1.4+/-1.0 versus 0.8+/-0.8 mm) and proximal furcation defects (1.2+/-1.3 versus 0.5+/-1.2 mm). The proportion of Class II furcations showing improvement to postsurgery Class I was 27.6% in smokers and 38.5% in non-smokers. After 6 months, 3.4% of presurgery Class I furcation defects in smokers showed complete closure, as compared to 27.8% in non-smokers. CONCLUSIONS: The results of the present study indicated that (1) FDS produced clinically and statistically significant PPD reduction, v-CAL gain, and h-CAL gain in Class I/II molar furcation defects, and (2) cigarette smokers exhibited a less favorable healing outcome following surgery in terms of both v-CAL and h-CAL gain.