Two-stage approach for class II mandibular furcation defect with insufficient keratinized mucosa: a case report with 3 years’ follow-up

Periodontal regenerative treatment is useful for intrabony defects and furcation involvement, but is difficult when there is insufficient keratinized mucosa to cover and maintain the regenerative material, particularly in the mandibular molar region. We report the case of a 27-year-old woman who underwent a two-stage surgical approach for a class II furcation defect with gingival recession and insufficient keratinized mucosal width (KMW) and vestibular depth at the mandibular left first molar. We first improved the KMW and keratinized mucosal thickness using an epithelial embossed connective tissue graft with enamel matrix derivative, and then focused on periodontal regeneration at the furcation defect using an enamel matrix derivative and a bovine-derived xenograft. Probing depth reduction, clinical attachment gain, horizontal probing depth reduction, KMW gain, and gingival recession reduction were observed 3 years postoperatively. This case report suggests that this novel staged approach may be effective for treating furcation defects with insufficient keratinized mucosa, thus providing useful insights into periodontal regeneration therapy.

Evaluation of Bed Depth Reduction, Media Change, and Partial Saturation as Combined Strategies to Modify in Vertical Treatment Wetlands

The aim of this work was to evaluate the performance of vertical subsurface flow treatment wetlands (VSSF TWs) for treating rural domestic wastewater when strategies such as bed depth reduction and media change are used in combination with bottom saturation. Two treatment wetland systems were implemented: normal (VF-N), with a bed depth of 1.0 m, and modified (VF-M), with a bed depth of 0.5 m and a bottom layer of natural zeolite. Schoenoplectus californicus was used as experimental plant. These two treatment systems were operated at a hydraulic loading rate of 120 mm/d in two phases. Phase I did not use bottom saturation, while Phase II involved a bottom saturation of the zeolite layer of the VF-M system. The results show that bed depth reduction did not have a significant effect (p > 0.05) in terms of organic matter, solids, and ammonium removal. Conversely, it had a significant influence (p < 0.05) on phosphate as well as a negative effect on pathogen removal. This influence could be explained by initial media capacity for phosphorus removal and filtration importance in the case of pathogens. Partial saturation only had a positive influence on total nitrogen removal. The addition of a bottom layer of natural zeolite showed no positive effect on nutrient removal. The plant showed adaptation and positive development in both VF-N and VF-M. The water balance showed that water loss was not influenced by bed depth reduction. Therefore, according to the previous results, a combination of the proposal modifications to VSSF TWs can be introduced for treating rural domestic wastewater.

Effectiveness of beta-tricalcium phosphate in comparison with other materials in treating periodontal infra-bony defects around natural teeth: a systematic review and meta-analysis

Background Beta-tricalcium phosphate in regenerative surgery has shown promising results in terms of bone gain and new vital bone formation; however, several studies have contradicted this finding. The aim of this study was to evaluate the effectiveness of beta-tricalcium phosphate compared to other grafting materials in the regeneration of periodontal infra-bony defects. Methods Electronic database (Cochrane, MEDLINE, PubMed, Embase, Science Citation Index Expanded) and manual searches for related data were performed up until March 2020. The outcomes were pocket depth reduction, clinical attachment level gain, and amount of bone fill. Results Five studies were selected based on the inclusion criteria. Bone regeneration with beta-tricalcium phosphate was observed to be superior to that with debridement alone but showed comparable results to other bone graft materials in terms of pocket depth reduction, clinical attachment level gain, and bone fill. Regenerative procedures for periodontal infra-bony defects that used beta-tricalcium phosphate in combination with other growth factors yielded superior outcomes. The meta-analysis revealed that for cases with two-wall defects, the use of beta-tricalcium phosphate yielded statistically significant differences in pocket depth reduction and clinical attachment level gain, but not in bone fill. Conclusions Beta-tricalcium phosphate appears to be a promising material for use in periodontal infra-bony defect regeneration around natural teeth. However, randomized clinical trials with larger sample sizes and more controlled study designs are needed to support these findings.

Comparative study in treatment of haemangioma with oral propranolol and combination effect of oral propranolol and topical timolol solution

Background: Haemangioma of infancy usually regresses on its own but recently there has been trend of use of beta blockers like propranolol. Here we assess the improvement in efficacy of combination of propranolol with timolol in decreasing lesion size and colour change. And assess whether the combination decreases the duration of the treatment.Methods: Total of 40 patients were included in our study with surface haemangioma under 12 years. Divided in to two groups of 20 each oral propranolol and timolol and propranolol only, treated for 6 months and were assessed by monthly measurements of lesion dimensions using measuring tape, USG and colour changes noted by clinical photographs on monthly basis. VAS scale was used to grade the improvements. Comparisons were made between the groups with statistical analysis.Results: VAS grade comparisons were insignificant p>0.05. Mean treatment duration was 4.65±2.601 months for Propranolol with timolol group and 5.50±3.171 months for propranolol only group. Statistically significant outcomes between 2 groups were noted in the depth category and total volume reduction of the lesion with p=0.019 and 0.033 respectively, in the subset of 0-12 months only with p=0.038.Conclusions: Clinically there is Volumetric reduction in terms depth reduction and a decrease in duration of treatment. Propranolol 2-3 mg/kg and Timolol solution of 0.5% applied thrice over the lesion was well tolerated without any serious adverse events. The combination therapy fails to demonstrate a statistically approvable shorter period of treatment as well as better efficacy when compared to oral propranolol alone.

Use of Platelet-Rich Fibrin in the Treatment of Periodontal Intrabony Defects: A Systematic Review and Meta-Analysis

Background. Platelet-rich fibrin (PRF) is a kind of autologous platelet concentrate which is easy to obtain and cheap. In recent years, it has been studied to improve the effect of periodontal regeneration. However, few studies have systematically evaluated the complementary effect of PRF in the treatment of intrabony defects. The present review is aimed at systematically assessing the effects of PRF on clinical and radiological outcomes of the surgical treatment of periodontal intrabony defects. Methods. The protocol was registered at PROSPERO (International Prospective Register of Systematic Reviews) as CRD42020206056. An electronic search was conducted in MEDLINE, Cochrane, and EMBASE databases. Only randomized clinical trials were selected. Systematically healthy patients with two or three walls of intrabony defects were considered. Intrabony defect (IBD) depth reduction and bone fill (BF) % were set as primary outcomes while probing depth (PD) reduction, clinical attachment level (CAL) gain, and gingival margin level (GML) gain were considered as the secondary outcome. When possible, a meta-analysis was performed. Results. Eighteen articles fulfilled the inclusion criteria, and seventeen studies were quantitatively analyzed. Of 17 studies, four were rated as high risk of bias and thirteen as the moderate risk of bias. Two comparisons were set: (1) open flap debridement (OFD) combined with PRF and OFD alone and (2) bone grafting (BG) combined with PRF and BG alone. Compared to OFD alone, OFD+PRF showed significantly greater in all primary and secondary outcomes. Compared to BG alone, BG+PRF showed significantly greater in IBD depth reduction, PD reduction, CAL gain, and GML gain. Conclusions. The use of PRF was significantly effective in the treatment of periodontal intrabony defects. The benefit of OFD+PRF may be greater than BG+PRF. PRF can promote early wound healing in periodontal surgery. As all included studies were not at low risk of bias, well-designed RCTs having a high methodological quality are needed to clarify the additional effectiveness of PRF in the treatment of intrabony defects in the future.

Efficacy of Probiotics as Adjunctive Therapy to Nonsurgical Treatment of Peri-Implant Mucositis: A Systematic Review and Meta-Analysis

Background: Peri-implant mucositis (PiM) is an inflammation of the soft tissues surrounding the dental implant and is the precursor of the destructive inflammatory peri-implantitis. PiM is usually reversible, but difficult to eradicate. Mechanical debridement (MD) is the conventional procedure to treat PiM although not enough to reach a complete resolution. Recently, probiotics have been considered in the treatment of peri-implant disease. Therefore, the aim of this systematic review and meta-analysis was to investigate the efficacy of the probiotic therapy combined with MD compared with MD alone or MD + placebo in patients with PiM.Methods: A search using electronic databases (MEDLINE, Science Direct databases, and Cochrane Central Register of Controlled Trials) and a manual search were performed up to November 2019 by two reviewers independently of each other. Eligible randomized controlled trials (RCTs) comparing MD + probiotic vs. MD were included. The quality assessment for all the selected RCTs was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions. Probing depth reduction was selected as the primary outcome. Weighted mean difference (WMD) and 95% confidence interval (CI) were calculated for continuous outcomes, and odds ratio (OR) and 95% CI were calculated for dichotomous outcomes, using random effect models. This review was registered on the PROSPERO database (CRD42020213625).Results: Five eligible publications were included in this systematic review and four in the meta-analysis. As regards the implant, the WMD in the probing depth reduction between the test and control group was −0.12 mm [95% CI (−0.38, 0.14), p = 0.38], meaning that the adjunctive probiotic therapy was not improving PiM compared with MD alone or MD + placebo. The meta-analysis also showed no statistically significant results in the secondary outcomes (reduction of full mouth plaque index and full mouth bleeding on probing, absence of bleeding on probing at implant level, and changes in microorganism load and species).Conclusion: The findings of this systematic review and meta-analysis suggested that the additional use of probiotics did not improve the efficacy of MD in PiM treatment regarding clinical and microbial outcomes, at least in a short-term.