Ramanauskaitė, Eglė

Background & Aim: Recently, a novel approach called ‘Clean and Seal’ was proposed to enhance biofilm removal during nonsurgical periodontal therapy. This method involves the use of sodium hypochlorite (NaOCl) and amino acids, followed by the application of cross-linked hyaluronic acid gel (xHyA), as a strategy to improve treatment outcomes. The aim of this study was to evaluate the current evidence on the potential clinical benefits of adding NaOCl/amino acids, xHyA, or their combination to subgingival debridement (SD) in nonsurgical periodontal therapy.

Methods: An electronic literature search was conducted in the MEDLINE (Ovid) and Cohrane Central Register of Controlled Trials (CENTRAL) databases for articles published up to 1 November 2024. Randomized controlled clinical trials in English that compare the effectiveness of NaOCl/amino acids, xHyA or their combination as adjuncts to SD with a follow-up of ≥ 3 months were included. A meta-analysis using the fixed-effects model was performed on the selected qualifying articles.

Results: The search identified 8 articles that met the inclusion criteria. The meta-analysis did not show statistically significant improvements in probing depth (PD) reduction (0.136 mm, 95% CI [−0.253 to 0.525], p = 0.104) or clinical attachment level (CAL) gain (0.242 mm, 95% CI [−0.144 to 0.628], p = 0.687) with adjunctive subgingival application of NaOCl/amino acids. Additionally, subgingival application of xHyA alone did not yield statistically significant improvements in PD (0.250 mm, 95% CI [−0.089 to 0.588], p = 0.525), though it showed a statistically significant improvement in CAL (0.710 mm, 95% CI [0.362 to 1.058], p < 0.001) compared to SD alone. The combination of NaOCl/amino acids and xHyA resulted in statistically significant improvements in both PD (1.02 mm, 95% CI [0.565–1.474], p < 0.0001) and CAL (0.927 mm, 95% CI [0.493–1.361], p = 0.004) compared to SD alone.

Conclusions: Adjunctive subgingival delivery of NaOCl/amino acids and xHyA provides statistically and clinically significant benefits compared to SD alone.

Background & Aim: Peri-implantitis is an inflammatory condition characterized by soft tissue inflammation and bone loss around dental implants, with prevalence rates between 28% and 51%. Various factors, such as bacterial biofilm, patient habits (e.g., smoking, poor dental care), environmental factors, and dentist expertise, may influence the onset and progression of the disease. As the number of dental implants increases, so will the incidence of peri-implantitis, highlighting the need for effective management strategies to prevent disease recurrence. To evaluate the recurrence rate of peri-implantitis (RecPI) following surgical treatment, considering different treatment approaches, including open flap, resective, and regenerative techniques.

Methods: Clinical trials with a minimum follow-up period of 2 years that assessed surgical treatment of peri-implantitis and its recurrence rate were included in the review. Other inclusion criteria were: English language, ability to access a full text.

Results: The systematic review included 10 studies with 934 implants in total. In studies using open flap debridement, 525 implants affected by peri-implantitis of which 261 (50.67%) exhibited the recurrence of the disease. Furthermore, research on surgical resective treatment approach revealed that out of 288 implants treated, 65 (22.57%) experienced the recurrence. Meanwhile, studies evaluating regenerative treatment reported 121 treated implants, with recurrence observed in 36 (29.75%) implants.

Conclusions: The extensive review analyzing the recurrence rates of peri-implantitis after different surgical treatment approaches indicates that the recurrence of a disease is dependent on the surgical intervention. In particular, open flap debridement demonstrated the highest recurrence, regenerative treatment presented a moderate, and resective method was associated with the lowest recurrence of peri-implantitis.

Background & Aim: Non-surgical approach for treating intrabony periimplantitis defects is considered ineffective in resolving probing depth (PD) and bleeding tendency (BoP) over a period of 12 months post-treatment. The case series addresses the impact of adjunctive application of a hypochlorite/aminoacid gel and crosslinked hyaluronic acid (xHyA) to non-surgical mechanical instrumentation protocol on clinical parameters change and radiographic alterations (MBL) 12 months after non-surgical therapy.

Methods: Study enrolls 40 adult patients aged from 18 to 80 who present with severe periimplantitis condition at least at one implant site. Patients are generally at good health condition, while diabetes mellitus, hypertension and other systemic disorders are excluded.

The intervention bases on repeated subgingival application of hypochlorite/aminoacid gel to enhance mechanical debridement as well as to decontaminate exposed implant surface during one visit. Once operator considers instrumentation completed, crosslinked hyaluronic acid (xHyA) gel floats the subgingival defects. The primary parameter is the change in PD assessed at 6 points and resolution of BoP, secondary parameter is the MBL change on a 2D periapical x-ray obtained at 12-months visit.

Results: From 30 patients treated so far, eight patients accomplished the 12-months follow-up. These patients received treatment at 14 implants with a mean initial PD of 7.1 ± 1.6 mm. Initial BoP was positive for 100% of all sites involved. At 12 months evaluation the mean PD was 2.9 ± 1.1 mm and BoP was reduced down to 7% positive sites. PD reduction equalled 4.2 ± 2.0 mm. Radiographically observed changes corroborate this clinical outcome by displaying MBL gain after 12 months.

Conclusions: Within the limitations of this case series we conclude that the preliminary results indicate for proposed adjunctive protocol an effectively enhanced decontamination effect on implant surface and sufficiently supported healing response in deep intrabony periimplantitis defects within non-surgical subgingival treatment.

Background: The aim of the present study was to evaluate clinical changes at the distal aspect of the second molar after removal of non-impacted third molars and application of cross-linked hyaluronic acid (xHyA) in patients with periodontitis.

Description of the procedure: Twenty-one patients diagnosed with stages II-III (Grades A/B) periodontitis were referred for 3rd molar extractions before periodontal treatment. Patients were randomly allocated into test and control groups: in control group after 3rd molar extraction a suture was affixed, whereas in test group the post-extractional alveolus was filled with cross-linked hyaluronic acid (xHyA). Clinical measurements were obtained at baseline (before extraction), after 3 and 6 months. Primary outcome variable was the change in probing depth (PD), secondary outcomes included changes in clinical attachment level (CAL), bleeding on probing (BOP) and plaque index (PI).

Outcomes: No statistically significant differences were observed between groups at baseline. After 3 and 6 months statistically significant differences were found in PD and CAL changes in both groups compared to baseline (p < 0.001). When a comparison between test and control was made, statistically significant differences were detected in changes of PD and CAL at 6 months in favour for test group (p = 0.012 and p = 0.006, respectively). BOP and PI decreased significantly in both groups at both timepoints (p < 0.05), however, no statistically significant difference was observed between the groups.

Conclusions: Within the limits of the present study, the adjunctive application of xHyA after 3rd molar extraction lead to significantly better clinical improvements at the distal aspect of 2nd molars.

Periodontitas – šešta pagal dažnumą liga pasaulyje ir dažniausia dantų netekimo priežastis suaugusių žmonių populiacijoje. Periodontito etiologija siejama su burnos ertmės mikrobiomo disbalansu, pasireiškianti progresuojančiu dantis supančių audinių (dantenų, periodonto raiščio, alveolinio kaulo) netekimu. Klinikiniai periodontito požymiai apima klinikinės jungties netekimą, radiologiškai stebimą alveolinio kaulo destrukciją, zonduojamas dantenų kišenes ir dantenų kraujavimą. Negydoma ar laiku nediagnozuota periodonto patologija lemia ankstyvą dantų netekimą, nors dauguma ligos atvejų gali būti gydomi, taip užkertant kelią dantų netekimui. Pagrindinis periodontologinio gydymo tikslas – sustabdyti ligos progresavimą, atkurti sveikus, stabilius periodonto audinius ir, jei įmanoma, regeneruoti prarastus. Pagrindinė sėkmingo periodontito gydymo sąlyga – efektyvus podanteninio biofilmo pašalinimas. Idealiu atveju, periodontologinio gydymo metu, periopatogeninių mikroorganizmų rūšys, sukeliančios ar palaikančios periodonto audinių infekcijas, turėtų būti pašalinamos arba stipriai sumažinamas jų kiekis. „Aukso standartas“ periodontito gydyme – kruopštus virš ir podanteninio apnašo ir konkrementų pašalinimas ultragarsu ir / ar rankiniais instrumentais. Tačiau šis gydymo būdas turi nemažai apribojimų – ligai pažengus, bakterinį apnašą, susikaupusį giliose kišenėse, furkacijose, intrakauliniuose defektuose, anatominėse šaknų įdubose ir vagelėse mechaniškai pašalinti tampa sunku ar net neįmanoma. Tyrimai rodo, kad, net ir po labai kruopštaus podanteninio konkrementų valymo, ant 30 proc. valytų šaknų paviršių lieka nenuvalytų dantų akmenų ir apnašo, o tai sąlygoja greitą mikroorganizmų rekolonizaciją į jau valytas sritis, o to rezultatas – sumažėjęs gydymo efektyvumas ir kliniškai stebimos negyjančios periodontologinės kišenės. Kadangi periodontitas yra mikroorganizmų sąlygota liga, logiška, kad kartu su mechaniniu instrumentavimu galima naudoti ir papildomas priemones, kurios padėtų eliminuoti ar inaktyvuoti patogeninę mikroflorą tose vietose, kur mašininiai ar rankiniai instrumentai fiziškai pasiekti negali. Pastaruoju metu literatūroje aptinkama duomenų apie „Clean and Seal“ (C&S) metodiką kaip galimą alternatyvą periodontito gydyme. C&S metodas paremtas dviejų papildomų priemonių (natrio hipochlorito (NaOCl) /amino rūgščių gelio (Perisolv®, Regedent AG, Zürich, Switzerland) ir vidutiniškai stabilizuotos didelio molekulinio svorio hialurono rūgšties (xHyA) (Hyadent BG, Regedent AG Zürich, Switzerland) gelio) ir kruopštaus podanteninio instrumentavimo panaudojimo kartu. Iki šiol nebuvo atlikta nė vieno atsitiktinės imties kontroliuojamo klinikinio tyrimo, kuris leistų išsiaiškinti, ar papildomas šių preparatų panaudojimas kartu su podanteniniu instrumentavimu nulemtų geresnius klinikinius bei mikrobiologinius periodontito gydymo rezultatus, lyginant su standartiniu periodontito gydymu, kai naudojamas ultragarsas ir rankiniai instrumentai. Šio darbo tikslas - ištirti klinikinius, mikrobiologinius ir histologinius papildomo NaOCl/amino rūgščių ir xHyA gelių naudojimo kartu su podanteniniu instrumentavimu rezultatus, palyginti juos vien su podanteninio instrumentavimo rezultatis, gydant II–III stadijos A, B laipsnių periodontitą. Nustatyti pagrindiniai darbo uždaviniai:

1. Nustatyti, ar papildomas NaOCl/amino rūgščių ir xHyA gelių kartu su podanteniniu instrumentavimu panaudojimas lemia geresnius klinikinius periodontito gydymo rezultatus (PD sumažėjimą, CAL padidėjimą, BOP sumažėjimą), palyginus su vien podanteniniu instrumentavimu.
2. Nustatyti, ar papildomas NaOCl/amino rūgščių ir xHyA gelių kartu su podanteniniu instrumentavimu panaudojimas lemia geresnius mikrobiologinius periodontito gydymo rezultatus (nustatyti pagrindinių periopatogenų – Aggregatibacter actinomycetemcomitans (A.a), Prevotella intermedia (P.i), Treponema denticola (T.d), Porphyromonas gingivalis (P.g), Tanerella forsythia (T.f) aptikimo dažnį ir bendrą skaičių prieš ir po gydymo), palyginus su standartiniu podanteniniu instrumentavimu.
3. Atlikti histologinę analizę ir nustatyti NaOCl/amino rūgščių ir xHyA gelių poveikį periodonto audiniams.

Background: This study aimed to subjectively assess the changes in the oral health status of pregnant women, to find out their attitudes and knowledge about possible changes in the oral cavity that occurred during pregnancy, and their influence on the outcomes of pregnancy. Methods: 112 pregnant women who visited the Republican Siauliai Hospital during their pregnancy participated in the study. An anonymous self-administered questionnaire was used to conduct the research, surveying their demographic characteristics, oral health changes and habits during pregnancy, and awareness of possible negative pregnancy outcomes. Results: The study involved 112 pregnant women, with 35 in the first trimester, 28 in the second, and 48 in the third trimester. The findings revealed that pregnant women do not take sufficient care of their oral health: more than half of the respondents did not visit an oral care specialist during pregnancy; 22.3% of women reported brushing their teeth only once a day or less; and 35.7% did not clean interdental surfaces at all. Statistically, significantly more urban women believed there is a relationship between maternal oral health and adverse pregnancy outcomes than women living in rural areas (p = 0.013). While significant oral health changes were not observed in the first trimester, more women in the second and third trimesters reported issues such as bleeding gums, swelling, plaque accumulation, tartar, and caries (p < 0.001). Conclusions: The attitude of women towards oral health during pregnancy and their understanding of the possible risks for unfavorable pregnancy outcomes are insufficient. Notably, oral health issues become more prominent in the second and third trimesters, necessitating appropriate oral care to reduce the incidence of oral and dental diseases during pregnancy. This underscores the importance of educational and preventive public health policies focused on oral care for pregnant women, aimed at increasing awareness and promoting practices that safeguard both maternal and fetal health.

To investigate the microbiological outcomes obtained with either subgingival debridement (SD) in conjunction with a gel containing sodium hypochlorite and amino acids followed by subsequent application of a cross-linked hyaluronic acid gel (xHyA) gel, or with SD alone.

Objectives To evaluate periodontal wound healing following scaling and root planing (SRP) in conjunction with the application of sodium hypochlorite/amino acids and cross-linked hyaluronic acid (xHyA) gels in dogs. Materials and Methods In four beagle dogs, 2-wall intrabony defects were created and metal strips were placed around the teeth. Clinical parameters were measured 4 weeks after plaque accumulation. The experimental root surfaces were subjected to SRP with either the subgingival application of a sodium hypochlorite/amino acid gel and a xHyA gel (test group) or SRP alone (control group) using a split-mouth design. Clinical parameters were re-evaluated at 6 weeks. The animals were sacrificed at 8 weeks for histological analysis. Results The test group showed significant improvements in all clinical parameters compared to the control group. Histologically, the test group exhibited statistically significantly greater new bone formation [i.e., length of newly formed bone, new bone area] compared with the control group (p< 0.05). Furthermore, statistically significantly greater formation of new attachment [i.e., linear length of new cementum adjacently to newly formed bone with inserting collagen fibers] and new cementum was detected in the test group compared with the control group at 8 weeks (p< 0.05 and p< 0.01, respectively). Conclusion The adjunctive subgingival application of sodium hypochlorite/amino acid and xHyA gels to SRP offers an innovative novel approach to enhance periodontal wound healing/regeneration. Clinical relevance The present findings have for the first-time shown histologic evidence for periodontal regeneration in support of this novel treatment modality.

Objectives: To compare the clinical outcomes obtained with either mechanical subgingival debridement in conjunction with a sodium hypochlorite and amino acids containing gel followed by subsequent application of a cross-linked hyaluronic acid gel (xHyA) gel, or with mechanical debridement alone. Materials and methods: Fourty-eight patients diagnosed with stages II-III (Grades A/B) generalised periodontitis were randomly treated with either scaling and root planing (SRP) (control) or SRP plus adjunctive sodium hypochlorite/amino acid and xHyA gels (test). The primary outcome variable was reduction of probing depth (PD), while changes in clinical attachment level (CAL), bleeding on probing (BOP) and plaque index (PI) were secondary outcomes. The outcomes were assessed at baseline, at 3 and 6 months following therapy. Results: All patients completed the 6 months evaluation. At 6 months, the test group showed statistically significantly better results in terms of mean PD reduction (2.9 ± 0.4 vs 1.8 ± 0.6 mm, p < 0.001). Similarly, mean CAL gain was statistically higher in the test group compared to the control one (test: 2.6 ± 0.5 vs control: 1.6 ± 0.6 mm, p < 0.001). Mean BOP decreased from 81.8 ± 16.2% to 48.9 ± 14.5% in control (p < 0.001) and from 83.2 ± 15.5% to 17.6 ± 11.5% in test (p < 0.001) groups with a statistically significant difference favouring the test group (p < 0.001). Mean PI scores were reduced statistically significantly in both groups (from 38.8 ± 26% to 26.5 ± 20.5% in control (p = 0.039) and from 60.6 ± 10.9% to 12.7 ± 8.9% in test group (p < 0.001)), with a statistically significant difference between the groups (p < 0.001). The number of moderate pockets (4-6 mm) were reduced from 1518 (41.2%) to 803 (22.6%) in the control and from 1803 (48.6%) to 234 (7.7%) in the test group with a statistically significant difference between the groups (p < 0.001), while the number of deep pockets (≥ 7 mm) changed from 277 (7.6%) to 35 (1.0%) in the control and from 298 (8.7%) to 4 (0.1%) in test group (p = 0.003). Conclusion: Within their limits the present data indicate that: a) both treatments resulted in statistically significant improvements in all evaluated clinical parameters, and b) the adjunctive subgingival application of sodium hypochlorite/amino acid and xHyA to SRP yielded statistically significantly higher improvements compared to SRP alone. Clinical relevance: The combination of sodium hypochlorite/amino acid and xHyA gels to subgingival mechanical debridement appears to represent a valuable approach to additionally improve the outcomes of non-surgical periodontal treatment. Clinical Trial Registration Number NCT04662216 (ClinicalTrials.gov).

Purpose: The adjunctive subgingival application of sodium hypochlorite/amino acid and a mixture of natural and cross-linked hyaluronic acid gels (high molecular weight) has recently been proposed as a novel modality to enhance the outcomes of non-surgical periodontal therapy. The aim of this prospective case series was to evaluate the clinical outcomes obtained following the subgingival application of a combination of sodium hypochlorite/amino acid and a mixture of natural and cross-linked hyaluronic acid (high molecular) gels in conjunction with non-surgical periodontal therapy. Material and Methods: Twenty-one systemically healthy, non-smoking patients diagnosed with stage II-III, grade A/B periodontitis underwent full-mouth subgingival debridement (SD) performed with ultrasonic and hand instruments. All sites with probing depths (PD) ≥ 4 mm were treated with additional repeated (ie, 2-3 times) instillation of sodium hypochlorite/amino acid gel in the periodontal pockets prior to and during SRP. Following mechanical debridement, a mixture of natural and cross-linked hyaluronic acid (high molecular) gel was applied in the pockets. The primary outcome variable was PD reduction; changes in clinical attachment level (CAL) and bleeding on probing (BOP) were the secondary outcomes. The clinical parameters were assessed at baseline, 3 and 6 months after therapy. Results: Compared to baseline, a statistically significant mean reduction of PD values ​​was obtained after 3 and 6 months, amounting to 2.6 ± 0.4 mm, and 2.9 ± 0.4 mm, respectively (p < 0.001). Mean CAL gain measured 2.3 ± 0.5 mm at 3 months and 2.6 ± 0.5 mm at 6 months in comparison to baseline (p < 0.001). Mean reduction of BOP values ​​was 54.9 ± 16.9% at 3 months and 65.6 ± 16.4% at 6 months (p < 0.001). The number of moderate pockets (4-5 mm) decreased from 1808 at baseline to 274 at the 6-month evaluation, and the number of deep (≥ 6 mm) pockets dropped from 319 to 3, respectively. Conclusion: The combination of sodium hypochlorite/amino acid and a mixture of natural and cross-linked hyaluronic acid (high molecular) adjunctive to subgingival debridement may represent a valuable approach to improve the outcomes of non-surgical periodontal treatment.