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Iijima Y, Yamada M, Takahashi T, Hino S, Sano M, Sakagami H, Horie N, Kaneko T. Persistent Gingival Bleeding Related to Periodontal Disease. Cureus 2025; 17:e77693. [PMID: 39839212 PMCID: PMC11748091 DOI: 10.7759/cureus.77693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2025] [Indexed: 01/23/2025] Open
Abstract
Objective More patients visit oral surgery outpatient clinics from evening to night to treat persistent gingival bleeding (PGB) related to periodontal disease (PD) (PD-PGB). Since there are few reports on PD-PGB, the present study performed a detailed characterisation of this disease. Materials and methods Patients who visited our oral surgery clinic between 1 January 2014 and 31 December 2022 to treat PD-PGB without trauma. Demographic data, systemic diseases and bleeding tooth characteristics were retrieved. The occurrence of systemic diseases was compared with that of the control group (patients consisting of temporomandibular joint dislocation and minor trauma). Results Among 295 patients with gingival bleeding (GB) unrelated to trauma, 193 patients (65.4%) showed postoperative bleeding, and 91 patients (30.1%) showed PD-PGB; 93.4% of patients over 60 years old showed PD-PGB. Patients in the PGB-RPD group showed a significantly higher percentage (57.1%) of taking anticoagulants and/or antiplatelets than the control group (24.2%) (P < 0.001) Significantly higher percentage of patients in the PGB-RPD group showed a significantly higher incidence of hypertension (68.1%) than the control group (34.1%) (P < 0.001). Bleeding is the most frequently observed in molars, with a depth of the pockets exceeding 4 mm. Conclusion PD-PGB accompanied by deep pockets was more common in older patients and aggravated by taking anticoagulants and/or antiplatelets and antihypertensives. PD-PGB is not rare, and periodontal maintenance, such as regular dental checks, is an important preventive measure.
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Affiliation(s)
- Yosuke Iijima
- Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, Saitama, JPN
| | - Miki Yamada
- Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, Saitama, JPN
| | - Takumi Takahashi
- Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, Saitama, JPN
| | - Shunsuke Hino
- Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, Saitama, JPN
| | - Motohiko Sano
- Division of Applied Pharmaceutical Education and Research, Hoshi University, Tokyo, JPN
| | - Hiroshi Sakagami
- Research Institute of Odontology, Meikai University, Saitama, JPN
| | - Norio Horie
- Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, Saitama, JPN
| | - Takahiro Kaneko
- Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, Saitama, JPN
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Kardaras G, Boariu M, Varlamov V, Vintila C, Boia S, Belova A, Rusu D, Machoy M, Solomon SM, Stratul SI. Three-Dimensional Planimetry Assessment of Dental Plaque-Covered Area Reduction after Rinsing with 0.2% Sodium Hypochlorite Solution as Part of a Guided Biofilm Therapy ® Protocol-Pilot Longitudinal Study. Biomedicines 2024; 12:2326. [PMID: 39457638 PMCID: PMC11504904 DOI: 10.3390/biomedicines12102326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 09/30/2024] [Accepted: 10/11/2024] [Indexed: 10/28/2024] Open
Abstract
Background/Objectives: Less often employed as a rinsing solution for controlling oral biofilms, NaOCL was used in oral rinses at various concentrations in steps 1 and 4 of periodontal therapy. The aim of this study was to quantitatively evaluate the biofilm-disruptive properties of a 0.2% NaOCl solution in standardized oral rinses using dedicated plaque-disclosing agents and 3D scanning methods in patients undergoing the regular Guided Biofilm Therapy® protocol. Methods: Eight patients with at least 20 teeth present evenly distributed between the two arches were included. After 24 h of refraining from oral hygiene, dental arches were stained with a disclosing agent, the subjects rinsed for 20 s, clinical photographs and 3D scans were performed, subjects rinsed again for 20 s, photographs and 3D scans were performed again, and then the GBT® protocol was resumed as usual. Data representing areas covered with dental plaque were acquired using the "Medit Scan for Clinics" software and then underwent a post-processing and rendering process. The outcome variable was the percent reduction in the plaque-covered areas. Results: For the upper jaw, the estimated mean percent reduction in the biofilm-covered area was 39.65%, while for the mandible, it was 38.26%. The analysis of individual photographs revealed changes in the plaque-covered areas and reductions in the color intensity of the residual plaque-covered areas under identical lighting conditions. Conclusions: When analyzed using 3D intraoral scanning, the 0.2% NaOCl rinsing solution seems to be a clinically efficient disruptor/dissolvent of the oral biofilm, both when integrated into modern protocols of periodontal therapy like GBT® and for home self-care.
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Affiliation(s)
- Georgios Kardaras
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (V.V.); (S.B.); (A.B.); (D.R.); (S.-I.S.)
| | - Marius Boariu
- Department of Endodontics, Faculty of Dental Medicine, TADERP Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Vadym Varlamov
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (V.V.); (S.B.); (A.B.); (D.R.); (S.-I.S.)
| | | | - Simina Boia
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (V.V.); (S.B.); (A.B.); (D.R.); (S.-I.S.)
| | - Alla Belova
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (V.V.); (S.B.); (A.B.); (D.R.); (S.-I.S.)
| | - Darian Rusu
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (V.V.); (S.B.); (A.B.); (D.R.); (S.-I.S.)
| | - Monika Machoy
- Department of Periodontology, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Sorina Mihaela Solomon
- Department of Periodontology, Faculty of Dental Medicine, Gr.T.Popa University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Stefan-Ioan Stratul
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (V.V.); (S.B.); (A.B.); (D.R.); (S.-I.S.)
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Rams TE, Slots J. Elevated subgingival temperature infers high bacterial pathogen counts in severe periodontitis. Clin Exp Dent Res 2024; 10:e891. [PMID: 38706420 PMCID: PMC11070767 DOI: 10.1002/cre2.891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/15/2024] [Accepted: 04/24/2024] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVES Periodontal inflammation may be assessed by bleeding on probing and subgingival temperature. This pilot study evaluated the intrapatient relationship between subgingival temperature and selected bacterial groups/species in deep periodontal pockets with bleeding on probing. MATERIALS AND METHODS In each of eight adults, an electronic temperature probe identified three "hot" pockets with elevated subgingival temperature and three "cool" pockets with normal subgingival temperature among premolars/molars with 6‒10 mm probing depths and bleeding on probing. Microbial samples collected separately from the hot and cool periodontal pockets were cultured for selected periodontal pathogens. RESULTS Hot compared to cool periodontal pockets revealed significantly higher absolute and normalized subgingival temperatures and yielded higher mean proportions of Porphyromonas gingivalis (10.2% for hot vs. 2.5% for cool, p = 0.030) and total red/orange complex periodontal pathogens (48.0% for hot vs. 24.6% for cool, p = 0.012). CONCLUSIONS Hot versus cool deep periodontal pockets harbored significantly higher levels of major periodontal pathogens. Subgingival temperature measurements may potentially be useful to assess risk of periodontitis progression and the efficacy of periodontal therapy.
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Affiliation(s)
- Thomas E. Rams
- Department of Periodontology and Oral ImplantologyTemple University School of DentistryPhiladelphiaPennsylvaniaUSA
| | - Jørgen Slots
- Division of Periodontology and Diagnostic SciencesUniversity of Southern California School of DentistryLos AngelesCaliforniaUSA
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Kardaras G, Christodorescu R, Boariu M, Rusu D, Belova A, Chinnici S, Vela O, Radulescu V, Boia S, Stratul SI. A Low-Cost Protocol Using the Adjunctive Action of Povidone-Iodine Irrigations and Sodium Hypochlorite Rinsing Solution in Step 2 of Periodontal Therapy for Patients with Stage III-IV Periodontitis: A Single-Blind, Randomized Controlled Trial. Dent J (Basel) 2024; 12:144. [PMID: 38786542 PMCID: PMC11119210 DOI: 10.3390/dj12050144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/18/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
In severe stages of periodontitis, conventional periodontal therapy and maintenance care are usually insufficient due to the viral and bacterial etiology; thus, a mechanical approach alone may not be sufficient to eliminate a substantial portion of subgingival pathogens, especially in deep periodontal sites. Background and Objectives: This single-blind, randomized clinical trial aimed to compare the clinical and microbiological efficacy of a low-cost protocol using povidone-iodine and sodium hypochlorite formulations as adjuncts to non-surgical therapy for patients with stage IV periodontitis when compared with chlorhexidine, the most commonly employed substance to date for antimicrobial regimens in periodontal therapy. Materials and Methods: Forty-five patients were randomly divided into two groups: control (subgingival instrumentation, chlorhexidine-assisted) and test (antiviral medication, subgingival instrumentation with povidone-iodine, sodium hypochlorite rinsing solution, and antibiotics). Clinical measurements and microbiological analyses were performed at baseline and after three months. Results: After three months, notable differences were found in the bacterial detection scores for Porphyromonas gingivalis (a significant reduction in detection frequency was observed in the test compared to the control (p = 0.021)), and there were significant reductions in detection in the test group for Tannerella forsythia and Treponema denticola, showing undetectable levels (p < 0.0001 for both). In the test group, the pocket probing depth median value was reduced significantly (p = 0.0005); similarly, bleeding on probing showed a marked decrease (p < 0.0001). However, changes in clinical attachment loss and full-mouth plaque score were not statistically significant. Conclusions: Using the proposed protocol, substantial improvements in clinical and microbiological parameters were obtained when compared with the current antimicrobial recommendations.
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Affiliation(s)
- Georgios Kardaras
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Ruxandra Christodorescu
- Department V Internal Medicine, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Marius Boariu
- Department of Endodontics, Faculty of Dental Medicine, TADERP Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Darian Rusu
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Alla Belova
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Salvatore Chinnici
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Octavia Vela
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Viorelia Radulescu
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Simina Boia
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Stefan-Ioan Stratul
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
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Zhu G, Yi X, Chen L, Liu Q. Association between gingival bleeding and hematuria as biomarkers of periodontitis and renal disease: a review. Odontology 2024; 112:19-26. [PMID: 37491546 DOI: 10.1007/s10266-023-00840-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/07/2023] [Indexed: 07/27/2023]
Abstract
Gingival bleeding is a common complaint and symptom in patients with periodontitis. In clinics, gingival bleeding is regarded as an important sign of gingival inflammation, which is also of great significance in predicting the activity of periodontitis. Existing research has indicated that periodontitis has an impact on distant sites, such as the kidney. Hematuria is the principal feature of glomerular disease, which can reflect the degree and condition of glomerular inflammation. Previous studies have revealed an association between periodontal diseases with renal diseases, so a study is necessary to discuss their representative signs of them. For the moment, there are no reports that are concerned about the correlation between gingival bleeding with hematuria. The main point of this text is to review the potential association between gingival bleeding with hematuria, reveal their underlying mechanisms, and provide instructions for the therapy of periodontitis and glomerular diseases.
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Affiliation(s)
- Guangxun Zhu
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xia Yi
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lili Chen
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China
| | - Qian Liu
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China.
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Almhöjd US, Lehrkinder A, Roos-Jansåker AM, Lingström P. Antimicrobial efficacy of chlorine agents against selected oral pathogens. Clin Oral Investig 2023; 27:5695-5707. [PMID: 37606720 PMCID: PMC10492701 DOI: 10.1007/s00784-023-05190-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/28/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Method-dependent comparison of antimicrobial agents' efficacy against oral pathogens. MATERIALS AND METHODS Several sodium hypochlorite solutions (NaOCl)-Perisolv®, Carisolv® and Dakin's solution-were equated with chlorhexidine (CHX) and hydrogen peroxide (H2O2) against ten oral micro-organisms related to caries and periodontitis using different minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) techniques. Agents were adjusted to the final 70 mmol/L concentration of active chlorine molecule. RESULTS Apart from H2O2 and the amino acids of Perisolv®, all the agents revealed an antimicrobial effect. Agar diffusion test ranked CHX (p < 0.05) as the most effective against all ten specimens, followed by the NaOCl of Perisolv® and Dakin's solution. Correspondingly, in broth microdilution on agar, CHX was the most effective in eradicating micro-organisms at 0.03 mmol/L compared with 2.2 mmol/L of Dakin's solution. In contrast, the bactericidal concentration of Dakin's solution was the most effective at 0.2 mmol/L, (p < 0.001), followed by Perisolv® (2.14 mmol/L), CHX (2.38 mmol/L) and Carisolv® (3.33 mmol/L) after 5 and 10 min in broth dilution test. In live/dead analysis, 60-min exposure to a 2-fold concentration of agents resulted in two-log Aggregatibacter actinomycetemcomitans inhibition by CHX (35 mmol/L) whilst Streptococcus mutans was more susceptible, in 0.8 and 8.8 mmol/L, after 10 min to CHX and Dakin's respectively. CONCLUSION Replacement of CHX with tested hypochlorite agents showed evident potential and promoted rapid antimicrobial effect. CLINICAL RELEVANCE Effective antimicrobial agents are crucial in controlling pathogen-induced oral infections increasing clinical possibilities to combat oral biofilms. Additionally, CHX substitution with hypochlorite agents could eliminate CHX's adverse effects.
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Affiliation(s)
- Ulrica Scherdin Almhöjd
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Box 450, SE-405 30, Gothenburg, Sweden.
| | - Anna Lehrkinder
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Box 450, SE-405 30, Gothenburg, Sweden
| | - Ann-Marie Roos-Jansåker
- Department of Periodontology, Faculty of Odontology, Malmö University, SE-205 06, Malmö, Sweden
| | - Peter Lingström
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Box 450, SE-405 30, Gothenburg, Sweden
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Lee W, Park JB. The clinical effect of sodium hypochlorite oral rinse on peri-implantitis lesion: A pilot study. Heliyon 2023; 9:e15859. [PMID: 37305462 PMCID: PMC10256906 DOI: 10.1016/j.heliyon.2023.e15859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/11/2023] [Accepted: 04/25/2023] [Indexed: 06/13/2023] Open
Abstract
Peri-implantitis poses an imminent challenge to the field of implant dentistry. Considering the promising findings of sodium hypochlorite and periodontal lesions, the aim of the present study was to evaluate the clinical effects of sodium hypochlorite oral rinse on peri-implantitis lesions. Twelve peri-implantitis patients were instructed to rinse with 15 mL of a fresh solution of 0.25% sodium hypochlorite for 30 s twice a week for 3 months. At baseline and 3-month visits, probing depth and modified sulcular bleeding index were recorded at 6 points per lesion (mesiobuccal, buccal, distobuccal, mesiolingual, lingual, and distolingual). Individual and total bacterial loads of 18 pre-designated species of microorganisms were analyzed by real-time PCR methods. Probing depth decreased after the experiment, with an average difference of 1.1 mm and a standard deviation of 1.7 mm. The modified sulcular bleeding index decreased by a mean value of 0.8 with a standard deviation of 1.1. This study demonstrated the clinical effects of sodium hypochlorite oral rinse on peri-implantitis lesions and the reduction of periodontal probing depth and gingival bleeding index. This study suggested that the concentration of 0.25% be used for treatment of peri-implantitis.
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Affiliation(s)
- Wonsup Lee
- Department of Prosthodontics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Jun-Beom Park
- Department of Periodontics, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
- Dental Implantology, Graduate School of Clinical Dental Science, The Catholic University of Korea, Seoul, Republic of Korea
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Rams TE, Slots J. Antimicrobial Chemotherapy for Recalcitrant Severe Human Periodontitis. Antibiotics (Basel) 2023; 12:265. [PMID: 36830176 PMCID: PMC9951977 DOI: 10.3390/antibiotics12020265] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
This study evaluated a combined systemic and topical anti-infective periodontal treatment of 35 adults who had experienced ongoing periodontal breakdown following conventional surgical periodontics. The prescribed anti-infective therapy, based on microbiological testing, consisted of a single course of metronidazole plus ciprofloxacin (23 patients), metronidazole plus amoxicillin/clavulanic acid (10 patients), and metronidazole plus ciprofloxacin followed by metronidazole plus amoxicillin/clavulanic acid (2 patients). In addition, the study patients received 0.1% povidone-iodine subgingival disinfection during non-surgical root debridement and daily patient administered oral irrigation with 0.1% sodium hypochlorite. At 1 and 5 years post-treatment, all study patients showed gains in clinical periodontal attachment with no further attachment loss, and significant decreases in pocket probing depth, bleeding on probing, and subgingival temperature. The greatest disease resolution occurred in patients who at baseline harbored predominantly major periodontal pathogens which post-antibiotics became non-detectable and substituted by non-periodontopathic viridans streptococci. The personalized and minimally invasive anti-infective treatment regimen described here controlled periodontitis disease activity and markedly improved the clinical and microbiological status of the refractory periodontitis patients.
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Affiliation(s)
- Thomas E. Rams
- Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, PA 19140, USA
| | - Jørgen Slots
- Division of Periodontology and Diagnostic Sciences, University of Southern California School of Dentistry, Los Angeles, CA 90089, USA
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Tabassum A, Madi M, Alabdulaziz A, Al Nasrallah Y, Alabdulaziz M, Ahmad Siddique I, Kazmi F. Prevalence of periodontitis based on retrospective radiographic evaluation at dental hospital in Eastern Province of Saudi Arabia: A retrospective study. Saudi Dent J 2022; 34:788-794. [PMID: 36570580 PMCID: PMC9767840 DOI: 10.1016/j.sdentj.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The contemporary information on the prevalence of periodontitis and associated risk factors is deficient in the Kingdom of Saudi Arabia. Our aim was to measure the prevalence of periodontitis and associated risk factors among the Saudi population in the Eastern Province of Saudi Arabia who visited the University Dental Hospital. Methods In this retrospective study, the demographic data and medical and dental records of 700 subjects were examined. Bitewing radiographs were analyzed to measure the alveolar bone loss in posterior teeth by measuring the distance between the cementoenamel junction and the crest of the alveolar bone. A chi-square test was performed to compare the severity of periodontitis. A comparison of multivariate mean bone loss was performed using a t-test. Logistic regression analysis was used to evaluate the predictors of periodontitis. A P-value equal to or under 0.05 reflected statistical significance. Results Among 700 cases, the patients' mean age was 35.6 ± 12.1; 52.6 % were male and 47.4 % were female. Overall periodontitis prevalence was 52.1 %. The distribution of mild, moderate, and severe periodontitis prevalence was 36.1 %, 14.1 %, and 1.8 %, respectively. The severity of periodontitis was statistically similar between males and females (p = 0.148); however, significantly more Saudi than non-Saudi patients had moderate periodontitis. Higher proportions of severe periodontitis were seen in the age group of over 50-years-old (p < 0.001) and in patients with poor oral hygiene (p < 0.001), diabetes mellitus (p < 0.005), and hypertension (p < 0.002). Six total predictors of periodontitis were depicted, i.e., age > 50 years (OR = 3.73), poor OH status (OR = 2.24), BOP (OR = 3.35), presence of plaque (OR = 2.61), diabetes mellitus (OR = 3.19), and hypertension (OR = 3.62). Conclusion The primary factors associated with the prevalence of periodontitis were age, nationality, diabetes, hypertension, BOP, plaque, and OH status. However, no association was observed between gender or cardiovascular disease and the prevalence of periodontitis in the studied population.
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Affiliation(s)
- Afsheen Tabassum
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31411, Saudi Arabia,Corresponding author.
| | - Marwa Madi
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31411, Saudi Arabia
| | - Ahmed Alabdulaziz
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31411, Saudi Arabia
| | - Yousif Al Nasrallah
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31411, Saudi Arabia
| | - Mohammed Alabdulaziz
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31411, Saudi Arabia
| | - Intisar Ahmad Siddique
- Lecturer, Lecturer-Research & Biostatistics, Department of Dental Education, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31411, Saudi Arabia
| | - Farhat Kazmi
- Department of Oral Pathology, Rashid Latif Dental College/Rashid Latif Medical Complex, Lahore, Pakistan
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El Mobadder M, Nammour S, Grzech-Leśniak Z, Grzech-Leśniak K. Efficacy of the Adjunct Use of Povidone-Iodine or Sodium Hypochlorite with Non-Surgical Management of Periodontitis: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11216593. [PMID: 36362818 PMCID: PMC9658783 DOI: 10.3390/jcm11216593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
This systematic review sought to assess the efficacy of combining either sodium hypochlorite or povidone-iodine as disinfection solutions with non-surgical treatment of periodontitis. An electronic search was conducted through PubMed, Scopus, Web of Science, CENTRAL, and Google Scholar from inception until 10 September 2022. Outcomes included clinical outcomes (probing pocket depth, plaque index, clinical attachment level, relative-horizontal attachment level, bleeding on probing, gingival recession, the position of gingival margin) and biochemical (BAPNA level) properties. A subgroup analysis was conducted according to the assessment timepoint. Ten studies reporting the use of povidone-iodine and five studies reporting the use of sodium hypochlorite were included in this review. Overall, in the meta-analysis of povidone-iodine, no significant changes were noted in any of the assessed outcomes; however, minor changes were noted in probing pocket depth and clinical attachment level at a specific timepoint. Regarding sodium hypochlorite, a significant reduction in all clinical outcomes, except for bleeding on probing, was noted. In conclusion, the use of povidone-iodine does not result in an improvement in clinical outcomes, whereas sodium hypochlorite has promising properties that result in significant improvement in probing pocket depth and clinical attachment level. However, more studies are needed to confirm these observations.
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Affiliation(s)
- Marwan El Mobadder
- Dental Surgery Department, Wroclaw Medical University, 50-425 Wroclaw, Poland
- Correspondence: or ; Tel.: +961-7134-3767
| | - Samir Nammour
- Department of Dental Sciences, Faculty of Medicine, University of Liege, 4000 Liege, Belgium
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11
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Effects of Periodontal Endoscopy-Assisted Nonsurgical Treatment of Periodontitis: Four-Month Results of a Randomized Controlled Split-Mouth Pilot Study. Int J Dent 2022; 2022:9511492. [PMID: 35082847 PMCID: PMC8786552 DOI: 10.1155/2022/9511492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/03/2022] [Indexed: 11/18/2022] Open
Abstract
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
was observed in nPE. CAL and PD improved significantly during NSPT in both groups
, with higher PD reduction
and CAL gain
in nPE. There are significantly longer TrT
and more surfaces with subgingival HDs evident in PE at T0
. 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.
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12
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Guimarães TC, Marques BBF, de Castro MV, Secco DA, Porto LCMS, Tinoco JMM, Tinoco EMB, Fletcher P, Fischer RG. Reducing the viral load of SARS‐CoV‐2 in the saliva of patients with COVID‐19. Oral Dis 2021; 28 Suppl 2:2474-2480. [DOI: 10.1111/odi.14118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Taísa Coelho Guimarães
- Department of Periodontology Dental School Rio de Janeiro State University Rio de Janeiro Brazil
| | | | - Marcelle Viana de Castro
- Histocompatibility and Cryopreservation Laboratory Rio de Janeiro State University Rio de Janeiro Brazil
| | - Daniele Angst Secco
- Histocompatibility and Cryopreservation Laboratory Rio de Janeiro State University Rio de Janeiro Brazil
| | - Luís Cristóvão Moraes Sobrino Porto
- Histocompatibility and Cryopreservation Laboratory Rio de Janeiro State University Rio de Janeiro Brazil
- Service of Clinical Pathology Piquet Carneiro Polyclinic Rio de Janeiro State University Rio de Janeiro Brazil
| | | | | | - Paul Fletcher
- Department of Periodontology Stony Brook School of Dental Medicine USA
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13
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Fidler A, Steyer A, Manevski D, Gašperšič R. Virus transmission by ultrasonic scaler and its prevention by antiviral agent: an in vitro study. J Periodontol 2021; 93:e116-e124. [PMID: 34730843 PMCID: PMC8661989 DOI: 10.1002/jper.21-0335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/05/2021] [Accepted: 10/25/2021] [Indexed: 11/15/2022]
Abstract
Background It is well recognized that dental procedures represent a potential way of infection transmission. With the COVID‐19 pandemic, the focus of dental procedure associated transmission has rapidly changed from bacteria to viruses. The aim was to develop an experimental setup for testing the spread of viruses by ultrasonic scaler (USS) generated dental spray and evaluate its mitigation by antiviral coolants. Methods In a virus transmission tunnel, the dental spray was generated by USS with saline coolant and suspension of Equine Arteritis Virus (EAV) delivered to the USS tip. Virus transmission by settled droplets was evaluated with adherent RK13 cell lines culture monolayer. The suspended droplets were collected by a cyclone aero‐sampler. Antiviral activity of 0.25% NaOCl and electrolyzed oxidizing water (EOW) was tested using a suspension test. Antiviral agents' transmission prevention ability was evaluated by using them as a coolant. Results In the suspension test with 0.25% NaOCl or EOW, the TCID50/mL was below the detection limit after 5 seconds. With saline coolant, the EAV‐induced cytopathic effect on RK13 cells was found up to the distance of 45 cm, with the number of infected cells decreasing with distance. By aero‐sampler, viral particles were detected in concentration ≤4.2 TCID50/mL. With both antiviral agents used as coolants, no EAV‐associated RK‐13 cell infection was found. Conclusion We managed to predictably demonstrate EAV spread by droplets because of USS action. More importantly, we managed to mitigate the spread by a simple substitution of the USS coolant with NaOCl or EOW.
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Affiliation(s)
- Aleš Fidler
- University of Ljubljana, Faculty of Medicine, Department of Endodontic and Restorative Dentistry.,University Clinical Centre Ljubljana, Department of Endodontic and Restorative Dentistry
| | - Andrej Steyer
- University of Ljubljana, Faculty of Medicine, Institute of Microbiology and Immunology
| | - Damjan Manevski
- University of Ljubljana, Faculty of Medicine, Institute for Biostatistics and Medical Informatics
| | - Rok Gašperšič
- University of Ljubljana, Faculty of Medicine, Department of Oral Medicine and Periodontology.,University Clinical Centre Ljubljana, Department of Oral Medicine and Periodontology
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14
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Hussain AM, van der Weijden GAF, Slot DE. Effect of a sodium hypochlorite mouthwash on plaque and clinical parameters of periodontal disease-a systematic review. Int J Dent Hyg 2021; 20:40-52. [PMID: 33971082 PMCID: PMC9292655 DOI: 10.1111/idh.12510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/10/2021] [Accepted: 05/04/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The present study aimed to establish the efficacy of sodium hypochlorite mouthwash (NaOCl-MW) compared with a control mouthwash on plaque and clinical parameters of periodontal disease. METHODS MEDLINE-PubMed, Embase and Cochrane-CENTRAL databases were searched for clinical trials on patients with gingivitis or periodontitis that assessed the effect of NaOCl-MW in comparison with a negative or positive control on plaque index (PI), gingival index (GI), and bleeding index (BI) scores and probing pocket depth (PPD). Data were extracted from the eligible studies. RESULTS Seven eligible papers were retrieved, which together represented six clinical trials. The studies showed considerable heterogeneity regarding methodological and clinical aspects that did not permit a meta-analysis. Two of the three studies in which NaOCl-MW was compared with a negative control showed that NaOCl-MW significantly reduced PI, GI and BI, and no effect was found on PPD. In three studies, NaOCl-MW was assessed using chlorhexidine mouthwash (CHX-MW) as a positive control; no difference was found for GI and BI. One of the three comparisons showed a statistically significant PI score favouring NaOCl-MW. One study measured PPD and found it to be significant in favour of NaOCl-MW. CONCLUSIONS Studies with a negative control group provided very weak quality evidence for a very small beneficial effect of NaOCl-MW on PI, GI and BI scores. Studies with a positive control group provided very weak quality evidence that NaOCl-MW had a similar effect as CHX-MW on PI, GI and BI scores. The outcome for PPD was inconclusive.
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Affiliation(s)
- Ahsan Mehran Hussain
- Department of Periodontology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - G A Fridus van der Weijden
- Department of Periodontology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Dagmar Else Slot
- Department of Periodontology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
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15
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Singh S, Sharma P, Kumar M. Evaluation of the effects of 0.05% sodium hypochlorite and 0.12% chlorhexidine gluconate twice daily rinse on periodontal parameters and gingival crevicular fluid HSV1 and CMV levels in patients with chronic periodontitis: a multicentric study. Med J Armed Forces India 2020; 78:157-163. [PMID: 35463538 PMCID: PMC9023539 DOI: 10.1016/j.mjafi.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/05/2020] [Indexed: 11/16/2022] Open
Abstract
Background Mechanical debridement of periodontal pockets remains the mainstay of therapy in all forms of periodontitis. There is 47% greater reduction in plaque amount when sodium hypochlorite (NaOCl) is used as an adjunct when compared with water rinsing. The aim of this study was to evaluate the effects of 0.05% NaOCl and 0.12% chlorhexidine gluconate twice daily rinse on periodontal parameters and gingival crevicular fluid (GCF) HSV1 and CMV levels in chronic periodontitis. Methods Patients assigned to group A were prescribed 0.05% NaOCl mouthwash for twice daily rinse. Patients in group B were prescribed 0.12% chlorhexidine gluconate mouthwash to be used twice daily. Evaluation of periodontal parameters was done at baseline and after six months following therapy. GCF HSV1 and CMV levels were evaluated using a polymerase chain reaction. Results A statistically significant difference was noted in the improvement in periodontal parameters between both groups, when evaluated six months following therapy with greater reduction in group A vis-a-vis group B. Conclusion NaOCl when prescribed as a twice daily mouthwash can be recommended as a part of the home care regime in patients with chronic periodontitis. It is more cost-effective, easily available and can be beneficial to the troops in difficult terrains and extremes of climates, where oral healthcare facilities are not easily accessible.
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Affiliation(s)
- Sangeeta Singh
- Classified Specialist (Periodentology), Army Dental Centre (Research & Referral), New Delhi, India
- Corresponding author.
| | - Parul Sharma
- Commanding Officer & Classified Specialist (Periodentology), 8 AFDC, 7 AFH Kanpur, India
| | - Mahadevan Kumar
- Professor (Microbiology), Bharti Vidyapeeth Medical College, Pune, India
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16
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Slots J. Primer on etiology and treatment of progressive/severe periodontitis: A systemic health perspective. Periodontol 2000 2020; 83:272-276. [PMID: 32385884 DOI: 10.1111/prd.12325] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Periodontology is an infectious disease-based discipline. The etiopathology of progressive/severe periodontitis includes active herpesviruses, specific bacterial pathogens, and proinflammatory cytokines. Herpesviruses and periodontopathic bacteria may interact synergistically to produce periodontal breakdown, and periodontal herpesviruses may contribute to systemic diseases. The infectious agents of severe periodontitis reside in deep pockets, furcation lesions, and inflamed gingiva, sites inaccessible by conventional (purely mechanical) surgical or nonsurgical therapy but accessible by systemic antibiotic treatment. This brief overview presents an effective anti-infective treatment of severe periodontitis, which includes systemic chemotherapy/antibiotics against herpesviruses (valacyclovir [acyclovir]) and bacterial pathogens (amoxicillin + metronidazole or ciprofloxacin + metronidazole) plus common antiseptics (povidone-iodine and sodium hypochlorite) and select ultrasonic scaling. The proposed treatment can cause a marked reduction or elimination of major periodontal pathogens, is acceptably safe, and can be carried out in minimal time with minimal cost.
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Affiliation(s)
- Jørgen Slots
- Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
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17
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Habibe CH, Yoshida RA, Gorjão R, de Gutierrez GM, Heller D, Birbrair A, Santos MTBR. Comparison of salivary cytokines levels among individuals with Down syndrome, cerebral palsy and normoactive. J Clin Exp Dent 2020; 12:e446-e451. [PMID: 32509226 PMCID: PMC7263772 DOI: 10.4317/jced.56336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/24/2020] [Indexed: 11/12/2022] Open
Abstract
Background Individuals with Down syndrome (DS) present increased susceptibility to infections and high prevalence of periodontal disease. The objective of this study is to evaluate the salivary concentrations of IL-1β, IL-6, IL-8, IL-10, TNFα and IL-12p70 of DS individuals and compare to cerebral palsy (CP) and normoactive patients (all with gingivitis).
Material and Methods Twenty-two individuals with DS, 24 with CP and 22 normoactive participated in this cross-sectional study. Salivary flow rate, osmolality rate, Oral Hygiene Index, Gingival Index (GI) and salivary inflammatory markers IL-1β, IL-6, IL-8, IL-10, TNFα and IL-12p70 were evaluated. Shapiro-Wilks, Chi-square, ANOVA One-Way and Kruskal Wallis tests were applied with significance level at 5%.
Results The groups were homogenous for gender, age, and IL12p70 cytokine (p>0.05). GI was significantly higher in DS compared to CP and healthy (p<0.05). CP presented reduced salivary flow and increased osmolality rate. CP showed significantly higher values for TNFα, IL10, and IL6 compared to DS and normoactive (p<0.05). DS and CP presented significantly higher values of IL-1β and IL8 compared to normoactive (p<0.05).
Conclusions Individuals with CP have higher risk to develop periodontal disease due to reduced salivary flow rate, increased salivary osmolality rate and elevated TNFα, IL-10, IL-6 compared to DS. Key words:Cytokines, biomarkers, gingivitis, periodontal diseases, Down syndrome, cerebral palsy, saliva.
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Affiliation(s)
- Carolina-Hartung Habibe
- DDS, MSc, PhD, Professor, Pediatric Dentistry, Centro Universitário de Volta Redonda, UniFOA, Av. Lucas Evangelista de Oliveira Franco, 866, Volta Redonda. Brazil
| | - Rosemeire-Arai Yoshida
- DDS, MSc student, Postgraduate Program in Dentistry, Cruzeiro do Sul University, Rua Galvão Bueno, 868 - Liberdade, São Paulo. Brazil
| | - Renata Gorjão
- MSc, PhD, Adjunt Professor, Postgraduate Program Interdisciplinary in Health Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868 - Liberdade, São Paulo. Brazil
| | - Gabriela-Mancia de Gutierrez
- DDS, MSc, Ph.D student, Postgraduate Program in Dentistry, Cruzeiro do Sul University, Rua Galvão Bueno, 868 - Liberdade, São Paulo. Brazil
| | - Debora Heller
- DDS, MSc, PhD, School of Dentistry, Cruzeiro do Sul University, Rua Galvão Bueno, 868 - Liberdade, São Paulo - SP, 01506-000, Brazil. Experimental Research Center, Albert Einstein Israeli Hospital, São Paulo, São Paulo, Brazil
| | - Alexander Birbrair
- DDS, MSc, PhD, Department of Radiology, Columbia University Medical Center, New York, New York 622 W 168th St, New York, NY 10032, EUA. Department of Pathology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria-Teresa-Botti-Rodrigues Santos
- DDS, MSc, PhD, Associate Professor, Individuals with Special Needs, Postgraduate Program in Dentistry, Cruzeiro do Sul University São Paulo, SP, Brazil
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18
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Abstract
Four billion individuals worldwide have a history of periodontitis, with the poorest people in society most affected. Periodontitis can lead to unsightly drifting of teeth and tooth loss that may interfere with the wellbeing of daily living and has also been linked to at least 57 medical diseases and disabilities. The etiology of severe periodontitis includes active herpesviruses, specific bacterial pathogens, and destructive immune responses, but herpesviruses seem to be the major pathogenic determinant. Periodontal herpesviruses that disseminate via the systemic circulation to nonoral sites may represent a major link between periodontitis and systemic diseases. Current treatment of periodontitis focuses almost exclusively on bacterial biofilm and will require revision. Periodontal therapy that targets both herpesviruses and bacterial pathogens can provide long-term clinical improvement and potentially reduces the risk of systemic diseases. Molecular diagnostic tests for periodontal pathogens may enable early microbial identification and preemptive therapy. This review details an efficient and reliable anti-infective treatment of severe periodontitis that can be carried out in minimal time with minimal cost.
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Affiliation(s)
- Jørgen Slots
- School of Dentistry, University of Southern California, Los Angeles, California
| | - Henrik Slots
- University of Nevada at Reno School of Medicine, Reno, Nevada.,St. George's School of Medicine, St. George, Grenada.,Renown Medical Center, Reno, Nevada
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19
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Abstract
Periodontology has evolved from a predominantly mechanical to a sophisticated infectious disease-based discipline. Research has paved the way for a greater understanding of the periodontal microbiome, improvement in periodontal diagnostics and therapies, and the recognition of periodontitis being associated with more than 50 systemic diseases. The etiopathology of progressive periodontitis includes active herpesviruses, specific bacterial pathogens, and proinflammatory immune responses. This article points to a role of periodontal herpesviruses in the development of systemic diseases and proposes treatment of severe periodontitis not only to avoid tooth loss, but also to reduce the risk for systemic diseases. An efficient, safe, and reliable anti-infective treatment of severe periodontitis is presented, which targets both herpesviruses and bacterial pathogens and which can be carried out in minimal time with minimal cost.
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Affiliation(s)
- Jørgen Slots
- Division of Periodontology, Diagnostic Sciences and Dental Hygiene Ostrow School of Dentistry of USC, University of Southern California, Los Angeles, California, USA
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20
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da Silva FRP, e Silva Conceição Pinto M, de Carvalho França LF, Alves EHP, dos Santos Carvalho J, Di Lenardo D, Brito TV, Medeiros JVR, de Oliveira JS, Freitas ALP, Barros FCN, dos Reis Barbosa AL, Vasconcelos DFP. Sulfated polysaccharides from the marine algae Gracilaria caudata prevent tissue damage caused by ligature-induced periodontitis. Int J Biol Macromol 2019; 132:1-8. [DOI: 10.1016/j.ijbiomac.2019.03.194] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/05/2019] [Accepted: 03/25/2019] [Indexed: 02/07/2023]
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21
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Roy M, Gastaldi G, Courvoisier DS, Mombelli A, Giannopoulou C. Periodontal health in a cohort of subjects with type 1 diabetes mellitus. Clin Exp Dent Res 2019; 5:243-249. [PMID: 31249705 PMCID: PMC6585577 DOI: 10.1002/cre2.178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/04/2019] [Indexed: 11/23/2022] Open
Abstract
To evaluate periodontal health and oral health behaviors in a cohort of subjects with type 1 diabetes (T1D), 50 persons with T1D (30 males and 20 females; mean age: 35.2 years) were recruited from the Diabetology Unit of the Geneva University Hospitals; 50 nondiabetic persons matched for gender, age, and smoking status comprised the control group. We assessed periodontal health using the gingival index (GI), plaque index, probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL) and recorded self-reported attitudes and behaviors regarding dental care. The two groups were compared using conditional logistic regression. With respect to the mean PD, CAL, and the mean number of sites with PD >4 mm that bled upon probing, there were no significant differences between the groups. However, subjects with diabetes had significantly more plaque and gingival inflammation and presented more sites with BOP compared with control subjects. Further analysis of the subjects in younger (<40 years) and older (>40 years) cohorts revealed a marked difference in GI between younger healthy and controls, which was also present in older patients and controls but much reduced in magnitude and significance. This marked difference in the gingival health of young versus old diabetic patients to matched controls may provide diagnostic advantages and screening and prevention opportunities to exploit. In spite of similar self-reported oral hygiene habits and frequency of dental visits, patients with T1D presented more plaque and more inflammation than healthy controls, particularly in the younger subjects. Gingivitis in young T1D patients may be an early indicator for more complicated diabetes and periodontitis in the future. Thus, patients with T1D mellitus should be screened for signs of periodontal disease early and should be motivated and instructed in good oral hygiene practices.
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Affiliation(s)
- Margaux Roy
- Division of PeriodontologyUniversity Clinics of Dental Medicine, University of GenevaGenevaSwitzerland
| | | | | | - Andrea Mombelli
- Division of PeriodontologyUniversity Clinics of Dental Medicine, University of GenevaGenevaSwitzerland
| | - Catherine Giannopoulou
- Division of PeriodontologyUniversity Clinics of Dental Medicine, University of GenevaGenevaSwitzerland
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22
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Abstract
This volume of Periodontology 2000 represents the 25th anniversary of the Journal, and uses the occasion to assess important advancements in periodontology over the past quarter-century as well as the hurdles that remain. Periodontitis is defined by pathologic loss of the periodontal ligament and alveolar bone. The disease involves complex dynamic interactions among active herpesviruses, specific bacterial pathogens and destructive immune responses. Periodontal diagnostics is currently based on clinical rather than etiologic criteria, and provides limited therapeutic guidance. Periodontal causative treatment consists of scaling, antiseptic rinses and occasionally systemic antibiotics, and surgical intervention has been de-emphasized, except perhaps for the most advanced types of periodontitis. Plastic surgical therapy includes soft-tissue grafting to cover exposed root surfaces and bone grafting to provide support for implants. Dental implants are used to replace severely diseased or missing teeth, but implant overuse is of concern. The utility of laser treatment for periodontitis remains unresolved. Host modulation and risk-factor modification therapies may benefit select patient groups. Patient self-care is a critical part of periodontal health care, and twice-weekly oral rinsing with 0.10-0.25% sodium hypochlorite constitutes a valuable adjunct to conventional anti-plaque and anti-gingivitis treatments. A link between periodontal herpesviruses and systemic diseases is a strong biological plausibility. In summary, research during the past 25 years has significantly changed our concepts of periodontitis pathobiology and has produced more-effective and less-costly therapeutic options.
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23
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Multi-omics Analysis of Periodontal Pocket Microbial Communities Pre- and Posttreatment. mSystems 2017; 2:mSystems00016-17. [PMID: 28744486 PMCID: PMC5513737 DOI: 10.1128/msystems.00016-17] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/20/2017] [Indexed: 12/12/2022] Open
Abstract
Periodontal disease affects the majority of adults worldwide and has been linked to numerous systemic diseases. Despite decades of research, the reasons for the substantial differences among periodontitis patients in disease incidence, progressivity, and response to treatment remain poorly understood. While deep sequencing of oral bacterial communities has greatly expanded our comprehension of the microbial diversity of periodontal disease and identified associations with healthy and disease states, predicting treatment outcomes remains elusive. Our results suggest that combining multiple omics approaches enhances the ability to differentiate among disease states and determine differential effects of treatment, particularly with the addition of metabolomic information. Furthermore, multi-omics analysis of biofilm community instability indicated that these approaches provide new tools for investigating the ecological dynamics underlying the progressive periodontal disease process. Periodontitis is a polymicrobial infectious disease that causes breakdown of the periodontal ligament and alveolar bone. We employed a meta-omics approach that included microbial 16S rRNA amplicon sequencing, shotgun metagenomics, and tandem mass spectrometry to analyze sub- and supragingival biofilms in adults with chronic periodontitis pre- and posttreatment with 0.25% sodium hypochlorite. Microbial samples were collected with periodontal curettes from 3- to 12-mm-deep periodontal pockets at the baseline and at 2 weeks and 3 months. All data types showed high interpersonal variability, and there was a significant correlation between phylogenetic diversity and pocket depth at the baseline and a strong correlation (rho = 0.21; P = 0.008) between metabolite diversity and maximum pocket depth (MPD). Analysis of subgingival baseline samples (16S rRNA and shotgun metagenomics) found positive correlations between abundances of particular bacterial genera and MPD, including Porphyromonas, Treponema, Tannerella, and Desulfovibrio species and unknown taxon SHD-231. At 2 weeks posttreatment, we observed an almost complete turnover in the bacterial genera (16S rRNA) and species (shotgun metagenomics) correlated with MPD. Among the metabolites detected, the medians of the 20 most abundant metabolites were significantly correlated with MPD pre- and posttreatment. Finally, tests of periodontal biofilm community instability found markedly higher taxonomic instability in patients who did not improve posttreatment than in patients who did improve (UniFrac distances; t = −3.59; P = 0.002). Interestingly, the opposite pattern occurred in the metabolic profiles (Bray-Curtis; t = 2.42; P = 0.02). Our results suggested that multi-omics approaches, and metabolomics analysis in particular, could enhance treatment prediction and reveal patients most likely to improve posttreatment. IMPORTANCE Periodontal disease affects the majority of adults worldwide and has been linked to numerous systemic diseases. Despite decades of research, the reasons for the substantial differences among periodontitis patients in disease incidence, progressivity, and response to treatment remain poorly understood. While deep sequencing of oral bacterial communities has greatly expanded our comprehension of the microbial diversity of periodontal disease and identified associations with healthy and disease states, predicting treatment outcomes remains elusive. Our results suggest that combining multiple omics approaches enhances the ability to differentiate among disease states and determine differential effects of treatment, particularly with the addition of metabolomic information. Furthermore, multi-omics analysis of biofilm community instability indicated that these approaches provide new tools for investigating the ecological dynamics underlying the progressive periodontal disease process.
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24
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Espíndola LCP, Colombo APV. Lack of adjunctive effect of 0.1% sodium hypochlorite mouthwash combined to full-mouth ultrasonic debridement on supragingival plaque, gingival inflammation, and subgingival microbiota: A randomized placebo-controlled 6-month trial. Clin Exp Dent Res 2017; 3:51-61. [PMID: 29744179 PMCID: PMC5719817 DOI: 10.1002/cre2.60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/05/2017] [Accepted: 02/08/2017] [Indexed: 12/13/2022] Open
Abstract
To test the adjunctive effect of 0.1% sodium hypochlorite (NaOCl) mouthwash combined to full‐mouth ultrasonic debridement (FMUD) on reducing supragingival plaque, gingival inflammation, and microbial pathogens. In this 6‐month double‐blinded randomized clinical trial, individuals with gingivitis were assigned to test (n = 16) or placebo group (n = 16) and received FMUD followed by rinsing with 0.1% NaOCl (test) or distilled water (placebo), respectively, twice a day for 1 month. Full‐mouth periodontal examination was performed at baseline, 1, 3, and 6 months posttherapy, and subgingival plaque samples were obtained at the same time points and analysed for their composition by checkerboard. Differences between groups over time were examined by Student t test, Mann–Whitney, generalized linear model, and Friedman and chi‐square tests. Both therapeutic protocols resulted in significant clinical improvement in periodontal parameters over time, except for probing depth and attachment level, which had a slight mean increase of 0.2 mm (p < .01). No significant differences between groups were observed for any clinical parameter (p > .05). Most species (>65%) decreased similarly in levels in both groups over time. Significant reductions in the microbial complexes were seen mainly at 1 and 3 months, but they returned to baseline levels in both groups, except for the red and yellow complexes, and other oral species, which were kept in low levels at 6 months (p < .05). A 0.1% NaOCl mouthwash did not provide additional benefits to FMUD in reducing supragingival plaque, gingivitis, and/or microbial pathogens.
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Affiliation(s)
- Laís Christina Pontes Espíndola
- Department of Clinics, School of Dentistry Federal University of Rio de Janeiro Brazil.,Department of Medical Microbiology, Institute of Microbiology Federal University of Rio de Janeiro Brazil
| | - Ana Paula Vieira Colombo
- Department of Clinics, School of Dentistry Federal University of Rio de Janeiro Brazil.,Department of Medical Microbiology, Institute of Microbiology Federal University of Rio de Janeiro Brazil
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Goh V, Hackmack PP, Corbet EF, Leung WK. Moderate- to long-term periodontal outcomes of subjects failing to complete a course of periodontal therapy. Aust Dent J 2017; 62:152-160. [DOI: 10.1111/adj.12440] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2016] [Indexed: 01/04/2023]
Affiliation(s)
- V Goh
- Faculty of Dentistry; The University of Hong Kong; Hong Kong SAR China
- Faculty of Dentistry; The National University of Malaysia; Kuala Lumpur Malaysia
| | - PP Hackmack
- Faculty of Dentistry; The University of Hong Kong; Hong Kong SAR China
| | - EF Corbet
- Faculty of Dentistry; The University of Hong Kong; Hong Kong SAR China
| | - WK Leung
- Faculty of Dentistry; The University of Hong Kong; Hong Kong SAR China
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26
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Bizzarro S, Van der Velden U, Loos BG. Local disinfection with sodium hypochlorite as adjunct to basic periodontal therapy: a randomized controlled trial. J Clin Periodontol 2016; 43:778-88. [PMID: 27169789 DOI: 10.1111/jcpe.12578] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 12/15/2022]
Abstract
AIM To investigate the clinical and microbiological effects of local disinfection with 0.5% sodium hypochlorite (NaOCl) with or without systemic antimicrobials (amoxicillin and metronidazole, AM) during basic periodontal therapy (BPT). MATERIAL AND METHODS In a randomized clinical trial (four groups), 110 chronic periodontitis patients received BPT plus local irrigation with saline (BPT + S), local disinfection with NaOCl (BPT + DIS), BPT + DIS + AM or BPT + S + AM. The outcome was analysed at baseline, 3, 6 and 12 months. RESULTS There was no difference in clinical attachment level gain at 12 months between the four groups. BPT + DIS showed no additional improvement compared to BPT + S; BPT + DIS + AM showed fewer sites with probing pocket depth (PPD) ≥7 mm versus BPT + S only up to 6 months (p = 0.037). In factorial analyses, additional clinical reduction for PPD (p = 0.023) and number of sites with PPD ≥5 (p = 0.007), ≥6 (p = 0.002) and ≥7 mm (p < 0.001) were found when AM was added to BPT, but not when DIS was applied. In all groups, a comparable decrease in targeted bacteria was found. AM caused adverse events in 22% of the patients. CONCLUSION Local disinfection with NaOCl, also in combination with AM, showed, after 1-year follow-up, no additional clinical and microbiological effects compared to BPT alone.
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Affiliation(s)
- Sergio Bizzarro
- Department of Periodontology, Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and VU University of Amsterdam, Amsterdam, The Netherlands
| | - Ubele Van der Velden
- Department of Periodontology, Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and VU University of Amsterdam, Amsterdam, The Netherlands
| | - Bruno G Loos
- Department of Periodontology, Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and VU University of Amsterdam, Amsterdam, The Netherlands
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Lanza E, Magan-Fernandez A, Bermejo B, de Rojas J, Marfil-Alvarez R, Mesa F. Complementary clinical effects of red complex bacteria on generalized periodontitis in a caucasian population. Oral Dis 2016; 22:430-7. [PMID: 26948988 DOI: 10.1111/odi.12471] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/22/2016] [Accepted: 03/01/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To relate five periodontopathogenic bacteria, including the red complex, to the severity, extent, and inflammation of the periodontal lesion in Caucasian patients with generalized aggressive and chronic periodontitis and to explore whether tobacco use is associated with a specific bacterial profile. MATERIALS AND METHODS A cross-sectional and analytic study was conducted in patients with aggressive and chronic periodontitis. Data were gathered on socio-demographic and periodontal variables, and RH-PCR was used to determine subgingival bacterial profile. Linear and logistic regression analyses were performed. RESULTS The study included 60 patients with aggressive and 123 with chronic periodontitis. Total red complex bacteria count was higher in aggressive periodontitis, mainly due to T. denticola (P = 0.015). In both periodontitis types, models showed an association between T. forsythia count and probing depth (B = 0.157, P = 0.030) and between T. denticola count and higher bleeding scores (B = 2.371, P = 0.027). Smoking did not affect the red complex bacteria count in either disease. CONCLUSIONS The prevalence of red complex bacteria was similar between aggressive and chronic periodontitis, but their count was higher in the former. In both diseases, T. forsythia was associated with greater severity and T. denticola with more severe bleeding. Tobacco smoking was not associated with the presence of red complex bacteria in either disease.
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Affiliation(s)
- E Lanza
- Private Periodontology Practice, Malaga, Spain
| | - A Magan-Fernandez
- Periodontology Department, School of Dentistry, University of Granada, Granada, Spain
| | - B Bermejo
- Echevarne Microbiology Laboratory, Malaga, Spain
| | - J de Rojas
- Private Periodontology Practice, Malaga, Spain
| | - R Marfil-Alvarez
- Periodontology Department, School of Dentistry, University of Granada, Granada, Spain
| | - F Mesa
- Periodontology Department, School of Dentistry, University of Granada, Granada, Spain
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Wilder RS, Bray KS. Improving periodontal outcomes: merging clinical and behavioral science. Periodontol 2000 2016; 71:65-81. [DOI: 10.1111/prd.12125] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 02/03/2023]
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Decker EM, Bartha V, Kopunic A, von Ohle C. Antimicrobial efficiency of mouthrinses versus and in combination with different photodynamic therapies on periodontal pathogens in an experimental study. J Periodontal Res 2016; 52:162-175. [PMID: 27038101 DOI: 10.1111/jre.12379] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVE In the therapy of destructive periodontal disease, chemical antimicrobial agents and increasingly photodynamic therapy (PDT) play an important adjunctive role to standard mechanical anti-infective treatment procedures. However, both antiseptic methods have their shortcomings in terms of eliminating periodontal pathogens. The aim of the study was to compare the antibacterial efficacy of different antiseptic mouthrinses, of a conventional and a new, modified PDTplus as well as of the different antiseptic mouthrinses combined with either the conventional or the modified PDTplus against periopathogens. MATERIAL AND METHODS Six representative periodontitis-associated bacterial strains were grown for 24 h under anaerobic conditions. After mixing the individual cell pellets they were exposed to 10 different antiseptic mouthrinse formulations: chlorhexidine (0.2%, 0.06%, CHX); CHX + cetylpyridinium chloride (each 0.05%); sodium hypochlorite (0.05%); polyhexanide (0.04%, PHMB1; 0.1%, PHMB2); octenidine dihydrochloride (0.1%); fluoride (250 ppm); essential oils; povidone iodine (10%); and saline (0.9%, NaCl) as control. Furthermore, the bacteria were treated with conventional PDT based on light-emitting diodes and a new modified photodisinfection combining photosensitizer with hydrogen peroxide to PDTplus also based on light-emitting diodes. In addition to the single treatments, a combined application of antiseptic exposure followed by use of PDT or PDTplus was performed. The microbial viability was characterized by analyzing colony growth and fluorescence-based vitality proportions. RESULTS Nearly all mouthrinses caused a statistically significant growth inhibition. The most effective antiseptics, CHX (0.2%), CHX/cetylpyridinium chloride and octenidine dihydrochloride, inhibited bacterial growth completely. Conventional PDT resulted in moderate reduction of colony growth. The modified PDTplus achieved maximum antimicrobial effect. The combination of antiseptic exposure and PDT against periopathogens predominantly increased antibacterial efficacy compared to the single applications. The mouthrinse containing essential oil seemed to interfere with PDT. CONCLUSION A combination therapy of preceding chemotherapeutical exposure and subsequent photodisinfection may be a more effective and promising antibacterial treatment than single applications of the antiseptic methods. The modified PDTplus using oxygen-enriched toluidine showed a superior antibacterial effect on periodontal pathogens to conventional PDT and to the majority of the investigated mouthrinses.
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Affiliation(s)
- E-M Decker
- Department for Pediatric and Operative Dentistry, Periodontology and Endodontology, University of Tübingen, Center of Dentistry, Oral Medicine and Maxillofacial Surgery, Tuebingen, Germany
| | - V Bartha
- Department for Pediatric and Operative Dentistry, Periodontology and Endodontology, University of Tübingen, Center of Dentistry, Oral Medicine and Maxillofacial Surgery, Tuebingen, Germany
| | - A Kopunic
- Department for Pediatric and Operative Dentistry, Periodontology and Endodontology, University of Tübingen, Center of Dentistry, Oral Medicine and Maxillofacial Surgery, Tuebingen, Germany
| | - C von Ohle
- Department for Pediatric and Operative Dentistry, Periodontology and Endodontology, University of Tübingen, Center of Dentistry, Oral Medicine and Maxillofacial Surgery, Tuebingen, Germany
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Liu X, Zhang Y, Zhou Z, Ma S. Retrospective study of combined splinting restorations in the aesthetic zone of periodontal patients. Br Dent J 2016; 220:241-7. [PMID: 26964599 PMCID: PMC5565939 DOI: 10.1038/sj.bdj.2016.178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2016] [Indexed: 12/19/2022]
Abstract
Evaluates the clinical performance of of a fiber-reinforced, composite-resin bonded splint; a bridge; a fiber post; and/or a resin veneer for the restoration of periodontally-involved anterior teeth. Shows that a combination of approaches is a good choice for minimally invasive prosthodontic treatment in the aesthetic zone in periodontal patients.
Aims This retrospective study evaluated the clinical performance of combining a fiber-reinforced, composite-resin (FRC) bonded splint; bridge; fiber post; and/or resin veneer for the restoration of periodontally-involved anterior teeth. Methods Sixty-three patients with periodontally-involved anterior teeth each received one of the following splinting restorations: FRC-bonded splint-bridges (SB), a combination of an FRC-bonded splint and resin veneer (SV), or FRC-bonded splints (S). Six patients with healthy periodontal teeth received orthodontic retainers with FRC-bonded splints (OS) as a control. Modified USPHS criteria were used to evaluate the effects of rehabilitation, and the periodontal pocket depth (PPD) and clinical attachment level (CAL) of the natural teeth were measured. Results All restorations resulted in good aesthetic outcomes. SV, S in combination with fiber posts and OS all resulted in 100% acceptable ratings for each category that was directly evaluated at each follow-up. The mean PPD was 3.5 ± 1.0 mm at baseline, decreased to 3.3 ± 1.0 mm after one year (p <0.05), and subsequently increased to 3.5±1.0 mm again after four years (p >0.05). These changes were similar to those in the mean CAL. Conclusion A combination of a FRC-bonded splint, bridge, fiber post and/or resin veneer for minimally invasive prosthodontic treatment in the aesthetic zone is a good choice for periodontal patients.
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Affiliation(s)
- X Liu
- The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Y Zhang
- The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Z Zhou
- The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - S Ma
- The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
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Jurczyk K, Nietzsche S, Ender C, Sculean A, Eick S. In-vitro activity of sodium-hypochlorite gel on bacteria associated with periodontitis. Clin Oral Investig 2016; 20:2165-2173. [DOI: 10.1007/s00784-016-1711-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 01/04/2016] [Indexed: 12/30/2022]
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Sawada K, Fujioka-Kobayashi M, Kobayashi E, Schaller B, Miron RJ. Effects of Antiseptic Solutions Commonly Used in Dentistry on Bone Viability, Bone Morphology, and Release of Growth Factors. J Oral Maxillofac Surg 2015; 74:247-54. [PMID: 26501425 DOI: 10.1016/j.joms.2015.09.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/22/2015] [Accepted: 09/25/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Antiseptic solutions are commonly used in dentistry for a number of sterilization procedures, including harvesting of bone chips, irrigation of extraction sockets, and sterilization of osteonecrotic bone. Despite its widespread use, little information is available regarding the effects of various antiseptic solutions on bone cell viability, morphology, and the release of growth factors. MATERIALS AND METHODS The antiseptic solutions included 1) 0.5% povidone iodine (PI), 2) 0.2% chlorhexidine diguluconate (CHX), 3) 1% hydrogen peroxide (H2O2), and 4) 0.25% sodium hypochlorite (HYP). Bone samples collected from porcine mandibular cortical bone were rinsed in the antiseptic solutions for 10 minutes and assessed for cell viability using an MTS assay and protein release of transforming growth factor (TGF-β1), bone morphogenetic protein 2 (BMP2), vascular endothelial growth factor (VEGF), interleukin (IL)-1β, and receptor activator of nuclear factor κB ligand (RANKL) using an enzyme-linked immunosorbent assay at 15 minutes and 4 hours after rinsing. RESULTS After antiseptic rinsing, changes to the surface protein content showed marked alterations, with an abundant protein layer remaining on CHX-rinsed bone samples. The amount of surface protein content gradually decreased in the following order: CHX, H2O2, PI, and HYP. A similar trend was also observed for the relative cell viability from within bone samples after rinsing, with up to 6 times more viable cells found in the CHX-rinsed bone samples than in the HYP- and PI-rinsed samples. An analysis of the growth factors found that both HYP and PI had significantly lower VEGF and TGF-β1 protein release from bone samples at 15 minutes and 4 hours after rinsing compared with CHX and H2O2. A similar trend was observed for RANKL and IL-1β protein release, although no change was observed for BMP2. CONCLUSIONS The results from the present study have demonstrated that antiseptic solutions present with very different effects on bone samples after 10 minutes of rinsing. Rinsing with CHX maintained significantly higher cell viability and protein release of growth factors potent to the bone remodeling cycle.
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Affiliation(s)
- Kosaku Sawada
- Resident, Department of Cranio Maxillofacial Surgery, Inselspital, University of Bern, Bern, Switzerland; and Nippon Dental University, School of Life Dentistry at Niigata, Advanced Research Center, Niigata, Japan
| | - Masako Fujioka-Kobayashi
- Resident, Department of Cranio Maxillofacial Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Eizaburo Kobayashi
- Resident, Department of Cranio Maxillofacial Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Benoit Schaller
- Professor, Department of Cranio Maxillofacial Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Richard J Miron
- Head, Department of Oral Surgery and Stomatology, Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
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Sawada K, Caballé-Serrano J, Bosshardt DD, Schaller B, Miron RJ, Buser D, Gruber R. Antiseptic solutions modulate the paracrine-like activity of bone chips: differential impact of chlorhexidine and sodium hypochlorite. J Clin Periodontol 2015; 42:883-891. [PMID: 26284317 DOI: 10.1111/jcpe.12447] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2015] [Indexed: 12/14/2022]
Abstract
AIM Chemical decontamination increases the availability of bone grafts; however, it remains unclear whether antiseptic processing changes the biological activity of bone. MATERIALS AND METHODS Bone chips were incubated with four different antiseptic solutions including (1) povidone-iodine (0.5%), (2) chlorhexidine diguluconate (0.2%), (3) hydrogen peroxide (1%) and (4) sodium hypochlorite (0.25%). After 10 min. of incubation, changes in the capacity of the bone-conditioned medium (BCM) to modulate gene expression of gingival fibroblasts was investigated. RESULTS Conditioned medium obtained from freshly prepared bone chips increased the expression of TGF-β target genes interleukin 11 (IL11), proteoglycan4 (PRG4), NADPH oxidase 4 (NOX4), and decreased the expression of adrenomedullin (ADM), and pentraxin 3 (PTX3) in gingival fibroblasts. Incubation of bone chips with 0.2% chlorhexidine, followed by vigorously washing resulted in a BCM with even higher expression of IL11, PRG4 and NOX4. These findings were also detected with a decrease in cell viability and an activation of apoptosis signalling. Chlorhexidine alone, at low concentrations, increased IL11, PRG4 and NOX4 expression, independent of the TGF-β receptor I kinase activity. In contrast, 0.25% sodium hypochlorite almost entirely abolished the activity of BCM, whereas the other two antiseptic solutions, 1% hydrogen peroxide and 0.5% povidone-iodine, had relatively no impact respectively. CONCLUSION These in vitro findings demonstrate that incubation of bone chips with chlorhexidine differentially affects the activity of the respective BCM compared to the other antiseptic solutions. The data further suggest that the main effects are caused by chlorhexidine remaining in the BCM after repeated washing of the bone chips.
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Affiliation(s)
- Kosaku Sawada
- Department of Cranio Maxillofacial Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Jordi Caballé-Serrano
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Oral and Maxillofacial Surgery, College of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Dieter D Bosshardt
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Benoit Schaller
- Department of Cranio Maxillofacial Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Richard J Miron
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Daniel Buser
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Reinhard Gruber
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland.,Department of Oral Biology, Medical University of Vienna, Vienna, Austria
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