Background

Periodontitis is a disease that leads to serious functional and esthetic dysfunctions. Periodontitis exists in different forms, and its etiology is related to multiple component causes. Two key processes involved in the evolution of this pathology are angiogenesis and inflammatory infiltrate.

The aim of this study was to understand if important factors such as smoking, gender, age, plaque, pus, and probing pocket depth could influence the histomorphological pattern of generalized stage III–IV, grade C periodontitis (GPIII–IVC), which is a particular form of periodontitis.

Methods: Eighteen subjects with GPIII–IVC were enrolled in this study. The percentage of inflammatory cells and the vascular area were measured and evaluated in relation to each periodontal disease-associated factor. Results: Females showed a significant increase in the percentage of inflammatory cells compared to males (6.29% vs. 2.28%, p-value = 0.020) and it was higher in non-smokers than in smokers (4.56% vs. 3.14%, p-value = 0.048). Young patients showed a significant increase in vascular area percentage compared to older patients (0.60% vs. 0.46%, p-value = 0.0006) and this percentage was also higher in non-smokers compared to smokers (0.41% vs. 0.55%, p-value = 0.0008). The vascular area was also more than halved in subjects with residual plaque on tooth surfaces (0.74% vs. 0.36%, p-value = 0.0005). Conclusions: These results suggested that even if these factors are commonly related to the worsening of periodontal status, some of them (pus and periodontal probing depth (PPD)) do not affect the inflammatory and vascular patterns.

The philosophy of prevention in all medical professions is increasing from a global perspective. In fact, prevention of chronic non-communicable diseases, the major bur- den of illness and disability in almost all countries in the world, has been strengthened in recent years.1 The mo- tivation is to ensure a better quality of life for people and to reduce public health expenditures.

In dentistry, periodontitis is one of the major chronic non-communicable diseases. World experts in periodon- tics and science have published several principles re- garding the prevention of periodontal diseases.2

Aims: This case series study aimed to assess the clinical outcomes of a novel protocol

for the treatment of patients with severe periodontitis.

Materials and Methods: Twenty (20) patients with severe periodontitis underwent a single session of One-Stage Full-Mouth Instrumentation (OSFMI) involving supra- and sub-gingival air-polishing with erythritol and chlorhexidine powder and ultrasonic root surface debridement and calculus removal, in association with systemic amoxicillin and metronidazole. Pocket Probing Depth (PPD), Clinical Attachment Level (CAL), Recession (REC), Bleeding on Probing (BOP) and Plaque Index (PI) were collected at baseline (T0), 6 weeks (T1), 3 months (T2) and 6 months (T3).

Results: At 6 months, 30% of subjects reached the primary clinical endpoint (≤ 4 sites with PD ≥ 5 mm). The percentage of BOP decreased from 49.08 (CI95% 36.06; 62.1) at T0 to 12.97 (CI95% 7.57; 18.37) at T3. The mean number pockets with PPD≥ 5 mm and PPD≥ 7 mm decreased significantly, from 46.0 and 20.6 at T0 to 11.5 and 2.8 at T3 respectively (p < 0.001).

Conclusions: The OSFMI protocol led to clinical results comparable to those obtained with traditional SRP. Researchers are encouraged to test this protocol in randomized clinical trials with longer periods of observation.