Background: The gold standard in treatment of periodontitis is mechanical removing of dental biofilm but using local delivery drugs as adjunctive to SRP is widely used to modulate inflammatory host and eradicate microbes. Tea tree oil (TTO) has a broad-spectrum antimicrobial, anti-inflammatory, antifungal, antiviral, antioxidant effect. This study aimed to assess clinically and biochemically the effect of intrapocket application of TTO (Melaleuca alternifolia) gel adjunctive to scaling and root planing (SRP) in the treatment of stage 2 (moderate) periodontitis and to correlate the biochemical levels with clinical response. Methods: A randomized, controlled clinical trial was conducted on thirty patients with stage 2 periodontitis. Patients were equally divided into two groups: Control Group treated with (SRP) alone and Test Group treated with SRP and locally delivered 5% TTO gel. Clinical assessment included pocket probing depth (PPD), clinical attachment loss (CAL), gingival index (GI) and bleeding on probing (BOP) measured at baseline and after 3 and 6 months. The level of matrix metalloproteinase-8 (MMP-8), in the gingival crevicular fluid (GCF) was also assessed at baseline and after1, 3 and 6 months by Enzyme-linked immunosorbent assay (ELISA) kit. Chi-square, Student t- tests, Mann–Whitney U test and Spearman correlation were the statistical tests used in the study. Results: An improvement of all clinical and biochemical parameters was observed (at p < 0.001) in both groups. A significant difference between the two groups was found in both clinical and biochemical parameters. Conclusion: The local delivery of TTO gel adjunctive to SRP proved to be effective in the treatment of stage II periodontitis. Trial registration The study was retrospectively registered at clinicaltrials.gov NCT04769271, on 24/2/2021.

Background: Early accurate radiographic assessment of peri-implant bone condition is highly important to avoid excessive loss of supporting bone and implant failure. Cone beam computed tomography (CBCT) is the radiographic technique of choice if peri-implant dehiscence and fenestration defects are suspected. The higher radiation dose and the presence of beam hardening artifacts are the main drawbacks of CBCT imaging techniques. This study aims to evaluate the influence of low-dose cone beam computed tomography (LD-CBCT) and metal artifact reduction (MAR) tool on the assessment of peri-implant dehiscence and fenestration.Methodology: Thirty titanium implants were inserted into bovine rib blocks. Twenty had standardized bone defects (10 with dehiscence and 10 with fenestration), while the remaining 10 were used as control group with no defects. Radiographic examinations held with high‐definition CBCT (HD-CBCT) and LD-CBCT with and without application of MAR tool. Images were assessed by four examiners for the presence or absence of peri-implant defects. The area under the area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, and accuracy were calculated for all radiographic protocols.Results: In the absence of MAR tool, there was no difference in AUC and diagnostic values between LD-CBCT and HD-CBCT for detection of both defects. When the MAR tool was applied, the AUC values, sensitivity, and accuracy were higher in HD-CBCT than in LD-CBCT for the detection of both defects, especially for the dehiscence, while specificity remained the same.Conclusion: LD-CBCT can be used in the evaluation of peri-implant dehiscence and fenestration without any decrease in diagnostic accuracy. The application of MAR tool decrease the diagnostic ability of both defects, especially for the detection of dehiscence defects.

Objectives: In this study the effect of Nitazoxanide (NTZ) delivered subgingivally as thermosensitive hydrogel on the clinical and biochemical outcomes of scaling and root planing (SRP) was evaluated compared to SRP alone in patients with stage II periodontitis. Materials and Methods: A randomized, controlled clinical trial was conducted on forty adult patients equally divided between a control group treated with full-mouth SRP and a test group treated with SRP and sub gingivally-delivered 0.01% NTZ gel. The gel was administered twice, one week after SRP and a week later. Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI), and matrix metalloproteinase-8 (MMP-8) levels in gingival crevicular fluid (GCF) were measured at baseline and after 3 and 6 months and compared in addition to the reduction in these values from baseline to 6 months using Mann-Whitney U test. Results: There were significantly greater reductions in the test than the control groups at 6 months regarding PD (mean= 3.1mm and 2.3mm, P= 0.001), CAL (2.3mm and 1.7mm, P= 0.013), percentage of sites with BoP (mean= 1.6% and 1%, P= 0.001), GI (mean= 2.3 and 1.6, P= 0.006), and MMP-8 level (mean= 1.8 and 0.9, P= 0.028). Conclusions: NTZ has potential when combined with SRP as an adjunctive for the treatment of stage II periodontitis, offering added benefit over SRP alone based on clinical and biochemical findings. Trial registration: The study was retrospectively registered at clinicaltrials.gov, NCT04768530 on 24/2/2021. Keywords: Antimicrobial, Biochemical, Gingival crevicular fluid, Matrix metalloproteinase-8, Periodontitis.

Objectives: to evaluate the influence of low-dose cone beam computed tomography (LD-CBCT) and metal artifact reduction (MAR) tool on the assessment of peri-implant dehiscence and fenestration. Methodology: Thirty titanium implants were inserted into bovine rib blocks. Twenty had standardized bone defects (10 with dehiscence and 10 with fenestration), while the remaining 10 were used as control group with no defects. Radiographic examinations held with high‐definition CBCT(HD-CBCT) and LD-CBCT with and without application of MAR tool. Images were assessed by four examiners for the presence or absence of peri-implant defects. The area under the area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, and accuracy were calculated for all radiographic protocols.Results: Results: In the absence of MAR tool, there was no difference in AUC and diagnostic values between LD-CBCT and HD-CBCT for detection of both defects. When the MAR tool was applied, the AUC values, sensitivity, and accuracy were higher in HD-CBCT than in LD-CBCT for the detection of both defects, especially for the dehiscence, while specificity remained the same.Conclusion: LD-CBCT can be used in the evaluation of peri-implant dehiscence and fenestration without any decrease in diagnostic accuracy. The application of MAR tool decrease the diagnostic ability of both defects, especially for the detection of dehiscence defects.Clinical relevance: low-dose protocols of CBCT devices can be performed to assess the peri-implant defects with a significant decrease in patient radiation dose. MAR algorithm is not recommended for use in the evaluation of peri-implant defects.