Objectives: To evaluate the treatment of peri‐implant mucositis (PM) using a nonsurgical submarginal peri‐implant instrumentation (NSPI) with or without chlorhexidine (CHX) solutions.Methods: Fifty‐six patients (28 per group) were randomly assigned to the test (NSPI + 0.12% mouthwash and subgingival CHX irrigation plus tongue brushing with 1% CHX gel) or the control group (NSPI + placebo mouthwash and subgingival placebo irrigation plus tongue brushing with placebo gel). At baseline, 1, 3, 6 months, bleeding on probing (BOP), probing pocket depth (PPD), modified gingival index (mGI), modified plaque index (mPlI), full‐mouth plaque score (FMPS), full‐mouth bleeding score (FMBS), and the proportions of Aggregatibacter actinomycetemcomitans , Porphyromonas gingivalis , Tannerella forsythia, and Treponema denticola were recorded. The BOP reduction was set as a primary outcome. Data were analyzed to assess BOP reduction at a 6‐month follow‐up and to identify significant predictors of implant‐site BOP through mixed generalized linear regression.Results: After 6 months in both groups, a significant reduction of BOP, PD, mPlI, mGI, FMBS, and FMPS was noted (p < 0.05). However, at 6 months, the test group was more effective than the controls in reducing median BOP (∆values control/test: 39.3% [95% CI 37.4–42.3] vs. 48.7 [95% CI 46.5–51.2], p = 0.044), as well as mPlI (p = 0.041) and the proportion of Treponema denticola (p = 0.039). Moreover, the implant‐sites BOP reduction was significantly influenced by test treatment (p < 0.001), history of periodontitis (p = 0.003), and a high number of cigarettes/day (p = 0.002), the proportion of Porphyromonas gingivalis (p = 0.021) and Tannerella forsythia (p = 0.032).Conclusions: NSPI + CHX showed better results compared to placebo in implant‐sites BOP reduction. The high number of cigarettes/day and the proportion of Porphyromonas gingivalis and T. forsythia negatively influenced the BOP reduction in PM‐treated patients.

Peri-implant soft tissues play a role of paramount importance, not only on the esthetic appearance, but also on the maintenance and long-term stability of implants. The present report presents the conclusions from the Consensus Conference of the South European North African Middle Eastern Implantology & Modern Dentistry Association (SENAME) (4–6 November 2016, Cairo, Egypt). The conference focused on the topic of the soft tissue around dental implants, and in particular, on the influence of implant configurations on the marginal soft tissues, soft tissue alterations after immediate, early or delayed implant placement and immediate loading, the long-term outcomes of soft tissue stability around dental implants, and soft tissue augmentation around dental implants. Thirty world experts in this field were invited to take part in this two-day event; however, only 29 experts were in the final consensus voting process.

Background: The mechanical disruption and removal of the subgingival biofilm represent the most important step in the treatment of periodontitis. However, in deep periodontal pockets, mechanical removal of the subgingival biofilm is difficult and frequently incomplete. Preliminary findings indicate that the use of amino acid buffered sodium hypochlorite (NaOCl) gel may chemically destroy the bacterial biofilm and facilitate its mechanical removal. Objectives: To clinically evaluate the efficacy of minimally invasive nonsurgical therapy (MINST) of periodontal pockets with or without local application of an amino acid buffered sodium hypochlorite (NaOCl) gel. Materials and methods: Forty untreated patients diagnosed with severe/advanced periodontitis (i.e. stage III/IV) with a slow/moderate rate of progression (i.e. grade A/B) were randomly allocated in two treatment groups. In the test group, the periodontal pockets were treated by means of MINST and NaOCl gel application, while in the control group, treatment consisted of MINST alone. Full-mouth plaque scores (FMPS), full-mouth bleeding scores (FMBS), probing depths (PD), clinical attachment levels (CAL) and gingival recessions (GR) were assessed at baseline and at 6 months following therapy. The primary outcome variable was PD reduction at sites with PD ≥ 5 mm at baseline. Results: At 6 months, statistically significant differences between the two groups were found (p = 0.001) in terms of PD and CAL change. No statistically significant differences were found in terms of GR (p = 0.81). The number of sites with PD ≥ 5 mm and BOP (+) decreased statistically significantly (p = 0.001), i.e. from 85.3 to 2.2% in the test group and from 81.6 to 7.3% in the control group, respectively. Statistically significant differences between test and control groups were recorded at 6 months (p = 0.001). MINST + NaOCl compared to MINST alone decreased statistically significantly (p = 0.001) the probability of residual PDs ≥ 5 mm with BOP− (14.5% vs 18.3%) and BOP+ (2.2% vs. 7.2%). Conclusions: Within their limits, the present results indicate that (a) the use of MINST may represent a clinically valuable approach for nonsurgical therapy and (b) the application of NaOCl gel in conjunction with MINST may additionally improve the clinical outcomes compared to the use of MINST alone. Clinical relevance: In patients with untreated periodontitis, treatment of deep pockets by means of MINST in conjunction with a NaOCl gel may represent a valuable approach to additionally improve the clinical outcomes obtained with MINST alone

Background: N‐terminal portion of the B‐type natriuretic propeptide (NT‐proBNP) has potentially been shown to play an important role in the development of periodontitis and cardiovascular disease (CVD). This study evaluated the efficacy of periodontal treatment on NT‐proBNP and related CVD biomarkers and explored whether subjects harboring high NT‐proBNP at baseline showed increased clinical benefits with the non‐surgical periodontal treatment performed with full‐mouth scaling and root planing (FM‐SRP) at 6‐month follow‐up.Methods: Forty‐eight patients with stage III periodontitis were randomized to receive minimal standard oral care (SOC) (n = 24) or FM‐SRP (n = 24) protocol. Clinical periodontal parameters (probing depth, clinical attachment loss, bleeding on probing), serum NT‐proBNP, α1‐antitrypsin, C‐reactive protein (hs‐CRP), endothelial cell‐specific molecule‐1 (ECM‐1), and neutrophil gelatinase‐associated lipocalin (NGAL) concentrations were assessed at baseline and at 1‐, 3‐, and 6‐ month follow‐up.Results: At 6 months, FM‐SRP was more effective than SOC in reducing periodontal parameters and mean proportions of NT‐proBNP (p = 0.004), hs‐CRP (p = 0.003), α1‐antitrypsin (p = 0.012), ECM‐1 (p = 0.014), and NGAL (p = 0.045). At 6‐month follow‐up, the reduced NT‐proBNP, α1‐antitrypsin, hs‐CRP, ECM‐1, and NGAL levels were significantly correlated with the extent of periodontitis (p < 0.05). Furthermore, the analysis of variance analysis evidenced that, at 6‐month follow‐up, FM‐SRP significantly impacted the reduction of NT‐proBNP, hs‐CRP, ECM‐1, and NGAL. Moreover, high levels of NT‐proBNP, hs‐CRP, ECM‐1, and NGAL at baseline significantly influenced the efficacy of periodontal treatment positively.Conclusion: In this study, FM‐SRP was more effective than SOC in reducing clinical variables and NT‐proBNP levels, although subjects who harbored high NT‐proBNP concentrations at baseline showed greater clinical benefits of periodontal treatment at 6‐month follow‐up.

Objectives: Minimally invasive flap designs have been introduced to enhance blood clot stability and support wound healing. Limited data appear to suggest, that in intrabony defects, better clinical outcomes can be achieved by means of minimally invasive flap compared to more extended flaps. The aim of this study was to evaluate the healing of intrabony defects treated with either minimally invasive surgical flaps or with modified or simplified papilla preservation techniques in conjunction with the application of an enamel matrix derivative (EMD). Materials and methods: Forty-seven subjects were randomly assigned to either test (N = 23) or control (N = 24) procedures. In the test group, the intrabony defects were accessed by means of either minimally invasive surgical technique (MIST) or modified minimally invasive surgical technique (M-MIST) according to the defect localization while the defects in the control group were treated with either the modified or simplified papilla preservation (MPP) or the simplified papilla preservation technique (SPP). EMD was used as regenerative material in all defects. The following clinical parameters were recorded at baseline and after 12 months: full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depths (PD), clinical attachment level (CAL), and gingival recession (GR). Early healing index (EHI) score was assessed in both groups 1 week following the surgery. CAL gain was set as primary outcome. Results: After 12 months follow-up, the CAL gain was 4.09 ± 1.68 mm in test group and 3.79 ± 1.67 mm in control group, while the PD reduction was 4.52 ± 1.34 mm and 4.04 ± 1.62 mm for test and control sites. In both groups, a minimal GR increase (0.35 ± 1.11 mm and 0.25 ± 1.03 mm) was noted. No residual PDs ≥ 6 mm were recorded in both groups. CAL gains of 4–5 mm were achieved in 30.4% and in 29.2% of test and control group, respectively. Moreover, CAL gains ≥ 6 mm were recorded in 21.7% of experimental sites and in 20.8% of control sites. No statistically significant differences in any of the evaluated parameters were found between the test and control procedures (P > 0.05). After 1 week post-surgery, a statistically significant difference (P < 0.05) between the groups was found in terms of EHI score. Conclusions: Within the limits of this pilot RCT, the results have failed to show any differences in the measured parameters following treatment of intrabony defects with EMD, irrespective of the employed surgical technique. Clinical relevance: In intrabony defects, the application of EMD in conjunction with either MIST/M-MIST or M-PPT/SPPT resulted in substantial clinical improvements.