Structure, governance and delivery of specialist training programs in periodontology and implant dentistry.

AIM: To update the competences and learning outcomes and their evaluation, educational methods and education quality assurance for the training of contemporary specialists in periodontology, including the impact of the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions (2018 Classification hereafter) and the European Federation of Periodontology (EFP) Clinical Practice Guidelines (CPGs). METHODS: Evidence was gathered through scientific databases and by searching for European policies on higher education. In addition, two surveys were designed and sent to program directors and graduates. RESULTS: Program directors reported that curricula were periodically adapted to incorporate advances in diagnosis, classification, treatment guidelines and clinical techniques, including the 2018 Classification and the EFP CPGs. Graduates evaluated their overall training positively, although satisfaction was limited for training in mucogingival and surgical procedures related to dental implants. Traditional educational methods, such as didactic lectures, are still commonly employed, but they are now often associated with more interactive methods such as case-based seminars and problem-based and simulation-based learning. The evaluation of competences/learning outcomes should employ multiple methods of assessment. CONCLUSION: An update of competences and learning outcomes of specialist training in periodontology is proposed, including knowledge and practical application of the 2018 Classification and CPGs. Harmonizing specialist training in periodontology is a critical issue at the European level.

Microstructural Changes of Human Dentin Tubules after Citric Acid Immersion of Specimens Treated with Different Desensitising Approaches: An SEM Analysis.

PURPOSE: This in-vitro study aimed to evaluate the effectiveness and acid resistance on dentin surfaces following the application of a linear-oscillating device (LOD) with a hydroxyapatite-based polishing fluid, Er:YAG laser or sodium fluoride (NaF) used alone or in combinations for desensitising purposes. MATERIALS AND METHODS: Freshly extracted impacted third molars were used to obtain 120 specimens, all completely immersed in 1% citric acid for 5 min and divided randomly into 6 groups. Group I, with no treatment, served as the control; group II: Er:YAG laser (30 Hz, 60 mJ/pulse, 10 s); group III: NaF gel; group IV: LOD; groups V and VI: the combinations of NaF+Er:YAG and LOD+Er:YAG, respectively, were applied. Following these treatments, the effectiveness of each was evaluated in half of the specimens in each group (n = 10). The other half of the specimens (n = 10) served for acid-resistance testing. All evaluations were made on SEM photomicrographs. RESULTS: The post-treatment tubule diameters and numbers were the lowest with LOD+Er:YAG, followed by NaF+Er:YAG, LOD, Er:YAG and NaF. Paired comparisons revealed LOD+Er:YAG to be the best treatment method (p < 0.05). After 3 h of acid immersion, all treatments revealed significant increases (p < 0.05) in both tubule number and diameter study between post-treatment and post-acid immersion values. The exception was LOD+Er:YAG. LOD+Er:YAG showed the highest resistance to acid challenge, presenting the lowest increase in tubular diameters and numbers followed by NaF+Er:YAG, LOD, Er:YAG and NaF. CONCLUSION: Combined LOD+Er:YAG treatment revealed the highest effectiveness and acid resistance. Further clinical studies are warranted to confirm these in-vitro results.

Treatment of residual pockets using an oscillating chitosan device versus regular curettes alone-A randomized, feasibility parallel-arm clinical trial.

BACKGROUND: A brush made of chitosan has shown to be an effective and harmless device for non-surgical treatment of mild to moderate peri-implantitis. To date, no study has evaluated the use of a chitosan brush in the non-surgical treatment of residual pockets in periodontal treatment. METHODS: Seventy-eight patients with periodontitis were included in this multicenter, randomized, examiner-blind clinical trial of 6 months duration. Patients with residual probing pocket depth (PPD) of ≥5 mm and ≤7 mm following previous active periodontal treatment were included. Patients were assigned either subgingival treatment with curettes (control) or an oscillating chitosan brush (test). Changes in bleeding on probing (BoP) and PPD between baseline and terminal evaluation at 6 months were evaluated. RESULTS: A significant reduction in both PPD and BoP was seen within both groups. There was no significant difference in BoP between test and control groups after 6 months, but the reduction in PPD was significantly improved in the test group (P ≤ 0.01). The combined outcome of no BOP and PPD ≤4 mm was significantly better in the test group (P ≤ 0.01). No adverse reactions were seen. CONCLUSION: Treatment of residual periodontal pockets (PPD = 5 to 7 mm) with a chitosan brush disclosed equal or better clinical results as compared to regular curettes. This study supports that a chitosan brush can be used for subgingival biofilm removal and soft tissue curretage in the treatment of periodontitis.

A Comparative Evaluation of Root Surface Biomodification with Erbium-Doped Yttrium Aluminum Garnet Laser, Ethylenediaminetetraacetic Acid Gel, and Titanium Nitride Curette: In Vitro Scanning Electron Microscope and Profilometry Analyses.

Objective: This study aims to evaluate the in vitro effects of different biomodification treatment methods on extracted tooth/root surfaces in terms of biologically acceptable changes favoring better periodontal healing. Background data: The use of various agents for root surface biomodification (RSB), during periodontal procedures is of critical importance to increase the success of the treatments through healing. Ethylenediaminetetraacetic acid (EDTA) is the most frequently used chemical RSB agent in periodontal clinical practice. Erbium-doped yttrium aluminum garnet (Er:YAG) lasers have well-known advantages on blood cell adhesion and fibrin network formation on root surfaces. Recently, novel titanium nitride (TIN) curettes are of great interest due to smoother surface changes obtained after their application. Materials and methods: Forty-four dentine specimens from extracted single-rooted teeth were randomly divided into four groups: Group 1: No treatment; Group 2: Er:YAG laser irradiation; Group 3: EDTA gel application; Group 4: TIN curette instrumentation. All specimen surfaces were wet polished before treatments. Before and after root surface roughness parameters of all specimens were assessed with a profilometer. Further, all scanning electron microscopy micrographs were analyzed and scored for root surface and smear layer morphology characteristics by two different blinded researchers. Results: There were no statistical differences between the initial roughness of all groups (p = 0.687). After treatments, EDTA gel group revealed an intact intertubular area, some smear debris on dentine surfaces, and partially occluded dentine tubules. Er:YAG laser created the highest roughness (p < 0.05) among all treatment groups with no smear layer and exhibited fully exposed dentine tubules and collagen fibrils. Surfaces instrumented with TIN curette were the smoothest (p < 0.05) and covered with a compact and thick smear layer. Conclusions: Within the limits of this study, Er:YAG laser-irradiated surfaces exhibited exposed collagen fibrils, and Er:YAG laser irradiation was found as the only method yielding the desired surface characteristics for better periodontal healing, where the fibrils are exposed in the absence of smear layer.

Profilometric Analysis of Periodontally Diseased Root Surfaces After Application of Different Instrumentation Tools: An In Vitro Study.

Objective: The topography of the root surface plays an important role in plaque accumulation, cell adhesion, and periodontal healing. The aim of this study is to profilometrically evaluate the root surface changes following the instrumentation using different tools. Methods: Forty dentin blocks of buccal and lingual root surfaces were obtained from 20 single-rooted periodontally diseased hopeless teeth and randomly divided into 4 groups. Each group was subjected to different root instrumentation tools such as stainless steel (SS) Gracey curette (Group 1); titanium nitride (TIN) Gracey curette (Group 2); ultrasonic piezoelectric device with a special tip designed for root surfaces (H3) (Group 3); and Er:YAG laser (Er:YAG tip) chisel (Group 4). A calibrated clinician instrumented all surfaces in each group. The root surfaces were profilometrically evaluated before and after instrumentations. Results: There were no statistical differences between the initial roughness levels of the groups. TIN curettes revealed the most prominent effect on smoothing the surface, whereas the Er:YAG tip showed the highest roughness in comparison with the other root surface instrumentation tools. Conclusions: Considering the importance of root surface roughness after treatment for the success of periodontal therapy, the TIN curette was the most periodontally appealing tool followed by H3, SS curette, and Er:YAG tip.

Efficacy of adjunctive photodynamic therapy in the treatment of generalized aggressive periodontitis: A randomized controlled clinical trial.

OBJECTIVES: Generalized aggressive periodontitis (GAgP) is a distinct type of periodontal disease characterized by rapid loss of attachment and alveolar bone occurring in young individuals. Photodynamic therapy (PDT) was introduced in periodontology as an adjunctive approach to non-surgical periodontal treatment (NPT) in periodontitis patients. In this trial, the aim was to evaluate the clinical and microbiological effects of adjunctive PDT to NPT in patients with GAgP. METHODS: In this prospective controlled clinical study, 24 systemically healthy, non-smoking subjects with GAgP were enrolled. Subjects were randomly assigned into a control group (n = 12) treated with NPT only or to a test group (n = 12) treated with NPT and PDT. Plaque index, sulcus bleeding index (SBI), probing depth (PD), relative attachment level, gingival recession, and tooth mobility were recorded at baseline and on day 63. Microbiological samples were obtained from the sites with PD ≥ 5 mm at both time periods and evaluated for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola via micro-IDent® test. RESULTS: Clinical and microbial parameters declined significantly in both groups after the treatments (P < 0.01). The comparisons between the groups showed that only the full mouth SBI score of the test group was significantly lower than the control group on day 63 (P < 0.05). Although the reduction in periodontopathogens of the test group was greater than the control group, there was no significant difference between the groups (P > 0.05). CONCLUSIONS: Within the limits of this study, it can be concluded that in the treatment of GAgP, usage of PDT as an adjunct to NPT does not lead to any beneficial effects on the investigated clinical and microbiological parameters except for SBI. Nevertheless, the statistically significant difference for the SBI score demonstrates that PDT may have additional effect on the reduction in gingival bleeding. Lasers Surg. Med. 51:167-175, 2019. © 2018 Wiley Periodicals, Inc.

The Influence of a Bifidobacterium animalis Probiotic on Gingival Health: A Randomized Controlled Clinical Trial.

BACKGROUND: There is growing interest in the use of probiotics in periodontal therapy; however, until now, most research has focused on lactobacilli probiotics. The aim of this study is to evaluate the effect of 4-week use of yogurt supplemented with Bifidobacterium animalis subsp. lactis DN-173010 versus a placebo yogurt, followed by a 5-day non-brushing period. METHODS: Individuals were included in this single-mask, randomized, controlled study if probing depth (PD) was ≤3 mm and attachment loss was ≤2 mm. After professional prophylaxis, they were randomized into two groups receiving yogurt containing either placebo or B. animalis for 28 days, followed by a 5-day non-brushing period. Outcome measures were plaque index (PI), gingival index (GI), bleeding on probing (BOP), PD, gingival crevicular fluid (GCF) volume, and total amount and concentration of interleukin (IL)-1ß in GCF. These were measured at baseline, after 28 days of study product use, and subsequently after 5 days of plaque accumulation. RESULTS: Fifty-one patients were analyzed. No intergroup differences could be detected before and after intake of study products. However, after plaque accumulation, significantly better results for all parameters were seen in the probiotic group compared with the control group (P <0.001): lower PI and GI, less BOP, less increase in GCF volume, and lower IL-1ß total amount/concentration. CONCLUSION: The use of a probiotic yogurt supplemented with B. animalis can have a positive effect on plaque accumulation and gingival inflammatory parameters after refraining from oral hygiene practices.

Periodontal treatment in a generalized severe chronic periodontitis patient: A case report with 7-year follow-up.

The aim of the periodontal treatment is to provide healthy and functional dentition all through a lifetime. In this report, periodontal treatment of a 42-year-old male patient with generalized severe chronic periodontitis is presented. He received initial periodontal treatment together with adjunctive antimicrobials. The devital teeth were endodontically treated, and free gingival grafts were placed at the inadequate keratinized tissue zones before regenerative surgery. Following the surgical treatment using enamel matrix derivatives and xenogenic bone graft combination, the patient was put on a strict recall program. After 12 months, favorable clinical and radiographical improvements were obtained. The 7-year maintenance of the present case with several initially hopeless teeth has been shown and discussed in this report. It can be concluded that optimum oral hygiene level as well as the positive cooperation of the patient enhanced the success of periodontal treatment results even in extremely severe periodontal destruction.

Evaluation of the clinical and antimicrobial effects of the Er:YAG laser or topical gaseous ozone as adjuncts to initial periodontal therapy.

OBJECTIVE: The aim of this study was to evaluate the clinical and microbiological results of treatment with the Er:YAG laser and topical gaseous ozone application as adjuncts to initial periodontal therapy in chronic periodontitis (CP) patients. BACKGROUND DATA: Although many studies have evaluated the effectiveness of the Er:YAG laser as an adjunct to initial periodontal therapy, few studies have focused on the use of gaseous ozone as an adjunct. MATERIALS AND METHODS: Thirty patients with CP were randomly divided into three parallel groups, each composed of 10 individuals with at least four teeth having at least one approximal site with a probing depth (PD) of ≥5 mm and a sulcus bleeding index (SBI) ≥2 in each quadrant. Groups of patients received: (1) Scaling and root planing (SRP)+Er:YAG laser; (2) SRP+topical gaseous ozone; or (3) SRP alone. The microbiological and clinical parameters were monitored at day 0 and day 90. RESULTS: At the end of the observation period, statistically significant improvements in clinical parameters were observed within each group. Parallel to the clinical changes, all treatments reduced the number of total bacteria and the proportion of obligately anaerobic microorganisms. Although intergroup comparisons of microbiological parameters showed no significant differences, clinical findings, including attachment gain and PD reduction, were found to be statistically significant in favor of the SRP+Er:YAG laser group. CONCLUSIONS: Although statistically nonsignificant, the fact that the obligate anaerobic change was mostly observed in the SRP+Er:YAG laser group, and a similar decrease was noted in the SRP+topical gaseous ozone group, shows that ozone has an antimicrobial effect equivalent to that of the Er:YAG laser.

Treatment of localized gingival recessions using enamel matrix derivative as an adjunct to laterally sliding flap: 2 case reports.

Predictable and optimal coverage of exposed root surfaces is an important goal in periodontal plastic surgery. In this report, recession coverage was performed as laterally sliding flap technique with the adjunctive use of enamel matrix derivative (EMD). The cases of 2 female patients with gingival recession on the maxillary canines are presented with 1-year follow-up observation. Initial vertical gingival recessions were 4.0 mm each, with a probing depth of 1.0 mm. The surgical procedure immediately produced a marked reduction in gingival recessions. In the course of healing, the soft tissue margin on the operated teeth showed some shrinkage in the first months. After 1 year, complete root coverage (100%) was observed, with a probing depth of 0.5 mm and 5.0-mm gain of clinical attachment in both cases, and there was 0.5-mm creeping tissue above the cemento-enamel junction. Within the limits of these cases, the results demonstrated the possibility of treating human buccal recessions with EMD plus laterally sliding flap, with predictable root coverage and clinical attachment gain.