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D'Ambrosio F. Periodontal and Peri-Implant Diagnosis: Current Evidence and Future Directions. Diagnostics (Basel) 2024; 14:256. [PMID: 38337772 PMCID: PMC10855505 DOI: 10.3390/diagnostics14030256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
Dentistry and periodontology in particular are constantly evolving in terms of both diagnostic and therapeutic tools [...].
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Affiliation(s)
- Francesco D'Ambrosio
- Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, Via S. Allende, 84081 Baronissi, Italy
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2
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Chew RJJ, Goh CE, Sriram G, Preshaw PM, Tan KS. Microbial biomarkers as a predictor of periodontal treatment response: A systematic review. J Periodontal Res 2023; 58:1113-1127. [PMID: 37724467 DOI: 10.1111/jre.13188] [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: 05/03/2023] [Revised: 06/30/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023]
Abstract
To evaluate the prognostic accuracy of microbial biomarkers and their associations with the response to active periodontal treatment (APT) and supportive periodontal therapy (SPT). Microbial dysbiosis plays a crucial role in the disease processes of periodontitis. Biomarkers based on microbial composition may offer additional prognostic value, supplementing the limitations of current clinical parameters. While these microbial biomarkers have been clinically evaluated, there is a lack of consensus regarding their prognostic accuracy. A structured search strategy was applied to MEDLINE (PubMed), Cochrane Library, and Embase on 1/11/2022 to identify relevant publications. Prospective clinical studies involving either APT or SPT, with at least 3-month follow-up were included. There were no restrictions on the type of microbial compositional analysis. 1918 unique records were retrieved, and 13 studies (comprising 943 adult patients) were included. Heterogeneity of the studies precluded a meta-analysis, and none of the included studies had performed the sequence analysis of the periodontal microbiome. Seven and six studies reported on response to APT and SPT, respectively. The prognostic accuracy of the microbial biomarkers for APT and SPT was examined in only two and four studies, respectively. Microbial biomarkers had limited predictive accuracy for APT and inconsistent associations for different species across studies. For SPT, elevated abundance of periodontal pathogens at the start of SPT was predictive of subsequent periodontal progression. Similarly, persistent high pathogen loads were consistently associated with progressive periodontitis, defined as an increased pocket probing depth or clinical attachment loss. While there was insufficient evidence to support the clinical use of microbial biomarkers as prognostic tools for active periodontal treatment outcomes, biomarkers that quantify periodontal pathogen loads may offer prognostic value for predicting progressive periodontitis in the subsequent supportive periodontal therapy phase. Additional research will be required to translate information regarding subgingival biofilm composition and phenotype into clinically relevant prognostic tools.
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Affiliation(s)
- Ren Jie Jacob Chew
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Charlene Enhui Goh
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Gopu Sriram
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
- Oral Care Health Innovations and Designs Singapore, National University of Singapore, Singapore, Singapore
| | | | - Kai Soo Tan
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
- Oral Care Health Innovations and Designs Singapore, National University of Singapore, Singapore, Singapore
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3
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Laugisch O, Auschill TM, Tumbrink A, Sculean A, Arweiler NB. Influence of Anti-Infective Periodontal Therapy on Subgingival Microbiota Evaluated by Chair-Side Test Compared to qPCR—A Clinical Follow-Up Study. Antibiotics (Basel) 2022; 11:antibiotics11050577. [PMID: 35625221 PMCID: PMC9137526 DOI: 10.3390/antibiotics11050577] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 01/27/2023] Open
Abstract
A chair-side test (CST) for five periodontal pathogens (Aggregatibacter actinomycetemcomitans, A.a.; Porphyromonas gingivalis, P.g.; Prevotella intermedia, P.i.; Treponema denticola, T.d.; Tannerella forsythia, T.f.) was compared with qPCR in a previous clinical study on 100 periodontitis patients at first diagnosis (T0). Following non-surgical treatment alone (SRP) or in combination with systemic or local antibiotics, 74 patients (57.4 ± 13.5 years) were again tested at the same sites from 14 to 24 months after T0. Bacterial elimination (%; compared to T0) was determined for each single species and compared between both test systems. In all patients, all five pathogens could not be fully eliminated regardless of therapy or test method. Tested with CST, the mean elimination ranged from 90% for SRP + Amoxicillin/Metronidazole to 59.13% for SRP only. The corresponding qPCR values were 30% and 29.6%. Only A.a. was eradicated in 100% by SRP + Amoxicillin/Metronidazole tested by CST, and it was 80% when qPCR was the test method. CST agreed with qPCR in 98.7% in the detection of A.a., and 74.3%, 78.4%, 73.0%, and 48.7% for P.g., P.i., T.d., and T.f., respectively. Neither conventional treatment nor the additional use of antibiotics—even with the correct indication—could completely eradicate the tested pathogens or prevent pocket reinfection.
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Affiliation(s)
- Oliver Laugisch
- Department of Periodontology and Peri-Implant Diseases, Philipps-University, 35039 Marburg, Germany; (O.L.); (T.M.A.); (A.T.)
| | - Thorsten M. Auschill
- Department of Periodontology and Peri-Implant Diseases, Philipps-University, 35039 Marburg, Germany; (O.L.); (T.M.A.); (A.T.)
| | - Anne Tumbrink
- Department of Periodontology and Peri-Implant Diseases, Philipps-University, 35039 Marburg, Germany; (O.L.); (T.M.A.); (A.T.)
- Private Practice, 48324 Sendenhorst, Germany
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland;
| | - Nicole B. Arweiler
- Department of Periodontology and Peri-Implant Diseases, Philipps-University, 35039 Marburg, Germany; (O.L.); (T.M.A.); (A.T.)
- Correspondence:
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4
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Sereti M, Zekeridou A, Cancela J, Mombelli A, Giannopoulou C. Microbiological testing of clinical samples before and after periodontal treatment. A comparative methodological study between real-time PCR and real-time-PCR associated to propidium monoazide. Clin Exp Dent Res 2021; 7:1069-1079. [PMID: 34216116 PMCID: PMC8638278 DOI: 10.1002/cre2.464] [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: 02/03/2021] [Revised: 05/10/2021] [Accepted: 05/31/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives The aim of the present methodological study was to evaluate the discrepancies in the detection of a number of periodontally involved pathogenic bacteria obtained from clinical samples by two methods: the quantitative Polymerase Chain Reaction (qPCR) and the qPCR combined with pre‐treatment by Propidium Monoazide (PMA). Material and methods Plaque and saliva samples were obtained from 30 subjects: 20 subjects with chronic or aggressive periodontitis in need of periodontal therapy with or without antibiotics and 10 subjects in Supportive Periodontal Treatment (SPT). The clinical samples taken before treatment (BL) and 1 month later (M1), were divided in two aliquots: one was immediately treated with PMA while the other was left untreated. All samples were further analyzed with qPCR after DNA extraction, for the detection of Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Treponema denticola (Td), Parvimonas micra (Pm), and Prevotella intermedia (Pi). Results Large inter‐individual variations were observed in the concentration of the studied bacteria. At both instances (BL and M1) and for the three groups, significantly lower counts of bacteria were depicted when plaque and saliva samples were pre‐treated with PMA as compared to those without treatment. Treatment resulted in significant decreases in the number of bacteria, mainly in the plaque samples. However, these changes were almost similar in the three groups independently of the method of detection used (PMA‐qPCR vs. q‐PCR). Conclusion Removal of DNA from non‐viable cells with PMA treatment is an easily applied step added to the classical qPCR that could give accurate information on the presence of viable bacterial load and evaluate the response to periodontal treatment.
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Affiliation(s)
- Maria Sereti
- Division of Regenerative Dentistry and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Alkisti Zekeridou
- Division of Regenerative Dentistry and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Jose Cancela
- Division of Regenerative Dentistry and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Andrea Mombelli
- Division of Regenerative Dentistry and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Catherine Giannopoulou
- Division of Regenerative Dentistry and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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5
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Feres M, Retamal-Valdes B, Gonçalves C, Cristina Figueiredo L, Teles F. Did Omics change periodontal therapy? Periodontol 2000 2020; 85:182-209. [PMID: 33226695 DOI: 10.1111/prd.12358] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The starting point for defining effective treatment protocols is a clear understanding of the etiology and pathogenesis of a condition. In periodontal diseases, this understanding has been hindered by a number of factors, such as the difficulty in differentiating primary pathogens from nonpathogens in complex biofilm structures. The introduction of DNA sequencing technologies, including taxonomic and functional analyses, has allowed the oral microbiome to be investigated in much greater breadth and depth. This article aims to compile the results of studies, using next-generation sequencing techniques to evaluate the periodontal microbiome, in an attempt to determine how far the knowledge provided by these studies has brought us in terms of influencing the way we treat periodontitis. The taxonomic data provided, to date, by published association and elimination studies using next-generation sequencing confirm previous knowledge on the role of classic periodontal pathogens in the pathobiology of disease and include new species/genera. Conversely, species and genera already considered as host-compatible and others less explored were associated with periodontal health as their levels were elevated in healthy individuals and increased after therapy. Functional and transcriptomic analyses also demonstrated that periodontal biofilms are taxonomically diverse, functionally congruent, and highly cooperative. Very few interventional studies to date have examined the effects of treatment on the periodontal microbiome, and such studies are heterogeneous in terms of design, sample size, sampling method, treatment provided, and duration of follow-up. Hence, it is still difficult to draw meaningful conclusions from them. Thus, although OMICS knowledge has not yet changed the way we treat patients in daily practice, the information provided by these studies opens new avenues for future research in this field. As new pathogens and beneficial species become identified, future randomized clinical trials could monitor these species/genera more comprehensively. In addition, the metatranscriptomic data, although still embryonic, suggest that the interplay between the host and the oral microbiome may be our best opportunity to implement personalized periodontal treatments. Therapeutic schemes targeting particular bacterial protein products in subjects with specific genetic profiles, for example, may be the futuristic view of enhanced periodontal therapy.
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Affiliation(s)
- Magda Feres
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, Brazil
| | - Belén Retamal-Valdes
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, Brazil
| | - Cristiane Gonçalves
- Department of Periodontology, Estácio de Sá University, Rio de Janeiro, Brazil
| | | | - Flavia Teles
- Center for Innovation & Precision Dentistry, School of Dental Medicine, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, USA
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6
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Antibiotic Resistance of Human Periodontal Pathogen Parvimonas micra Over 10 Years. Antibiotics (Basel) 2020; 9:antibiotics9100709. [PMID: 33080856 PMCID: PMC7602954 DOI: 10.3390/antibiotics9100709] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/16/2020] [Accepted: 10/16/2020] [Indexed: 12/12/2022] Open
Abstract
Changes were evaluated over 10 years in the in vitro resistance of human periodontopathic strains of Parvimonas micra to four antibiotics. Subgingival biofilms culture positive for P. micra from 300 United States adults with severe periodontitis in 2006, and from a similar group of 300 patients in 2016, were plated onto anaerobically incubated enriched Brucella blood agar alone, or supplemented with either doxycycline (4 mg/L), clindamycin (4 mg/L), amoxicillin (8 mg/L), or metronidazole (16 mg/L). P. micra growth on antibiotic-supplemented media indicated in vitro resistance to the evaluated antibiotic concentration. P. micra resistance was significantly more frequent among patients in 2016, as compared to 2006, for doxycycline (11.3% vs. 0.3% patients; 37.7-fold increase), and clindamycin (47.3% vs. 2.0% patients; 23.7-fold increase) (both p < 0.001), whereas resistance to amoxicillin (2.3% vs. 1.0% patients) and metronidazole (0% vs. 0.3% patients) remained low and statistically unchanged between the two patient groups (p-values > 0.05). No P. micra isolates in 2006 or 2016 were jointly resistant in vitro to both amoxicillin and metronidazole. The alarming increases in subgingival P. micra resistance to doxycycline and clindamycin raise serious questions about the empiric use of these antibiotics, either locally or systemically, in the treatment of United States periodontitis patients harboring subgingival P. micra.
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Cosgarea R, Eick S, Jepsen S, Arweiler NB, Juncar R, Tristiu R, Salvi GE, Heumann C, Sculean A. Microbiological and host-derived biomarker evaluation following non-surgical periodontal therapy with short-term administration of systemic antimicrobials: secondary outcomes of an RCT. Sci Rep 2020; 10:16322. [PMID: 33004857 PMCID: PMC7530673 DOI: 10.1038/s41598-020-73054-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/04/2020] [Indexed: 12/23/2022] Open
Abstract
Nonsurgical periodontal therapy with adjunctive use of systemic antimicrobials (for 7–14 days) showed improved clinical, microbiological and immunological results over the mechanical protocol alone. Considering the increasing risk for antimicrobial resistance with longer antibiotic regimes, it is important to establish the optimal antibiotic protocol with a maximum antimicrobial benefit and minimum risk for adverse effects. The aim of the study was to evaluate the microbiological and inflammatory outcomes 12-months after a 3-/7-day systemic antibiotic protocol [amoxicillin (AMX) + metronidazole (MET)] adjunctive to subgingival debridement in severe periodontitis compared to mechanical treatment alone. From the initially treated 102 patients, 75 subjects (Placebo group: n = 26; 3-day AMX + MET group: n = 24; 7-day AMX + MET group: n = 25) completed the 12-month examination. Clinical parameters, eight periodontal pathogens and inflammatory markers were determined at baseline and 3-, 6-, 12-months after therapy using real-time PCR and ELISA respectively. After 6 months, several periodontopathogens were significantly more reduced in the two antibiotic groups compared to placebo (p < 0.05). After 1 year, both antibiotic protocols showed significant reductions and detection of the keystone pathogen P. gingivalis compared to placebo. Antibiotic protocols, smoking, disease severity, baseline-BOP, -CAL and -IL-1β, as well as detection of T. denticola at 12-months significantly influenced the residual number of deep sites. The present data indicate that the systemic use of both short and longer antibiotic protocols (AMX + MET) adjunctive to nonsurgical periodontal therapy lead to higher microbiological improvements compared to subgingival debridement alone. The two investigated antibiotic protocols led to comparable microbiological and inflammatory results.
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Affiliation(s)
- Raluca Cosgarea
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnen str 17, 53111, Bonn, Germany. .,Clinic for Prosthetic Dentistry, University Iuliu-Hatieganu, Cluj-Napoca, Romania. .,Department of Periodontology and Peri-implant Diseases, Philipps University Marburg, Marburg, Germany.
| | - S Eick
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - S Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Welschnonnen str 17, 53111, Bonn, Germany
| | - N B Arweiler
- Department of Periodontology and Peri-implant Diseases, Philipps University Marburg, Marburg, Germany
| | - R Juncar
- Department of Dental Medicine, University of Oradea, Oradea, Romania
| | - R Tristiu
- Clinic for Prosthetic Dentistry, University Iuliu-Hatieganu, Cluj-Napoca, Romania
| | - G E Salvi
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - C Heumann
- Department for Statistics, Ludwig-Maximilians University, Munich, Germany
| | - A Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
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8
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Abdallaoui-Maan L, Bouziane A. Effects of timing of adjunctive systemic antibiotics on the clinical outcome of periodontal therapy: A systematic review. J Clin Exp Dent 2020; 12:e300-e309. [PMID: 32190202 PMCID: PMC7071537 DOI: 10.4317/jced.56324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/25/2019] [Indexed: 11/05/2022] Open
Abstract
Background Many systematic reviews and meta-analysis have indicated beneficial effects of adjunctive systemic antibiotics in periodontal therapy in specific situations. However, some essential issues such as the ideal time of their administration during periodontal therapy remain unanswered. This systematic review aimed to determine at which phase of periodontal treatment would adjunctive systemic antibiotics lead to the best clinical outcomes, during the active phase or in the reevaluation phase.
Material and Methods Searches in the databases Medline, Scopus and Cochrane Library were conducted. The randomized clinical trials and retrospective cohort studies comparing the clinical benefits of adjunctive systemic antibiotic administration in the active phase of periodontal treatment versus their administration in the reevaluation phase were included. The primary outcomes assessed were differences in clinical changes in periodontal pocket depth and clinical attachment loss at all post-treatment phases.
Results Of the 6209 records identified, two randomized clinical trials and two retrospective cohort studies were eligible according to inclusion criteria. Two studies suggested there were greater clinical benefits when systemic antibiotics were prescribed during the active phase of periodontal therapy than in the reevaluation phase while two other studies showed no significant difference in clinical outcomes at 6 months between these two different timing of administration.
Conclusions The evidence available and evaluated in this systematic review is of heterogeneous quality and limited by the restricted number of studies and their dissimilarities in their study design and outcome reporting. Despite insufficient evidence to determine the ideal time to the adjunctive systemic antibiotic administration in the periodontal therapy, it seems that prescription of systemic antibiotic at the active phase of periodontal therapy leads to better clinical outcomes. Key words:Active phase; periodontal therapy, periodontitis, reevaluation, systemic antibiotics, timing.
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Affiliation(s)
- Lamiaa Abdallaoui-Maan
- Department of periodontology, Faculty of Dental Medicine, Mohammed V University in Rabat, Morocco
| | - Amal Bouziane
- Department of periodontology, Faculty of Dental Medicine, Mohammed V University in Rabat, Morocco.,Laboratory of Biostatistics, Clinical Research and Epidemiology, Mohammed V University in Rabat, Morocco
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Alqerban A. Efficacy of antimicrobial photodynamic and photobiomodulation therapy against Treponema denticola, fusobacterium nucleatum and human beta defensin-2 levels in patients with gingivitis undergoing fixed orthodontic treatment: A clinic-laboratory study. Photodiagnosis Photodyn Ther 2020; 29:101659. [DOI: 10.1016/j.pdpdt.2020.101659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/06/2020] [Accepted: 01/10/2020] [Indexed: 12/11/2022]
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Arweiler NB, Marx VK, Laugisch O, Sculean A, Auschill TM. Clinical evaluation of a newly developed chairside test to determine periodontal pathogens. J Periodontol 2019; 91:387-395. [DOI: 10.1002/jper.19-0180] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/18/2019] [Accepted: 07/21/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Nicole B. Arweiler
- Department of Periodontology & Peri‐implant Diseases Philipps‐University Marburg Germany
| | - Vanessa K. Marx
- Department of Periodontology & Peri‐implant Diseases Philipps‐University Marburg Germany
| | - Oliver Laugisch
- Department of Periodontology & Peri‐implant Diseases Philipps‐University Marburg Germany
| | - Anton Sculean
- Department of Periodontology University of Bern Bern Switzerland
| | - Thorsten M. Auschill
- Department of Periodontology & Peri‐implant Diseases Philipps‐University Marburg Germany
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12
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Jensen AB, Haubek D, Claesson R, Johansson A, Nørskov‐Lauritsen N. Comprehensive antimicrobial susceptibility testing of a large collection of clinical strains ofAggregatibacter actinomycetemcomitansdoes not identify resistance to amoxicillin. J Clin Periodontol 2019; 46:846-854. [DOI: 10.1111/jcpe.13148] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 03/21/2019] [Accepted: 05/20/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Anne B. Jensen
- Department of Dentistry and Oral Health Aarhus University Aarhus Denmark
- Department of Clinical Microbiology Aarhus University Hospital Aarhus Denmark
| | - Dorte Haubek
- Department of Dentistry and Oral Health Aarhus University Aarhus Denmark
| | - Rolf Claesson
- Division of Oral Microbiology, Department of Odontology, Faculty of Medicine and Odontology Umeå University Umeå Sweden
| | - Anders Johansson
- Division of Periodontology, Department of Odontology, Faculty of Medicine and Odontology Umeå University Umeå Sweden
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Megally A, Zekeridou A, Cancela J, Giannopoulou C, Mombelli A. Short ultrasonic debridement with adjunctive low-concentrated hypochlorite/amino acid gel during periodontal maintenance: randomized clinical trial of 12 months. Clin Oral Investig 2019; 24:201-209. [PMID: 31079243 DOI: 10.1007/s00784-019-02949-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/03/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The objective of this study was to evaluate the benefit of repeated subgingival cleaning with a low-concentrated hypochlorite/amino acid gel in subjects in maintenance care with residual pockets ≥ 5 mm. MATERIAL AND METHODS Examiner masked, randomized two-arm parallel design. Thirty-two adult periodontal patients in maintenance phase, > 3 months after periodontal therapy, with at least one residual periodontal pocket ≥ 5 mm, were randomly assigned to treatment by subgingival ultrasonic debridement with the gel or ultrasonic debridement only. At months 0, 4, and 8, all sites presenting with a probing depth (PD) ≥ 5 mm were treated. Six sites were monitored on each tooth. The primary end point was the presence or absence of PD ≥ 5 mm after 12 months. Secondary clinical outcomes were oral tissue safety; patient acceptance; changes in PD; bleeding on probing; recession after 4, 8, and 12 months; and the presence or absence of six target microorganisms in treated pockets at baseline, after 7 days and 4 months. RESULTS A total of 365 sites in 32 patients with PD ≥ 5 mm were treated at baseline. At the final evaluation at month 12, 47% of these sites in the test and 49% in the control group were still in this PD category. The difference between baseline and month 12 was significant in both groups (p < 0.01), whereas the difference between groups was not. Repeated short ultrasonic instrumentation with adjunctive administration of the test product resulted in a clinical attachment level (CAL) gain of 1.02 mm (p < 0.01) and led to - 0.97 mm of pocket reduction (p < 0.01) without inducing further recession. However, repeated short ultrasonic debridement without the gel led to a similar clinical outcome (p < 0.01). No adverse events were recorded. CONCLUSIONS Short ultrasonic instrumentation of residual pockets with PD ≥ 5 mm during maintenance visits resulted in a clinically relevant CAL gain and PD reduction in the order of 1 mm in 1 year, without inducing further recession. CLINICAL RELEVANCE This study corroborates the benefit of regular maintenance care after periodontal therapy, including short debridement of the residual pockets.
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Affiliation(s)
- Andrew Megally
- University Clinic of Dental Medicine, Division of Periodontology, University of Geneva, 1 rue Michel-Servet, 1211, Geneva 4, Switzerland
| | - Alkisti Zekeridou
- University Clinic of Dental Medicine, Division of Periodontology, University of Geneva, 1 rue Michel-Servet, 1211, Geneva 4, Switzerland
| | - José Cancela
- University Clinic of Dental Medicine, Division of Periodontology, University of Geneva, 1 rue Michel-Servet, 1211, Geneva 4, Switzerland
| | - Catherine Giannopoulou
- University Clinic of Dental Medicine, Division of Periodontology, University of Geneva, 1 rue Michel-Servet, 1211, Geneva 4, Switzerland
| | - Andrea Mombelli
- University Clinic of Dental Medicine, Division of Periodontology, University of Geneva, 1 rue Michel-Servet, 1211, Geneva 4, Switzerland.
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14
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Li X, Zuo Z, Chen Q, Li J, Tang W, Yang P. Progranulin is highly expressed in patients with chronic periodontitis and protects against experimental periodontitis in rats. J Periodontol 2018; 89:1418-1427. [PMID: 29999528 DOI: 10.1002/jper.18-0132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/02/2018] [Accepted: 06/03/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND The autocrine growth factor progranulin (PGRN) plays a crucial role in the physiological and pathological processes. However, its function in chronic periodontitis (CP) remains unclear. METHODS Forty-five CP patients and 43 healthy controls were recruited. Expressions of PGRN in gingival biopsies were assessed by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and immunohistochemistry, respectively. The levels of PGRN, tumor necrosis factor alpha (TNF-α), and interleukin-1 beta (IL-1β) in the gingival crevicular fluid (GCF) before and after non-surgical periodontal treatment were quantified by ELISA. In addition, recombinant human PGRN (rhPGRN) or its vehicle was injected into the gingiva of rats with ligature-induced experimental periodontitis to test its influence on the disease process. Local inflammatory cell infiltration and alveolar bone loss were assessed by histomorphometric analysis, and the expression levels of TNF-α and IL-1β in the gingiva were determined by RT-qPCR and ELISA. RESULTS PGRN expression was increased in the gingiva and GCF of patients with CP compared with healthy controls. With the decline of periodontal clinical indices, the molar ratio of PGRN to TNF-α in GCF at 1 month after non-surgical treatment was significantly higher than at baseline (35.31 ± 22.09 vs 25.67 ± 16.19, P < 0.01). In rats with experimental periodontitis, local administration of rhPGRN attenuated inflammatory cell infiltration (P < 0.05), inhibited alveolar bone loss (P < 0.05) and decreased TNF-α and IL-1β levels (both P < 0.01) compared with the vehicle treatment group. CONCLUSION These findings suggest that progranulin is highly expressed in the gingiva and GCF of patients with CP and protects against experimental periodontitis in rats.
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Affiliation(s)
- Xiao Li
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong University, Jinan, Shandong, China.,Department of Periodontics, Jinan Stomatological Hospital, Jinan, Shandong, China
| | - Zhibin Zuo
- Department of Periodontics, Jinan Stomatological Hospital, Jinan, Shandong, China
| | - Qian Chen
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong University, Jinan, Shandong, China.,Department of Periodontology, School of Dentistry, Shandong University
| | - Jing Li
- Department of Pathogenic Biology, School of Basic Medical Science, Shandong University
| | - Wei Tang
- Department of Pathogenic Biology, School of Basic Medical Science, Shandong University
| | - Pishan Yang
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong University, Jinan, Shandong, China.,Department of Periodontology, School of Dentistry, Shandong University
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Abazi B, Mihani J. Prescription of Antibiotics for Periodontal Disease among Dentists in the Region of Tirana. Open Access Maced J Med Sci 2018; 6:1486-1491. [PMID: 30159082 PMCID: PMC6108801 DOI: 10.3889/oamjms.2018.300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/07/2018] [Accepted: 07/04/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND: Periodontal disease has been and will be a challenge for dentists in the entirety of oral pathologies. To date, there is no data regarding the prescription of antibiotics for periodontitis in the district of Tirana. AIM: Evaluate aspects related to the pattern of prescription of antibiotics among dentists in Tirana region for periodontitis. METHODS: Prescriptions from dental practitioners were collected from 25 pharmacies, randomly selected. The only prescription containing a diagnosis of periodontitis, with at least one antibiotic given, was included in the study. Data analysis was done with SPSS 20. RESULTS: Out of 1159 initial prescriptions, only 314 met the selection criteria. The average age of patients was 39.91 ± 15.21 years. Mean duration of therapies was 5.57 ± 1.5 days. The most common form of prescription was one broad-spectrum antibiotic (74.5%), combined antibiotics therapy (22.3%) and narrow-spectrum antibiotic (3.2%). Combined antibiotics involved the use of Metronidazole with Amoxicillin (12.1%) and Metronidazole with Spiramycin (10.2%). Significant differences in the patterns of prescription were identified in relation with patient age and therapy duration (P < 0.05). No statistical difference was found in the patient’s gender and the typology of the therapy (P > 0.05). CONCLUSIONS: Our study shows prescription characteristics of antibiotics for periodontal disease by dentists in Tirana for the first time. Amoxycillin is the most prescribed antibiotic, followed by amoxicillin with clavulanic acid. We found variation in dosage, frequency and duration for all antibiotics used, and perceptible discrepancies between observed and recommended practice. Guidelines on rational antibiotic use are needed for dental practitioners in Tirana and the Republic of Albania for better management of periodontitis and resistance prevention.
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Affiliation(s)
- Besian Abazi
- Albanian University, Faculty of Medical Sciences, Department of Dentistry, Tirana, Albania
| | - Joana Mihani
- University of Medicine Tirana, Department of Pharmacy, Tirana, Albania
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