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Disclaimer. MeSH Bookshelf Epub 2021 Feb 8. Interestingly, some of the common human periodontopathogens such as Haemophilus (formerly Actinobacillus) actinomycetemcomitans are notably absent in animals. The aim of this article is to report a comprehensive periodontal treatment in a 23-year-old male who was referred to the periodontology department due to complaints of tooth mobility and gum infections diagnosed with generalized stage IV, grade C periodontitis according to the clinical, systemic, and family history features observed. Associations, though not causal relationships, with periodontitis have been suggested for several conditions: Notably, the 2017 system published by AAP/EFP eliminates use of the diagnostic categories Chronic and Aggressive periodontitis. 2023 Jan 13;12:1125463. doi: 10.3389/fcimb.2022.1125463. Comparison of the Marginal Bone Loss in One-stage versus Two-stage Implant Surgery. Int J Dent Hyg. The 4 Stages of Gum Disease - Dental Diseases Oral Dis 2020;26(2):439-46. 2006 Oct;17 Suppl 2:35-51. As a review, the periodontal classifications were revised in 1999 and classified as chronic, aggressive (localized and generalized), necrotizing, and a manifestation of systemic disease.1 New technology, research, and information has emerged in the past 18 years which led to the new revisions. This S3 Level CPG was developed by the European Federation of Periodontology (EFP), following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process. Berglundh T, Armitage G, Araujo MG, et al. Conclusions: The paper describes a simple matrix based on stage and grade to appro- J Prosthet Dent. Methods: Eighteen subjects with GPIIIIVC were enrolled in this study. You are accessing a machine-readable page. The four stages (stage 1-4) of periodontitis are determined by several variables. HHS Vulnerability Disclosure, Help Results: Females showed a significant increase in the percentage of inflammatory cells compared to males (6.29% vs. 2.28%, Periodontitis is a disease that, if untreated, leads to serious functional and aesthetic impairments, as well as a strong conditioning of social life, resulting in impairment in life quality [, This disease is characterized by a microbially-associated, host-mediated inflammation that results in the loss of periodontal attachment, clinically detected as clinical attachment loss (CAL) [, In 2018, the American Academy of Periodontology and the European Federation of Periodontology published a new classification of periodontal diseases. You seem to have javascript disabled. Use to remove results with certain terms 0000030272 00000 n Periodontal risk assessment (PRA) for patients in supportive periodontal therapy (SPT). Association of periodontitis with Oral Cancer: A Case-Control Study. government site. Journal of Dental Research, 85(6), 547-551. This treatment of periodontal disease can be non-surgical or surgical with the optimal treatment being based on individual patient, site, and systemic factors. Multiple external root resorptions in a patient with Stage IV, Grade C The four stages (stage 1-4) of periodontitis are determined by several variables. Sarah has clinical experience in both the private and public health sectors. -, Caton J.C., Armitage G., Berglundh T., Chapple I.L.C., Jepsen S., Kornman K.S., Mealey B.L., Papapanou P.N., Sanz M., Tonetti M. A new classification scheme for periodontal and peri-implant diseases and conditionsIntroduction and key changes from the 1999 classification. Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Hu KF, Ho YP, Ho KY, Wu YM, Wang WC, Chou YH. For more information on the new AAP periodontal classification guidelines, click here. Comparative evaluation of demineralized freeze-dried bone allograft Pregnancy complications: An umbrella review of 23 systematic reviews found that periodontitis during pregnancy seems to contribute to increased risk of preterm birth, low birthweight infants and preeclampsia. Texture of the diet, toys, and treats can affect the self-cleansing mechanisms of the teeth. Periodontitis and respiratory diseases: A systematic review with meta-analysis. 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New AAP Periodontal Classification Guidelines - Today's RDH Patients often require several treatment sessions for complete debridement of the tooth surfaces.21 After scaling, root planing, and other adjunctive treatment approaches such as use of antibiotic therapy, the periodontal tissues require approximately 4 weeks to demonstrate optimal effects of nonsurgical therapy.21, Many moderate to advanced cases require surgical access to the root surface for root planing and reducing pocket depth, which will allow the patient to achieve successful home care.21, A patient with gingivitis can revert to a state of health with a reduced periodontium, but due to the host-related disease susceptibility, a periodontitis patient remains a periodontitis patient, even following successful therapy, and requires lifelong supportive care to prevent recurrence of disease.2 Further, patients with more severe periodontitis Stage and Grade have been found to be more likely to experience disease recurrence and tooth loss without regular periodontal maintenance visits. 8600 Rockville Pike Next, we look at the patient-specific factors that contribute to the complexity of long-term management such as probing depths, the number of lost teeth, the shape of bone loss, access for hygiene, occlusal trauma, tooth alignment, and many others. Periodontitis requires more aggressive periodontal treatment. The effect of periodontal treatment on diabetes-related parameters such as glycemic control is still inconclusive. The guidelines go on to endorse use of systemic sub-antimicrobial dose doxycycline along with scaling and root planing for patients with moderate-to-severe periodontitis. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. New and exciting things were happening at this past EuroPerio9 held in Amsterdam from June 20th-23rd, 2018. There are several actions that could trigger this block including submitting a certain word or phrase, a SQL command or malformed data. 2022 John Wiley & Sons A/S. The vascular density of the marginal gingiva is supported by arteries that extend into the periodontal ligament and the alveolar bone and periosteum [, The percentage of the vascular area was statistically significantly higher in the no plaque group than in the plaque group. Qiao Y, Wang Z, Li Y, et al. 0000027973 00000 n Treatment of early periodontitis includes tooth scaling and root planingaccompanied by improved oral hygiene. ; Jepsen, S.; Kornman, K.S. 14 on 251 periodontitis cases. generalized). Risk factor analysis is used as grade modier. 2015;69:717. ), which require additional interventions following completion of active periodontal therapy. 0000001972 00000 n Periodontitis exists in different forms, and its etiology is related to multiple component causes. J Med Case Rep. 2015;9:211. Schnabl D, Thumm FM, Kapferer-Seebacher I, Eickholz P. Healthcare (Basel). A patient is said to have periodontitis if: interdental clinical. Staging intends to classify the severity and extent of a patients disease based on a measurable amount of destroyed/damaged tissue from periodontitis. Considering the vascular area, young patients showed a significant increase compared to older patients and it was higher in non-smokers than smokers. American Journal of Orthodontics and Dentofacial Orthopedics, 157(2), 156-164.e117. 2015 May;113(5):371-82. American Academy of Periodontology. The AAP released two documents titled Three Steps to Staging and Grading a Patient and Staging and Grading Periodontitis. A quick synopsis of the three stages are as follows; Step 1: Initial Case Overview to Assess Disease, the recommendation is to conduct a screening consisting of radiographs, probing depths, and missing teeth. F: 904-249-8554, 1409 Kingsley Avenue, Suite 9A, Periodontitis Stage III-IV, Grade C and Correlated Factors: A Histomorphometric Study Authors Barbara Buffoli 1 , Gianluca Garzetti 2 , Stefano Calza 3 , Eleonora Scotti 4 , Elisa Borsani 5 , Veronica Cappa 6 7 , Lia Rimondini 8 9 , Magda Mensi 10 Affiliations ; Lee, J.H. Two key processes involved in the evolution of this pathology are angiogenesis and inflammatory infiltrate. 2012 Jun;83(6):731-43. Histomorphometric analyses were performed by two blinded investigators at the Section of Anatomy and Physiopathology of the University of Brescia. A separate guideline covering the treatment of Stage IV periodontitis will be published. They may even be beneficial by helping to limit the numbers of periodontopathogenic bacteria. A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification. Although this microbiota does stimulate an immune response, the bacteria in an otherwise healthy mouth exist in relative commensal harmony with the host. J Clin Periodontol 2018;45 Suppl 20:S219-S29. She loves not only educating patients but also students pursuing a dental hygiene career, and current dental professionals. P: 904-249-8448 J Dent. hb``f``g`e`\ @16s0080 ^`K'4m`6GH00@QegVc4kX71j0~dH'X!~uZ)FB Z00% (; J( endstream endobj 17 0 obj <>>> endobj 18 0 obj <>/Font<>/ProcSet[/PDF/Text]/Properties<>>>/Rotate 0/TrimBox[0.0 0.0 792.0 612.0]/Type/Page>> endobj 19 0 obj <> endobj 20 0 obj <>stream Periodontal diseases. Staging and grading of periodontitis: Framework and proposal of a new Sgolastra F, Petrucci A, Gatto R, Monaco A. 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). Generalized stage IV, grade C periodontitis results in rapid bone destruction in the periodontium and can lead to early tooth loss. Berglundh, T., Armitage, G., Araujo, M. G., Avila-Ortiz, G., Blanco, J., Camargo, P. M., . The .gov means its official. 2017 Jun;44(6):612-9. and M.M. Bethesda, MD 20894, Web Policies 2020 Apr;91(4):442-453. doi: 10.1002/JPER.19-0141. A periodontal pocket is defined as a pathologically deepened gingiva sulcus, according to the definition reported by the American Academy of Periodontology. Cardiovascular diseases: Although a causal relationship has not been established, the presence of periodontal disease has been associated with various cardiovascular diseases including myocardial infarction. Periodontol 2000. Eldzharov A, Kabaloeva D, Nemeryuk D, Goncharenko A, Gatsalova A, Ivanova E, Kostritskiy I, Carrouel F, Bourgeois D. J Clin Med. Epub 2021 Jul 19. Therefore, following periodontitis treatment, besides its stage and grade classification, the patient must be classified into a stable or unstable periodontitis patient status. All in all, this Staging and Grading system helps your periodontist provide a patient-centered evaluation and treatment plan as well as an effective way to communicate more clearly with our patients. A Feature Other antibiotics investigated for the treatment of Grade C periodontitis include amoxicillin-clavulanate potassium, tetracycline, ciprofloxacin, and . In this study, we did not compare the percentage of the vascular area and inflammatory cells with healthy patients, but we evaluated how some factors (smoking, age, PPD, plaque) influenced these percentages in GPIIIIVC patients. methods, instructions or products referred to in the content. This can reverse gingivitis, returning the gingiva to a healthy, uninflamed state. PMC Lang, N.P. Removal of the bacterial plaque on the tooth surfaces is of utmost importance. Please enable it to take advantage of the complete set of features! 2012 Oct;39(8):541-4, 547-8, 551-2. J. Clin. The worst periodontal condition is evident in patients with generalized stage III-IV, grade C periodontitis. Know, V.; Caton, J.C. Commentary: Prognosis revisited a system for assigning periodontal prognosis. J Periodontol 2018;89 Suppl 1:S74-S84. Supportive periodontal treatment: Pocket depth changes and tooth loss. The Merck Veterinary Manual was first published in 1955 as a service to the community. Would you like email updates of new search results? Cao R, Li Q, Wu Q, et al. Enter search terms to find related veterinary topics, multimedia and more. J Periodontol. J Clin Periodontol 2021;48(8):1008-18. Clinicians should initially assume Grade B disease and seek specific evidence to shift towards grade A or C, if available. A workshop titled the World Workshop occurred in November 2017.1 This World Workshop consisted of expert participants, along with the AAP and EFP, as they were tasked with reviewing multiple publications, including review papers and consensus reports that led to the new guidelines.1. Periodontal disease is a chronic infection that can result in the destruction of tooth-supporting structures (i.e., the gingiva, periodontal ligament, and/or alveolar bone) and eventual tooth loss.6, According to analysis of data from the National Health and Nutrition Examination Survey (NHANES) collected from 2009 to 2014, roughly 42% of dentate adults 30 years of age or older in the United States have some form of periodontitis (mild, moderate or severe).7 The prevalence of periodontitis increases with age; it is significantly more common in males than in females, and in non-Hispanic Blacks and Hispanics than non-Hispanic whites.7. For mild to moderate periodontitis, the focus will be on clinical attachment loss (CAL). 22. The binary coded variable BoP was summarized as counts and percentages. ; Kim, H.D. doi: 10.1111/jcpe.12945. Tooth loss and radiographic bone loss in patients without regular supportive care: A retrospective study. In order to be human-readable, please install an RSS reader. J. Clin. Background: The bacteria in plaque are predominantly nonmotile, gram-positive aerobes, including Staphylococcus spp and Streptococcus spp, but many others are also present. The goal of periodontal treatment is to eliminate dysbiotic plaque biofilm from the tooth surface and to establish an environment that allows the maintenance of health. Periodontitis exists in different forms, and its etiology is related to multiple component causes. FOIA A stage 3 furcation involvement exists when a periodontal probe extends under the crown of a multirooted tooth, through and through from one side of the furcation out the other. Yardley, PA: Professional Audience Communications, Inc.; 2010. A., Melis, M., & Zawawi, K. H. (2021). 2023 Jan 17;16:235-244. doi: 10.2147/JIR.S395777. According to ADA clinical practice guidelines on non-surgical treatment,23 derived from a 2015 systematic review,23 scaling and root planing without adjuncts is the treatment of choice for patients who have periodontitis. Get Directions Stage IV periodontitis shares the severity and complexity characteristics of stage III periodontitis, but includes the anatomical and functional sequelae of tooth and periodontal attachment loss (tooth flaring and drifting, bite collapse, etc. In conclusion and within the limitations of the present study, the administration of L. rhamnosus SP1 or azithromycin in the treatment of stage III periodontitis generalized grade B failed to produce additional beneficial effects when compared to SRP on its own. 2021 Mar 18;10(6):1262. doi: 10.3390/jcm10061262. With this assumption, we decided to discuss the results factor by factor for simplifying the comprehension. Severe or very severe periodontitis will be considered Stage III or Stage IV. J Clin Periodontol 2018;45 Suppl 20:S1-S8. official website and that any information you provide is encrypted %PDF-1.4 % The present S3 Level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat patients with stage IV periodontitis and to maintain a healthy dentition over lifetime, according to the available evidence at the time of publication. doi:10.1002/jper.18-0157. and transmitted securely. Periodontal and Orthodontic Synergy in the Management of Stage IV Periodontitis: Challenges, Indications and Limits. conceived and designed the experiments; B.B. performed the experiments; S.C. and V.C. Department of Scientific Information, Evidence Synthesis & Translation Research, ADA Science & Research Institute, LLC. Unable to load your collection due to an error, Unable to load your delegates due to an error. Periodontal diseases. J Clin Periodontol. ; Michalowicz, B.S. Root scaling (removing plaque and calculus on exposed root surfaces) and planing (smoothing the root surfaces by removing textural irregularities and diseased cementum) are performed, followed by gingival curettage that removes the infected and inflamed inside layer of a periodontal pocket. Published by John Wiley & Sons Ltd. Rheumatoid arthritis: A 2020 systematic review indicates that periodontitis may increase the risk of developing rheumatoid arthritis. Severe crowding can be relieved through selective extractions, predisposing anatomy can be modified, diabetes or renal failure can be treated and controlled, and inappropriate behaviors or parafunctional habits that damage the tissues can be addressed. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. . Caton, J. G., Armitage, G., Berglundh, T., Chapple, I. L., Jepsen, S., Kornman, K. S., . J Clin Periodontol 2018;45 Suppl 20:S162-S70. To fully understand the "Three Steps to Staging and Grading a . Gut microbiota-dependent trimethylamine n-oxide pathway contributes to the bidirectional relationship between intestinal inflammation and periodontitis. Garbo D, Aimetti M, Bongiovanni L, Vidotto C, Mariani GM, Baima G, Romano F. Life (Basel). Tomasi, C.; Leyland, A.H.; Wennstrm, J.L. Sex differences in destructive periodontal disease: Exploring the biologic basis. In this case report, we present a patient with stage IV/ grade C periodontitis who achieved a good treatment outcome following nonsurgical periodontal treatment, orthodontic treatment, and prosthodontic treatment with a Maryland bridge, bringing new insight into the treatment of advanced periodontal disease. Introduction In particular, our null hypothesis had been to find a statistically significant major mean percentage of the vascular area and inflammatory cells in non-smoker patients due to the effects of smoking on biological tissues. Clinical or Laboratorial Research Manuscript, Case Report / Clinical Technique Manuscript, Department of Periodontics, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran, Postgraduate Student, Department of Periodontics, School of Dentistry, Tehran University of Medical Sciences, International Campus, Tehran, Iran, All the contents of this journal, except where otherwise noted, is licensed under a, Vol. Grade of periodontitis is estimated with direct or indirect evidence of progression rate in three categories: slow, moderate and rapid progression (Grade A-C). 0000029217 00000 n A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and a structured consensus process with leading experts and a broad base of stakeholders. 0000056742 00000 n J Indian Soc Periodontol. J Clin Periodontol 2018;45 Suppl 20:S171-S89. Newman MG, Takei HH. Meyer-Bumer, A.; Pritsch, M.; Cosgarea, R.; el Sayed, N.; Kim, T.S. Prevalence, General and Periodontal Risk Factors of Gastroesophageal Reflux Disease in China. Calsina, G.; Ramn, J.M. J Dent Res 2022;101(3):270-77. BMC Cardiovasc Disord 2017;17(1):50. A stage 2 mobility is present when tooth mobility is increased in any direction other than axial over a distance of >0.5 mm and up to 1 mm. She is currently completing a doctorate program in health sciences. The goal of periodontal treatment is to eliminate dysbiotic plaque biofilm from the tooth surface and to establish an environment that allows the maintenance of health. Response of chronic and aggressive periodontitis to treatment. However, this factor should be investigated more. Jacksonville, FL 32256 Please note that many of the page functionalities won't work as expected without javascript enabled. Durable bonds at the adhesive/dentin interface: an impossible mission or simply a moving target. Philadelphia: Elsevier; 2019. Modern Periodontics is dedicated to provide optimal oral health through education, prevention and treatment. Step 3: Establish Grade focuses on assessing risk factors, systemic considerations, and outcomes of non-surgical periodontal therapy. https://doi.org/10.3390/biomedicines7020043, Buffoli, Barbara, Gianluca Garzetti, Stefano Calza, Eleonora Scotti, Elisa Borsani, Veronica Cappa, Lia Rimondini, and Magda Mensi. Periodontol 2000 2020;82(1):257-67. Clinical effects of probiotic or azithromycin as an adjunct to scaling Al-Harthi, S., Barbagallo, G., Psaila, A., d'Urso, U., & Nibali, L. (2021). Acta Odontol Latinoam. Females showed a significant increase in inflammatory infiltrate compared to males (6.29% vs. 2.28%. Saving such teeth also requires endodontic therapy (see below), and the prognosis is determined by the extent of periodontal disease. Caton JG, Armitage G, Berglundh T, et al. ; Bissada, N.F. Materials and methods: Methods: Twenty-four patients with stage IV/grade C periodontitis who received combined periodontal and orthodontic treatment were included in this study. Meyle, J.; Chapple, I. Molecular aspects of the pathogenesis of periodontitis. generalized). Stage IV grade C periodontitis; Aggressive periodontitis; Dental implants; Maintenance; Regeneration. Also, a periodontist will compare radiographs taken over time to further assess rates of progression. Masamatti SS, Kumar A, Virdi MS. Periodontal diseases in children and adolescents: a clinician's perspective part. An official website of the United States government. 13th ed. J Formos Med Assoc. Treatment of stage IV periodontitis: The EFP S3 level clinical - PubMed Recurrence and progression of periodontitis and methods of management in long-term care: A systematic review and meta-analysis. https://www.mdpi.com/openaccess. . Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Sreedevi, M.; Ramesh, A.; Dwarakanath, C. Periodontal status in smokers and nonsmokers: A clinical, microbiological, and histopathological study. Multiple requests from the same IP address are counted as one view. A randomized controlled trial of implant-retained mandibular overdentures. Considering the vascular area, young patients showed a significant increase compared to older patients (0.60% vs. 0.46%. Under the 2017 system, the current categories of periodontitis are3, Necrotizing periodontal diseases feature papilla necrosis, bleeding, and pain, and are associated with impaired immune response,3 Periodontitis as a manifestation of systemic disease focuses on diseases and conditions other than diabetes (e.g., genetic disorders, neoplasms, and other metabolic and endocrine disorders).4, 20. Federal government websites often end in .gov or .mil. Careers. Statistical analyses were performed by statistician from the University of Brescia. Once the determination of periodontitis has been made, the disease is classified according to one of four Stages (I-IV) based upon the most severe area of disease presentation, which describe the disease severity and extent of disease, focusing on attachment and bone loss (Table 1A). Inflammatory mediators produced by the host directly result in bone and tissue damage around the root. Tonetti, M.S. Combined periodontal and prosthodontic treatment demands of patients require a structured coordination of pretreatments and an adequate choice of restorations. Periodontitis is a more severe disease that involves inflammation of the periodontal ligament and alveolar bone, eventually causing loss of attachment (periodontal pocketing, gingival recession, bone resorption). We do not control or have responsibility for the content of any third-party site. New classification of periodontal diseases (NCPD): an - Nature This treatment of periodontal disease can be non-surgical or surgical with the optimal treatment being based on individual patient, site, and systemic factors. J Clin Periodontol 2018;45 Suppl 20:S286-S91. |, Modern Periodontics and Implant Dentistry. Effects of smoking on non-surgical periodontal therapy in patients with periodontitis Stage III or IV, and Grade C. Chronic Periodontitis Prevention, Diagnosis and Treatment: A Systematic Review [Internet]. those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). This is determined usually by comparing the patients disease level to their age. In the literature, gender differences in periodontal diseases have been reported. Preshaw, P.M.; Henne, K.; Taylor, J.J.; Valentine, R.A.; Conrads, G. Age-related changes in immune function (immune senescence) in caries and periodontal diseases: A systematic review. 2019 Sep 6;11(9):e5586. Ioannidou E, Hall Y, Swede H, Himmelfarb J. Periodontitis associated with chronic kidney disease among Mexican Americans. 0000056248 00000 n 0000099634 00000 n Visit our dedicated information section to learn more about MDPI. Shallow periodontal pockets are treated in a closed fashion, but pockets >6 mm deep require open surgery (creation of a periodontal flap) to expose the root surface and alveolar bone for adequate treatment (root scaling/planing and alveoloplasty). 0000028701 00000 n The collection of the samples was carried out under topical anesthesia with 2% mepivacaine and epinephrine 1:100,000 [, Sections were deparaffinized in xylene, rehydrated, and stained with hematoxylineosin staining (Bio-Optica, Milan, Italy) and MassonGoldner trichrome staining (Merck KGaA, Darmstadt, Germany) for the evaluation of the percentage of inflammatory cells and the vascular area (. The aim of this article is to report a comprehensive periodontal . Angeline Kuznia and Douglas I. Storch, of Modern Periodontics PA. | All Rights Reserved 2018. Evaluation of Microcirculation, Cytokine Profile, and Local Antioxidant Protection Indices in Periodontal Health, and Stage II, Stage III Periodontitis. Cochrane Database Syst Rev 2018;1:CD009376. The Veterinary Oral Health Council website (www.vohc.org ) provides further information about products that meet certain requirements for plaque and/or calculus control. Find support for a specific problem in the support section of our website. 2022 May;52(3):511-525. ; Papapanou, P.N. ; Tonetti, M.S. Get Directions Kasprzak, A.; Surdacka, A.; Tomczak, M.; Konkol, M. Role of high endothelial postcapillary venules and selected adhesion molecules in periodontal diseases: A review. Kamil W, Al Bayati L, Hussin AS, Hassan H. Reconstruction of advanced bone defect associated with severely compromised maxillary anterior teeth in aggressive periodontitis: a case report. Clin Oral Implants Res. Local placement of a gel containing antibiotics (eg, doxycycline) into cleaned periodontal pockets may be helpful. permission provided that the original article is clearly cited. Implants. Lancet. 2018 May;16(2):210-218. doi: 10.1111/idh.12290. Clinical efficacy of Lactobacillus reuteri-containing - SpringerLink