Aim The aim of this review is to assess study design and risk of bias related to primary outcome in recently published randomized controlled trials (RCTs) in periodontology. Method An electronic (Medline, EMBASE and Cochrane library) and a manual search were completed to detect RCTs in humans, with an outcome in the field of periodontology and published in English from January 2018 up to March 2020. Results Data extraction of 318 publications meeting the inclusion criteria was performed by two reviewers. Most studies adopted a parallel‐group superiority design in a university setting. Overall, 54% of papers reported the primary outcome and relative sample size calculation, while only 37% also included reproducibility estimates relative to the primary outcome. Papers published in journals with higher impact factors had better compliance with primary outcome reporting and lower overall risk of bias scores. Conclusion Improvements in the quality of RCTs in periodontology are still needed. The importance of defining a clinically relevant study primary outcome and building the study around it needs to be emphasized. Furthermore, RCTs in periodontology could consider, when appropriate, some of the study design options which facilitate application of the principles of personalized medicine.

Periodontal treatment is quickly moving towards a philosophy consisting of a less invasive approach. In this context, minimally invasive nonsurgical therapy (MINST) is a promising option. This paper reviews the concepts behind minimal invasiveness in nonsurgical periodontology and reports the state‐of the art evidence for this topic. Instruments used and protocols suggested for these applications are introduced and discussed. The original papers reviewed show probing pocket depth (PPD) reductions and clinical attachment level (CAL) gains ranging from 2 to 4 mm between baseline and 6 months to 5 years posttreatment for intrabony defects and from 1.5 to 3 mm between baseline and 2‐6 months of follow‐up for full‐mouth results. These clinical outcomes are accompanied by statistically significant reductions in radiographic bone defect depth and increases in intrabony defect angles posttreatment. Wound healing mechanisms following MINST are presented, and clinical applications and directions for future research are suggested.

Untreated periodontal intrabony defects are associated with increased risk of progression and tooth loss. 1,2 In parallel with remarkable improvements in the surgical management of intrabony defects in a regenerative direction, [3][4][5] Minimally invasive non-surgical therapy (MINST) has emerged as a valid treatment approach leading to clinical and radiographic healing of such defects. 6,7 It is evident that clinical response and complete resolution of surgically treated intrabony defects are affected by defect morphology. In particular, deeper defects, with a narrower angle and increased number of walls, have a tendency to be associated with improved clinical outcomes following surgery. 8 Although it has been suggested that the same may apply to defects treated with MINST, 9 the evidence is a lot more limited, also due to the fact that, by definition, intra-surgical assessment is not feasible in defects treated only non-surgically.The ability to identify defects suitable for specific treatments modalities is very important, with the aim to be able to personalize treatment. In particular, being able to predict the likelihood of achieving important endpoints such as 'pocket closure' 10 or 'composite outcome' 11 could better inform joint decision making between therapist and patient, as well as strengthen treatment strategies.

To appraise the literature on the prevalence of the JP2 clone of Aggregatibacter actinomycetemcomitans (A.a.) and on its association with presence and progression of periodontitis in different populations. A systematic search of the literature was conducted in Medline, Embase and Cochrane Library for studies reporting data on detection of the JP2 clone of A.a. A total of 56 papers were included in the review, from an initial search of 685 titles. Studies were carried out in populations with a mean age of 26.34 years (range 6.24–53.85 years). Just over 16% of the overall population assessed (n = 13 751) had the JP2 clone detected. Meta‐analyses included 16 studies and 1775 patients, and revealed an association between detection of the JP2 clone and diagnosis of periodontitis (RR = 1.86, 95% 1.43–2.42) from saliva and plaque, with high heterogeneity (I2 = 85%, p < .00001). Meta‐analyses included 5 studies and 616 patients, and revealed an association between baseline detection of the JP2 clone and onset of periodontitis over 2 to 5 years (RR = 4.12, 95% 2.42–7.00), with high heterogeneity (I2 = 81%, p < .0003). From the overall risk of bias score, 29 papers were judged as low risk of bias, whilst the remaining papers were judged to have an overall medium or high risk of bias. Detection of the JP2 clone of A.a. in subgingival plaque and saliva samples is associated with increased odds of diagnosis of periodontitis and may be able to predict onset of periodontitis. This systematic review provides clear evidence that in certain populations, the JP2 clone of A.a. is associated with early‐onset periodontitis. Furthermore, detection of this bacterium seems to be predictive of disease onset.

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