Surgical and Non-Surgical Procedures Associated with Recurrence of Periodontitis in Periodontal Maintenance Therapy: 5-Year Prospective Study

<div><p>Background and Objective</p><p>Prospective studies that investigated the influence of surgical and nonsurgical procedures in the recurrence of periodontitis and tooth loss in periodontal maintenance therapy (PMT) programs have not been previously reported. The objective of this study was to evaluate longitudinally the recurrence of periodontitis in regular compliers (RC) and irregular compliers (IC) individuals undergoing surgical and non-surgical procedures over 5 years in a program of PMT.</p><p>Materials and Methods</p><p>A total of 212 individuals participated in this study. Full-mouth periodontal examination including bleeding on probing, probing depth, and clinical attachment level were determined at all PMT visits over 5 years. The recurrence of periodontitis was evaluated in RC and IC individuals undergoing surgical and non-surgical procedures in PMT. The influences of risk variables of interest were tested through univariate analysis and multivariate logistic regression.</p><p>Results</p><p>Recurrence of periodontitis was significantly lower among RC when compared to IC. Individuals with recurrence of periodontitis and undergoing surgical procedures showed higher probing depth and clinical attachment loss than those who received non-surgical procedures. Recurrence of periodontitis was higher in individual undergoing surgical procedures and irregular compliance during PMT.</p><p>Conclusions</p><p>Irregular compliance and surgical procedures in individuals undergoing PMT presented higher rates of recurrence of periodontitis when compared to regular compliant patients undergoing non-surgical procedures.</p></div

Final logistic regression model for the recurrence of periodontitis at final examinations.

<p>BOP = bleeding on probing; PD = probing depth; CI = confidence interval.</p><p>Final logistic regression model for the recurrence of periodontitis at final examinations.</p

Periodontal status of individuals with recurrence of periodontitis with surgical or non-surgical procedures during PMT at final examination.

<p>*Mean % of affected sites ± standard deviation</p><p>Comparisons between treatment modalities within each group (RC surgical versus RC non-surgical, and IC surgical versus IC non-surgical) followed by distinct capital letters are significantly different (Student-t test for dependent samples). Comparisons between groups within each treatment modality (RC surgical versus IC surgical, and RC non-surgical versus IC non-surgical) followed by distinct lower cases letters are significantly different (Student-t test for independent samples). Multiple comparisons adjusted by Bonferroni correction (p<0.04).</p><p>Periodontal status of individuals with recurrence of periodontitis with surgical or non-surgical procedures during PMT at final examination.</p

Recurrence of periodontitis and non-surgical or surgical procedures performed during PMT (full-mouth, non-molar and molar) in RC and IC groups.

<p>Comparisons between RC and IC followed by different letters are significant(p <0.05).</p><p>Recurrence of periodontitis and non-surgical or surgical procedures performed during PMT (full-mouth, non-molar and molar) in RC and IC groups.</p

Changes in PD, CAL, PI, and BOP at 1-to-5 years (mean per individuals) by surgical or non-surgical procedures in RC and IC individuals with recurrence of periodontitis.

<p>Probing depth and Clinical attachment level (Fig 1a and Fig 1b): IC>RC;IC Surgical (ICS) >IC Non-Surgical (ICNS) = RC Surgical (RCS) >RC Non-Surgical (RCNS)^*; Plaque index (Fig 1c): IC>RC; ICS >ICNS and RCS = RCNS^**; Bleeding on probing (Fig 1d): IC>RC; RCS = ICS and ICS = ICNS^*; ^*Statistically significant increase in PD, CAL, and BOP per years, using Welch test and Tamhane post hoc analysis (p<0.05). ^**Statistically significant increase in plaque index per years, using ANOVA and Bonferroni post hoc analysis (p<0.05).</p

Effects of chlorhexidine preprocedural rinse on bacteremia in periodontal patients: a randomized clinical trial

<div><p>Abstract Objective: Single dose of systemic antibiotics and short-term use of mouthwashes reduce bacteremia. However, the effects of a single dose of preprocedural rinse are still controversial. This study evaluated, in periodontally diseased patients, the effects of a pre-procedural mouth rinse on induced bacteremia. Material and Methods: Systemically healthy individuals with gingivitis (n=27) or periodontitis (n = 27) were randomly allocated through a sealed envelope system to: 0.12% chlorhexidine pre-procedural rinse (13 gingivitis and 13 periodontitis patients) or no rinse before dental scaling (14 gingivitis and 15 periodontitis patients). Periodontal probing depth, clinical attachment level, plaque, and gingival indices were measured and subgingival samples were collected. Blood samples were collected before dental scaling, 2 and 6 minutes after scaling. Total bacterial load and levels of P. gingivalis were determined in oral and blood samples by real-time polymerase chain reaction, while aerobic and anaerobic counts were determined by culture in blood samples. The primary outcome was the antimicrobial effect of the pre-procedural rinse. Data was compared by Mann-Whitney and Signal tests (p<0.05). Results: In all sampling times, polymerase chain reaction revealed higher blood bacterial levels than culture (p<0.0001), while gingivitis patients presented lower bacterial levels in blood than periodontitis patients (p<0.0001). Individuals who experienced bacteremia showed worse mean clinical attachment level (3.4 mm vs. 1.1 mm) and more subgingival bacteria (p<0.005). The pre-procedural rinse did not reduce induced bacteremia. Conclusions: Bacteremia was influenced by periodontal parameters. In periodontally diseased patients, pre-procedural rinsing showed a discrete effect on bacteremia control.</p></div