Effects of air polishing and an amino acid buffered hypochlorite solution to dentin surfaces and periodontal ligament cell survival, attachment, and spreading

Supra- and sub-gingival instrumentation of periodontitis with the adjunctive treatment of a chloramine - a one-year randomized clinical trial study

Periodontitis is a bacterial-induced disease and for this reason controlling the microbiota is a necessity. Therapy includes self-performed daily oral hygiene in combination with supra- and sub-gingival instrumentation. An adjunctive antimicrobial agent may improve the outcome.

AIMS

To assess whether a chloramine (Perisolv®) has an adjunctive effect to non-surgical periodontal therapy and whether non-surgical periodontal therapy affects quality of life.

MATERIAL AND METHODS

Thirty-eight patients were randomized to a test or a control group. Clinical indices were performed at baseline and at three and twelve months. In the test group, Perisolv® was applied initially and after the sub-gingival instrumentation in pathological pockets. Oral health-related quality of life was measured with the Oral Health Impact Profile (OHIP) instrument at baseline and twelve months.

RESULTS

In both groups, an initial probing pocket depth (PPD) of > 4 mm and bleeding on probing (BOP) were statistically reduced (p < 0.002 and p < 0.002 respectively) at twelve months and after adjustment for Bonferroni. There were no significant differences between the test and the control group in terms of the number of PPD, BOP or plaque index, or in the mean OHIP score.

CONCLUSIONS

Chloramine did not have an adjunctive effect, but the overall therapy was significantly efficacious both clinically and in terms of quality of life.

TRIAL REGISTRATION

Registered at www.

CLINICALTRIALS

gov:NCT05757921.

Effect of sodium hypochlorite gel on bacteria associated with periodontal disease

OBJECTIVES

An adjunct in non-surgical periodontal therapy might be sodium hypochlorite (NaOCl)-based agents. The purpose of the present in vitro study was to get deeper knowledge on the influence of different parameters as time after mixing, pH, and chemical composition of an amino acid 0.475% NaOCl (AA-NaOCl) gel consisting of two components on its anti-biofilm activity.

MATERIALS AND METHODS

Six-species biofilms were cultured for 5 days, before AA-NaOCl gel was applied. In the different series, the influence of the time after mixing of the two components before application, of the concentration of NaOCl in the gel mixture, of the pH of the gel mixture, and of an exchange of the amino acid component by hyaluronic acid (HA), was analyzed.

RESULTS

Mixing time point experiments showed that the AA-NaOCl gel is capable of statistically significantly reducing colony-forming unit (cfu) counts up to 30 min after mixing, but only up to 20 min after mixing the reduction was more than 2 log10 cfu. The pH experiments indicate that a reduced pH results in a reduced activity of the NaOCl formulation. NaOCl concentrations in the formulation in the range from 0.475 to 0.2% provide adequate activity on biofilms. A HA/NaOCl gel was equally active against the biofilm as the AA-NaOCl gel.

CONCLUSION

Mixing of the components should be made in a timeframe of 20 min before applications. An optimization of the composition of the NaOCl formulation might be possible and should be a topic in further in vitro studies.

CLINICAL RELEVANCE

The AA-NaOCl gel formulation can be mixed up to 20 min before application. Further, the study indicates that the composition of the NaOCl gel formulation can be optimized.

Effects of an amino acid buffered hypochlorite solution as an adjunctive to air-powder abrasion in open-flap surface decontamination of implants failed for peri-implantitis: an ex vivo randomized clinical trial

OBJECTIVES

To evaluate ex vivo the efficacy of an amino acid buffered hypochlorite solution supplemented to surface debridement with air-powder abrasion in removing bacterial biofilm following open-flap decontamination of implants failed due to peri-implantitis.

MATERIALS AND METHODS

This study was an ex vivo, single-blind, randomized, intra-subject investigation. Study population consisted of 20 subjects with at least three implants failed for peri-implantitis (in function for > 12 months and progressive bone loss exceeding 50%) to be explanted. For each patient, implants were randomly assigned to surface decontamination with sodium bicarbonate air-powder abrasion (test-group 1) or sodium bicarbonate air-powder abrasion supplemented by amino acid buffered hypochlorite solution (test-group 2) or untreated control group. Following open-flap surgery, untreated implants (control group) were explanted. Afterwards, test implants were decontaminated according to allocation and explanted. Microbiological analysis was expressed in colony-forming units (CFU/ml).

RESULTS

A statistically significant difference in the concentrations of CFU/ml was found between implants of test-group 1 (63,018.18 ± 228,599.36) (p = 0.007) and implants of test-group 2 (260.00 ± 375.80) (p < 0.001) compared to untreated implants (control group) (86,846.15 ± 266,689.44). The concentration of CFU/ml on implant surfaces was lower in test-group 2 than in test-group 1, with a statistically significant difference (p < 0.001).

CONCLUSION

The additional application of amino acid buffered hypochlorite solution seemed to improve the effectiveness of implant surface decontamination with air-powder abrasion following open-flap surgery.

CLINICAL RELEVANCE

Lacking evidence on the most effective method for biofilm removal from contaminated implant surfaces, the present experimental study provides further information for clinicians and researchers.

Sodium Hypochlorite and Diode Laser in Non-Surgical Treatment of Periodontitis: Clinical and Bacteriological Study with Real Time Polymerase Chain Reaction (PCR)

Increasing the disinfection during non-surgical treatment of periodontitis is primordial. This study assesses the effectiveness of sodium hypochlorite and a 980 nm diode laser in non-surgical treatment of periodontitis. Thirty sites of localized periodontitis with a probing pocket depth (PPD) of ≥ 6 mm were included. Fifteen underwent scaling root planing (SRP group) and 15 underwent SRP + 0.5% NaOCl and a 980 nm diode laser (study group). A biological molecular test and real time polymerase chain reaction (RT-PCR) were performed before (T0) and after intervention (T1). Total bacterial count and counts of Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Prevotella intermedia, Peptostreptococcus micros, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans, Eubacterium nodatum, Capnocytophaga gingivalis were assessed. Plaque index (PI), bleeding on probing (BOP), gingival recession (GR), PPD and clinical attachment loss (CAL) were evaluated at T0, and 3 and 6 months after. Study group showed a statistically significant reduction of TBC (5.66 × 10⁸ CFU/mL) compared to SRP (6.2 × 10⁹ CFU/mL). Both groups showed a statistically significant reduction of Treponema denticola, Tannerella forsythia, Prevotella intermedia, Peptostrep. (micromonas) micros and Fusobacterium nucleatum; however, a significant reduction of Eubacterium nodatum and Capnocytophaga gingivalis was observed in the study group. At T6, both groups had a statistically significant reduction of PI, BOP, GR, PD and CAL. The study group showed more GR compared to SRP and a significant reduction of PD (4.03 mm ± 0.49) compared to SRP (5.28 mm ± 0.67). This study reveals that NaOCl and a diode laser are effective as an adjunctive to the non-surgical treatment of periodontitis.

Clinical and microbiological effects of a single application of sodium hypochlorite gel during subgingival re-instrumentation: a triple-blind randomized placebo-controlled clinical trial

OBJECTIVES

The aim of this study is to assess the clinical and microbiological effects of a single subgingival administration of sodium hypochlorite gel (NaOCl) and compare it with 1% chlorhexidine (CHX) gel and a placebo gel following mechanical re-instrumentation during supportive periodontal therapy (SPT).

MATERIALS AND METHODS

Sixty-two patients who had been treated for stage III-IV periodontitis and enrolled in SPT were included in the study based on following criteria: (1) active periodontal therapy completed at least 6 months before enrollment in the study, (2) presence of at least 4 non-adjacent sites with probing pocket depths (PPDs) ≥ 4 mm with bleeding on probing (BOP), or presence of 5-8 mm PPDs with or without BOP. All sites presenting PPD ≥ 4 mm and BOP at baseline and 3-, 6-, and 9-month follow-up timepoints were subgingivally re-instrumented with ultrasounds. Selected patients were randomly assigned into three groups and treated additionally with a single subgingival administration of NaOCl gel (group A); 1% CHX gel (group B); and placebo gel (group C). Main outcome variable was pocket closure at 12 months. Secondary outcome variables were changes in mean PPD, BOP, and clinical attachment level (CAL) along with changes in the numbers of the following five keystone bacterial pathogens: Aggregatibacter actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), Prevotella intermedia (P.i.), Tannerella forsythia (T.f.), and Treponema denticola (T.d.).

RESULTS

At 12 months, pocket closure was obtained in 77.5% in the NaOCl treated sites. The reduction in PPD was higher with CHX than with NaOCl, although a statistically significant adjunctive effect for NaOCl (P = 0.028) was only observed in comparison with placebo only. Mean CAL improved in all groups and at all timepoints, compared to the baseline (P < 0.05). However, after 6 months, CAL gain was statistically significantly higher in the NaOCl treated group than following application of CHX (P = 0.0026).

CONCLUSION

In SPT patients, a single adjunctive use of a NaOCl gel may provide benefits in controlling inflammation and residual pockets.

TRIAL REGISTRATION

ISRCTN Registry of Clinical Trials (ISRCTN11387188).

CLINICAL RELEVANCE

A baseline single application of NaOCl gel in conjunction with mechanical debridement may achieve substantial pocket closure in patients enrolled in SPT; treatment time, cost, and applicability considerations should be taken into account when selecting this therapy.

Cytotoxic Effects on Gingival Mesenchymal Stromal Cells and Root Surface Modifications Induced by Some Local Antimicrobial Products Used in Periodontitis Treatment

(1) Background: this study aims to test the cytotoxicity of three antimicrobial products used in periodontitis treatment on gingival mesenchymal stem cells (gMSCs) and their influence on root surfaces and gMSC adhesion. We tested the null hypothesis that the effects of the antimicrobials did not differ. (2) Methods: the commercial products based on sulphonic/sulphuric acids, sodium hypochlorite and silver nanoparticles, in five different concentrations, were added to culture medium for growing gMSCs. Cell proliferation capacity was tested using the Cell Counting Kit-8 (CCK8) and their viability was determined by succinate dehydrogenase activity (MTT) assay. Scanning electron microscopy evaluated the adhesion of gMSCs on root samples treated mechanically and with commercial products. (3) Results: the products induced a dose-dependent cytotoxicity in terms of reduced proliferation and viability of gMSCs, as well as cell shape modifications. Significant differences in CCK8 values between the different commercial products were observed. Based on proliferation tests, the null hypothesis was rejected. When MTT values of the three products were compared with each other, no significant differences were observed for any of the five concentrations (p = 0.065, p = 0.067, p = 0.172, p = 0.256, p = 0.060). (4) Conclusions: the three antimicrobials had a certain degree of cytotoxicity on gMSCs. gMSCs repopulated treated root surfaces.

Changes in clinical parameters following adjunctive local sodium hypochlorite gel in minimally invasive nonsurgical therapy (MINST) of periodontal pockets: a 6-month randomized controlled clinical trial

BACKGROUND

The mechanical disruption and removal of the subgingival biofilm represent the most important step in the treatment of periodontitis. However, in deep periodontal pockets, mechanical removal of the subgingival biofilm is difficult and frequently incomplete. Preliminary findings indicate that the use of amino acid buffered sodium hypochlorite (NaOCl) gel may chemically destroy the bacterial biofilm and facilitate its mechanical removal.

OBJECTIVES

To clinically evaluate the efficacy of minimally invasive nonsurgical therapy (MINST) of periodontal pockets with or without local application of an amino acid buffered sodium hypochlorite (NaOCl) gel.

MATERIALS AND METHODS

Forty untreated patients diagnosed with severe/advanced periodontitis (i.e. stage III/IV) with a slow/moderate rate of progression (i.e. grade A/B) were randomly allocated in two treatment groups. In the test group, the periodontal pockets were treated by means of MINST and NaOCl gel application, while in the control group, treatment consisted of MINST alone. Full-mouth plaque scores (FMPS), full-mouth bleeding scores (FMBS), probing depths (PD), clinical attachment levels (CAL) and gingival recessions (GR) were assessed at baseline and at 6 months following therapy. The primary outcome variable was PD reduction at sites with PD ≥ 5 mm at baseline.

RESULTS

At 6 months, statistically significant differences between the two groups were found (p = 0.001) in terms of PD and CAL change. No statistically significant differences were found in terms of GR (p = 0.81). The number of sites with PD ≥ 5 mm and BOP (+) decreased statistically significantly (p = 0.001), i.e. from 85.3 to 2.2% in the test group and from 81.6 to 7.3% in the control group, respectively. Statistically significant differences between test and control groups were recorded at 6 months (p = 0.001). MINST + NaOCl compared to MINST alone decreased statistically significantly (p = 0.001) the probability of residual PDs ≥ 5 mm with BOP- (14.5% vs 18.3%) and BOP+ (2.2% vs. 7.2%).

CONCLUSIONS

Within their limits, the present results indicate that (a) the use of MINST may represent a clinically valuable approach for nonsurgical therapy and (b) the application of NaOCl gel in conjunction with MINST may additionally improve the clinical outcomes compared to the use of MINST alone.

CLINICAL RELEVANCE

In patients with untreated periodontitis, treatment of deep pockets by means of MINST in conjunction with a NaOCl gel may represent a valuable approach to additionally improve the clinical outcomes obtained with MINST alone.

Effects of air abrasive decontamination on titanium surfaces: A systematic review of in vitro studies

BACKGROUND

Air abrasion (AA) is one of the decontamination methods that have demonstrated promising results in treating peri-implant diseases.

PURPOSE

This systematic review aimed at evaluating the in vitro effect of AA on surface change, cleaning efficacy, and biocompatibility of titanium surfaces and at comparing it with other decontamination methods.

MATERIALS AND METHODS

A comprehensive search was conducted up to April 2018 using PubMed, Scopus, and Google Scholar databases to identify studies on the decontamination effect of AA. All types of titanium surfaces, abrasive powders, contaminated surfaces, and measuring methods were included.

RESULTS

Overall, 1502 articles were identified. After screening the titles and abstracts, and carefully reading the full-texts, 48 articles published between 1989 and 2018 were selected. AA was considered almost safe, particularly for the nonmodified surfaces. Nevertheless, harder powders such as sodium bicarbonate tended to damage the surface more than glycine. AA resulted in surface change similar to plastic curettes and Er: YAG lasers. Regarding the cleaning efficacy, there was no significant difference between glycine and sodium bicarbonate, but different mixtures of calcium phosphate, hydroxyapatite, and erythritol were superior to glycine. AA was superior or equal to all other decontamination methods in cleaning. Regarding biocompatibility, AA was more successful in preserving biocompatibility for noncontaminated surfaces compared with contaminated surfaces and when used with erythritol and osteoinductive powders.

CONCLUSIONS

AA can efficiently remove contamination without serious damage to the surface. The main drawback of the AA method seems to be its limitation in restoring the biocompatibility of the surface.

Osteoblast growth, after cleaning of biofilm-covered titanium discs with air-polishing and cold plasma

AIM

To investigate the effects of a combined biofilm removal with an optimized air polishing and a cold plasma device on cells in vitro.

MATERIALS AND METHODS

A 7-day-old biofilm was removed from rough titanium discs with an air-polishing device with erythritol powder (AP) or with a cold atmospheric pressure argon plasma (CAP) device or in combination of both (AP + CAP). The removal efficacy was evaluated by subsequent cell seeding of osteoblast-like cells (MG-63). The cell spreading was analysed after 5 days of incubation by scanning electron microscopy. Separately, the surface hydrophilicity was analysed by measuring the water contact angle (WCA) of the disc for each treatment method.

RESULTS

The mechanical plaque removal with AP rendered specimen conducive for cell growth, 85% of the surface was covered with cells. An advantage of the combination of AP + CAP was not detectable compared to AP (cell coverage ranged from 57% up to 75%). After sole CAP treatment, microorganisms re-grew and destroyed all cells. The WCA was reduced by all treatment methods.

CONCLUSION

An AP treatment has the potential to remove biofilm from rough implant surfaces completely. In contrast to our hypothesis, the combination of plasma and AP treatment did not enhance osteoblast spreading.