Polynucleotides and Hyaluronic Acid (PN-HA) mixture showed several effects in modulation of healing process. The aim of this study was to assess the safety and clinical performance of PN-HA alone or in association with Deproteinized Bovine Bone Mineral (DBBM) with papillary preservation flaps (PPF) in the treatment of residual pockets. A total of 43 patients with 55 infra-bony defects were recruited; 30% were smokers. The mean baseline Probing Depth (PD) was 7.7 ±1.9 mm with a corresponding mean recession (Rec) of 1.9± 1.3 mm. The depth of infra-bony defect at the surgical measurement was 5.2±2.1 mm. DBBM was applied at 56% of the defects considered as not-containing based on clinical judgment. Healing was uneventful at all sites. After one year, PD reduction was 4.4±1.8 mm with a Rec increase of 1.0 ±0.8 mm. Detected bone fill at x-ray was 3.5 ± 1.9mm. The multilevel analysis showed that absence of smoking habits was associated with improved PD reduction (P =0.026) and bone gain (P= 0.039). PN-HA mixture is a safe product for periodontal surgery and seems to promote clinical benefit in the treatment of residual pockets associated to infra-bony defects. Keywords: case series, hyaluronic acid, intrabony defect, periodontal regeneration, periodontitis, polynucleotides

The aim of this article is to present a clinical case of a 54-year-old patient where the cementoenamel junction (CEJ) level was restored and a root coverage procedure carried out after gingival augmentation on the mandibular teeth. A very thin buccal keratinized tissue (KT) was detected apical to the recessions. The restorative approach consisted of identifying the lost CEJ, thus differentiating the area of restoration from the area of root coverage of the abraded teeth. Subsequently, a free gingival graft (FGG) was applied. A coronally advanced flap procedure was performed 3 months later. The clinical outcomes obtained through combined restorative/ periodontal treatment were maintained at the 4-year follow-up.

Im vorliegenden Artikel wird der Fall eines 54-jährigen Patienten vorgestellt, bei dem an zwei Unterkieferzähnen das Niveau der Schmelz-Zement- Grenze (SZG) wiederhergestellt und nach einer Gingivaaugmentation eine Wurzeldeckung durchgeführt wurde. Apikal der Rezessionen fand sich nur sehr dünnes keratinisiertes Gewebe. Das restaurative Vorgehen bestand in der Rekonstruktion der verlorenen SZG, um an den abradierten Zähnen den Restaurationsbereich vom Bereich der Wurzeldeckung zu differenzieren. Anschließend wurde ein freies Gingivatransplantat eingebracht. Drei Monate später wurde ein Eingriff mit koronalem Verschiebelappen ausgeführt. Die Ergebnisse dieser restaurativen und parodontalen Kombinationsbehandlung waren bei der 4-Jahres-Nachkontrolle noch stabil.

Purpose: The aim of this long-term cohort study was to evaluate the efficacy and complications of fixed partial dentures in a convenience sample of 100 patients with periodontal disease who were treated and maintained periodontal patients after 20 years. Materials and Methods: After active treatment, including periodontal surgery and endodontic and prosthetic treatment, patients were enrolled in a supportive periodontal care (SPC) program with 3- to 6-month recalls. All patients showed clinical data recorded at (1) the original consultation (T0), (2) the first SPC visit following the completion of prosthetic treatment (T1), and (3) at the latest SPC clinical session 20 years after T1 (T2). Multivariate analyses were performed to investigate the influence of clinical variables on the risk of prosthetic abutment (PA) loss after 20 years' visits. Results: The final sample comprised 100 patients. At T1, a total of 948 PAs represented the original sample of experimental teeth. At the 20-year follow-up, a total of 854 PAs (90.1%) were still in function, while 94 (9.9%) PAs in 41 patients (41%) were lost during SPC; 98% of lost PA were endodontically treated. Vertical root fracture (48%) was the major cause of PA loss, while progression of periodontitis caused 31% of PA loss. Age (P = .002), Full-Mouth Plaque Score (P .0001), Full-Mouth Bleeding Score (P = .0002), and oral parafunctions (P = .0083) were associated with increased probability of PA failure. Among clinical-related factors, endodontic treatment (P = .0082), root resection/ amputation (P .0001), multi-rooted teeth (P = .0005), and abutment associated with parafunction (P .0001) were associated with increased risk of abutment loss after 20 years. Conclusions: Perioprosthetic treatment in compliant patients is highly successful after 20 years of SPC.

Purpose: The treatment of gingival inflammation is associated with improved glycaemic control in diabetic patients. The goal of this parallel-randomised controlled trial (RCT) was to test the shortterm effects of professional oral hygiene procedures on plasma glucose levels in systemically healthy individuals. Materials and methods: Systemically healthy individuals with gingivitis and no sign of periodontitis were enrolled at a private practice in Italy. Patients were randomised to either a 1 hour (h) session of professional oral hygiene procedures or to 1 h in the waiting room. Not fasting blood glucose levels were assessed by a blind examiner at baseline (T0), 1 h (T1) and 2 h (T2) after procedures and finally 1 week after (T3). Oral hygiene procedures were then performed also in the control group. Results: Twenty patients were randomly allocated to each group. There were no drop-outs. Blood glucose levels at T0 (P = 0.0001) and time of measurement (P = 0.0001) were statistically significant, while oral hygiene procedures were not (mean difference between groups 0.77 mg/dl, 95%CI -2.64 mg/dl; 4.18 mg/dl, P = 0.6581). Mean blood glucose levels decreased between T0 and T1, were stable between T1 and T2 and showed similar levels to baseline after 1 week (T3) for both groups. Conclusion: This short-term RCT showed that professional oral hygiene procedures were not able to influence plasma glucose levels in individuals with gingivitis, but otherwise systemically healthy. Keywords: gingivitis, glucose level, glycaemia, treatment

The aim of this study was to conduct a 1-year full esthetic evaluation of the treatment outcomes of gingival recession using the root coverage esthetic score (RES) system. One hundred patients with 195 single or multiple recessions were treated using different techniques. One year after surgery, the clinical outcomes were evaluated. Only 21 of 195 (11%) treated recessions obtained the maximum RES score (10), while 68 recessions (35%) showing complete root coverage obtained lower scores. Both single and multiple recessions treated with a coronally advanced flap with or without connective tissue grafting achieved similar RES scores. Free gingival grafts showed the lowest score.

Gingival recession is often associated with abrasion in the cervical area with an unidentifiable cementoenamel junction (CEJ). This condition complicates the diagnosis and treatment of gingival recession. The aim of this study was to propose a technique to identify the CEJ level for planning periodontal and restorative treatment of the recession. The CEJ of a contralateral homologous tooth or adjacent teeth was used to replicate the lost CEJ at the treated tooth. Reconstruction of the CEJ using composite resin and a coronally advanced flap, with or without a connective tissue graft, was performed for 25 recessions in 12 patients. After 2 years, 20 defects (80%) showed complete root coverage with a significant recession reduction (2.4 mm, P .0001).

The aim of this article was to present the treatment of an unesthetic smile in a 27-year-old woman showing gingival recession, gingival asymmetry, and an altered passive eruption in the natural dentition. First, an apically positioned flap with osseous resective surgery was applied to correct the gingival asymmetry at the maxillary right incisors. The amount of bone resection was determined by means of bone sounding at the maxillary left incisors. Six weeks later, a coronally advanced flap procedure was performed to cover the gingival recession at the maxillary right canine, along with an enamelplasty and a direct composite resin restoration. The patient was satisfied with the final treatment outcome.

Aim: The aim of this study was to evaluate differences in the inflammatory profile of young (=40 years) systemically healthy periodontal patients comparing chronic (CP) versus aggressive periodontitis (AP) in terms of cytokines, chemokines and C-reactive protein levels. Methods: Systemically healthy subjects affected by severe CP or AP were enrolled in this study. Differential diagnosis was performed according to the criteria suggested by the American Academy of Periodontology. Blood samples for the evaluation of high sensitivity C-reactive protein levels, cytokine levels (IL-1ß, IL-1RA, IL-4, IL-6, IL-10, IL-12, interferon-γ, interferon-γ-inducible protein 10, tumour necrosis factor α) and chemokine levels (IL-8, vascular endothelial growth factor, monocyte chemoattractant protein 1, macrophage inflammatory protein 1α and macrophage inflammatory protein 1ß) were obtained from all patients. Results: A total of 45 systemically healthy patients with severe periodontitis were consecutively selected, 21 with CP (mean age 36.8 ± 3.5; mean clinical attachment level [CAL] 4.72 ± 0.69) and 24 with AP (mean age 35.9 ± 3.8; mean CAL 4.68 ± 0.75). No statistically significant difference between the two groups was detected for periodontal variables and for all the investigated inflammatory markers. Conclusions: The inflammatory profile of severe periodontitis in young patients (=40 years) may be similar for chronic and aggressive types. Differential diagnosis between CP and AP may not be able to detect a different systemic inflammatory profile in young adults. Keywords: aggressive periodontitis, chemokines, chronic periodontitis, cytokines, host response, systemic inflammation

Aim: The aim of the present explorative cross-sectional study was to evaluate the potential role of some periodontal variables in predicting sub-clinical atherosclerosis and systemic inflammation in young adults (=40 years) with severe periodontitis compared with healthy individuals without periodontitis. Materials and methods: A total of 90 systemically healthy subjects, 45 (mean age 36.35±3.65 years) affected by severe periodontitis (test group) and 45 individuals (mean age 33.78±3.28 years) without a history of periodontal disease (control group) were enrolled in the present study. Test and control groups were paired for age, gender, body mass index (BMI) and smoking habits. Carotid intima-media thickness (carotid IMT) was bilaterally assessed by ultrasonography at the level of the common carotid artery to evaluate sub-clinical atherosclerosis. Blood samples to assess inflammatory markers (leucocytes, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total serum cholesterol, high sensitivity C-reactive protein, glucose and haemoglobin A1c% were taken. Results: In periodontal patients, mean probing depth (PD) was a predictor of mean carotid IMT (P=0.0005), BMI (P=0.0002), systolic blood pressure (P=0.0300) and diastolic blood pressure (P= 0.0199). Full-mouth bleeding score (FMBS) was a predictor of C-reactive protein levels (P=0.0218). In controls, full-mouth plaque score was a predictor of glucose levels (P=0.0074) and higher FMBS of lower triglycerides levels (P=0.0312). Conclusion: Mean PD and FMBS may predict sub-clinical atherosclerosis and systemic inflammation in young adults with severe periodontitis.