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The threat of Coronavirus Disease 2019 (COVID-19) to health systems in sub-Saharan Africa (SSA) can be compared metaphorically to a lake in Africa infested with a bask of crocodiles and the saying "the eye of the crocodile." In the lake, only the eyes of the crocodile appear on the surface while the rest of the body is submerged in water. In this Viewpoint, the eyes and the body of the crocodile represent the public health preparedness and health systems, respectively, in SSA.The selection of proper outcome measures is a critical step in clinical research. Most randomized clinical trials (RCTs) assessing the effects of initial anti-infective periodontal therapies use surrogate outcomes as primary outcome variables, such as mean changes in probing depth (PD) or in clinical attachment. However, these parameters do not reflect disease remission/control at patient level, which has led to subjective interpretations of the data from RCTs and Systematic Reviews. Based on a comprehensive analysis of 724 patients from USA, Germany and Brazil treated for periodontitis, this paper suggests that the clinical endpoint of "≤4 sites with PD≥5mm" is effective in determining disease remission/control after active periodontal treatment and therefore, may represent a pertinent endpoint for applying the treat-to-target concept in RCTs. Furthermore, regression models showed that the presence of >10% and >20% sites with bleeding on probing in the mouth post-treatment increases the risk of a patient leaving the endpoint from 1-2 years (OR=3.5 and 8.7, respectively). CC-486 Researchers are encouraged to present results on this outcome when reporting their trials, as this will allow for an objective comparison across studies and facilitate systematic reviews, and consequently, the extrapolation of data from research to clinical practice. Copyright© by the International Academy of Periodontology.BACKGROUND AND OBJECTIVES Applications of porous titanium granule (PTG) in periodontal (furcation defects) and non-periodontal treatments have shown promising results. However, its role in periodontal intrabony defects still remains unexplored. Thus, we aim to assess the feasibility of PTG in obtaining reconstruction in intrabony defects and compare the outcome with that of open flap debridement (OFD). METHODS Ten patients (three females and seven males) with a mean age of 34.7 years who constituted twenty (20) bilateral intrabony defects were recruited. Each patient contributed to two defects which were randomly treated by OFD alone (control group) or by OFD followed by grafting with PTG (test group). All the clinical and radiological parameters were recorded at baseline, three, six and nine months and statistically analyzed. RESULTS The results of this study demonstrated that in clinical parameters there is no significant differences in the improvement from baseline to nine months. However, regarding the radiographic defect fill, there was significant gain from baseline to nine months only in the PTG sites. CONCLUSION Within the limits of our study, the results of this trial indicate that reconstructive periodontal surgery with PTG offers minimal radiographic defect resolution with no significant improvements in clinical endpoints compared to open flap debridement. Copyright© by the International Academy of Periodontology.OBJECTIVES This study investigated changes induced by Porphyromonas gingivalis and on gastrointestinal histology and gut microbiome in a mouse model of experimental periodontitis. The effect of probiotic Lactobacillus rhamnosus GG (LGG) in altering these changes was also investigated. METHODS IThirty-six mice were allocated into six groups. Experimental alveolar bone loss was induced by oral inoculation with P. gingivalis and F. nucleatum. LGG was orally inoculated or orally gavaged. Gastrointestinal tissue changes were assessed using histological analysis and immunohistochemistry. Caecal microbiome was analysed by sequencing 16S rRNA genes of caecal content. RESULTS Inoculation with P. gingivalis and F. nucleatum induced inflammation throughout gastrointestinal tract (p less than 0.05), increased expression of IL-6 in ileum (p = 0.052) and altered composition of caecal microbiome (p less than 0.05) in experimental mice compared to controls. Mice treated with LGG had reduced tissue inflammation in duodenum (p = 0.044) and lowered levels of IL-6 in ileum (p = 0.048) when compared with disease. LGG therapy influenced gut microbiome changes. CONCLUSION P. gingivalis and F. nucleatum inoculation induced significant changes in intestinal inflammation and caecal microbiome. Oral gavage with LGG exerted a protective effect against intestinal inflammation and limited gut microbiome changes associated with P. gingivalis and F. nucleatum. Copyright© by the International Academy of Periodontology.OBJECTIVES To evaluate periodontal parameters of abutment teeth and interproximal sites, in patients with mandibular class I Kennedy Removable Partial Dentures (RPD), after 4 years of periodontal treatment. METHODS Fourteen patients with periodontal disease were treated and evaluated for the following parameters plaque index (PI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), clinical attachment loss (CAL) and keratinized mucosa (KM). Parameters were compared between abutment teeth with direct and indirect retainers at all time-points. Periodontal maintenance was recorded at 6, 18 and 48 months. Data were analyzed using the Friedman and Wilcoxon Tests. RESULTS Most patients (n=11; 78.6%) included were female and had a mean age of 66 years (± 7.8). After 48 months, a significant reduction was only observed in PI for both abutment teeth; in contrast, PD, GR, CAL and KM all increased by the end of the study. BOP increased at 48 months for the abutment teeth with direct retainers. The distal site of the abutment teeth with direct retainers presented higher values for GR and CAL. CONCLUSIONS Non-surgical periodontal therapy was effective during the first 18 months, but periodontal conditions were worse at 48 months after therapy. The distal sites of abutment teeth with direct retainers presented the worst periodontal conditions. Copyright© by the International Academy of Periodontology.
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