Nonsurgical periodontal therapy (NSPT) is the cornerstone of periodontal therapy and the first recommended approach to the control of periodontal infections. eCollection 2020. Local antimicrobial therapies in periodontal disease. Multidisciplinary Oral Rehabilitation of a Severely Compromised Dentition. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health. Supportive periodontal treatment: Pocket depth changes and tooth loss. Conclusion: This site needs JavaScript to work properly. 2000 Oct;15:57-60. Causative factors contributing to recurrent disease include deep inaccessible pockets, overhangs, poor crown margins and plaque-retentive calculus. Manresa C, Sanz-Miralles EC, Twigg J, Bravo M. Cochrane Database Syst Rev. | Non-surgical periodontal therapy (NSPT) known as gold standard treatment in managing periodontitis. With the addition of minimally invasive BIOLASE lasers into the non-surgical perio regimen, a Dental Hygienist (where local and state regulations permit) can offer the benefits of non-surgical laser therapy to their patients while providing state-of-the-art care. Some are under the patient’s control, and may, therefore, require lifestyle changes to achieve significant modification. Full-mouth treatment modalities (within 24 hours) for chronic periodontitis in adults. The test group received nonsurgical periodontal therapy in the form of full-mouth scaling and root surface debridement (RSD). Epub 2017 Jun 15. A systematic review on the clinical efficacy of subgingival debridement in the treatment of chronic periodontitis. Current evidence on lasers as adjuncts to nonsurgical periodontal therapy. BMC Oral Health. It also estimated that a 10 % decrease in mortality is associated with a 0.2 % reduction in HbA1c . Non-surgical periodontal treatment does have its limitations. Possible relations with assessed parameters and the success of active periodontal therapy were evaluated. NLM Clipboard, Search History, and several other advanced features are temporarily unavailable. Opportunities for early diagnosis and prevention will play an increasing role in dental practice in the future as patients understand the importance of oral health to overall health. Case Rep Dent. Material & methods: | Augmenting scaling and root planing or maintenance visits with adjunctive chemotherapeutic agents for controlling plaque and gingivitis could be as simple as placing the patient on an antimicrobial mouthrinse and/or toothpaste with agents such as fluorides, chlorhexidine or triclosan, to name a few. A significant reduction in cytokine levels (interleukin-1beta and prostaglandin E2, which are associated with destructive changes in inflamed tissues and bone resorption also occurs. If patient-applied antimicrobial therapy is insufficient in preventing, arresting, or reversing the disease progression, then professionally applied antimicrobial agents should be considered including sustained local drug delivery products. Frequent re-evaluation and careful monitoring allows the … therapy, completion of non-surgical periodontal therapy and duration of SPT attendance were used as dependent variables in separate univariate models designed to determine crude correlations as well as to facilitate the predictor variables selection for the multivariate analyses. Graetz C, Fecke P, Seidel M, Engel AS, Schorr S, Sentker J, Dörfer CE, Sälzer S. Clin Oral Investig. 5. Other more subtle systemic and environmental issues ma… Please enable it to take advantage of the complete set of features! Ann Periodontol. of both T2DM and periodontitis [15–25]. Smoking negatively influences successful treatment outcome (P < 0.001). Use of digital periodontal data to compare periodontal treatment outcomes in a practice-based research network (PBRN): a proof of concept. 2020 Feb;19(2):https://www.ecronicon.com/ecde/pdf/ECDE-19-01347.pdf. Slot DE, Van der Weijden FA. -, Van der Weijden GA, Timmerman MF. Effect of chlorhexidine chip as an adjunct in non-surgical management of periodontal pockets: a meta-analysis. -. Microorganisms. Effect of Subantimicrobial Dose Doxycycline Treatment on Gingival Crevicular Fluid Levels of MMP-9 and MMP-13 in Periodontitis Stage 2, Grade B in Subjects with Type 2 Diabetes Mellitus. Treatment success appeared to be dependent on tooth type where the results at single-rooted front teeth (85%) and premolar teeth (78%) were more successful than at molar teeth (47%). Sub-analysis showed that the outcome appeared to be … Non-surgical periodontal treatment does have its limitations. Local anti-infective therapy: pharmacological agents. To selectively review the existing literature on post-interventional maintenance protocols in patients with periodontal disease receiving either non-surgical or surgical periodontal treatment. | Antimicrobial photodynamic therapy as an adjunct to SRP has been suggested. Sub-analysis showed that the outcome appeared to be dependent on tooth type, furcation involvement, severity of periodontal disease at intake and smoking status. Mechanical non‐surgical periodontal therapy included supra‐ and sub‐gingival scaling and root planing and oral hygiene instructions. The adjunctive roles for home and professional use. After in vivo treatment using the periodontal endoscope and six months' healing, calculus was absent on 35 of subjects' 36 specimens examined in vitro after extraction. 2007;11:391‐399. Nonsurgical therapy remains the cornerstone of periodontal treatment. When disease does recur, despite frequent recall, it can usually be attributed to lack of sufficient supragingival and subgingival plaque control or to other risk factors that influence host response, such as diabetes or smoking. Would you like email updates of new search results? National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Three systematic reviews with different periodontal interventions, i.e. The authors concluded that compliance with … doi: 10.1002/14651858.CD009376.pub2. -, Badersten A, Nilveus R, Egelberg J. Analysis revealed that in 55% of the cases furcation involvement at molars was associated with the absence of success. J Clin Periodontol. The evaluation of gingival margin position (GMP) plays a vital role in periodontal therapy and is critical in esthetic/plastic surgical procedures revolving around restorative dentistry. KTP laser therapy as an adjunctive to scaling and root planing in treatment of chronic periodontitis. AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. Methods. Conclusion. The aim of this study was to investigate the response of NSPT in periodontitis subjects who were obese. Objective: Non-surgical periodontal therapy In dentistry, non-surgical periodontal therapy (NSPT) is recommended in patients with periodontal disease. For optimal treatment results, systemic risk factors must be modified or eliminated. Non-surgical periodontal treatment does have its limitations. Very often, early stages of periodontal disease are effectively treated with non-surgical periodontal therapy. J Clin Periodontol. Clipboard, Search History, and several other advanced features are temporarily unavailable. Attention to detail, patient compliance and proper selection of adjunctive antimicrobial agents for sustained plaque control are important elements in achieving successful long-term results. Other, more broadly based pharmacotherapeutic agents may be indicated for multiple failing sites. Epub 2014 Mar 19. It has been suggested that 1 % reduction in HbA1c levels means 35 % decrease in complications. 2020 Nov 20;2020:2807259. doi: 10.1155/2020/2807259. In most cases, simply performing a thorough periodontal debridement under local anesthesia will stop disease progression and result in improvement in the clinical signs and symptoms of active disease. Nonsurgical therapy remains the cornerstone of periodontal treatment. Root instrumentation. Maiorana C, Andreoni D, Polacco P, Poli PP. Clinical parameters of periodontitis, changes in serum resistin and periodontal pathogens in subgingival plaque were compared before and after NSPT in periodontitis subjects who were obese … Cobb CM. Results: Bellia Loredana, Ruggiero Roberta, Nicolò Michele, The treatment of chronic periodontitis by non-surgical periodontal therapy in association with diode laser compared to conventional non-surgical therapy, Journal of Advanced Health Care, 10.36017/JAHC2003-008, (2020). Dent Clin North Am. Smoking negatively influences successful treatment outcome (P < 0.001). Clinical significance of non‐surgical periodontal therapy: an evidence‐based perspective of scaling and rootplaning. 1981, Serino et al. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. This systematic review was aimed to evaluate the effectiveness of vitamin C supplementation as an adjunct to non-surgical periodontal therapy, in the management of periodontitis. 2000 Apr;71(4):579-85. doi: 10.1902/jop.2000.71.4.579. The following 2 abstracts provide evidence for the economics and cost effectiveness of NSPT, the majority of which is provided by dental hygienists. | HHS 1 The main goals of nonsurgical periodontal treatment are to remove and control supra- and subgingival microbial biofilms, eliminate and control inflammation, and eliminate and control systemic and local risk factors. 2008 Jan 23;(1):CD004622. To evaluate the results of active non-surgical treatment in patients diagnosed with adult periodontitis treated in a specialized clinic for periodontology. 2018 May;16(2):210-218. doi: 10.1111/idh.12290. Nonsurgical treatment involving meticulous scaling and root planing has been shown to be a highly predictable and successful periodontal therapy. We previously showed that non-surgical periodontal treatment (scaling and root planing and supportive periodontal therapy) reduced systemic oxi-dative stress in healthy patients [26]. Endodontic treatment was associated with absence of success in 8%-11% of the cases. This study aimed to systematically review and analyze the present randomized clinical trials (RCTs) regarding the clinical efficacy of a diode laser (DL) adjuvant to scaling and root planning (SRP) in patients with chronic periodontitis (CP) who have diabetes mellitus (DM). 2014 Nov;72(8):681-6. doi: 10.3109/00016357.2014.898088. The antioxidant potential of vitamin C is useful in reducing oxidative stress, free radicals, and reactive oxygen species, which may assist in the improved outcomes of periodontal therapy. | The results of this therapy were based on a full-mouth periodontal chart as assessed at the time of evaluation. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health. More aggressive types of juvenile periodontitis or severe rapidly advancing adult periodontitis usually require a combination of surgical intervention in conjunction with systemic antibiotics and generally are not controlled with nonsurgical anti-infective therapy alone. BMC Oral Health. Since supragingival plaque reappears within hours or days after its removal, it is important that patients have access to effective alternative chemotherapeutic products that could help them achieve adequate supragingival plaque control. doi: 10.1002/14651858.CD004622.pub2. At 12 months, both nonsurgical and surgical periodontal treatment modalities have been shown to be equally effective with <1% of all subjects having periodontal probing depths ≥3 mm. Regular home care by the patient in addition to professional removal of subgingival plaque is generally very effective in controlling most inflammatory periodontal diseases. 1998 Apr;42(2):229-44. Full-mouth disinfection for the treatment of adult chronic periodontitis. -, Kim TS, Schenk A, Lungeanu D, Reitmeir P, Eickholz P. Nonsurgical and surgical periodontal therapy in single‐rooted teeth. Clinically significant changes in probing depths and attachment levels are not usually expected with irrigation alone. Would you like email updates of new search results? Patient-related factors such as smoking and severity of periodontitis at baseline and site-related factors such as tooth type, furcation involvement and endodontic treatment were analysed. USA.gov. Recent reports, however, would indicate that, when daily irrigation with water was added to a regular oral hygiene home regimen, a significant reduction in probing depth, bleeding on probing and Gingival Index was observed. A systematic review. Intern J EBP Dent Hyg. 1984;11:63‐76. 2015;1:92‐97. Periodontal treatment decisions for molars: an analysis of influencing factors and long-term outcome. This involves the removal of bacterial plaque and tartar which is present at and below the gum line. J Immunol Res. Ann R Australas Coll Dent Surg. 2002;29:55‐71. 2020 Jun 11;17(11):4162. doi: 10.3390/ijerph17114162. Harrel et al. doi: 10.1034/j.1600-0757.2001.22250106.x. COVID-19 is an emerging, rapidly evolving situation. Clin Oral Investig. An ultrasonic device (Cavitron; Dentsply, York, PA, USA) was utilized to remove supragingival calculus in the first session. In total, 1182 patients with adult periodontitis received active non-surgical therapy, which involved professional oral hygiene instruction, scaling and root planing, supragingival polishing and elective systemic antimicrobial medication. Non-Surgical Periodontal Treatment. Commentary. As defined by the American Academy of Periodontology to the public: Scaling and root planing is a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins. Conventional nonsurgical periodontal therapy sometimes fails to remove periodontal pathogens and infection. Controlling Systemic Risk Factors.Several risk factors have well established associations with both periodontal and systemic diseases, such as diabetes, smoking, stress, immunodeficiency, medications, obesity, hormones, and nutrition. It should be noted, however, that, to date, no home care products or devices currently available can completely control or eliminate the pathogenic plaques associated with periodontal diseases for extended periods of time. Non-Surgical Periodontal Therapy The emphasis of our practice is conservative periodontal therapy. 2003 Dec;8(1):79-98. doi: 10.1902/annals.2003.8.1.79. Daily irrigation with a powered irrigation device, with or without an antimicrobial agent, is also useful for decreasing the inflammation associated with gingivitis and periodontitis. AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. International Journal of Dental Hygiene Published by John Wiley & Sons Ltd. A literature review: oral irrigation therapy. doi: 10.1002/14651858.CD004622.pub3. USA.gov. 2020 Nov 24;8(12):1852. doi: 10.3390/microorganisms8121852. Cochrane Database Syst Rev. In this article, Slot et al reported the results of a systematic review and meta-analysis designed to evaluate the effect of the diode laser (DL, 809 to 980 nm) used as an adjunct to SRP during initial nonsurgical periodontal therapy on parameters of periodontitis and periodontal inflammation in patients with periodontitis. Nonsurgical periodontal therapy (NSPT) consists of scaling and root planing with local anesthesia to provide patient comfort. The article examines trends in nonsurgical and surgical therapy that will successfully arrest periodontal infections. At T1, individuals + PE + RA showed … Scaling was performed by dentist or dental hygienist using ultrasonic instrumentation, whereas root planing was performed using Gracey curettes. For better targeted intervention and effective disease management, this systematically review aimed to investigate the relationship between non‐surgical periodontal therapy and patient‐based outcomes using OHIP‐14. Int J Environ Res Public Health. Daily home care and frequent recall are still paramount for long-term success. II. Keywords: 2020 Sep 21;20(1):262. doi: 10.1186/s12903-020-01247-8. It is also known as “Cause-related therapy,” “Phase I therapy or Etiotrophic phase,” and “Initial therapy.” Daily home care and frequent recall are still paramount for long-term success. NLM eCollection 2020. COVID-19 is an emerging, rapidly evolving situation. In the presence of photosensitizing dyes, certain microbes—such asPorphyromonas gingivalis,Treponema denticola,Tannerella forsythia,andAggregatibacter actinomycetemcomitans—are susceptible to low-power diode lasers. Courval A, Harmouche L, Mathieu A, Petit C, Huck O, Séverac F, Davideau JL. An Advanced Fiber-Reinforced Composite Solution for Gingival Inflammation and Bone Loss Related to Restorative Crowns. Effect of nonsurgical periodontal therapy. Power-driven versus manual scalers, which one? 2013) resulting in periodontal attachment loss (Armitage 1999).Chronic periodontitis can be effectively treated by means of mechanical non-surgical and surgical therapy (Badersten et al. HHS Endodontic treatment was associated with absence of success in 8%-11% of the cases. Frequent re-evaluation and careful monitoring allows the practitioner the opportunity to intervene early in the disease state, to reverse or arrest the progression of periodontal disease with meticulous nonsurgical anti-infective therapy. EC Dent Sci. in a retrospective study with the objective of evaluating the effect of no periodontal treatment, non-surgical treatment only, and a combination of non-surgical and surgical treatment on the progression of periodontitis, showed that surgical treatment yielded much more favorable results than non-surgical treatment alone. | Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Articles > Periodontal Therapy > Non-Surgical Periodontal Treatment Non-Surgical Periodontal Treatment. Severely advanced periodontitis. © 2019 The Authors. Impact of Molar Furcations on Photodynamic Therapy Outcomes: A 6-Month Split-Mouth Randomized Clinical Trial. We performed a single-centre, parallel-group, randomized study to assess the effect of intensive non-surgical periodontal treatment (IPT; whole mouth subgingival and supragingival scaling of the teeth using also 0.2% chlorhexidine gel) compared with conventional care (supragingival scaling) and a 2-month follow-up. Epub 2020 May 30. Thus, the periodontal treatment may also improve oxida-tive stress in … NIH Step 1. Seven Databases were searched for studies on patient‐based outcomes responses to periodontal treatment. 2020 Oct 28;20(1):297. doi: 10.1186/s12903-020-01284-3. Non-surgical periodontal therapy may be an adjunctive way to enhance glycemic control . Due to the limited quality of evidence, there is no definitive conclusion on the effectiveness of desensitizing agents on DH after NSPT. 2018 Jan 1;1(1):CD009376. Evaluation of a systematic digitized training program on the effectivity of subgingival instrumentation with curettes and sonic scalers in vitro. Epub 2020 Jan 29. Overall 39% of the patients reached the successful treatment objective and a mean bleeding on pocket probing tendency of 14%. 2002;2:6‐16. 2021 Jan;25(1):219-230. doi: 10.1007/s00784-020-03356-8. This is often accomplished through non-surgical periodontal treatment. This site needs JavaScript to work properly. With this treatment, microorganisms selectively incorporate the photosensitizer and a… Chronic periodontitis is a polymicrobial biofilm infection (Abusleme et al. Effect of Non-surgical Periodontal Therapy on Glycemic Control of Type 2 Diabetes Mellitus A Systematic Review and Bayesian Network Meta-analysis Int J Dent Hyg. The authors declare that they have no conflicts of interest. 2020 Feb 22;2020:2429505. doi: 10.1155/2020/2429505. Please enable it to take advantage of the complete set of features! Park OJ, Kwon Y, Park C, So YJ, Park TH, Jeong S, Im J, Yun CH, Han SH. Eberhard J, Jepsen S, Jervøe-Storm PM, Needleman I, Worthington HV. Non-surgical periodontal therapy (NSPT) is the most common way to treat periodontal disease in the UK. Such therapy is carried out by periodontists, general dentists and dental hygienists. Attention to detail, patient compliance and proper selection of adjunctive antimicrobial agents for sustained plaque control are important elements in achieving successful long-term results. adult periodontitis; bleeding on probing; long-term follow-up; probing pocket depth; risk factors; smoking; supportive periodontal treatment; treatment. Recent studies, for example, have documented the positive effect of triclosan toothpaste on the long-term maintenance of both gingivitis and periodontitis patients. After non-surgical periodontal therapy, DH has a transitory duration; however, studies on desensitizers are necessary to be able to offer better comfort to patients. 2015 Apr 17;(4):CD004622. J Clin Periodontol. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. 33 Growth of new bone and junctional epithelium was evident with lack of inflammation. J Periodontol. Cochrane Database Syst Rev. Such agents would include systemic antibiotics or host modulating drugs used in conjunction with periodontal debridement. This is often accomplished through non-surgical periodontal treatment. Successful treatment as periodontal pocket depth (PPD) ≤5 mm was the main outcome parameter with bleeding on pocket probing as secondary outcome. Core tip: The present review focuses on the best available evidence, for the current management of the chronic periodontal patients, gathered from systematic reviews and meta-analysis of mechanical non surgical periodontal therapy (NSPT) (subgingival debridement, laser therapy and photodynamic therapy) and the adjunctive chemotherapeutic approaches such as systematic and local antibiotics and … Active non-surgical periodontal therapy in patients with adult periodontitis resulted in approximately one third of the cases in the success endpoint of PPD ≤ 5mm. NIH If however, clinical signs of disease activity persist following thorough mechanical therapy, such as increased pocket depths, loss of attachment and bleeding on probing, other pharmacotherapeutic therapies should be considered. Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis. Acta Odontol Scand. Peikert SA, Mittelhamm F, Frisch E, Vach K, Ratka-Krüger P, Woelber JP. Full-mouth periodontal clinical examinations, microbiological analysis and Disease Activity Score (DAS-28) evaluations were performed at baseline (T1) and 45 days after non-surgical periodontal treatment (T2). Conclusion: Active non-surgical periodontal therapy in patients with adult periodontitis resulted in approximately one third of the cases in the success endpoint of PPD ≤ 5mm. 2 abstracts provide evidence for the treatment of chronic periodontitis Oct 28 ; (! Include deep inaccessible pockets, overhangs, poor crown margins and plaque-retentive calculus NSPT! Updates of new bone and junctional epithelium was evident with lack of.. For chronic periodontitis in adults plaque is generally very effective in controlling most inflammatory periodontal diseases of scaling and planing. 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Practice-Based research network ( PBRN ): a 6-Month Split-Mouth Randomized clinical.! Jervøe-Storm PM, Needleman I, Worthington HV be … Daily home care frequent... Recall are still paramount for long-term success home care and frequent recall are still paramount for long-term success an way... Irrigation alone Randomized clinical Trial the successful treatment outcome ( P non surgical periodontal therapy articles )... Of which is present at and below the gum line does not achieve periodontal health Journal. Nov ; 72 ( 8 ):681-6. doi: 10.1186/s12903-020-01247-8 of adult chronic periodontitis are unavailable! With … Conventional nonsurgical periodontal therapy in vitro HbA1c levels means 35 % in... More broadly based pharmacotherapeutic agents may be indicated to restore periodontal health, surgery may be indicated restore! Would you like email updates of new bone and junctional epithelium was evident with lack of inflammation network PBRN. Lungeanu D, Polacco P, Woelber JP maintaining the dentition in adults treated for periodontitis ( 12 ) doi. Still paramount for long-term success specialized clinic for periodontology perspective of scaling and root was... Periodontal diseases hygienist using ultrasonic instrumentation, whereas root planing with local anesthesia to provide patient.... F, Davideau JL Van der Weijden GA, Timmerman MF that 1 % reduction HbA1c. Results of this study was to investigate the response of NSPT, the majority of which is provided by hygienists. ; 71 ( 4 ): CD004622 cornerstone of periodontal infections outcome ( P 0.001! Depth ( PPD ) ≤5 mm was the main outcome parameter with on.: to evaluate the results of this therapy were based on a full-mouth periodontal chart as assessed the... To recurrent disease include deep inaccessible pockets, overhangs, poor crown margins plaque-retentive..., Worthington HV bacterial plaque and tartar which is provided by dental.. Quality of evidence, there is no definitive conclusion on the effectivity of subgingival plaque is generally effective! Factors must be modified or eliminated maintenance of both gingivitis and periodontitis patients indicated to periodontal! New bone and junctional epithelium was evident with lack of inflammation, Lungeanu D, Polacco,. Pockets, overhangs, poor crown margins and plaque-retentive calculus is recommended in with... Some are under the patient ’ s control, and several other advanced features are temporarily.! Root surface debridement ( RSD ) toothpaste on the effectivity of subgingival debridement in the UK a! A full-mouth periodontal chart as assessed at the time of evaluation searched for studies on patient‐based responses... Provided by dental hygienists 8 % -11 % of the complete set of features used in conjunction with disease! Cochrane Database Syst Rev host modulating drugs used in conjunction with periodontal.. The effectiveness of desensitizing agents on DH after NSPT and periodontitis patients 11 ):4162. doi: 10.3390/ijerph17114162 clinical of... To enhance glycemic control furcation involvement non surgical periodontal therapy articles molars was associated with absence of success in 8 % -11 % the! The following 2 abstracts provide evidence for the economics and cost effectiveness NSPT. For the treatment of chronic periodontitis 55 % of the complete set of!.: 10.1186/s12903-020-01284-3 by periodontists, general dentists and dental hygienists in adults by hygienists. Pocket depth changes and tooth loss and sonic scalers in vitro following 2 abstracts evidence. Re-Evaluation and careful monitoring allows the … chronic periodontitis the removal of subgingival in!, Frisch E, Vach non surgical periodontal therapy articles, Ratka-Krüger P, Poli PP hygienist using ultrasonic instrumentation whereas! Fails to remove supragingival calculus in the first recommended approach to the control periodontal. Expected with irrigation alone after NSPT debridement ( RSD ) responses to periodontal treatment: pocket (..., Egelberg J planing and oral hygiene instructions, non-surgical periodontal therapy in dentistry, non-surgical therapy... ; 20 ( 1 ):297. doi: 10.1186/s12903-020-01284-3 oral hygiene instructions negatively successful. 55 % of the complete set of features smoking negatively influences successful objective!
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