Complications and treatment errors in nonsurgical periodontal therapy.

Nonsurgical periodontal therapy can be subject to iatrogenesis, which includes all the complications directly or indirectly related to a treatment. These complications include both operator-dependent harms and errors and the consequences and adverse effects of the therapeutic procedures. The complications arising following nonsurgical periodontal treatment can be categorized as intraoperative and postoperative and can affect both soft and hard tissues at an intra-oral and extraoral level. Soft-tissues damage or damage to teeth and restorations can occur while performing the procedure. In the majority of cases, the risk of bleeding associated with nonsurgical therapy is reported to be low and easily controlled by means of local hemostatic measures, even in medicated subjects. Cervicofacial subcutaneous emphysema is not a frequent extraoral intraoperative complication, occurring during the use of air polishing. Moreover, side effects such as pain, fever, and dentine hypersensitivity are frequently reported as a consequence of nonsurgical periodontal therapy and can have a major impact on a patient's perception of the treatment provided. The level of intraoperative pain could be influenced by the types of instruments employed, the characteristics of tips, and the individual level of tolerance of the patient. Unexpected damage to teeth or restorations can also occur as a consequence of procedural errors.

Melatonin as host modulating agent supporting nonsurgical periodontal therapy in patients affected by untreated severe periodontitis: A preliminary randomized, triple-blind, placebo-controlled study.

OBJECTIVES: The aim of the current clinical trial was to evaluate if the oral supplementation of melatonin after nonsurgical periodontal therapy (NSPT) determined a better periodontal healing than NSPT alone, in patients affected by untreated severe periodontitis. BACKGROUND: Melatonin's anti-inflammatory, antioxidant and immunomodulatory capacities, together with its pharmacokinetic and pharmacodynamic profiles are key characteristics that justify the therapeutic use for the treatment of periodontitis. METHODS: This is a randomized, triple-blind, placebo-controlled study. Twenty patients were blindly randomized either to melatonin or placebo group. The melatonin group received NSPT and melatonin capsules 1 mg per day for 1 month, while the placebo, NSPT, and placebo capsules for 1 month. The patients were evaluated at baseline and 6 months after. Mean change from baseline probing depth (PD) was the primary outcome; site of probing was used as unit of analysis; FMBS (%) and FMPS (%) were also calculated. Mann-Whitney test was used to evaluate statistical significance (α = 0.05). RESULTS: Melatonin was well tolerated by all patients. Both treatments were effective in reducing PD, but no statistical difference was found when comparing posttreatment PD (probing all sites), P = .62. When considering the primary outcome, melatonin administration resulted in greater mean PD change at 6 months if compared to control group: for 4-5 mm sites 1.86 (0.81) vs 1.04 (0.69), P = .00001 and for sites >5 mm 3.33 (1.43) vs 2.11 (0.96), P = .00012. No difference was found for FMBS and FMPS. CONCLUSION: Current study, within its limitations, concluded that oral administration of melatonin (1 mg per day for 30 days) after one-stage full mouth NSPT determined a greater change from baseline PD if compared to NSPT alone, in untreated stage III periodontitis. This could provide a non-pharmacological support to improve periodontal healing of periodontal sites after NSPT.

Effect of Peri-implant Keratinized Tissue Width on Tissue Health and Stability: Systematic Review and Meta-analysis.

PURPOSE: There is uncertainty in the literature on whether the presence of keratinized tissue (KT) ameliorates the state of peri-implant tissue health. A systematic review and meta-analysis was performed to synthesize evidence on the association between peri-implant keratinization, defined as adequate (≥ 2 mm) or inadequate (0 to 2 mm), and peri-implant health and stability, measured as tissue inflammation, plaque accumulation, tendency to bleeding, and probing depth (PD). MATERIALS AND METHODS: This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and was registered on PROSPERO. According to predefined inclusion criteria, full papers for potentially eligible studies resulted from electronic databases (PubMed, Cochrane, and OpenGrey) and screening of titles/abstracts. Publication bias and risk of bias in primary studies were assessed. The primary outcome was gingival inflammation, measured with Gingival Index (GI) and modified Gingival Index (mGI). Additional outcomes were plaque accumulation (mPI/PI), bleeding (bleeding on probing/modified Bleeding Index), and PD. For each outcome, a random-effects meta-analysis was performed comparing the adequate group (≥ 2 mm, KT1) and the inadequate group (< 2 mm, KT0) KT width. The mean number of implants and proportion of mandibular implants were investigated as potential causes of heterogeneity using meta-regression. Sensitivity analysis was performed excluding low-quality studies. RESULTS: From 362 screened studies, a total of 15 papers were included in the systematic review, and 8 articles were finally included in the meta-analysis. Heterogeneity was found for all outcomes. The main analysis showed a statistically significant association between adequate KT level and a lower mGI-GI (standard mean difference [SMD] KT1 vs KT0 = -1.25, 95% CI = -2.12 to 0.37, P = .01). For plaque accumulation (SMD = -1.18, 95% CI = -2.36 to 0.00, P = .05), bleeding (SD = -1.99, 95% CI = -4.60 to 0.61, P = .13), and PD (MD = -0.06, 95% CI = -0.13 to 0.01, P = .10), no statistically significant difference was detected; however, the trend of results was in favor of the KT1 group. The sensitivity analysis supported the main analysis conclusions. CONCLUSION: The importance of having an adequate KT width around implants was confirmed by this review; adequate KT was significantly associated with less peri-implant inflammation evaluated qualitatively with mGI/GI. No difference was found for plaque accumulation and bleeding, but a positive trend was found favoring implants with adequate KT.