OBJECTIVES:Vitamin D3 status profoundly affects oral health and disease. Over the last decade, evidence has emerged that vitamin D3 activation can also occur in peripheral tissues. This narrative review was conducted to critically analyze the state of the art about the presence and activity of enzymes involved in the bioactivation of vitamin D3 in the oral tissues. DESIGN:A comprehensive literature search was performed in PubMed and Google Scholar. The search included articles published in English without any time limit. Keywords included but not limited to the combinations of: "vitamin D3", "25(OH)D3", "1,25(OH)2D3", "oral tissues", "megalin", "CYP27B1", "extrarenal", and "antimicrobial peptides". Further studies were identified by screening the reference lists of the relevant publications. RESULTS:Various vitamin D3 metabolites influence the inflammatory response and the production of antimicrobial peptides in various oral cells. The enzyme CYP27B1, which is responsible for the conversion of 25(OH)D3 into 1,25(OH)2D3 and its bioactivation, is present in various oral tissues and cells. The existence and physiological significance of local vitamin D3 activation in oral tissues remain unclear. Most of 25(OH)D3 is bound to the vitamin D-binding protein (DBP) and must be dissociated for activation. It is unclear whether and how this uncoupling occurs in oral tissue. CONCLUSION:Currently, there is rather indirect evidence that vitamin D3 could be bioactivated in oral tissues. Further studies on the local conversion of vitamin D3 to 25(OH)D3 and, subsequently, to 1,25(OH)2D3 in oral tissue, their regulation, and the role of free and bioavailable vitamin D3 metabolites are required.

Background/Objectives: This systematic review and meta-analysis evaluated the clinical effectiveness of regenerative surgical treatments compared with open flap debridement (OFD) in the management of peri-implantitis and, secondarily, assessed whether more advanced regenerative approaches, including guided bone regeneration (GBR), platelet-rich fibrin (PRF), and hyaluronic acid (HA), provide additional clinical benefit compared with bone grafting alone. Methods: A comprehensive search of PubMed, Scopus, and Web of Science was conducted in accordance with PRISMA guidelines and the PICO model, covering the period from 1993 to 2024. From 2119 identified articles, 63 full-text papers were reviewed, and 12 studies met all inclusion criteria. These studies compared regenerative treatments with OFD and bone grafting using clinical outcomes of probing pocket depth (PPD), radiographic bone level (RBL), bleeding on probing (BOP), suppuration (SUP), mucosal recession (REC), and clinical attachment level (CAL). Meta-analysis was performed using a random-effects model. Results: Regenerative treatments demonstrated superior outcomes in radiographic bone level gain compared with OFD (p < 0.001), while no statistically significant differences were observed for PPD (p = 0.77), BOP (p = 0.13), SUP (p = 0.42), REC (p = 0.14), or CAL (p = 0.96). Comparisons between bone grafting and other regenerative materials also showed no statistically significant differences. Conclusions: Regenerative procedures improved radiographic bone outcomes but did not consistently outperform OFD in soft tissue parameters, and no advanced regenerative modality demonstrated clear clinical superiority over bone grafting alone. Further high-quality randomized controlled trials with standardized methodologies are needed to establish clinical guidelines for peri-implantitis surgery.

BACKGROUND:Interest in antimicrobial surfaces for dental devices, such as aligners and brackets, is growing. These surfaces are designed to retard biofilm formation. One approach is to load essential oils (EOs) into the material. The focus of this study was the antibacterial, anti-biofilm, and anti-inflammatory activities of an EO solution. METHODS:The EO solution contained cinnamaldehyde, methyl salicylate, eucalyptol, limonene, and trans-anethole dissolved in distilled water (dH2O) with polyglycerol-4-laurate/sabacate (basic solution). The positive control was 0.2% chlorhexidine digluconate (CHX). The antibacterial activity of the EO and the basic solution was tested against selected oral bacteria. Multispecies biofilms were formed on specimens of a cellulose-based (test) material loaded with the EO solution or the basic solution, and on a polyurethane-based (reference) material loaded with CHX. The level of IL-8 released from gingival fibroblasts (GF) exposed to the solutions was measured. RESULTS:The EO solution clearly inhibited bacterial growth. However, the basic solution also acted as a growth inhibitor at higher concentrations. The EO solution reduced the metabolic activity of the formed biofilm. In addition, the basic solution decreased biofilm mass and colony-forming unit counts. The basic solution was not inferior to CHX on the reference material. However, only the basic solution, not the EO solution, suppressed the release of IL-8 from GF when stimulated with bacteria. CONCLUSION:Applying essential oils (EOs) to surfaces may be an effective way to inhibit biofilm formation. The basic solution, which is polyglyceryl-laurate-based, exhibits anti-biofilm and anti-inflammatory properties. Further in vitro research should aim to gain a deeper understanding of the solubilizer's mechanisms and optimize the composition of the added essential oils before testing in clinical trials.

Long-term color match is one of the most important characteristics of aesthetic restorative materials as discoloration constitutes a primary reason for otherwise unnecessary replacements. The aim of the present in vitro study was to evaluate the color stability of frequent dental materials (ceramic, composite, orthodontic adhesive) induced by common antiseptic mouthrinses taking into account black tea consumption and mechanical cleaning. Twenty-four disc-shaped specimens (8 × 2 mm) were made of the materials Ceram.x Spectra™ ST HV, Ceram.x Spectra™ flow, Ceramill® Zolid HT+ PS and Unitek™ Transbond™ LR. Each of the following solutions was tested on six pieces per material: Chlorhexamed forte (CHX), octenident® (OCTD), octenimed® (OCTM) and artificial saliva (control). Dental samples underwent a total of 30 discoloration cycles in which they were alternatively placed into artificial saliva, black tea and respective mouthrinse or only in artificial saliva. After every 10 cycles, discs were mechanically cleaned with toothbrush and toothpaste. After 30 cycles, dental specimens were submitted to professional polishing. Color shifts were measured at different time-points using the VITA Easyshade® V spectrophotometer and displayed as total color difference ∆E (mean ± standard error). A post-hoc Tukey test (⍺ = 0.05) was applied to the mean ∆E values after 30 cycles to determine discoloration discrepancies between various mouthrinses as well as the control. Moreover, photos of individual discs were taken at all measurement times to visualize potential color changes by eye. All mouthrinses showed major color shifts in the clinically visible range compared to the control on all different dental materials tested. However, CHX caused significantly more discoloration than OCTM and OCTD. Established color changes could be almost completely removed by simple brushing and even further by professional polishing to clinically acceptable levels on all tested materials. Prolonged application of antiseptic mouthrinses may cause discoloration on different restorative materials. To maintain aesthetically satisfying conditions, patients should be educated about the importance of daily mechanical tooth brushing and regular professional polishing.

Low‐level laser therapy (LLLT) has been shown to exert biostimulatory effects, including increased cell proliferation and accelerated wound healing. Hence, the use of LLLT as an adjunct to scaling and root planing (SRP) for improved periodontal treatment outcomes has been examined. The aim of this study was to evaluate the clinical effect of adjunctive LLLT in the treatment of periodontitis with a 980-nm diode laser. Patients with a periodontal screening index of 3 or 4 who met the inclusion criteria were recruited and randomized into two groups for treatment allocation in a split-mouth design. The maxillary and mandibular left or right quadrants of the patients were assigned to either the test (SRP + LLLT) or the control (SRP) group. During the two final debridement sessions, LLLT was applied on one side of each study participant´s upper and lower jaws. The reevaluation of the clinical parameters and microbiological assays was performed 12 weeks after the initial therapy. Both groups presented significant reductions in clinical parameters (p < 0.001). However, no statistically significant differences between the test and control groups were found for any of the parameters (all p values were greater than 0.05). The recolonization of P. gingivalis and T. denticola was not significantly reduced in the laser group. The clinical parameters in both groups improved similarly after initial periodontal treatment. LLLT with the chosen settings did not show a beneficial effect during the initial nonsurgical treatment of periodontitis. LLLT is under discussion for periodontal therapy as a promising treatment modality. Compared with nonsurgical therapy alone, adjunctive periodontal treatment with a diode laser did not improve the clinical parameters of periodontitis patients in this study. Currently, there is no recommended treatment protocol for adjunctive LLLT in periodontitis, which needs to be further investigated with other laser settings. ISRCTN registry (#ISRCTN11275257), retrospectively registered, 16.10.2023.

BACKGROUND:The use of video teaching material is increasingly popular and has been useful under Covid-19 teaching circumstances, where practical courses have been somewhat limited according to the pandemic situation. The objective of this trial was to evaluate whether high-quality educational videos-viewed once or repeatedly-can effectively support dental students in acquiring practical skills for delivering oral hygiene instructions, while also enhancing their confidence and sense of safety. This study aims to contribute preliminary insights into the potential value of video-assisted learning in this specific context within dental education. METHODS:82 students from the 2nd term of dental school were enrolled in this study and randomly assigned to two groups. The participants watched two videos showing the application of the Bass toothbrushing method and the interdental brushing technique. Group 1 viewed the video only once, whereas Group 2 viewed the videos repeatedly every week on four consecutive weeks before the seminar. By the end of the four weeks, the students participated in a practical test by blinded examiners to evaluate the level of their obtained skills of oral hygiene instructions, demonstrated on a plastic model. The data analysis was conducted by an individual who was not involved in teaching or supervising the student courses. RESULTS:The results of this trial show that the students subjectively gained confidence in performing the techniques accurately, after watching the videos. The participants exhibited significant improvement in toothbrushing technique and applying the interdental brush after repetitive viewing of the videos compared to single viewing. There were no significant differences between groups regarding the assessment of the size of interdental spaces using a colorimetric probe. CONCLUSION:The findings of this trial support earlier studies indicating that video-based learning can serve as an effective resource for students in preclinical dental education, improving comprehension and practical skills. While enhanced technique and brush application were linked to multiple video viewings, the measurement of interdental spaces did not yield significant differences across groups.

Background: Periodontitis is an inflammatory condition initiated by oral bacteria and is associated with several systemic diseases. Quercetin is an anti-inflammatory and anti-bacterial poly-phenol present in various foods. The aim of this meta-analysis was the evaluation of the effects of quercetin administration in animal models of experimental periodontitis. Methods: A systematic search was performed in electronic databases using the following search terms: “periodontitis” or “periodontal disease” or “gingivitis” and “quercetin” or “cyanidanol” or “sophoretin” or “pentahydroxyflavone”. In vivo preclinical animal models of experimental periodontal disease with a measurement of alveolar bone loss were included in the analysis. The risk of bias of the included studies was assessed using the SYRCLE tool. Results: The systematic search yielded 335 results. Five studies were included, four of them qualified for a meta-analysis. The meta-analysis showed that quercetin administration decreased alveolar bone loss (τ2 = 0.31, 1.88 mm 95%CI: 1.09, 2.67) in experimental periodontal disease animal models. However, the risk of bias assessment indicated that four SYRCLE domains had a high risk of bias. Conclusions: Quercetin diminishes periodontal bone loss and prevents disease progression in animal models of experimental periodontal disease. Quercetin might facilitate periodontal tissue hemostasis by reducing senescent cells, decreasing oxidative stress via SIRT1-induced autophagy, limiting inflammation, and fostering an oral bacterial microenvironment of symbiotic microbiota associated with oral health. Future research will show whether and how the promising preclinical results can be translated into the clinical treatment of periodontal disease.

Objectives This study aimed to evaluate the impact of enamel matrix derivative (EMD) application following subgingival instrumentation of residual pockets in periodontitis patients on inflammatory host response, microbiological composition, and clinical outcome. Methods In this double-blinded randomized controlled trial, a total of 22 patients with generalized periodontitis stage III or IV presenting with ≥ 6 mm probing pocket depth (PPD) at re-evaluation after initial periodontal therapy were included. Participants were randomly allocated at a 1:1 ratio to subgingival instrumentation with (EMD +) or without (EMD-) non-surgical EMD application into the pocket. PPD, clinical attachment level (CAL), bleeding on probing (BoP), plaque index (PI), as well as a panel of pro-inflammatory cytokines and periodontal pathogen count in the gingival crevicular fluid (GCF) of the respective sites were evaluated at baseline (T0) and six months afterwards (T1). Results Both treatment groups showed a significant PPD reduction (EMD + 1.33 ± 1.15 mm, p < 0.001; EMD- 1.32 ± 1.01 mm, p < 0.001) as well as CAL gain (EMD + 1.13 ± 1.58 mm, p < 0.001; EMD- 0.47 ± 1.06 mm, p = 0.005) from T0 to T1. While no intergroup differences for PPD reduction were observed, CAL gain was higher in EMD + sites compared to EMD- ( p = 0.009). No essential effects on cytokine expression as well as bacterial count were detected. Conclusions Application of EMD as an adjunct to subgingival instrumentation of residual pockets yielded benefits regarding CAL gain; however, effects on PPD reduction, inflammatory cytokines, and bacterial count were negligible. Trial registration ClinicalTrials.gov (NCT04449393), registration date 26/06/2020. Clinical relevance Based on the obtained results, additional non-surgical EMD application compared to subgingival instrumentation alone showed no clinically relevant effects on treatment outcome and underlying biological mechanisms.

The aim of this study was the evaluation of the in vitro efficacy of a carbon dioxide (CO2) laser, a tetracalcium phosphate/dicalcium phosphate anhydrate (TP/DP) desensitizer and the combination of the desensitizer and additional CO2 laser irradiation as a treatment modality for cervical dentin hypersensitivity. A total of 48 dental specimens, prepared from extracted human premolars and molars, were divided into four groups: a control group, a TP/DP desensitizer paste group, a CO2 laser (10.600-nm wavelength) group, and a paste and laser group. The specimens were coated with nail varnish except in the marked area and were then immersed in 2% methylene blue dye for 1 h. The specimens were then washed, dried, and cut longitudinally. Thereafter, photos of 40 dentin specimens were taken and evaluated. The area of penetration was assessed and reported as percentage of the dentin surface area. Additionally eight dental specimens were examined with the aid of a scanning electron microscope and evaluated. Significant differences in the penetration depth were found for all experimental groups compared to the control group. The lowest penetration area was detected in the paste-laser group (16.5%), followed by the laser (23.7%), the paste (48.5%), and the control group (86.2%). The combined treatment of the CO2 laser and a TP/DP desensitizer was efficient in sealing the dentinal surface and could be a treatment option for cervical dentin hypersensitivity.

Direct pulp capping (DPC) is reliable in pulp exposure management. Objective: This study aimed to assess the success rate of DPC materials and different laser protocols. The included procedures were CO2 laser (n = 1147), Er: YAG laser (n = 69), and 980 nm diode laser (n = 124), on the one hand, and Ca (OH)2 (n = 376) and bioactive tricalcium silicate paste, on the other (n = 279). Materials and methods: Data from 1995 DPC cases were included. For laser groups, irradiation was used to coagulate the pulp exposure followed by Ca (OH)2 placement. Data with follow-up at 12, 24, and 36 months post-treatment were included. The irradiation parameters for the CO2 laser were as follows: energy density per pulse of 141 J/cm², 1 W power, 0.3 mm beam diameter, 100 ms pulse duration, and 1 Hz, and a series of five pulses maximum were delivered during 5 s. For the 980 diode lasers: 1.5 W power, continuous wave (CW), 400 μm fiber diameter, contact mode, 190.98 W/cm2 power density, and total delivered energy density of 2387 J/cm2. For the Er: YAG laser: 0.5 W output power, 9.95 J/cm2 energy density, a beam diameter of 0.8 mm, 300 µsec pulse duration, 10 Hz, non-contact mode, irradiation with air without water spray, and an average irradiation time of 8–10 s. Results: At the 3-year follow-up, the success percentages were as follows: CO2 (88.01%) > Ca (OH)2 (75.72%) > diode (70.01%) > Er: YAG (54.55%) > bioactive tricalcium silicate paste (51.1%). The timing of permanent filling (immediate or delayed), patient age, size of pulp exposure, tooth type, and exposure etiology significantly affected the success rate. Patients aged ≤ 35 years presented higher success (70.91%) compared to those ≥ 36 years (61.2%). Immediate permanent fillings increase the success rate (71.41%) compared to delayed permanent fillings (65.93%). Exposure in molars and premolars significantly lowers the success rate (60.3%) compared to canines and incisors (72.1%). Idiopathic pulp exposure presented higher success (72.58%) compared to caries-related causes (63.7%). Conclusion: The highest success rate was in the CO2 laser group followed by the diode and Ca (OH)2, Er: YAG, and bioactive tricalcium silicate material (biodentine) groups. The age factor, filling timing, size of exposure, tooth type, and exposure etiology can significantly affect the success rate of DPC.

Objectives: The use of lasers for debonding adhesively luted ceramic restorations is a rather recent oral laser application in dentistry. The removal of all-ceramic restorations in the mouth can often be a troublesome task. A novel method for the debonding of ceramic restorations without damaging the restorations is Er:YAG laser irradiation. The aim of this study was to evaluate the Er:YAG laser for debonding procedures of different dental ceramics and to identify appropriate laser settings. Material and methods: Lithium disilicate, zirconium-reinforced lithium silicate, feldspatic ceramic, and zirconium dioxide were investigated. Ten ceramic rectangular-shaped specimens with 1 and 2 mm thickness were produced from each material. All specimens were irradiated with four different power settings 1.5; 2.5; 3.5; 4.5 W, pulse duration 50 μs, laser repetition rate 10 Hz, time of irradiation 10 s. The transmitted energy was measured with a powermeter. Additionally the suitability of the Er:YAG laser to remove the adhesively bonded ceramic and the time until loss of retention was evaluated. Results: The transmission rate for 1 and 2 mm platelets was determined for zirconium-reinforced lithium silicate at 54.6%/35.6%, lithium disilicate at 53.2%/35.7%, zirconium dioxide at 40.6%/32.4%, and for the feldspathic ceramic at 19.4%/10.1%. For zirconium-reinforced lithium silicate and zirconium dioxide 2.5 W (250 mJ/10 Hz) was an appropriate energy level for effective debonding. Whereas for lithium disilicate and for feldspathic ceramic, 4.5 W (450 mJ/10 Hz) is required for efficient debonding. Conclusions: There are differences regarding transmission rates between ceramic types for the Er:YAG laser light and additionally depending on the type of ceramic different energy settings should be used for adequate debonding. Based on our in-vitro experiments we recommend 2.5 W for zirconium-reinforced lithium silicate and zirconium dioxide and 4.5 W for lithium disilicate and feldspatic ceramic. Transmission rates of different ceramic types and varying influences of thicknesses and bonding materials should be considered to adjust the laser parameters during laser debonding of adhesively luted all-ceramic restorations.

The aim of this in vitro study was to evaluate the effects of erbium-doped yttrium aluminum garnet (Er:YAG) laser irradiation on titanium surface topography and the proliferation and differentiation of osteoblasts using standard clinical treatment settings. Er:YAG laser irradiation at two levels ((1): 160 mJ, pulse at 20 Hz; (2): 80 mJ, pulse at 20 Hz) was applied to moderately rough and smooth titanium disks before MG-63 osteoblast-like cells were cultured on these surfaces. Titanium surface and cell morphology were observed by scanning electron microscopy. Cell proliferation/viability was measured by CCK-8 test. Gene expression of alkaline phosphatase (ALP), osteocalcin (OC), osteoprotegerin (OPG), receptor activator of nuclear factor kappa-B ligand (RANKL), and collagen type 1 was measured by qPCR, and OPG and OC protein production was determined by enzyme-linked immunosorbent assay. Treatment with Er:YAG laser at 160 mJ/20 Hz markedly caused heat-induced fusion of titanium and cell condensation on moderately rough surfaces, but not in smooth surfaces. MG-63 proliferation/viability decreased after 5 days in moderately rough surfaces. The expression of ALP, OC, OPG, and collagen type 1 was unaffected by laser treatment at 160 mJ/20. Laser irradiation at 80 mJ/20 Hz enhanced RANKL gene expression after 5 days in moderately rough surfaces. Study results suggest that Er:YAG laser irradiation at clinically relevant setting has no essential effect on osteogenic gene and protein expression of osteoblasts. However, surface structure, cell attachment, and proliferation are influenced by both treatment protocols, which implies that caution should be taken in the clinical treatment of peri-implant diseases when Er:YAG laser is used.

Platelets are involved in a variety of diseases, making their adequate functional assessment is essential. However, due to their easily activatable nature this has some methodological pitfalls. Therefore, the availability of stable, easily measurable surrogate markers would be beneficial. In this regard, some evidence suggests that certain microRNAs (miRNAs) circulating in plasma might be useful. We aimed to corroborate their suitability by analyzing plasma samples obtained in a randomized controlled trial, which assessed the effects of periodontal treatment on platelet function. We hypothesized that miRNA levels mirror changes of platelet activation and -function. Both platelet function and miRNA abundance were quantified using state-of-the-art flow cytometry and qPCR methods. The following miRNAs were quantified: 223-3p, 150-5p, 197-3p, 23a-3p, 126-3p, 24-3p, 21-5p, 27b-3p, 33a-5p, 320a, 191-5p, 28-3p, 451a, 29b-3p, and 1-3p. However, periodontal treatment did not affect the abundance of any investigated miRNAs to a relevant extent. Platelet activation and reactivity indices did neither correlate with any tested miRNA at baseline, nor after the treatment period. In addition, there was no evidence that investigated miRNAs were released by platelets, as suggested previously. In conclusion, our data suggest that in patients suffering from periodontal disease the investigated miRNAs are unlikely to be suitable biomarkers for platelet function. Our data aim to raise awareness that previously determined platelet activation dependent circulating miRNAs are not suitable as platelet biomarkers in all cohorts.

Saliva has the potential to be used as a diagnostic and monitoring tool for various diseases if biomarkers of an adequate sensitivity and specificity could be identified. Several reviews and even meta-analyses have been performed in recent years, which have found some candidate biomarkers for periodontitis, like macrophage inflammatory protein-1 alpha, interleukin-1ß, interleukin-6, matrix metalloproteinase-8, or hemoglobin. However, none of those are currently in use to replace conventional periodontal diagnostics with a periodontal probe. For periimplantitis, to date, heterogeneity of different study protocols and implant types did not permit to discover clear biomarkers, which were able to distinguish between healthy and diseased implants. Few proinflammatory cytokines, similar to periodontitis, have been characterized as adjunct tools to clinical diagnosis. The additional determination of antimicrobial peptides, bone turnover markers, and bacteria could help to enhance sensitivity and specificity in a combined model for periodontitis and periimplantitis. Furthermore, proteomic approaches might be preferred over single biomarker determinations. A global consensus is also needed to harmonize salivary sampling methods as well as procedures of biomarker analysis to ensure future comparability.

To investigate plaque inhibition of 0.1% octenidine mouthwash (OCT) vs. placebo over 5 days in the absence of mechanical plaque control. For this randomized, placebo-controlled, double-blind, parallel group, multi-center phase 3 study, 201 healthy adults were recruited. After baseline recording of plaque index (PI) and gingival index (GI), collection of salivary samples, and dental prophylaxis, subjects were randomly assigned to OCT or placebo mouthwash in a 3:1 ratio. Rinsing was performed twice daily for 30 s. Colony forming units in saliva were determined before and after the first rinse. At day 5, PI, GI, and tooth discoloration index (DI) were assessed. Non-parametric van Elteren tests were applied with a significance level of p < 0.05. Treatment with OCT inhibited plaque formation more than treatment with placebo (PI: 0.36 vs. 1.29; p < 0.0001). OCT reduced GI (0.04 vs. placebo 0.00; p = 0.003) and salivary bacterial counts (2.73 vs. placebo 0.24 lgCFU/ml; p < 0.0001). Tooth discoloration was slightly higher under OCT (DI: 0.25 vs. placebo 0.00; p = 0.0011). Mild tongue staining and dysgeusia occurred. OCT 0.1% mouthwash inhibits plaque formation over 5 days. It therefore can be recommended when regular oral hygiene is temporarily compromised. When individual plaque control is compromised, rinsing with octenidine mouthwash is recommended to maintain healthy oral conditions while side effects are limited.

Objectives Nd:YAG and Er:YAG lasers have been previously used as an adjunct in periodontal therapy. The aim of this single-blinded randomized controlled clinical trial was to evaluate the efficacy of a combined application of Nd:YAG and Er:YAG laser irradiation in periodontal treatment. Materials and methods Twenty-two patients with at least one site of ≥ 6 mm periodontal probing depth (PPD) after mechanical debridement with curettes and sonic instruments at periodontal reevaluation were included in the study. Patients were randomly allocated at a 1:1 ratio to either a combined Nd:YAG/Er:YAG laser therapy (test group) or a “turned off” laser therapy (control group). The Nd:YAG laser was used for periodontal pocket deepithelialization and to stabilize the resulting blood clot. The Er:YAG laser was primarily used for root surface modification. PPD (mm), clinical attachment level (CAL, mm), and bleeding on probing (BOP, +/−) at the site of laser treatment were evaluated at baseline and 2 months after treatment. Results The mean improvements from baseline to 2-month follow-up for PPD were significantly better in the laser group (2.05 ± 0.82 mm) compared to the control group (0.64 ± 0.90 mm; p = 0.001). Likewise, the gain in CAL was significantly better in the laser group (1.50 ± 1.10 mm) than in the control group (0.55 ± 1.01mm; p = 0.046). Conclusions The combined application of Nd:YAG and Er:YAG laser irradiation as an adjunct to conventional non-surgical therapy showed a significant beneficial effect on periodontal treatment results. Clinical relevance Combined Nd:YAG and Er:YAG laser irradiation could be a useful procedure additionally to conventional non-surgical periodontal therapy to improve periodontal treatment results. Clinical trial registration ISRCTN registry #ISRCTN32132076

BACKGROUND:Previous in vitro studies have proven laser fluorescence measurement using a 655-nm Indium Gallium Arsenide Phosphide (InGaAsP) based diode laser radiation to be a useful tool to detect subgingival calculus. The aim of this prospective study was to evaluate the 655-nm InGaAsP diode laser in detecting subgingival calculus in patients with periodontal disease compared with photographic assessment during periodontal surgery. METHODS:Twelve patients (six women, six men) aged between 21 and 75 years with periodontitis scheduled for periodontal surgery were included in this prospective study. All laser fluorescence measurements were made before periodontal surgery. Intraoperatively a mucoperiostal flap was performed, subgingival calculus was visualized, and photographic images were taken. The presence of calculus was recorded for each evaluated site. RESULTS:A total of 115 tooth surface sites of 32 teeth from the 12 patients were evaluated before (laser) and during surgery (image). Compared with image evaluation the laser assessment showed a sensitivity of 0.70 (CI0.025 0.53 to CI0.975 0.83) and a specificity of 0.97 (CI0.025 0.85 to CI0.975 0.99). The overall probability to correctly detect subgingival calculus with the laser (accuracy) was 0.82 (CI0.025 0.74 to CI0.975 0.88). CONCLUSIONS:The 655-nm diode laser was able to detect subgingival calculus. Hence, the 655 nm diode laser may be used as an additional tool for calculus detection in non-surgical periodontal therapy.

Purpose: Osteoarthritis (OA) is a leading cause of pain and disability worldwide which increases with older age. Furthermore, OA constitutes an enormous disease burden on the current as well as the future health systems, economy and communities. Recently, there has been growing evidence for associations between OA and oral health conditions, such as periodontitis and temporomandibular disorders. For example, on one hand periodontitis was found to be associated with the presence and severity of radiographic signs of OA, on the other hand patients suffering from OA usually have difficulties to manage and maintain their oral and dental hygiene. This two-way relationship between oral health and OA indicates that outcomes of both conditions including patient-reported outcomes would be influenced by one another. Therefore, the aim of our project was to incorporate oral and dental patient-reported outcomes in a large multicenter osteoarthritis registry in Austria (BLOAR- Better Life with Osteoarthritis registry), to psychometrically test the oral health instruments in OA patients and to analyze the dental and oral outcomes in relation to the OA outcomes. Methods: The BLOAR registry includes a consecutive convenience sample of patients ≥ 18 years of age with any type of OA diagnosed by physicians. Oral and dental instruments including the Oral Health Impact Profile (OHIP)-14, one of the most commonly used instruments measuring oral health-related quality of life in adults, the self-reported periodontitis questionnaire and the temporomandibular disorders questionnaire were administered in addition to the documentation of the clinical symptoms, involvement of joints, socio-demographic variables, functional status, pain, quality of life, imaging data and biomarkers. We used descriptive statistics to analyze and report the dental and oral outcomes in relation to the OA outcomes. Psychometric testing of the oral health instruments followed the classical test theory and the Rasch model. Results: To date seven-hundred participants in the registry from six Austrian centers had both their oral health as well as OA outcomes measured. A sub-sample of 360 patients was used to psychometrically test and adapt the OHIP-14. Of those 360 patients, 260 (72.2%) were females and 224 (62.2%) were aged between 56 and 75 years. Regarding oral health characteristics, 93 (25.8%) were edentulous, and 78 (21.7%) self-reported gingival bleeding, while 45 (12.5%) reported temporomandibular joint pain. OHIP-14 median total raw score was 1 (inter quartile range from 0 to 6). OHIP-14 was found to be unidimensional and showed good fit to the Rasch model. However, regarding the targeting, the instrument needs adaptations for this patient group. Conclusions: BLOAR is the first Austrian multicenter registry for OA which includes also dental and oral health outcomes. This project is a multistep project starting with creating and validating an oral health module within the registry, which will create a reliable comprehensive database to understand oral health involvement in osteoarthritis and to further develop a multidisciplinary approach for managing OA patients. Oral health is an essential component of general health and needs more attention in osteoarthritis patients.

Background Photoactivated disinfection (PAD) could support the periodontal treatment outcome. The effect of the light emitting diode (LED) as an innovative light source in PAD is under discussion. The aim of this study was to evaluate the clinical and microbiological effect of adjunctive PAD in the treatment of periodontitis with a red LED as light source. Methods Twenty patients with periodontitis completed this split-mouth study. The left and right side of the jaws were randomly assigned to either test or control group. After conservative periodontal treatment in both groups, the test group received two sessions of adjunctive PAD (red LED, 635 nm, photosensitive dye, 0.01% tolonium chloride), whereas the control group received no adjunctive PAD. The parameters of clinical periodontal examination-including probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP) and microbiological assays (PCR) were evaluated before and after treatment. Results After 3 months, both treatment groups showed significant improvements regarding BOP, PD, and CAL compared to baseline, with no significant difference between control and treatment group. The recolonization of Porphyromonas gingivalis and Treponema denticola was reduced after adjuvant treatment, but not significantly. Conclusions The positive effect of adjunctive PAD regarding clinical parameters was reported in recent trials. In this study and with the current settings, both treatment groups showed similar clinical results after initial periodontal treatment, without beneficial effect of adjunctive PAD.

Periodontitis is associated with systemic inflammation, elevated platelet activation and enhanced risk for cardiovascular diseases, while periodontal treatment reduces tissue inflammation and shows desirable effects on the oral biofilm and dental health. However, subgingival debridement during conservative treatment can lead to local trauma and transient bacteraemia, which might affect cardiovascular risk in these patients. Therefore, we investigated the effect of periodontal treatment on systemic platelet activation. In a prospective therapeutic trial, 26 patients underwent periodontal treatment and patient blood was analysed immediately before and immediately after intervention for platelet activation markers (flow cytometric analysis of P-selectin, CD63 and CD40L surface expression, integrin αIIbβ3 activation and fibrinogen binding, intra-platelet reactive oxygen species production, platelet-leukocyte aggregate formation and intra-platelet vasodilator-stimulated phosphoprotein phosphorylation) in response to adenosine diphosphate (ADP). The present study shows that basal platelet activation levels remain largely unaltered in response to periodontal treatment. We also did not observe significant changes in platelet reactivity in response to different concentrations of platelet agonist ADP. Subgingival debridement does not result in relevantly elevated platelet activation. Thus, augmented platelet activation seems unlikely to be a causative triggering factor that increases the short-term risk for platelet-mediated thrombotic events in response to subgingival debridement. Subgingival debridement is a safe procedure and does not increase the short-term risk for platelet-mediated thrombotic events.