Objective. Although the therapeutic effects of nonsurgical periodontal therapy (NSPT) are well established, the clinical benefits of the additional use of periodontal endoscopy (PE) remain controversial. Therefore, this randomized controlled split-mouth pilot study evaluated the effect of NSPT using PE versus NSPT without nPE on bleeding on probing (BOP) in sites with probing depth (PD)≥4 mm (primary outcome), PD, clinical attachment level (CAL), number of hard deposits (HDs), and treatment time per tooth (TrT). Methods. Two calibrated operators performed NSPT in twenty periodontitis patients, randomized into two quadrants for PE or nPE treatment. BOP, PD, and CAL were recorded at the first visit for NSPT (T0) and during reevaluation (T1: mean (SD) 119.7 (24.6) days after T0). The average TrT and the number of sites with HDs were documented at T0. Results. For BOP, no significant differences were found at the patient’s level (10/10 (male/female); aged 54.3 (10.9) years) neither within or between the groups. At tooth surface level, a lower number of surfaces with BOP p = 0.026 was observed in nPE. CAL and PD improved significantly during NSPT in both groups p ≤ 0.001 , with higher PD reduction p < 0.001 and CAL gain p < 0.001 in nPE. There are significantly longer TrT p < 0.001 and more surfaces with subgingival HDs evident in PE at T0 p = 0.001 . Conclusion. Whereas subgingival HDs can be visually detected with PE during NSPT, no additional clinical benefits regarding BOP, PD, or CAL were notable compared to conventional systematic periodontal instrumentation. Additionally, PE-assisted NSPT required a longer treatment time.

Objectives SOPs recommend high-volume evacuation (HVE) for aerosol-generating procedures (AGPs) in dentistry. Therefore, in the exploratory study, the area of splatter contamination (SCON in %) generated by high-speed tooth preparation (HSP) and air-polishing (APD) was measured when different suction cannulas of 6 mm diameter (saliva ejector (SAE)), 11 mm (HC11), or 16 mm (HC16) were utilized versus no-suction (NS). Materials and methods Eighty tests were performed in a closed darkened room to measure SCON (1m circular around the manikin head (3.14 m2) via plan metrically assessment through fluorescence technique. HSP (handpiece, turbine (Kavo, Germany)) or APD (LM-ProPowerTM (Finland), Airflow®-Prophylaxis-Master (Switzerland)) for 6 min plus 5 s post-treatment were performed either without suction or with low-flow (150 l/min for SAE) or high-flow rate (250 l/min/350 l/min for HC11/HC16) suction. All tests were two-tailed (p≤0.05, Bonferroni corrected for multi-testing). Results Irrespective the AGP, SCON was higher for NS (median [25th; 75th percentiles]: 3.4% [2.6; 5.4]) versus high-flow suction (1.9% [1.5; 2.5]) (p=0.002). Low-flow suction (3.5% [2.6; 4.3]) versus NS resulted in slightly lower but not statistically significantly lower SCON (p=1.000) and was less effective than high-flow suction (p=0.003). Lowest contamination values were found with HC16 (1.9% [1.5; 2.5]; p≤0.002), whereat no significant differences were found for HC11 (2.4% [1.7; 3.1]) compared to SAE (p=0.385) or NS (p=0.316). Conclusions Within study’s limitations, the lowest splatter contamination values resulted when HC16 were utilized by a high-flow rate of ≥250 l/min. Clinical relevance It is strongly recommended to utilize an HVE with suction cannulas of 16mm diameter for a high-flow rate during all AGPs and afterwards also to disinfect all surface of patients or operators contacted.

Background The familiar aids for interdental cleaning such as dental floss or interdental brushes (IDB) are often associated with difficult handling or an increased potential for trauma. Interdental picks (IRP), which have no metal core and silicone flaps instead of nylon brushes, offer the alternative. However, in-vitro studies found a lower cleaning effectiveness combined with higher forces for cleaning compared with conventional IDBs. The aim of this in-vitro study was to measure the experimental cleaning forces (ECF) using IRP with versus without an artificial saliva (AS; GUM Hydral, Sunstar Suisse SA, Etoy, Switzerland). Methods The test set-up was developed to investigate the cleaning of 3D-printed interdental area (IDR) mimicking human teeth (Form 2, Formlabs Sommerville, MA, USA) under standardized conditions. Three different morphologies (isosceles triangle, convex, concave) and three different sizes (1.0 mm,1.1 mm,1.3 mm) were used. Two different IRPs (GUM Soft-picks Advanced: SPA versus GUM Soft-picks Advanced Plus: SPA+, Sunstar Suisse SA, Etoy, Switzerland) in three sizes (small, regular, large), were used with versus without AS. ECF during ten cleaning cycles were recorded by a load cell [N]. Results Using AS leaded to significant lower values for ECF than without (1.04 ± 0.66 N versus 1.97 ± 1.01 N, p < 0.001). In general, a lower ECF was recorded for convex IDR compared to isosceles triangle and concave morphologies (p < 0.001) as well as for gap sizes of 1.3 mm compared to the smaller sizes (p < 0.001). For SPA+ we found significantly higher force values than for SPA (1.67 ± 0.93 N versus 1.31 ± 0.97 N, p < 0.001) independent of the use of AS. Conclusion Within the study´s in-vitro limitations, we found AS reduced ECF of IRPs by half and allowed using larger diameters interdentally, which could be associated with (1) a higher cleaning effectiveness and (2) a higher acceptance e.g. of patients with dry mouth. This has to be confirmed by further clinical investigations.

Aim There is a lack of data on long-term impact of different psychological variables on periodontitis. Aim of the current study was to investigate the impact of psychological factors in patients with chronic periodontitis (CP; according to the 1999 Classification of Periodontal Diseases) to explain adherence to or discontinuation of supportive periodontal therapy (SPT) in a university setting. Methods A sample of n = 119 patients were examined in a questionnaire-based, cross-sectional survey. All patients had received active periodontal treatment (APT) and were reevaluated in a university setting (Kiel) before 2016 [T1: start SPT]. Patients who showed sufficient adherence to SPT of ≥ 2 years (maximum ± 6 months of deviation between SPT intervals, last visit and questionnaire at T2) were assigned to the adherence group (AG: n = 58), or, if they interrupted SPT or stopped treatment altogether, to the non-adherence group (NAG: n = 61). In addition to dental parameters, we assessed socio-demographic, treatment-related (critical attitudes/complaints), dental as well as psychological variables (especially psychological attachment, but also dental fear, patient participation style, personality functioning) and examined between-group differences as well as possible mediating factors of non-adherence to treatment continuation. Results For both groups we found similar average observation time (NAG/AG: 15.9(8.9)/14.9(10.6)years). There were significant differences in age, critical attitudes, dental fear, and patient participation style between the groups. With the help of exploratory sequential mediation models, we found a significant indirect pathway of the impact of attachment anxiety on discontinuation of treatment mediated through dental fear and number of critical attitudes/complaints. Conclusion Considering the limitations, dentists should be aware of personality-related risk-factors such as attachment anxiety as well as their interplay with levels of dental fear and critical attitudes which may influence adherence to SPT. Trial registration: The clinical trial was retrospectively registered in the DRKS—German Clinical Trials Register (https://www.drks.de) with registration DRKS00030092 (26/08/2022).

Objectives. The study aimed to analyze different ways to control air quality during/after aerosol-generating procedures (AGPs) in a small skills lab with restricted natural air ventilation in preclinical dental training (worst-case scenario for aerogen infection control). Different phases were investigated (AGP1: intraoral high-volume evacuation (HVE); AGP2: HVE plus an extraoral mobile scavenger (EOS)) and afterward (non-AGP1: air conditioning system (AC), non-AGP2: AC plus opened door). Methods. Continuous data collection was performed for PM1, PM2.5, and PM10 (µg/m3), CO2 concentration (ppm), temperature (K), and humidity (h−1) during two summer days (AGP: n = 30; non-AGP: n = 30). While simulating our teaching routine, no base level for air parameters was defined. Therefore, the change in each parameter (Δ = [post]-[pre] per hour) was calculated. Results. We found significant differences in ΔPM2.5 and ΔPM1 values (median (25/75th percentiles)) comparing AGP2 versus AGP1 (ΔPM2.5: 1.6(0/4.9)/−3.5(−10.0/−1.1), p = 0.003 ; ΔPM1: 1.6(0.6/2.2)/−2.2(−9.3/−0.5), p = 0.001 ). Between both non-AGPs, there were no significant differences in all the parameters that were measured. ΔCO2 increased in all AGP phases (AGP1/AGP2: 979.0(625.7/1126.9)/549.9(4.0/788.8)), while during non-AGP phases, values decreased (non-AGP1/non-AGP2: −447.3(−1122.3/641.2)/−896.6(−1307.3/−510.8)). ∆Temperature findings were similar (AGP1/AGP2: 12.5(7.8/17.0)/9.3(1.8/15.3) versus non-AGP1/non-AGP2: −13.1(−18.7/0)/−14.7(−16.8/−6.8); p ≤ 0.003 )), while for ∆humidity, no significant difference ( p > 0.05 ) was found. Conclusions. Within the limitations of the study, the combination of HVE and EOS was similarly effective in controlling aerosol emissions of particles between one and ten micrometers in skill labs during AGPs versus that during non-AGPs. After AGPs, air exchange with the AC should be complemented by open doors for better air quality if natural ventilation through open windows is restricted.