Abstract There is scarcity of information on the determinants of periodontitis in Latin America and Caribbean countries. We conducted a comprehensive review of studies examining the association of smoking and diabetes with periodontitis outcomes in this region. We searched for population-based, cross-sectional and prospective cohort studies from Latin America and the Caribbean region that reported on the association between smoking or diabetes and periodontitis. Databases were searched up to October 2023 by two reviewers. Subsequently, two authors independently conducted a rigorous data extraction process, focusing on study characteristics, the definition of exposures, and periodontitis outcomes, including measures of association and main findings. The results revealed a significant association between smoking and periodontitis, with a stronger effect observed in heavy smokers. Conversely, while some studies observed a higher prevalence of periodontitis among diabetic individuals, the association between diabetes and periodontitis was not significant after adjusting for confounding factors. These findings underscore a significant research gap in population-based studies on the effect of smoking and diabetes on periodontitis within Latin American and Caribbean countries, particularly when it comes to cohort studies. Addressing these gaps is crucial for a deeper understanding of these associations, which could lead to more effective prevention and treatment strategies in the region. countries populationbased, populationbased population based, based crosssectional cross sectional 202 reviewers Subsequently process characteristics exposures smokers Conversely individuals factors associations 20 2

Resumo As terapias não cirúrgicas têm sido recomendadas e empregadas como uma modalidade menos invasiva e econômica no manejo da periodontite. Nesse contexto, diferentes protocolos terapêuticos têm sido testados nas últimas décadas. Portanto, mapear as tendências e padrões científicos fornece insights críticos sobre o estado da pesquisa na área, o que ainda não foi explorado em estudos gerais de tratamento não cirúrgico da periodontite. Artigos de 2001 a 2020 foram analisados na base Web of Science usando termos/palavras-chave apropriados. A seleção dos artigos e a extração dos dados foram realizadas por examinadores calibrados. Todos os artigos focados no tratamento não cirúrgico da periodontite foram incluídos. Foram realizadas análises descritivas, bivariadas e de regressão logística multivariada. Foram incluídos 1.519 artigos. Ensaios clínicos randomizados (ECR) foram o design mais utilizado (44,1%), e o controle profissional do biofilme foi o tema mais estudado (35,6%). A Europa publicou o maior número de artigos (41,1%). Os EUA foi o país que mais colaborou com outros países. Ásia (p<0,001), América do Sul (p=0,004) e Oceania/África (p=0,016) mostraram menor chance de ter colaboração internacional. Estudos da América do Norte tinham mais probabilidade de serem ECR do que estudos da Europa (p=0,050); estudos focados no controle profissional do biofilme (p<0,001) e outros tópicos (p<0,001) tinham menos probabilidade de serem avaliados por ECR. O campo de tratamento não cirúrgico da periodontite conduziu principalmente ECRs e o tema mais explorado por todos os estudos foi o controle profissional do biofilme. A colaboração internacional e a condução de ECRs neste campo ocorreram principalmente entre países de alta renda. Descentralizar os recursos científicos, estabelecer conexões integrativas globalmente e avaliar novos tópicos podem melhorar a Periodontia baseada em evidências. contexto décadas Portanto área 200 202 termos/palavraschave termospalavraschave termos/palavras chave termos palavras apropriados calibrados descritivas multivariada 1519 1 519 1.51 (ECR 44,1%, 441 44,1% , 44 (44,1%) 35,6%. 356 35,6% . 35 6 (35,6%) 41,1%. 411 41,1% 41 (41,1%) p<0,001, p0001 p p<0,001 0 001 p=0,004 p0004 004 (p=0,004 OceaniaÁfrica Oceania África p=0,016 p0016 016 (p=0,016 p=0,050 p0050 050 (p=0,050) (p<0,001 renda evidências 20 palavraschave termospalavras 151 51 1.5 44,1 4 (44,1% 35,6 3 (35,6% 41,1 (41,1% p000 p<0,00 00 p=0,00 (p=0,00 p=0,01 p001 01 (p=0,01 p=0,05 p005 05 (p=0,050 (p<0,00 2 15 5 1. 44, (44,1 35, (35,6 41, (41,1 p00 p<0,0 p=0,0 (p=0,0 (p=0,05 (p<0,0 (44, (35, (41, p0 p<0, p=0, (p=0, (p<0, (44 (35 (41 p<0 p=0 (p=0 (p<0 (4 (3 p< p= (p= (p< ( (p

Abstract Nonsurgical therapies have been recommended and employed as a less invasive and cost-effective modality in managing periodontitis. In this context, different therapeutic protocols have been tested in the last decades. Therefore, mapping the scientific trends and patterns provides critical insights into the state of research in the field, which has not been explored for overall nonsurgical periodontitis treatment studies. Articles from 2001 to 2020 were retrieved from the Web of Science database using appropriate terms and keywords. Article selection and data extraction were performed by calibrated examiners. All articles focusing on nonsurgical periodontitis treatment were included. Descriptive, bivariate, and multivariate logistic regression analyses were conducted. 1,519 articles were included. Randomized clinical trials (RCTs) were the most used design (44.1%), and professional biofilm control was the topic most studied (35.6%). Europe published the most significant number of articles (41.1%). The USA was the country that collaborated more with other countries. Asia (p<0.001), South America (p=0.004), and Oceania/Africa (p=0.016) showed a lower chance to have international collaboration. Studies from North America were more likely to be RCTs than studies from Europe (p=0.050); studies focusing on professional biofilm control (p<0.001) and other topics (p<0.001) were less likely to be evaluated by RCTs. The nonsurgical periodontitis treatment field mainly conducted RCTs, and the topic most explored by all studies was professional biofilm control. International collaboration and conduct of RCTs in this field occurred mainly among high-income countries. Decentralizing scientific resources, making integrative connections globally, and evaluating new topics may improve evidence-based periodontology. costeffective cost effective context decades Therefore 200 202 keywords examiners included Descriptive bivariate 1519 1 519 1,51 (RCTs 44.1%, 441 44.1% , 44 (44.1%) 35.6%. 356 35.6% . 35 6 (35.6%) 41.1%. 411 41.1% 41 (41.1%) countries p<0.001, p0001 p p<0.001 0 001 p=0.004, p0004 p=0.004 004 (p=0.004) OceaniaAfrica Oceania Africa p=0.016 p0016 016 (p=0.016 p=0.050 p0050 050 (p=0.050) (p<0.001 highincome high income resources globally evidencebased evidence based periodontology 20 151 51 1,5 44.1 4 (44.1% 35.6 3 (35.6% 41.1 (41.1% p000 p<0.00 00 p=0.00 (p=0.004 p=0.01 p001 01 (p=0.01 p=0.05 p005 05 (p=0.050 (p<0.00 2 15 5 1, 44. (44.1 35. (35.6 41. (41.1 p00 p<0.0 p=0.0 (p=0.00 (p=0.0 (p=0.05 (p<0.0 (44. (35. (41. p0 p<0. p=0. (p=0. (p<0. (44 (35 (41 p<0 p=0 (p=0 (p<0 (4 (3 p< p= (p= (p< ( (p

Abstract Randomized clinical trials (RCTs) are human studies carried out to compare different treatments or interventions, and their results are used to support clinical decision-making and improve patient care. Herein, the aim of this study was to review the selection process of study outcomes in periodontology. Primary outcomes should draw the main conclusions of the study, whereas secondary outcomes should only be used to help explain the main findings and generate future research hypothesis. Outcomes are classified as clinically relevant (CROs) or surrogate outcomes. CROs – the first option for primary outcome variables - should convey not only substantial health benefits, but also be deemed important by patients. In periodontology, tooth loss/retention and oral health–related quality of life (OHRQoL) are examples of CROs. While tooth loss has main limitations as a primary outcome, emerging evidence suggest that patient-reported outcome measures (PROMs) can accurately detect OHRQoL following periodontal therapy. When CROs cannot be assessed, validated surrogate outcomes can be used as proxies. Primary outcome variables should reflect a treatment endpoint at the patient level that can be easily used to inform decision-making in daily practice. These outcomes should allow the implementation of a treat-to-target concept in which the intervention can be clearly judged against a prespecified treatment target. Recently, the presence of at most 4 sites with periodontal probing depth ≥5 mm post-treatment was suggested as an effective endpoint for periodontal trials. In perspective, a combination of validated clinical parameters and PROMs will provide a more comprehensive assessment of periodontal treatments.

Abstract: Gingivitis and periodontitis are associated with a negative impact on Oral Health Related Quality of Life (OHRQoL), exerting a significant influence on aspects related to the patients' function and esthetics. Periodontitis has been associated with several systemic conditions, including adverse pregnancy outcomes, cardiovascular diseases, type 2 diabetes mellitus (DM), respiratory disorders, fatal pneumonia in hemodialysis patients, chronic renal disease and metabolic syndrome. The aim of this paper was to review the results of different periodontal treatments and their impacts on patients' OHRQoL and systemic health. Non-surgical and surgical periodontal treatments are predictable procedures in terms of controlling infection, reducing probing pocket depth and gaining clinical attachment. In addition, the treatment of periodontitis may significantly improve OHRQoL and promote a reduction in the levels of systemic markers of inflammation, including some cytokines associated with cardiovascular diseases. Studies have also suggested that periodontal treatment may improve glycemic control in patients with DM. Strategies and actions for preventing the onset and recurrence of periodontitis, and the challenges facing the field of periodontology in the XXI century are presented in this review.

Abstract Objective: The microbial composition of pericoronitis (Pc) is still controversial; it is not yet clear if the microbial profile of these lesions is similar to the profile observed in periodontitis (Pd). Therefore, the aim of the present study was to describe the microbial profile of Pc lesions and compare it directly with that of subjects with Pd. Methodology: Subjects with Pc and Pd were selected, and subgingival biofilm samples were collected from (i) third molars with symptomatic Pc (Pc-T), (ii) contralateral third molars without Pc (Pc-C) and (iii) teeth with a probing depth >3 mm from subjects with Pd. Counts and proportions of 40 bacterial species were evaluated using a checkerboard DNA-DNA hybridization technique. Results: Twenty-six patients with Pc and 18 with Pd were included in the study. In general, higher levels of microorganisms were observed in Pd. Only Actinomyces oris and Eubacterium nodatum were present in higher mean counts in the Pc-T group in comparison with the Pc-C and Pd-C groups (p<0.05). The microbiota associated with Pc-T was similar to that found in Pc-C. Sites with Pc lesions had lower proportions of red complex in comparison with the Pd sites. Conclusion: The microbiota of Pc is very diverse, but these lesions harbour lower levels of periodontal pathogens than Pd.

Abstract The aim was of this study was to determine the current weight of evidence for the existence of specific differences between the microbiota of healthy teeth and healthy implants, or of teeth with periodontitis and implants with peri-implantitis. A systematic review was conducted according to the PRISMA statement. The MEDLINE, EMBASE and Cochrane databases were searched up to February 2018 for studies comparing microbiological data of biofilm samples collected from healthy teeth and implants or from teeth with periodontitis and implants with peri-implantitis. The weight of evidence was defined in three categories (strong, moderate and mild/some), according to the difference in number of studies showing statistically significantly higher counts and/or proportions and/or abundance and/or prevalence of microorganisms in health or in disease. Of the 132 articles identified, 8 were included. A wide range of microorganisms were present in different conditions but no microorganisms showed strong, moderate or mild/some evidence for a specific association with either teeth or implants. The results of this systematic review indicated that there is insufficient evidence in the literature to support specific differences between microorganisms colonizing teeth and implants, either in health or in disease.

ABSTRACT: Periodontal surgical techniques have emerged over time with the aim of achieving periodontal regeneration and improving its predictability. Leukocyte and Platelet-Rich Fibrin (L-PRF) has been proposed as an alternative, for not requiring anticoagulants in its preparation and for performing sustained release of growth factors for at least 7 days. The aim of this narrative review is to describe the available evidence on the use of L-PRF in periodontal intra-bony defects. An electronic and hand search was conducted in MEDLINE and Cochrane Library databases. Of 494 papers retrieved, 12 were selected for this review. The results suggest that even if L-PRF shows benefits when used in regenerative periodontal treatment of intra-bony defects, clinical trials with standardized methodological design are necessary to compare L-PRF with biomaterials usually used in these defects.

RESUMEN: Diferentes técnicas quirúrgicas periodontales han surgido a lo largo del tiempo con el objetivo de lograr una regeneración periodontal y mejorar su predictibilidad. La Fibrina Rica en Plaquetas y Leucocitos (L-PRF) se ha posicionado como una alternativa para cumplir este objetivo, debido a que no requiere anticoagulantes en su preparación y muestra liberación sostenida de factores de crecimiento durante por lo menos 7 días. El objetivo de esta revisión narrativa es describir la evidencia disponible sobre el uso de L-PRF en defectos intra-óseos. Se realizó una búsqueda en las bases de datos MEDLINE y Cochrane Library, exploración manual y páginas web. De un total de 494 artículos recuperados, fueron seleccionados 12 publicaciones para esta revisión. Los resultados sugieren que L-PRF muestra beneficios al ser utilizada en el tratamiento periodontal regenerativo de defectos intra-óseos. Sin embargo, son necesarios ensayos clínicos con diseño metodológico estandarizado que permitan comparar L-PRF con biomateriales habitualmente empleados en el tratamiento de estos defectos.

RESUMO Objetivo: Identificar e quantificar os níveis de três espécies bacterianas que foram recentemente apontadas como possíveis “novos” patógenos periodontais (Enterococcus faecalis, Staphylococcus warneri e Staphylococcus aureus), em indivíduos periodontalmente saudáveis e com periodontite crônica generalizada. Métodos: A amostra foi composta por 30 indivíduos adultos com periodontite crônica generalizada e 10 periodontalmente saudáveis. Nove amostras de biofilme subgengival foram coletadas por indivíduo e analisadas individualmente pela técnica de checkerboard DNA-DNA hybridization. Resultados: Os níveis médios de E. faecalis e S. warneri foram maiores no grupo com periodontite crônica do que no de saúde periodontal (p<0,05). Além disso, um maior percentual de indivíduos com periodontite estavam colonizados pelas três espécies avaliadas em comparação com os indivíduos saudáveis (p<0,05). Essa diferença entre os dois grupos foi de 40 pontos percentuais para E. faecalis (presente em 90% dos indivíduos com periodontite e 50% dos saudáveis) e S. warneri (100% e 60%, respectivamente), e de 26 pontos percentuais para S. aureus (86% e 60%, respectivamente). Conclusão: E. faecalis e S. warneri tem potencial para serem patógenos periodontais. O papel do S. aureus foi menos evidente, uma vez que esta espécie estava mais prevalente e em níveis relativamente mais altos do que as outras duas espécies em saúde. Estes dados podem guiar futuros estudos sobre o papel dessas espécies na etiologia das periodontites e ajudar a estabelecer tratamentos mais eficazes para essas infecções.

ABSTRACT Objective: To identify and quantify the levels of three bacterial species that have recently been identified as potential “new” periodontal pathogens (Enterococcus faecalis, Staphylococcus aureus and Staphylococcus warneri) in subjects with periodontal health and generalized chronic periodontitis. Methods: Thirty adults with generalized chronic periodontitis and 10 periodontally healthy were included in this study. Nine subgingival biofilm samples were collected per subject and individually analyzed by checkerboard DNA-DNA hybridization technique. Results: The mean levels of E. faecalis and S. warneri were higher in chronic periodontitis than in periodontal health (p<0.05). Furthermore, a higher percentage of subjects with periodontitis were colonized by the three species evaluated in comparison with healthy subjects (p<0.05). This represented a difference of 40 percentage points between the two groups, for E. faecalis (present in 90% of individuals with periodontitis and 50% of the healthy individuals) and S. warneri (100% and 60%, respectively), and 26 percentage points for S. aureus (86% and 60%, respectively). Conclusion: E. faecalis and S. warneri have the potential to be periodontal pathogens. The role of S. aureus was less evident, since this species was more prevalent and at relatively higher levels in health than the other two species. These data might guide future studies on the role of these microorganisms in the etiology of periodontitis and help to establish more effective treatments for these infections.

Abstract The aim of this randomized, single blinded clinical trial was to evaluate the effect of a pre-procedural mouthwash containing cetylpyridinium chloride (CPC), zinc lactate (Zn) and sodium fluoride (F) in the reduction of viable bacteria in oral aerosol after a dental prophylaxis with ultrasonic scaler. Sixty systemically healthy volunteers receiving dental prophylaxis were randomly assigned to one of the following experimental groups (15 per group): (i) rinsing with 0.075% CPC, 0.28% Zn and 0.05% F (CPC+Zn+F), (ii) water or (iii) 0.12% chlorhexidine digluconate (CHX), and (iv) no rinsing. Viable bacteria were collected from different locations in the dental office on enriched TSA plates and anaerobically incubated for 72 hours. The colonies were counted and species were then identified by Checkerboard DNA–DNA Hybridization. The total number of colony-forming units (CFUs) detected in the aerosols from volunteers who rinsed with CPC+Zn+F or CHX was statistically significantly (p<0.05) lower than of those subjects who did not rinse or who rinsed with water. When all locations were considered together, the aerosols from the CPC+Zn+F and CHX groups showed, respectively, 70% and 77% fewer CFUs than those from the No Rinsing group and 61% and 70% than those from the Water group. The mean proportions of bacterial species from the orange complex were statistically significantly (p<0.05) lower in aerosols from the CPC+Zn+F and CHX groups compared with the others two groups. In conclusion, the mouthwash containing CPC+Zn+F, is effective in reducing viable bacteria in oral aerosol after a dental prophylaxis with ultrasonic scaler.