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March 2015
Volume 36, Issue 3

Influence of intra-pocket anesthesia gel on treatment outcome in periodontal patients:a randomized controlled trial

Derman SH, Lowden CE, Hellmich M, Noack MJ. J Clin Periodontol. 2014;41(5):481-488.

This study compared the treatment outcome after scaling and root planing using local anesthesia gel or injected local anesthesia. Thirty-eight patients with periodontitis and good general health were included in a randomized, single-blind, split-mouth clinical trial. Probing depths and clinical attachment levels were recorded at baseline and 6 weeks after treatment. Scaling and root planing procedures were performed using two types of local anesthesia for separate treatment appointments. Anesthetics used were intra-pocket lidocaine and prilocaine gel (2.5% each) and injected articaine (1:100,000 adrenaline). Type of anesthesia for first appointment was randomized and switched for second appointment. Patients' pain perception and anesthesia acceptance were recorded. No influence of applied type of anesthesia could be detected for change of probing pocket depths and clinical attachment level (P > 0.05). These findings are valid even for deeper pockets. Gel group had significant higher intraoperative pain perception. In retrospect, 69% of patients favored gel. CONCLUSION: Treatment outcome is not compromised by use of anesthesia gel in comparison to injected anesthesia. The same beneficial results for probing pocket depths and clinical attachment gain could be detected. The majority of patients prefer local anesthesia gel despite a slightly greater procedural discomfort.

Principles in prevention of periodontal diseases

Tonetti MS, Eickholz P, Loos BG, et al. J Clin Periodontol. 2015 Jan 29. doi:10.1111/jcpe.12368. [Epub ahead of print]

The objective of this workshop was to review critical scientific evidence regarding periodontitis and develop recommendations to improve: plaque control at the individual and population level (oral hygiene); control of risk factors; and delivery of preventive professional interventions. Discussions were informed by various systematic reviews, and recommendations were developed and graded using a modification of the GRADE system. Key messages included: an appropriate periodontal diagnosis is needed before submitting individuals to professional preventive measures and is used to determine the type of preventive care; preventive measures are not sufficient for treatment of periodontitis; repeated and individualized oral hygiene instruction and professional mechanical plaque (and calculus) removal are important components of preventive programs; behavioral interventions to improve individual oral hygiene need to set specific goals and incorporate planning and self-monitoring; brief interventions for risk factor control are key components of primary and secondary periodontal prevention.

Radiographic evaluation of immediately loaded implants supporting 2-3 units fixed bridges in the posterior maxilla

Cesaretti G, Botticelli D, Renzi A, et al. Clin Oral Implants Res. 2015 Feb 9. doi:10.1111/clr.12565. [Epub ahead of print]

This study compared the survival rate and alveolar bone levels at implants installed in healed sites and functionally loaded within 1 h from installation or after 3 months. It involved a total of 30 patients and 71 implants; 36 were test implants and 35 were control. The test implants were immediately loaded with a temporary reconstruction in proper occlusion, while the randomly selected control sites received the final reconstruction after 3 months. Radiographic bone levels were determined after implant installation, prosthesis delivery, and at annual intervals thereafter. No biological and technical complications were observed during the 3-year follow-up. After 1 year of function, similar bone levels were observed at both sites, and no differences were found in the subsequent observation periods. CONCLUSION: Survival rates and radiographic bone levels after 1, 2, and 3 years of observation did not differ between conventionally installed implants loaded immediately or delayed (after 3 months). Moreover, insertion torque values did not affect osseointegration.

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