One-Year Outcomes of Subcrestal Platform-Switched Implants With and Without Sterile Prosthetic Abutments: A Randomized Controlled Trial.

Surface contaminants on customized implant abutments could trigger inflammatory response in the peri-implant tissues. The aim of this randomized controlled study was to assess the radiographic bone changes around implants restored with customized, platform-switched abutments, with and without autoclave treatment, 12 months after definitive restoration. Dental implants were placed 1 mm subcrestally in 64 systemically healthy patients (mean age 63.3 ± 10.0 years, 31 with history of periodontitis) to replace single or multiple missing teeth. According to a randomization list, abutments were subjected to steam and autoclave sterilization (43 implants, test group) or steam cleaning alone (44 implants, control group). Periapical standardized radiographs were taken at the time of implant insertion, prosthetic abutment connection and 12 months after definitive cement-retained restoration. All implants were clinically stable without any sign of infection at the 12-month follow-up. An average marginal bone loss of 0.25 ± 0.19 mm was found in the test group compared to 0.35 ± 0.23 mm in the control group without statistically significant difference, while the percentage of bleeding sites was significantly higher in the control group (8.7 ± 13.1% versus 19.1 ± 19.8%, P = .035). Autoclave treatment of customized abutments would seem to reduce the inflammatory response around subcrestally placed implants.

Pocket closure after repeated subgingival instrumentation: a stress test to the EFP guideline for stage III-IV periodontitis.

OBJECTIVES: To study the effects of one or two repeated subgingival instrumentations (RSI) in achieving the endpoints of therapy (EoT) in open pockets [residual probing pocket depth (PPD) ≥ 6 mm and PPD 4-5 mm with bleeding on probing (BoP)] after steps I-II of therapy. MATERIALS AND METHODS: Twenty-five patients (3,552 total sites; 1,450 open pockets) with stage III-IV periodontitis received steps I-II of periodontal therapy and were re-evaluated after 4-6 weeks (T1). Residual pockets received RSI at T1 and at 3 months (T2). EoT (PPD < 4 or PPD < 6 BoP-) rate at T1, T2 and 6 months (T3) was computed. The number of needed surgeries and treatment costs were calculated. RESULTS: At T1, 67.6% of open pockets achieved EoT. At residual PPD ≥ 6 mm at T1 (n = 172), one and two RSI resulted in 33.1% and 45.9% of EoT at T2 and T3, respectively. At residual PPD 4-5 mm with BoP at T1 (n = 298), one and two RSI resulted in 66.8% and 72.1% of EoT at T2 and T3, respectively. PPD at T1 predicted EoT after RSI in both cases, while tooth type only in residual PPD 4-5 mm BoP + . At T1, mean number of surgeries per patient and associated costs were significantly higher than after one/two RSI. CONCLUSIONS: RSI may achieve EoT in residual PPD 4-5 mm BoP + and PPD ≥ 6 mm in a considerable number of cases. CLINICAL RELEVANCE: These findings may support the administration of one/two cycles of RSI prior to surgical approach. PROTOCOL REGISTRATION: ClinicalTrials.gov identification number: NCT04826926.

Effect of sub-marginal instrumentation before surgical treatment of peri-implantitis: A multi-centre randomized clinical trial.

AIM: The present multi-centre randomized clinical trial with 12 months of follow-up aimed at studying the added effect of sub-marginal instrumentation before surgical treatment of peri-implantitis. MATERIALS AND METHODS: Forty-two patients diagnosed with peri-implantitis were recruited. After a behavioural intervention phase including oral hygiene instructions, patients were randomized to either receiving supra- and sub-marginal instrumentation on their affected implants (control group: 21 patients and 29 implants) or only supra-marginal instrumentation (test group: 21 patients and 24 implants), before undergoing surgery. Changes in the deepest probing pocket depth (PPD) with respect to baseline and a composite outcome of treatment success (no implant loss, no bone loss > 0.5 mm, no bleeding or suppuration on probing [BoP/SoP], and PPD ≤ 5 mm) at the 12-month examination were regarded as the primary outcomes of the trial. RESULTS: At the 12-month examination, changes in the deepest PPD with respect to baseline amounted to -2.96 mm in the control group and to -3.11 mm in the test one (MD = -0.16; SE = 0.56; p = .769), while 21.4% of the implants in the control group and 33.3% in the test group presented treatment success (OR = 1.83; SE = 1.15; p = .338). With the exception of a longer non-surgical treatment duration in the control group (differences in  = -14.29 min; SE = 2.91; p < .001), no other secondary (e.g., soft-tissue recession, keratinized mucosa height, and bone level changes, as well as BoP, SoP, profuse bleeding and implant loss rates) or exploratory (i.e., early wound healing, aesthetics, surgical and total treatment duration, surgery difficulty, intra-operative bleeding, and adverse events) outcome demonstrated statistically significant differences between groups. CONCLUSIONS: The present multi-centre randomized clinical trial did not demonstrate an added effect of performing sub-marginal instrumentation 6 weeks before the surgical treatment of peri-implantitis. Larger clinical trials are however needed to confirm the present findings (Clinicaltrials.gov: NCT03620331).

Chemical cleansing as an adjunct to subgingival instrumentation with ultrasonic and hand devices in deep periodontal pockets: a randomized controlled study.

PURPOSE: The aim of this randomized clinical trial was to assess whether chemical cleansing using a sulfonic/sulfuric acid gel solution (HBX) as an adjunct to scaling and root planing (SRP) resulted in a decrease in residual plaque and calculus in deep periodontal pockets compared to SRP alone. METHODS: Fifty-six patients with 56 hopeless posterior teeth, scheduled for extraction due to severe periodontitis, were enrolled in this study. Each tooth was randomly assigned to 1 of the 2 experimental procedures. The test teeth were subjected to the irrigation of the subgingival area with HBX for 2 minutes, followed by SRP with hand and ultrasonic instruments for 14 minutes, and then extracted. The control teeth received only mechanical instrumentation before extraction. Residual biofilm was evaluated on photographs and measured as total area and percentage of root surface covered by remaining plaque (RP) or calculus (RC) after treatment. RESULTS: The initial pocket depth (PD) and total subgingival root surface area were similar between the 2 treatment groups. After treatment, the total subgingival root area covered by RP and RC was statistically significantly larger (P<0.001) in the control group than in the test group. The test teeth showed a lower percentage of RP, but a higher percentage of RC than the control teeth (both P<0.001). Complete calculus removal was achieved in 42% of the control teeth surfaces and in 25% of the test teeth surfaces for a PD of 4 mm. CONCLUSIONS: The additional chemical cleansing with HBX resulted in a statistically significant improvement in bacterial plaque removal during SRP of deep pockets, but it was not effective in reducing calculus deposits.

Pocket resolution in regenerative treatment of intrabony defects with papilla preservation techniques: A systematic review and meta-analysis of randomized clinical trials.

AIM: To systematically assess the clinical performance of different approaches for periodontal regeneration of intrabony defects in terms of pocket resolution compared to access surgery with papilla preservation techniques (PPTs). MATERIAL AND METHODS: Systematic literature searches were conducted on PubMed, EMBASE, and CENTRAL up to April 2020 to identify RCTs on regenerative treatment [guided tissue regeneration (GTR) or enamel matrix derivative (EMD) with or without biomaterials] of intrabony defects using PPTs. Results were expressed as weighted mean percentages (WMP) or risk ratios of pocket resolution at 12 months (considering both final PD ≤ 3 mm and ≤4 mm). RESULTS: A total of 12 RCTs were included. Based on a final PD ≤ 3 mm or PD ≤ 4 mm, the WMP of pocket resolution was 61.4% and 92.1%, respectively. EMD and GTR obtained comparable results. Pairwise meta-analysis identified a greater probability of achieving pocket resolution for GTR compared to PPTs. The number needed to treat for GTR to obtain one extra intrabony defect achieving PD ≤ 3 mm or PD ≤ 4 mm over PPTs was 2 and 4, respectively. CONCLUSION: Regenerative surgery represents a viable approach to obtain final PD ≤ 4 mm in the short-term.

The staging and grading system in defining periodontitis cases: consistency and accuracy amongst periodontal experts, general dentists and undergraduate students.

AIM: The objective of this study was to evaluate consistency and accuracy of the periodontitis staging and grading classification system. METHODS: Thirty participants (10 periodontal experts, 10 general dentists and 10 undergraduate students) and a gold-standard examiner were asked to classify 25 fully documented periodontitis cases twice. Fleiss kappa was used to estimate consistency across examiners. Intraclass correlation coefficient (ICC) was used to calculate consistency across time. Quadratic weighted kappa and percentage of complete agreement versus gold standard were computed to assess accuracy. RESULTS: Fleiss kappa for stage, extent and grade were 0.48, 0.37 and 0.45 respectively. The highest ICC was provided by students for stage (0.91), whereas the lowest ICC by general dentists for extent (0.79). Pairwise comparisons against gold standard showed mean value of kappa >0.81 for stage and >0.41 for grade and extent. Agreement with the gold standard for all three components of the case definition was achieved in 47.2% of cases. The study identified specific factors associated with lower consistency and accuracy. CONCLUSIONS: Diagnosis was highly consistent across time and moderately between examiners. Accuracy was almost perfect for stage and moderate for grade and extent. Additional efforts are required to improve training of general dentists.

Pocket elimination after osseous resective surgery: A systematic review and meta-analysis.

AIM: To systemically review the available evidence on the clinical performance of osseous resective surgery (ORS) in the treatment of residual periodontal defects in terms of pocket elimination and biological costs in patients with chronic periodontitis. MATERIALS AND METHODS: Three databases (PubMed, EMBASE and Cochrane) were searched up to January 2019. Clinical trials with a follow-up duration of at least 12 months after ORS with or without fibre retention technique were included. Quantitative synthesis was conducted with random-effect meta-analysis. RESULTS: Overall, 1,765 studies were retrieved, of which 53 full-text articles were screened by two reviewers. Finally, a total of three RCTs were included in the meta-analysis. Random-effect meta-analysis showed a weighted mean percentage of pocket elimination (final PD ≤ 4 mm) at 12 months of 98.3% (95% CI: 96.8; 99.7) with I2 of 26%. The weighted mean amount of resected bone was 0.87 mm (95% CI: 0.49; 1.25), and the weighted mean increase in gingival recession was 2.13 mm (95% CI: 1.49; 2.78) at 12 months. CONCLUSIONS: ORS represents an effective surgical approach for the elimination of residual periodontal pockets in the short to medium term. Additional randomized controlled clinical trials with data on pocket elimination are warranted.

Quality of methods and reporting in association studies of chronic periodontitis and IL1A -889 and IL1B +3953/4 SNPs: A systematic review.

OBJECTIVE: The aim of this systematic review was to evaluate the quality of reporting and methodology in genetic association studies between IL1A -889 and IL1B +3954 polymorphisms and chronic periodontitis. BACKGROUND: Evidence provided by periodontal research on genetic risk factors is of uttermost importance in clinical practice as a possible diagnostic and prognostic tool for periodontitis. Inadequate reporting of results as well as high risk of bias due to methodological inconsistency hampers the integration of evidence in terms of clinical applicability. METHODS: This review includes case-control studies in humans published between 1997 and July 2017. Searching was conducted through MEDLINE, EMBASE, and search handing. Specific scoring systems have been developed to evaluate the quality of methods and reporting. Each article was scored according to its adequacy, and then, the total number and the percentage of items positively qualified for both methods and reporting were calculated. The quality of methods in studies scoring 0-6, 7-12, and 13-16 was, respectively, considered poor, moderate, and good. For reporting, scores of 0-9, 10-18, and 19-26 were deemed of poor, moderate, and good quality, respectively. Pearson's correlation coefficient was calculated to explore the correlation between the year of publication and the quality in terms of methods and reporting. RESULTS: From the 531 screened studies, 52 met the inclusion criteria and were thus included in the study. The quality of methods and reporting of published genetic association papers on IL1 and chronic periodontitis is moderate. On a scale from 0 to 16, the mean score for methods of the reviewed studies was 8.19 ± 1.93. The items more frequently considered inadequate concerned the handling of confounders in statistical analysis, especially oral hygiene habits, socioeconomic status, subgingival colonization of specific periodontal pathogens, and stress. A significant positive correlation was found between the year of publication and the quality scores in terms of method (r = 0.401, P = 0.003). In terms of reporting, the mean score was 14.83 ± 3.04 on a scale from 0 to 26 and it was considered overall moderate. No statistically significant correlation was found between the year of publication and the quality of reporting (P = 0.266). CONCLUSIONS: The association between IL1A -889 and IL1B +3954 polymorphisms and chronic periodontitis is questionable due to methodological inconsistency. Evidence arising from meta-analysis is unreliable due to high risk of bias and moderate quality in terms of reporting.

Adjunctive efficacy of diode laser in the treatment of peri-implant mucositis with mechanical therapy: A randomized clinical trial.

OBJECTIVES: Due to the inconclusive findings on the effect of laser therapy in the management of peri-implant diseases, the aim of this study was to analyze the adjunctive clinical efficacy of 980-nm diode laser (DL) irradiation in the treatment of peri-implant mucositis with mechanical debridement. MATERIAL AND METHODS: Two hundred and twenty patients with one implant diagnosed with peri-implant mucositis (probing depth [PD] ≥ 4 mm and bleeding on probing [BoP] [primary outcome]) were randomly allocated to test and control treatments. Patients in the control group (n = 110) received debridement using curettes and ultrasonic devices, while patients allocated in the test group (n = 110) received mechanical therapy in combination with DL irradiation (setting 980 nm, 2.5 W, 10 kHz, pw, 30 s). BoP, presence of plaque, and PD were recorded at baseline, 1 month, and 3 months after treatment. RESULTS: Both therapeutic modalities yielded similar clinical improvements with comparable reductions in the number of BoP-positive sites, plaque scores, and PD values at 3 months (all p-values > 0.05). Complete disease resolution was obtained in 38/110 (34.5%) implants in the test group compared with 34/110 (30.9%) implants in the control group at the end of the observation period. CONCLUSION: Based on these results, the adjunct use of DL did not yield any statistically significant clinical benefit as compared to nonsurgical mechanical treatment alone in controlling peri-implant inflammation at 3 months.

Occlusive Titanium Barrier for Immediate Bone Augmentation of Severely Resorbed Alveolar Sockets with Secondary Soft Tissue Healing: A 2-Year Case Series.

This case series evaluated bone dimensional changes following the application of an occlusive titanium barrier on severely resorbed fresh extraction sockets to achieve bone regeneration. Six extraction sites with buccal bone loss were filled with a xenograft and covered with a titanium plate fixed by two miniscrews and left intentionally exposed. No infection occurred. After 4 months of healing, sufficient hard tissue had formed to allow implant insertion. Mean vertical bone gain was 7.3 ± 2.2 mm at the buccal side and 4.2 ± 1.2 mm at the lingual side. The average bone width augmentation was 23 ± 1.0 mm. At 24 months, all implants were clinically successful. Based on these preliminary findings, occlusive titanium barriers without primary closure may be successfully used in immediate alveolar reconstruction procedures.

Human intrabony defect regeneration with micrografts containing dental pulp stem cells: A randomized controlled clinical trial.

AIM: The goal of this study was to evaluate if dental pulp stem cells (DPSCs) delivered into intrabony defects in a collagen scaffold would enhance the clinical and radiographic parameters of periodontal regeneration. MATERIALS AND METHODS: In this randomized controlled trial, 29 chronic periodontitis patients presenting one deep intrabony defect and requiring extraction of one vital tooth were consecutively enrolled. Defects were randomly assigned to test or control treatments which both consisted of the use of minimally invasive surgical technique. The dental pulp of the extracted tooth was mechanically dissociated to obtain micrografts rich in autologous DPSCs. Test sites (n = 15) were filled with micrografts seeded onto collagen sponge, whereas control sites (n = 14) with collagen sponge alone. Clinical and radiographic parameters were recorded at baseline, 6 and 12 months postoperatively. RESULTS: Test sites exhibited significantly more probing depth (PD) reduction (4.9 mm versus 3.4 mm), clinical attachment level (CAL) gain (4.5 versus 2.9 mm) and bone defect fill (3.9 versus 1.6 mm) than controls. Moreover, residual PD < 5 mm (93% versus 50%) and CAL gain ≥4 mm (73% versus 29%) were significantly more frequent in the test group. CONCLUSIONS: Application of DPSCs significantly improved clinical parameters of periodontal regeneration 1 year after treatment.

Effectiveness of Enamel Matrix Derivative in Conjunction with Particulate Autologous Bone in the Treatment of Noncontained Intrabony Defects: A 2-Year Prospective Case Series.

This case series evaluated the healing of deep intrabony defects treated with a combination of enamel matrix derivative and autologous particulate bone harvested from the buccal and lingual/palatal cortical plate with a Piezosurgery device. A total of 15 defects with a predominantly one- or two-wall component were consecutively treated in 15 patients with advanced chronic periodontitis. In all selected sites, the three-wall component was ≤ 25% of the total defect depth. Clinical and radiographic parameters were recorded at baseline and 12 and 24 months postoperatively. All defects showed favorable clinical and radiographic outcomes at the 24-month follow-up. The probing depth reduction was 4.4 ± 1.6 mm, and more than 50% of the defects presented clinical attachment level gain of at least 5 mm. The bone fill was 3.1 ± 1.6 mm.

Regenerative Treatment of Periodontal Intrabony Defects Using Autologous Dental Pulp Stem Cells: A 1-Year Follow-Up Case Series.

The present case series aimed to explore the potential clinical benefits of the application of dental pulp stem cells (DPSCs) in the regenerative treatment of deep intrabony defects. A total of 11 isolated intrabony defects in 11 chronic periodontitis patients were accessed with a minimally invasive flap and filled with DPSCs loaded on a collagen sponge. A tooth requiring extraction for impaction or malpositioning was used as an autologous source for DPSCs. An average clinical attachment level gain of 4.7 ± 1.5 mm associated with a residual mean probing depth (PD) of 3.2 ± 0.9 mm and remarkable stability of the gingival margin was observed at 1 year. Complete pocket closure (PD < 3 mm) was achieved in 63.6% of the experimental sites. Clinical outcomes were supported by the radiographic analysis showing a bone fill of 3.6 ± 1.9 mm.

A novel flapless approach versus minimally invasive surgery in periodontal regeneration with enamel matrix derivative proteins: a 24-month randomized controlled clinical trial.

OBJECTIVES: This investigation was designed to compare the effectiveness of enamel matrix derivative (EMD) proteins in combination with flapless or flap procedure in periodontal regeneration of deep intrabony defects. MATERIALS AND METHODS: Thirty chronic periodontitis patients who had at least one residual periodontal defect with an intrabony component of ≥3 mm were consecutively enrolled. Defects were randomly assigned to test or control treatments which both consisted of the use of EMD to reach periodontal regeneration. Test sites (n = 15) were treated according to a novel flapless approach, whereas control sites (n = 15) by means of minimally invasive surgery (MIST). Clinical and radiographic parameters were recorded at baseline, 12 and 24 months post-operatively. RESULTS: Both therapeutic modalities yielded similar probing depth (PD) reduction and clinical attachment level (CAL) gain at 24 months. In flapless-treated sites, a mean PD reduction of 3.6 ± 1.0 mm and a CAL gain of 3.2 ± 1.1 mm were observed. In the MIST group, they were 3.7 ± 0.6 and 3.6 ± 0.9 mm. The operative chair time was twice as long in the MIST compared to the flapless group, whereas comparable patient-oriented outcomes were observed. CONCLUSION: The flapless procedure may be successfully applied in the regenerative treatment of deep intrabony defects reaching clinical outcomes comparable with those of minimally invasive surgical approaches and may present important advantages in terms of reduction of operative chair time. CLINICAL RELEVANCE: The use of EMD as an adjunct to non-surgical periodontal treatment may be considered a suitable option to treat defects mainly in the anterior sextants.

Enamel Matrix Derivative Proteins in Combination with a Flapless Approach for Periodontal Regeneration of Intrabony Defects: A 2-Year Prospective Case Series.

The present case series evaluated the potential benefits of a flapless approach in the regenerative treatment of residual deep intrabony defects. In each of 11 patients, one periodontal defect with an intrabony component of ≥ 3 mm was treated regeneratively using enamel matrix derivative combined with a closed surgical technique. Clinical and radiographic parameters were recorded at baseline and at 12 and 24 months postoperatively. All defects experienced favorable clinical and radiographic outcomes at the 24-month follow-up. When considering only sites located in the anterior region, all experienced complete pocket closure.

Increase in Periodontal Interleukin-1ß Gene Expression Following Osseous Resective Surgery Using Conventional Rotary Instruments Compared with Piezosurgery: A Split-Mouth Randomized Clinical Trial.

The purpose of this study was to evaluate the early inflammatory response following osseous resective surgery (ORS) with Piezosurgery compared to commonly used diamond burs. A sample was selected of 24 bilateral posterior sextants requiring ORS in 12 chronic periodontitis patients in a split-mouth design. In 12 sextants, bone recontouring was performed using a piezoelectric device. In the contralateral sextants, rotary instruments were used. Sextants treated with Piezosurgery obtained similar 12-month clinical results but lower postsurgical gene expression of interleukin-1ß (IL-1ß), a well-known proinflammatory cytokine, and lower patient morbidity compared with sextants treated with rotary instruments. In spite of the longer surgical time, the use of Piezosurgery for ORS seems to promote more favorable wound healing compared with rotary instruments, as the lower pain and the low levels of IL-1ß mRNA at the surgical sites suggest a milder underlying inflammatory response.

Osteogenic Potential of Human Oral-Periosteal Cells (PCs) Isolated From Different Oral Origin: An In Vitro Study.

The periosteum is a specialized connective tissue containing multipotent stem cells capable of bone formation. In this study, we aimed at demonstrating that human oral periosteal cells derived from three different oral sites (upper vestibule, lower vestibule, and hard palate) represent an innovative cell source for maxillo-facial tissue engineering applications in terms of accessibility and self-commitment towards osteogenic lineage. Periosteal cells (PCs) were isolated from patients with different ages (20-30 yy, 40-50 yy, 50-60 yy); we then analyzed the in vitro proliferation capacity and the bone self-commitment of cell clones culturing them without any osteogenic supplement to support their differentiation. We found that oral PCs, independently of their origin and age of patients, are mesenchymal stem cells with stem cell characteristics (clonogenical and proliferative activity) and that, even in absence of any osteogenic induction, they undertake the osteoblast lineage after 45 days of culture. These results suggest that oral periosteal cells could replace mesenchymal cells from bone marrow in oral tissue-engineering applications.

Soft tissue and crestal bone changes around implants with platform-switched abutments placed nonsubmerged at subcrestal position: a 2-year clinical and radiographic evaluation.

PURPOSE: To evaluate crestal bone changes around implants with platform-switched abutments placed 1 mm subcrestally in a prospective clinical investigation. MATERIALS AND METHODS: Forty consecutive systemically healthy patients (mean age ± standard deviation [SD], 55.2 ± 8.7 years) with one or more missing teeth were consecutively treated with 1-mm subcrestally positioned, platform-switched, tapered, full treated implants restored with coded abutments. A total of 58 implants were placed. Final restorations were delivered 4 to 8 months after implant insertion. Digital standardized periapical radiographs using customized film holders were obtained at the time of implant insertion, and at 12 and 24 months after final prosthesis placement. Marginal peri-implant bone levels were measured at the mesial and distal surfaces of each implant using digital image software. RESULTS: All implants osseointegrated and were clinically stable at the 2-year follow-up. The cumulative survival rate was 100%. From implant insertion to the 2-year follow-up, the mean bone loss was 0.32 ± 0.37 mm. No significant differences related to sex, implant site, and bone density were observed. The mean midbuccal and interproximal soft tissue margin positions were 1.13 ± 0.5 mm and 1.15 ± 0.6 mm coronal to the prosthetic finish line, respectively. CONCLUSION: There is limited clinical information regarding the amount of marginal bone loss around two-piece platform-switched implants placed at subcrestal positions. Results of this study suggest that platform switching and subcrestal location of the implant-abutment interface may be effective in reducing bone loss and in preserving esthetics around dental implants.

Prevalence of periodontitis in an adult population from an urban area in North Italy: findings from a cross-sectional population-based epidemiological survey.

AIM: There is a paucity of up-to-date data regarding prevalence and risk indicators of periodontitis in Italy. Therefore, the aim of this study was to evaluate the prevalence of periodontitis and its risk indicators among adults from an urban area in North Italy. MATERIAL AND METHODS: This cross-sectional survey used a stratified two-stage probability sampling method to draw a representative sample of the adult population of the city of Turin. About 1600 individuals, 20-75 years old, were randomly selected and 736 subjects agreed to participate (47% of the sampled subjects). Clinical parameters were assessed using a full-mouth protocol. Logistic models were applied to assess associations between periodontitis and its putative risk indicators. Age was included as restricted cubic spline. RESULTS: Based on CDC/AAP case definition, the prevalence estimates of severe and moderate periodontitis were 34.94% (95% CI: 31.23-38.74) and 40.78% (95% CI: 36.89-44.79). The probability of periodontitis increased in smokers (adjusted OR 2.06, 95% IC: 1.26-3.37, p = 0.004) and with age but leveled off in the 50+ year-old group (p < 0.001). CONCLUSION: Periodontitis was highly prevalent in the Turin population. The present data will enable development of appropriate public health programs and allocation of resources.

Use of Dental Pulp Stem Cells/Collagen Sponge Biocomplex in the Treatment of Non-Contained Intrabony Defects: A Case Series.

INTRODUCTION: Because of their accessibility and biologic features, dental pulp stem cells (DPSCs) hold great promise for regeneration in clinical applications. To the best of the authors' knowledge, no data are available concerning their regenerative potential in human periodontal intrabony defects. The present case series explores the clinical and radiographic effectiveness of autologous DPSCs/collagen sponge biocomplex in the treatment of non-contained intrabony defects in patients with chronic periodontitis. CASE SERIES: Four healthy patients displaying at least one prevalently 1- or 2-wall intrabony defect and one vital third molar requiring extraction were consecutively included in the study. Before surgery, patients were enrolled in a strict periodontal program including oral hygiene instructions and scaling and root planing. The third molar was extracted and used as the autologous DPSC source. The dental pulp was mechanically dissociated and filtered through 50-µm pores to obtain a cellular suspension enriched in stem cells. The selected intrabony defects, one per patient, were filled with the cellular suspension endorsed onto a collagen sponge. The mean probing depth decreased from 8.0 ± 0.8 mm at baseline to 3.3 ± 1.0 mm at the 12-month evaluation. The mean clinical attachment level amounted to 11.0 ± 0.8 mm before the surgery and to 6.0 ± 1.4 mm at 12 months. At the end of the observational period, the mean radiographic defect fill was 4.2 ± 1.9 mm. CONCLUSION: Within the limitations of this case series, it can be concluded that autologous DPSCs may represent a very promising tool for the treatment of angular bone defects with unfavorable architecture.