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Background Non-surgical periodontal therapy (NSPT) is the cornerstone of periodontitis management. This comparative clinical study evaluates the effectiveness of three different non-surgical treatment approaches in three treatment groups, namely, Quadrant-wise Scaling and Root Surface Debridement (Q-Sc + RSD), Full-mouth Disinfection (FMDis), and Full-mouth Debridement (FMDeb). Methods A total of 45 patients with generalised stage II and III periodontitis were randomly assigned to one of the three treatment groups. Plaque scores (PS), bleeding scores (BS) and probing pocket depths (PD) were recorded at baseline and post-NSPT. Data were analyzed to compare the changes in PS, BS, and PD distribution at baseline and post-NSPT in all three groups. Results All three treatment approaches resulted in statistically significant reductions in PS, BS, and PD distribution compared to baseline. However, FMDeb and FMDis protocols demonstrated greater reductions in BS and PD distribution compared to the Q-Sc + RSD protocol. Remarkably low BS were observed in all three study groups at the post-treatment evaluation, with statistically significant differences compared to their respective pre-treatment BS. Conclusions All three treatment approaches were effective in reducing PS, BS, and PD in patients with periodontitis, while FMDeb and FMDis protocols demonstrated superior effectiveness in terms of reduction of BS and PD, compared to the Q-Sc + RSD protocol. Further research with larger sample sizes and longer follow-up periods may be warranted to confirm these findings and evaluate the long-term clinical outcomes of these different debridement approaches of NSPT. Clinical trial no The UK’s Clinical Study Registry ISRCTN13350022, 28/05/2025, retrospectively registered.

Objectives Periodontitis is a multifactorial inflammatory disease leading to the progressive destruction of the tooth‐supporting apparatus. The management of residual periodontal pockets remains a challenge for Step 3 periodontal therapy. This systematic review aims to evaluate the potential and efficacy of the periodontal endoscope in managing residual periodontal pockets during Step 3 periodontal therapy. Material and Methods A comprehensive search was conducted in Medline, PubMed, Cochrane Library, Embase, Scopus, and Web of Science databases up to December 2024. Studies included were randomized controlled trials (RCTs) comparing periodontal endoscope‐assisted subgingival debridement (EASD) with repeated root surface debridement (RSD) and access flap periodontal surgery (AFPS). Data extraction and risk of bias assessment were performed independently by two reviewers. Results Five RCTs were included, involving 155 subjects and 4072 sites. EASD showed a significantly higher periodontal probing depth (PPD) reduction compared to repeated RSD, with a weighted mean difference (WMD) of 0.5 mm (95% CI: 0.19–0.81) at 3‐month postoperation. At 6‐month postoperation, the WMD of PPD and clinical attachment level (CAL) changes were 0.84 mm (95% CI: 0.60–1.09) and 0.89 mm (95% CI: 0.45–1.34), respectively, in favor of EASD. EASD showed a significantly higher prevalence ratio (20%) of pocket resolution (PPD ≤ 4 mm) compared to repeated RSD at 6‐month postoperation. No significant differences were observed between EASD and AFPS in the changes of CAL, PPD and prevalence of pocket resolution (PPD ≤ 4 mm). The overall certainty of the evidence was deemed to be “low” for EASD versus repeated RSD comparisons and “moderate” for EASD versus AFPS comparisons. Conclusions EASD demonstrated superior clinical outcomes compared to repeated RSD in managing residual periodontal pockets. Further high‐quality research is necessary to validate these findings and explore the long‐term benefits of EASD. Summary Endoscope‐assisted subgingival debridement (EASD) improves clinical attachment level (CAL) at 6‐month, and probing pocket depth (PPD) at 3‐ and 6‐month postoperation compared to repeated root surface debridement (RSD). No significant difference between EASD and access flap periodontal surgery (AFPS). in CAL gain, PPD reduction and prevalence of pocket resolution at 3 months postoperation. Higher prevalence ratio (20%) on pocket resolution (PPD ≤ 4 mm) in favor of EASD over repeated RSD was observed at 6 months postoperation.

Objective This study aimed to compare the short-term clinical and radiographic outcomes of the Entire Papilla Preservation (EPP) technique versus Open Flap Debridement (OFD) in the treatment of isolated intrabony periodontal defects, with both approaches performed using bovine-derived xenograft and a leukocyte- and platelet-rich fibrin (L-PRF) membrane. Materials and methods This retrospective study included 28 patients diagnosed with Stage 3 Grade B periodontitis, who underwent either EPP ( n  = 14) or OFD ( n  = 14) using bovine-derived xenograft and L-PRF following initial non-surgical periodontal therapy. Clinical parameters—including clinical attachment level (CAL) and probing depth (PD)—were recorded as primary outcomes at baseline and 6 months postoperatively. Early wound healing index (EHI), and patient-reported pain using a visual analogue scale (VAS) were considered secondary outcomes and were assessed within the first postoperative week. Standardized periapical radiographs were used to evaluate defect resolution. Statistical analysis was performed using Student’s t-test, paired sample t-test, and chi-square test, with the significance level set at p  < 0.05. Results Both groups showed significant CAL gain postoperatively. The EPP group demonstrated a higher mean CAL gain (4.64 ± 1.10 mm) compared to the OFD group (3.43 ± 1.32 mm). A statistically significant difference in the distribution of CAL gain categories between the groups was observed ( p  = 0.006). PD reduction was observed in both groups with no significant difference ( p  = 0.62). REC increased significantly in the OFD group ( p  < 0.05), whereas changes in the EPP group were not statistically significant ( p  > 0.05). EPP resulted in significantly lower postoperative VAS scores and higher EHI scores ( p  < 0.001), indicating better patient comfort and faster early healing. Conclusion The EPP technique resulted in greater CAL gain and reduced postoperative discomfort than OFD when both were performed with bovine-derived xenograft and L-PRF. These findings suggest that EPP may serve as a minimally invasive and effective alternative for managing isolated intrabony defects, particularly when preservation of the interdental papilla is desired. Clinical relevance The EPP technique, designed to preserve the interdental papilla and support primary closure, may be considered a minimally invasive alternative to OFD in suitable cases of isolated intrabony defects. Trial registration Trial registration is also available at ClinicalTrials.gov. Clinical Trials-ID: NCT06687785 Registration Date: 07.11.2024

Background and Objectives: This randomized, double-arm, multicentric clinical trial aims to compare the clinical outcomes following the treatment of suprabony periodontal defects using open flap debridement (OFD) with or without the application of hyaluronic acid (HA). Materials and Methods: Sixty systemically healthy patients with at least two teeth presenting suprabony periodontal defects were randomly assigned with a 1:1 allocation ratio using computer-generated tables into a test (OFD + HA) or control group (OFD). The main outcome variable was clinical attachment level (CAL). The secondary outcome variables were changes in mean probing pocket depth (PPD), gingival recession (GR), full-mouth plaque score (FMPS), and full-mouth bleeding score (FMBS). All clinical measurements were carried out at baseline and 12 months. Results: Sixty patients, thirty in each group, were available for statistical analysis. The mean CAL gain was statistically significantly different (p < 0.001) in the test group compared with the control group (3.06 ± 1.13 mm vs. 1.44 ± 1.07 mm). PPD reduction of test group measurements (3.28 ± 1.14 mm) versus the control group measurements (2.61 ± 1.22 mm) were statistically significant (p = 0.032). GR changes were statistically significant only in the test group 0.74 ± 1.03 mm (p < 0.001). FMBS and FMPS revealed a statistically significant improvement mostly in the test group. Conclusions: Suprabony periodontal defects could benefit from the additional application of HA in conjunction with OFD in terms of improvement of the clinical parameters compared with OFD alone.

The incidence of necrotising soft-tissue infections has increased during recent decades such that most physicians might see at least one case of these potentially life-threatening infections in their career. Despite advances in care, necrotising soft-tissue infections are still associated with high morbidity and mortality, underlining a need for continued education of the medical community. In particular, failure to suspect necrotising soft-tissue infections, fuelled by poor awareness of the disease, promotes delays to first surgical debridement, amplifying disease severity and adverse outcomes. This Review will focus on practical approaches to management of necrotising soft-tissue infections including prompt recognition, initiation of specific management, exploratory surgery, and aftercare. Increased alertness and awareness for these infections should improve time to diagnosis and early referral to specialised centres, with improvement in the prognosis of necrotising soft-tissue infections.

The bubbling community of microorganisms, consisting of diverse colonies encased in a self-produced protective matrix and playing an essential role in the persistence of infection and antimicrobial resistance, is often referred to as a biofilm. Although apparently indolent, the biofilm involves not only inanimate surfaces but also living tissue, making it truly ubiquitous. The mechanism of biofilm formation, its growth, and the development of resistance are ever-intriguing subjects and are yet to be completely deciphered. Although an abundance of studies in recent years has focused on the various ways to create potential anti-biofilm and antimicrobial therapeutics, a dearth of a clear standard of clinical practice remains, and therefore, there is essentially a need for translating laboratory research to novel bedside anti-biofilm strategies that can provide a better clinical outcome. Of significance, biofilm is responsible for faulty wound healing and wound chronicity. The experimental studies report the prevalence of biofilm in chronic wounds anywhere between 20 and 100%, which makes it a topic of significant concern in wound healing. The ongoing scientific endeavor to comprehensively understand the mechanism of biofilm interaction with wounds and generate standardized anti-biofilm measures which are reproducible in the clinical setting is the challenge of the hour. In this context of “more needs to be done”, we aim to explore various effective and clinically meaningful methods currently available for biofilm management and how these tools can be translated into safe clinical practice.

ObjectiveMinimally invasive surgical necrosectomy and endoscopic necrosectomy, compared with open necrosectomy, might improve outcomes in necrotising pancreatitis, especially in critically ill patients. Evidence from large comparative studies is lacking.DesignWe combined original and newly collected data from 15 published and unpublished patient cohorts (51 hospitals; 8 countries) on pancreatic necrosectomy for necrotising pancreatitis. Death rates were compared in patients undergoing open necrosectomy versus minimally invasive surgical or endoscopic necrosectomy. To adjust for confounding and to study effect modification by clinical severity, we performed two types of analyses: logistic multivariable regression and propensity score matching with stratification according to predicted risk of death at baseline (low: <5%; intermediate: ≥5% to <15%; high: ≥15% to <35%; and very high: ≥35%).ResultsAmong 1980 patients with necrotising pancreatitis, 1167 underwent open necrosectomy and 813 underwent minimally invasive surgical (n=467) or endoscopic (n=346) necrosectomy. There was a lower risk of death for minimally invasive surgical necrosectomy (OR, 0.53; 95% CI 0.34 to 0.84; p=0.006) and endoscopic necrosectomy (OR, 0.20; 95% CI 0.06 to 0.63; p=0.006). After propensity score matching with risk stratification, minimally invasive surgical necrosectomy remained associated with a lower risk of death than open necrosectomy in the very high-risk group (42/111 vs 59/111; risk ratio, 0.70; 95% CI 0.52 to 0.95; p=0.02). Endoscopic necrosectomy was associated with a lower risk of death than open necrosectomy in the high-risk group (3/40 vs 12/40; risk ratio, 0.27; 95% CI 0.08 to 0.88; p=0.03) and in the very high-risk group (12/57 vs 28/57; risk ratio, 0.43; 95% CI 0.24 to 0.77; p=0.005).ConclusionIn high-risk patients with necrotising pancreatitis, minimally invasive surgical and endoscopic necrosectomy are associated with reduced death rates compared with open necrosectomy.

Optimal timing for excisional debridement in geriatric burns remains unclear. We hypothesized that early debridement (ED: ≤72 ​h) is associated with improved outcomes. A 6-year (2017–2022) analysis of the TQIP database was done to isolate geriatric (≥65 years) burn patients (2nd or 3rd degree with TBSA ≥10 ​%) undergoing excisional debridement. Propensity score matching (1:1) adjusted for demographics, injury severity, and frailty. Outcomes were mortality, complications, length of stay (LOS), and discharge disposition. After matching 882 patients, ED (n ​= ​294) was associated with lower rates of sepsis (2.4 ​% vs. 7.1 ​%) and deep vein thrombosis (2.0 ​% vs. 6.1 ​%) (p ​< ​0.05). There was no difference in mortality. ED had shorter hospital (12 vs. 23 days, p ​< ​0.001) and ICU LOS (9 vs. 16 days, p ​< ​0.001). ED had higher routine discharge (25.9 ​% vs. 16.3 ​%, p ​= ​0.039). Early excisional debridement within 72 ​h is associated with reduced complications and shorter hospitalization in geriatric burn patients. Level III retrospective study. •Early debridement (≤72 ​h) in geriatric burns reduces complications and length of stay.•Delayed debridement is associated with increased sepsis risk.•Each day of delay raises risk of complications by 4.7 ​% and hospital stay by 1.23 days (p ​< ​0.001 for both). [Display omitted]

This network meta-analysis aims to compare the clinical efficacy of seven non-surgical therapies for peri-implant disease, including laser treatment, photobiomodulation therapy (PBMT), photodynamic therapy (PDT), systemic antibiotics (SA), probiotics, local antimicrobials (LA), and air-powder polishing (APP) combined with mechanical debridement (MD). We conducted searches in four electronic databases, namely PubMed, Embase, Web of Science, and The Cochrane Library, to identify randomized controlled trials of non-surgical treatments combined with MD for individuals (aged at least 18 years) diagnosed with peri-implantitis or peri-implant mucositis with a minimum of 3 months follow-up. The outcomes of the study were the reduction in pocket probing depth (PPD) and bleeding on probing (BoP), plaque index (PLI), clinical attachment level (CAL), and marginal bone loss (MBL). We employed a frequency random effects network meta-analysis model to combine the effect sizes of the trials using standardized mean difference (SMD) and 95% confidence intervals (CIs). Network meta-analyses include network plots, paired comparison forest plots, league tables, funnel plots, surface under the cumulative ranking area (SUCRA) plots, and sensitivity analysis plots. The results showed that, for peri-implantitis, PBMT +MD demonstrated the highest effect in improving PPD (SUCRA = 75.3%), SA +MD showed the highest effect in improving CAL (SUCRA = 87.4%, SMD = 2.20, and 95% CI: 0.38 to 4.02) and MBL (SUCRA = 99.9%, SMD = 3.92, and 95% CI. 2.90 to 4.93), compared to MD alone. For peri-implant mucositis, probiotics +MD demonstrated the highest effect in improving PPD (SUCRA = 100%) and PLI (SUCRA = 83.2%), SA +MD showed the highest effect in improving BoP (SUCRA = 88.1%, SMD = 0.77, and 95% CI: 0.27 to 1.28), compared to MD alone. Despite the ranking established by our study in the treatment of peri-implant disease, decisions should still be made with reference to the latest treatment guidelines. There is still a need for more high-quality studies to provide conclusive evidence and especially a need for studies regarding direct comparisons between multiple treatment options.

BackgroundMinimally invasive surgical necrosectomy plays an important role in the management of infected pancreatic necrosis, with a goal of removing debris and debriding necrotic tissue. Pulse lavage is designed to simultaneously hydrostatically debride and remove the infected necrotic tissue with suction. It is also able to remove significant amounts of debris without traumatic manipulation of the necrotic tissue which may be adherent to surrounding tissue and can result in injury.Methods and resultsThe surgical technique of utilising a waterjet pulse lavage device during the minimally invasive necrosectomy is detailed. Sixteen patients being managed via a step-up approach underwent endoscopic necrosectomy via a radiologically placed drain tract. All sixteen patients were successfully managed endoscopically without conversion to open necrosectomy, and survived their admission. There were no complications associated with the use of the waterjet pulse lavage.ConclusionWaterjet pulse lavage is a useful adjunct in minimally invasive necrosectomy, which reduces the length of the necrosectomy procedure, and facilitates removal of necrotic tissue while minimising the risk of traumatising healthy tissue.