Surgical periodontal therapy with and without initial scaling and root planing in the management of chronic periodontitis: a randomized clinical trial.

AIM: To compare the outcomes of surgical periodontal therapy with and without initial scaling and root planing. METHODS: Twenty-four patients with severe chronic periodontitis were enrolled in this pilot, randomized controlled clinical trial. Patients were equally allocated into two treatment groups: Control group was treated with scaling and root planing, re-evaluation, followed by Modified Widman Flap surgery and test group received similar surgery without scaling and root planing. Clinical attachment level, probing depth and bleeding on probing were recorded. Standardized radiographs were analysed for linear bone change from baseline to 6 months. Wound fluid inflammatory biomarkers were also assessed. RESULTS: Both groups exhibited statistically significant improvement in clinical attachment level and probing depth at 3 and 6 months compared to baseline. A statistically significant difference in probing depth reduction was found between the two groups at 3 and 6 months in favour of the control group. No statistically significant differences in biomarkers were detected between the groups. CONCLUSIONS: Combined scaling and root planing and surgery yielded greater probing depth reduction as compared to periodontal surgery without initial scaling and root planing.

Locally-delivered antibiotics for management of periodontitis: current understanding.

The primary etiology of periodontitis is bacterial plaque in a susceptible host. In an attempt to eradicate or reduce periopathogenic bacterial levels, locally-delivered antibiotic (LDA) agents have been suggested and have shown promising results. By applying the antibiotics locally, clinicians are able to overcome some of the disadvantages of systemic antibiotics in the management of periodontal patients. However, selecting a specific LDA to treat periodontitis out of the many available agents is not an easy task. Furthermore, timing of when to apply these agents can also be challenging. This literature review discusses the current understanding of the use of LDA in the management of periodontitis. A decision tree was developed in an attempt to guide the clinician in understanding the indications for the use of controlled delivery antimicrobial agents as an adjunct or alternative to traditional treatment modalities.

Implant microdesigns and their impact on osseointegration.

Researchers are in constant search for the ideal implant surface condition in an attempt to improve osseointegration of the implant and to increase bone-to-implant contact. Although introduction of rough surfaces was able to overcome a lot of limitations that presented with machined surfaces, they are still incapable of ensuring predictable results and guaranteed success. Various techniques in implant surface modifications have been proposed, all aimed at improving bone formation around dental implants. Understanding how surface modification of dental implants can impact osseointegration might help the clinician to maximize the success rate of implants and diminish the complications that can be encountered after their placement. In view of that, this article is aimed at assessing the different surface conditioning techniques available and will present a review of the literature that focuses on the influence of microdesign of dental implants on their osseointegration.

Managing peri-implant bone loss: current understanding.

PURPOSE: With the improved macro- and micro-designs, dental implants enjoy a high survival rate. However, peri-implant bone loss has recently emerged to be the focus of implant therapy. As such, researchers and clinicians are in need of finding predictable techniques to treat peri-implant bone loss and stop its progression. MATERIALS AND METHODS: Literature search on the currently available treatment modalities was performed and a brief description of each modality was provided. RESULTS: Numerous techniques have been proposed and none has been shown to be superior and effective in managing peri-implant bone loss. This may be because of the complex of etiological factors acting on the implant-supported prosthesis hence the treatment approach has to be individually tailored. CONCLUSION: Due to the lack of high-level clinical evidence on the management of peri-implant bone loss, the authors, through a literature review, attempt to suggest a decision tree or guideline, based on sound periodontal surgical principles, to aid clinicians in managing peri-implantitis associated bone loss.