Effect of initial periodontal therapy on the frequency of detecting Bacteroides forsythus, Porphyromonas gingivalis, and Actinobacillus actinomycetemcomitans

Additional benefit of systemic antibiotics in subgingival instrumentation of stage III and IV periodontitis with Aggregatibacter actinomycetemcomitans: A retrospective analysis

AIM

To evaluate subgingival instrumentation (SI) in periodontitis stage III and IV, grade B and C with systemic antibiotics (AB) only after detection of Aggregatibacter actinomycetemcomitans.

MATERIALS AND METHODS

Patients of the Department of Periodontology of Goethe University Frankfurt/Germany were screened for microbiological testing between 2008 and 2018. All patients with aggressive and generalized severe chronic periodontitis were tested. In case of positive subgingival A. actinomycetemcomitans tests, SI was combined with AB; in all other cases it was not (nAB). Clinical examinations were performed before (T0), 12.4 (9.4/15.1) weeks after SI (T1), and at the last supportive periodontal care (T2; 3.1 [1.4/5.5] years after T1). Results at T1/T2 were assessed as "treat-to-target" endpoint (≤4 sites with probing pocket depths ≥5 mm).

RESULTS

Four-hundred and twenty-five patients (280 stage III/145 stage IV, 95 grade B/330 grade C) provided complete data (AB 144/nAB 281) for T0 and T1, and 332 (AB 121/nAB 211) for T2. At T1/T2, AB resulted in 53 (37%)/76 (63%) patients with "treat-to-target" endpoint, and nAB in 76 (27%)/91 (43%) (p = .038/.001).

CONCLUSIONS

In periodontitis stage III and IV, grade B and C with subgingival A. actinomycetemcomitans infection, SI with AB resulted in higher rate of "treat-to-target" endpoint than exclusive SI in patients without the infection.

Microbiological effects of amoxicillin plus metronidazole in the treatment of young patients with Stages III and IV periodontitis: A secondary analysis from a 1-year double-blinded placebo-controlled randomized clinical trial

BACKGROUND

Despite the body of evidence supporting the clinical benefits of metronidazole (MTZ) and amoxicillin (AMX) in the treatment of young patients with periodontitis, the microbiological outcomes of this antibiotic protocol have been less explored. This study evaluated the microbiological effects of adjunctive MTZ+AMX in the treatment of young patients with periodontitis.

METHODS

Subjects with periodontitis Stages III or IV and ≤30 years old were randomly allocated to receive scaling and root planing (SRP) with placebo (n = 15) or with MTZ (400 mg) and AMX (500 mg) three times a day for 14 days (n = 15). Nine subgingival biofilm samples per subject (three samples from each probing depth (PD) category: ≤3, 4-6, and ≥7 mm) were collected at baseline and 3-, 6-, and 12-months post-treatment and individually analyzed for 40 bacterial species by checkerboard DNA-DNA hybridization.

RESULTS

Thirty subjects (15/group) with mean ages 27.6 ± 3.5 (control) and 26.8 ± 3.9 (test) were included. At 12 months post-therapy, the antibiotic group harbored lower proportions of red complex (1.3%) than the placebo group (12.5%) (p < 0.05). SRP + MTZ+AMX was more effective than mechanical treatment in reducing levels/proportions of several pathogens and increasing proportions of Actinomyces species (p < 0.05). Levels/proportions of Aggregatibacter actinomycetemcomitans were only reduced in the antibiotic group (p < 0.05). This group also exhibited greater reduction in the number of sites with PD ≥5 mm and higher percentage of subjects reaching the clinical end point for treatment (≤4 sites with PD ≥5 mm) than the control group (p < 0.05).

CONCLUSION

SRP+MTZ+AMX allowed for establishing a long-term healthier subgingival biofilm community and periodontal clinical condition, than SRP only.

A re-evaluation of scaling and root planing

BACKGROUND

Extensive reviews on the role of scaling and root planing (SRP) in the treatment of periodontitis have been previously published. This commentary will address the importance of subgingival calculus in the progression and treatment of periodontitis and addresses factors that make the execution of a "definitive" SRP a critical part of therapy.

METHODS

A search for articles, using keywords relevant to the subject , (e.g., periodontitis, dental scaling, root planing, dental calculus, biofilm, inflammation) was conducted using PubMed, Ovid Medline, Cochrane Reviews and the ADA Center for Evidence Based Dentistry data bases. Additionally, references cited in relevant articles were also considered.

RESULTS

Surfaces of subgingival calculus are covered with a biofilm of metabolically active bacteria. Periodontal inflammation is clearly related to the presence of calculus and biofilm. The primary goal of SRP is removal of subgingival calculus and biofilm deposits to create a biologically compatible root surface and reduce the inflammatory burden. Current evidence suggests that inflammation associated with periodontal infections affects both the immediate oral environment and the patient's systemic health.

CONCLUSION

SRP is still critical to the treatment of periodontitis. SRP involving deep probing depths (≥ 5 mm) and root surfaces with anatomical and surface irregularities, regardless of the type of instrumentation, requires time, exceptional skill and perseverance, and patient compliance with periodontal maintenance. Sites with persistent nonresponding probing depths and signs of inflammation following a definitive SRP, should be considered for surgical intervention.

Comparative evaluation of 2% turmeric extract with nanocarrier and 1% chlorhexidine gel as an adjunct to scaling and root planing in patients with chronic periodontitis: A pilot randomized controlled clinical trial

Context

Nanoparticles, owing to their smaller size, penetrate regions inaccessible to other delivery systems, such as periodontal pockets. Thus, the present study aimed to comparatively evaluate efficacy of 2% curcumin with nanocarrier and 1% chlorhexidine gel as a local drug delivery (LDD) in the treatment of periodontal pockets.

Materials and Methods

Forty-five chronic periodontitis patients with pocket depth 5-7 mm in two or more teeth were selected. Full-mouth scaling and root planing (SRP) was done for all patients followed by random allocation to the three treatment groups, namely SRP group (Group 1), 2% curcumin with nanogel (Group 2), and 1% chlorhexidine gel (Group 3). Clinical parameter assessment and microbiological analysis of subgingival plaque samples for Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Tannerella forsythia (Tf) was done at baseline, 21^st day, and 45^th day.

Results

The results showed that when the two LDD agents were used as an adjunct to SRP in chronic periodontitis, there was an improvement in all clinical parameters. Evaluation of microbiological parameters also showed a significant reduction in Aa, Pg, and Tf levels. Comparison of 2% turmeric extract with a nanocarrier system with 1% chlorhexidine gel showed that both the agents had a comparable antibacterial effect on the three selected periodontopathic bacteria.

Conclusion

The present study showed that both the LDD agents showed an effective improvement of clinical and microbiologic parameters. 2% curcumin delivered with a nanocarrier system showed results comparable to chlorhexidine gel and hence shows promising future as an LDD agent in the treatment of periodontal pockets.

Protozoans in subgingival biofilm: clinical and bacterial associated factors and impact of scaling and root planing treatment

Objective: In patients with periodontitis, identification of protozoans and evaluation of some bacteria and clinical parameters associated and assessment of scaling and root planing (SRP) impact on their detection.

Methods: Before and after SRP, subgingival microbiota was collected in two pathological and one healthy site from 30 periodontitis patients. One healthy site from 30 control patients was also sampled. The usual clinical periodontal parameters were recorded; microbial detection was determined by PCR hybridization system for bacteria and qPCR for protozoans.

Results: In periodontitis group, Trichomonas tenax and two subtypes of Entamoeba gingivalis (ST1 and a variant ST2) were detected in respectively 33.3%, 70% and 18.3% of pathological samples, and in 6.7%, 10% and 3.3% healthy samples. In control group, ST1 alone was found in 3.3% of individuals. ST1 was associated with Gingival Index, Clinical Attachment Level (p ≤ 0.03) and with the total bacterial count (p = 0.02). T. tenax alone was associated with P. gingivalis, T. denticola and E. nodatum (p ≤ 0,02). After therapy, only T. tenax detection decreased significantly (p = 0.004) and no association between the protozoan elimination and improvement of pathological sites was found.

Conclusions: Protozoans were associated with some clinical parameters and/or periodontopathogens in patients with periodontitis.

In vitro effect of diode laser against biofilm of Aggregatibacter actinomycetemcomitans

Objective:

The main objective is to investigate the antibacterial effect of diode laser against Aggregatibacter actinomycetemcomitans biofilm.

Materials and Methods:

Biofilms of A. actinomycetemcomitans plus Streptococcus sanguinis grown on bovine root surfaces were treated with an 810-nm diode laser using a noncontact pulsed mode with a pulse interval and pulse length of 20 ms. Four protocols, that is, one episode of 1.5 or 2.5 W for 30 s and three episodes of 1.5 or 2.5 W for 30 s were tested. No treatment and 0.2% chlorhexidine treatment served as negative and positive controls, respectively. Viable bacterial number was determined by colony counting.

Results:

Treatment with chlorhexidine and all laser protocols except that using single episode of 1.5 W reduced the number of A. actinomycetemcomitans in either single-species or dual-species biofilm compared to negative control. A higher percentage of A. actinomycetemcomitans reduction was demonstrated after increasing the power output or repeating the irradiation.

Conclusions:

The laser protocols used in this study could reduce the number of viable bacteria but not eradicate A. actinomycetemcomitans biofilm.

[Effects of oral interventions on carotid artery in rats with chronic periodontitis for the detection of Porphyromonas gingivalis and the expression of C-reactive protein]

OBJECTIVE

This study aimed to establish a SD rat model of chronic periodontitis (CP) merged with hyperlipidemia (HL), perform periodontal treatment, detect the expression of partial C-reactive protein (CRP) and Porphyromonas gingivalis (P. gingivalis) in the rat carotid artery, and explore the relationship between periodontitis and atherosclerosis.

METHODS

SD rats were randomly divided into three groups: control group (A), HL group (B), and CP+HL group (C). Group C rats were divided into natural process group (C1), scaling and root planning group (C2), and tooth extraction group (C3). Group C2 rats were randomly divided into C2-1 (scaling and root planning group) and C2-2 (scaling and root planning+minocyline+systemic antibiotics group). Group C3 rats were randomly divided into C3-1 (tooth extraction group) and C3-2 (tooth extraction+systemic antibiotic group). One rat from group B was randomly selected and sacrificed after 15 weeks. Subsequently, the carotid vascular tissue was collected for oil red O staining. Modeling was successful when foam cell formation was observed. Periodontal treatments were conducted twice, and euthanasia was performed after the experiment. Moreover, double-carotid artery bifurcation was carried out to detect the expression of CRP and P. gingivalis. Immunohistochemical and 16sRNA semiquantitative methods were used to detect the CRP expression and the relative contents of P. gingivalis, respectively.

RESULTS

Immunohistochemical results showed that the CRP-positive expression in groups B and C was significantly higher than that in group A (P<0.05). The CRP-positive expression in other group C rats were significantly lower than that in group C1 (P<0.05). The CRP-positive expression in group C2-2 was the lowest among the groups (P<0.05). The relative quantity of P. gingivalis in group C1 was the highest and significantly higher than that in groups A and B (P<0.05). The relative quantities of P. gingivalis in groups C2-1, C2-2, C3-1, and C3-2 were significantly lower than that in group C1 (P<0.05), and the quantity in group C3-2 was the lowest (P<0.05).

CONCLUSIONS

Rats with CP associated with HL will increase the CRP expression and oral bacteria quantity on carotid artery, and lesions will gradually aggravate. Interventions, such as periodontal basic treatment and tooth extraction, could improve carotid artery lesions. The basic treatment with local and systemic anti-inflammatory drugs exerts the most satisfactory effect on local CRP expression. Tooth extraction with antibiotics is an effective method on reducing oral bacteria in carotid artery. Periodontal basic treatment associated with local and systemic antiflammatory drugs can obviously improve the effect.
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Detection of subgingival periodontal pathogens--comparison of two sampling strategies

OBJECTIVE

The aim of the study is to compare detection frequency of periodontal pathogens in patients with aggressive/severe chronic periodontitis using pooled plaque samples from the deepest pockets per quadrant/per sextant.

METHODS

In 100 patients with aggressive/chronic periodontitis, subgingival plaque was sampled from the deepest pockets per quadrant (MT4) and per sextant (MT6). Plaque samples were taken using two sterile paper points simultaneously. One paper point from each pocket was pooled with the three other paper points of the pockets (MT4). Subsequently, the remaining four paper points were pooled with two paper points from the deepest pockets from the two remaining sextants (MT6). The content of each vial was analyzed with nucleic-acid based methods for Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Porphyromonas gingivalis, Treponema denticola, Prevotella intermedia, Parvimonas micra, Fusobacterium nucleatum, Campylobacter rectus, Eubacterium nodatum, Eikenella corrodens, and Capnocytophaga sp.

RESULTS

The detection frequency of A. actinomycetemcomitans (MT4/MT6) at 22/24 %, T. forsythia at 93/96 %, P. gingivalis at 78/79 %, T. denticola at 88/90 %, P. intermedia at 40/46 %, P. micra at 75/79 %, F. nucleatum at both 99 %, C. rectus at 84/89 %, E. nodatum at 62/65 %, E. corrodens at 80/87 %, and Capnocytophaga sp. at 49/58 % was higher with MT6 than with MT4. None of these differences were statistically significant.

CONCLUSION

The detection frequency of the investigated periopathogens was statistically insignificant higher with the sampling method MT6 compared with MT4.

CLINICAL RELEVANCE

In daily dental practice, the plaque sampling of the deepest pockets per quadrant seems to be sufficient.

Colonization and Persistence of Labeled and "Foreign" Strains of Aggregatibacter actinomycetemcomitans Inoculated into the Mouths of Rhesus Monkeys

Aggregatibacter actinomycetemcomitans (Aa) is a pathobiont and part of a consortium of bacteria that can lead to periodontitis in humans. Our aim was to develop a model for oral inoculation of labeled Aa into a suitable host in order to study Aa traits and ecological factors that either enhance or repress its persistence. Primate species were screened for Aa to select a host for colonization studies. Macaca mulatta (Rhesus/Rh) was selected. Rh Aa strains were isolated, subjected to sequencing and functional analysis for comparison to human strains. "Best" methods for microbial decontamination prior to inoculation were assessed. Three groups were studied; Group 1 (N=5) was inoculated with Aa Spectinomycin resistant (SpecR) Rh strain 4.35, Group 2 (N=5) inoculated with Aa SpecR human strain IDH 781, and Group 3 (N=5) the un-inoculated control. Repeated feeding with pancakes spiked with SpecRAa followed high dose oral inoculation. Cheek, tongue, and plaque samples collected at baseline 1, 2, 3, and 4 weeks after inoculation were plated on agar; 1) selective for Aa, 2) enriched for total counts, and 3) containing 50 µg/ml of Spec. Aa was identified by colonial morphology and DNA analysis. Rh and human Aa had > 93-98 % genome identity. Rh Aa attached to tissues better than IDH 781 in vitro (p < 0.05). SpecR IDH 781 was not recovered from any tissue at any time; whereas, RhSpecR 4.35 was detected in plaque, but never tongue or cheek, in all monkeys at all times (> 1 × 10⁵ colonies/ml; p < 0.001). In conclusion, the primate model provides a useful platform for studying integration of Aa strains into a reduced but established oral habitat. Primate derived SpecRAa was consistently detected in plaque at all collection periods; however, human derived Aa was never detected. The model demonstrated both microbial as well as tissue specificity.

Non-surgical periodontal therapy: An update on current evidence

Periodontal disease is an inflammatory condition that involves a complex interaction between pathogenic bacteria, environmental and acquired factors and host related factors. Till recently periodontal treatment was directed primarily towards reduction of bacterial load by subgingival debridement of root surfaces and modification of environmental risk factors. The current paradigm of periodontal disease stresses greater role of host-mediated inflammatory response in tissue destruction characteristic of periodontal disease. Various therapeutic modalities have been developed adjuvant to mechanical periodontal therapy. The use of laser and photodynamic therapy show great promise but their effectiveness has still not been conclusively proven. Chemotherapeutic agents, either systemic and local antimicrobials or host modulating drugs, played pivotal role in better and more predictable management of periodontal disease. The present review focuses on the best available evidence, for the current management of the chronic periodontal patients, gathered from systematic reviews and meta-analysis of mechanical non surgical periodontal therapy (NSPT) (subgingival debridement, laser therapy and photodynamic therapy) and the adjunctive chemotherapeutic approaches such as systematic and local antibiotics and antiseptics, subgingival pocket irrigation and host modulation therapies. The review also attempts to briefly introduce future developments in some of these modalities. At the end, the review summarizes the analysis of the current evidence that suggests that thorough subgingival debridement remains the mainstay of NSPT and that adjunct use of chemotherapeutic agents may offer better management of clinical parameters in periodontitis patients.

Effects of nonsurgical periodontal therapy on clinical response, microbiological profile, and glycemic control in Malaysian subjects with type 1 diabetes

The association between diabetes mellitus and chronic periodontal disease has long been established. Most of the researches linking these two very common chronic diseases were based on type 2 diabetes mellitus and chronic periodontal disease. However, this study was conducted to investigate the association between type 1 diabetes and chronic periodontal disease in Malaysian subjects. Forty-one Malaysian subjects, of which 20 subjects were type 1 diabetics and with chronic periodontal disease (test group) and 21 subjects with only chronic periodontal disease (control group), were included in the study. Periodontal parameters and plaque samples for microbiological evaluation were done at baseline, 2 and 3 months after nonsurgical periodontal therapy. Blood samples were taken from only the test group and evaluated for HbA1c at baseline and 3 months after periodontal therapy. There were no statistically significant difference in periodontal parameters between groups (P>0.05) and no significant improvement in the level of HbA1c in the test group. Microbiological studies indicated that there were significant reductions in the levels of the tested pathogens in both groups. The results of our study were similar to the findings of several other studies that had been done previously.

Subgingival plaque sampling after combined mechanical and antibiotic nonsurgical periodontal therapy

AIM

This study aimed to make a comparison of two sampling strategies of subgingival plaque after combined mechanical-antibiotic periodontal therapy.

METHODS

Thirty patients (18 female) suffering from aggressive (n = 12) or generalised severe chronic (n = 18) periodontitis were included. Aggregatibacter actinomycetemcomitans had been detected subgingivally in all prior to anti-infective therapy (AT) and combined mechanical-antibiotic AT had been rendered. After AT clinical examinations were performed and subgingival plaque was sampled from the same four sites as prior to AT (ASPRE) as well as from the four deepest sites after AT (DEEP). Per patient two pooled samples (ASPRE/DEEP) were generated and analysed for A. actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola using a commercial 16S rRNA test.

RESULTS

ASPRE failed to detect A. actinomycetemcomitans, DEEP detected A. actinomycetemcomitans only in two patients (7 %). Only for T. forsythia DEEP (53 %) provided higher detection frequencies than ASPRE (27 %; p = 0.005). Detection frequencies of P. gingivalis and T. denticola ranged from 47 to 53 %.

CONCLUSION

After combined mechanical-antibiotic AT sampling the deepest sites revealed higher detection rates. Combined mechanical-antibiotic AT suppresses A. actinomycetemcomitans to a higher extent than P. gingivalis, T. forsythia and T. denticola.

Effect of Scaling and Root Planing on Detection of Tannerella forsythia in Chronic Periodontitis

Aim. This study was aimed to determine the prevalence of Tannerella forsythia in subgingival plaque samples of chronic periodontitis patients having different level of periodontal destruction and to assess the effect of scaling and root planing (SRP) on prevalence of T. forsythia. Materials and Methods. Study included 3 groups: group 1 were healthy individuals, group 2 had periodontitis with probing depth ≤ 5 mm, and group 3 had periodontitis with probing depth > 5 mm. Subjects in groups 2 and 3 exhibited both healthy and diseased periodontal sites. Prevalence of T. forsythia was determined using polymerase chain reaction. Subjects in groups 2 and 3 received SRP and were reevaluated three months after SRP. Results. T. forsythia was not detected in group 1. It was found in diseased sites in 40% and 73.33% of patients from groups 2 and 3, respectively. It was also found in healthy sites in 6.67% and 13.33% of patients from groups 2 and 3, respectively. The detection frequency of T. forsythia after SRP was 6.67% and 13.33% in groups 2 and 3, respectively. Conclusion. The results indicate a possible association between periodontal disease and presence of T. forsythia. Also, the detection frequency of T. forsythia was reduced after SRP.

Detection ofTannerella forsythiaand/orPrevotella intermediaMight Be Useful for Microbial Predictive Markers for the Outcome of Initial Periodontal Treatment in Koreans

A proportion of diseased sites in periodontal disease do not respond to the initial treatment, which might be due in part to the presence of specific microbial pathogens. The aim of this study was to clarify the value of microbial screening for predicting the outcome of periodontal treatment in Koreans using a polymerase chain reaction (PCR). This study enrolled 32 adults with periodontal disease. Microbial and clinical examinations were performed at the baseline and after the initial treatment (professional toothbrushing, scaling, and root planing). Subgingival plaque samples were taken from four sites in each subject (total 128 samples). PCR was used to detect the four putative pathogenic bacteria. There was an improvement in the average of each clinical measurement after the initial treatment. However, approximately half of the sites exhibiting bleeding upon probing (BOP) at the baseline still exhibited bleeding after treatment. There was a close association between the presence of BOP and the presence of Tannerella forsythia (formerly Bacteroides forsythus) and/or Prevotella intermedia. Furthermore, the sites harboring both T. forsythia and P. intermedia at the baseline had a poorer response to treatment than the sites where these two species were not detected. Therefore, microbial screening for T. forsythia and P. intermedia might be useful for predicting the treatment outcome in Koreans.

Molecular detection of Aggregatibacter actinomycetemcomitans on metallic brackets by the checkerboard DNA-DNA hybridization technique

INTRODUCTION

The purpose of this randomized clinical study was to evaluate the presence of the periodontal pathogen Aggregatibacter actinomycetemcomitans on metallic brackets and the effectiveness of a 0.12% chlorhexidine digluconate mouthwash in inhibiting this microorganism.

METHODS

The study involved 35 patients of both sexes having orthodontic treatment with fixed appliances between the ages of 14 and 22 years, randomized into 2 groups: experimental (n = 17) and control (n = 18). Two new metallic brackets were placed on the patients' premolars, and the subjects rinsed with a solution of 0.12% chlorhexidine digluconate or a placebo solution twice a week for 30 days. After that, the brackets were removed and underwent microbiologic analysis with the checkerboard DNA-DNA hybridization technique. Data were analyzed by using the Student t, Fisher exact, and Mann-Whitney tests at the significance level of 5%.

RESULTS

The results showed that A actinomycetemcomitans was present in all brackets from the subjects in the control group vs 83% of the subjects who rinsed with chlorhexidine digluconate (P <0.0001). There were also significantly lower levels of this species in the chlorhexidine digluconate group compared with the control group (P = 0.0003).

CONCLUSIONS

We concluded that 0.12% chlorhexidine digluconate rinsing, twice a week for 30 days during orthodontic treatment, is effective in reducing the presence and levels of A actinomycetemcomitans on metallic brackets.

A.actinomycetemcomitans-induced periodontal disease promotes systemic and local responses in rat periodontium

AIM

To characterize the histologic and cellular response to A. actinomycetemcomitans (Aa) infection.

MATERIAL & METHODS

Wistar rats infected with Aa were evaluated for antibody response, oral Aa colonization, loss of attachment, PMN recruitment, TNF-α in the junctional epithelium and connective tissue, osteoclasts and adaptive immune response in local lymph nodes at baseline and 4, 5 or 6 weeks after infection. Some groups were given antibacterial treatment at 4 weeks.

RESULTS

An antibody response against Aa occurred within 4 weeks of infection, and 78% of inoculated rats had detectable Aa in the oral cavity (p < 0.05). Aa infection significantly increased loss of attachment that was reversed by antibacterial treatment (p < 0.05). TNF-α expression in the junctional epithelium followed the same pattern. Aa stimulated high osteoclast formation and TNF-α expression in the connective tissue (p < 0.05). PMN recruitment significantly increased after Aa infection (p < 0.05). Aa also increased the number of CD8(+) T cells (p < 0.05), but not CD4(+) T cells or regulatory T cells (Tregs) (p > 0.05).

CONCLUSION

Aa infection stimulated a local response that increased numbers of PMNs and TNF-α expression in the junctional epithelium and loss of attachment. Both TNF-α expression in JE and loss of attachment was reversed by antibiotic treatment. Aa infection also increased TNF-α in the connective tissue, osteoclast numbers and CD8(+) T cells in lymph nodes. The results link Aa infection with important characteristics of periodontal destruction.

Experimental periodontal disease treatment by subgingival irrigation with tetracycline hydrochloride in rats

Objective

The aim of this study was to compare subgingival irrigation with tetracycline hydrochloride (TTC-HCL) as adjunctive treatment to scaling and root planning (SRP) on induced periodontitis in rats.

Material and methods

In 60 rats, periodontal disease was ligature-induced at the mandibular left first molar. After 7 days, the ligature was removed and all animals were submitted to SRP, and divided into 2 groups according to the following treatment: C (n=30) - subgingival irrigation with 1 mL of saline; T (n=30) - subgingival irrigation with 1 mL of TTC-HCL (50 mg/mL). Ten animals in each group were euthanized at 7, 15 and 30 days posttreatment. The histometric values were statistically analyzed (p<0.05).

Results

In the histometric analysis, at 7, 15 and 30 days, Group T (0.72±0.05 mm², 0.57±0.14 mm², 0.62±0.07 mm²), showed less bone loss (p<0.05) than Group C (1.35±0.25 mm²; 1.40±0.31 mm²; 1.29±0.27 mm²), respectively.

Conclusions

Subgingival irrigation with TTC-HCL was an effective adjunctive treatment for periodontal disease induced in rats.

Antimicrobial photodynamic therapy in the non-surgical treatment of aggressive periodontitis: microbiological profile

The aim of this trial was to investigate changes occurring in the subgingival microbiological composition of subjects with aggressive periodontitis, treated with antimicrobial photodynamic therapy (aPDT), in a single episode, or scaling and root planing (SRP), in a split-mouth design on -7, 0, and +90 days. Ten patients were randomly assigned to either aPDT using a laser source in conjunction with a photosensitizer or SRP with hand instruments. Subgingival plaque samples were collected and the counts of 40 subgingival species were determined using checkerboard DNA-DNA hybridization. The data were analyzed using the method of generalized estimating equations (GEE) to test the associations between treatments, evaluated parameters, and experimental times (α = .05). The results indicated that aPDT and SRP affects different bacterial species, with aPDT being effective in reducing numbers of A. actinomycetemcomitans than SRP. On the other hand, SRP was more efficient than aPDT in reducing the presence of periodontal pathogens of the Red Complex. Additionally, a recolonization in the sites treated by aPDT was observed, especially for T. forsythia and P. gingivalis. Under our experimental conditions, this trial demonstrates that aPDT and SRP affected different groups of bacteria, suggesting that their association may be beneficial for the non-surgical treatment of aggressive periodontitis.

Denaturing gradient gel electrophoresis analysis with different primers of subgingival bacterial communities under mechanical debridement

DGGE of 16S rDNA is one of the most frequently used methods to study microbial communities. In this study, the DGGE profiles of different 16S rDNA regions of the periodontal pathogens Porphyromonas gingivalis, Fusobacterium nucleatum, and Prevotella nigrescens were investigated. The results suggested that V3-V5 and V6-V8 fragments may be suitable for community analysis of subgingival bacteria. Further analysis of subgingival samples with V3-V5 and V6-V8 regions as target fragments suggested that, in chronic periodontitis, re-colonization by periodontal bacteria with a population very similar to the baseline may occur by 6 weeks after mechanical debridement.

Predation of oral pathogens by Bdellovibrio bacteriovorus 109J

Periodontal diseases are multifactorial infections elicited by a complex of primarily gram-negative bacteria that interact with host tissues and lead to the destruction of the periodontal structures. Bdellovibrio bacteriovorus is a gram-negative bacterium that preys upon other gram-negative bacteria. It was previously shown that B. bacteriovorus has an ability to attack and remove surface-attached bacteria or biofilms. In this study, we examined the host specificity of B. bacteriovorus strain 109J and its ability to prey on oral pathogens associated with periodontitis, including; Aggregatibacter actinomycetemcomitans, Eikenella corrodens, Fusobacterium nucleatum, Prevotella intermedia, Porphyromonas gingivalis and Tannerella forsythia. We further demonstrated that B. bacteriovorus 109J has an ability to remove biofilms of Ei. corrodens as well as biofilms composed of A. actinomycetemcomitans. Bdellovibrio bacteriovorus was able to remove A. actinomycetemcomitans biofilms developed on hydroxyapatite surfaces and in the presence of saliva, as well as to detach metabolically inactive biofilms. Experiments aimed at enhancing the biofilm removal aptitude of B. bacteriovorus with the aid of extracellular-polymeric-substance-degrading enzymes demonstrated that proteinase-K inhibits predation. However, treating A. actinomycetemcomitans biofilms with DspB, a poly-N-acetylglucosamine (PGA) -hydrolysing enzyme, increased biofilm removal. Increased biofilm removal was also recorded when A. actinomycetemcomitans PGA-defective mutants were used as host cells, suggesting that PGA degradation could enhance the removal of A. actinomycetemcomitans biofilm by B. bacteriovorus.

Aggregatibacter actinomycetemcomitans as an early colonizer of oral tissues: epithelium as a reservoir?

This study examined in vivo and in vitro colonization by Aggregatibacter actinomycetemcomitans, an organism highly associated with aggressive periodontitis. Thirteen volunteers (5 were A. actinomycetemcomitans positive for buccal epithelial cells [BECs] and teeth, 5 were A. actinomycetemcomitans positive for teeth only, and 3 were A. actinomycetemcomitans-negative controls) had two mandibular stents fabricated. Each stent contained 3 removable hydroxyapatite (HA) tooth surrogates. One HA square was removed from a stent at 5 time points over 7 h to assess the transfer of A. actinomycetemcomitans from teeth or BECs to HA. Streptococcus, Actinomyces, A. actinomycetemcomitans, and total anaerobic counts were evaluated on each square over time. In vitro experiments evaluated binding, desorption, transfer, and reattachment of A. actinomycetemcomitans wild-type and mutant strains to BECs and saliva-coated HA (SHA). Streptococcus and Actinomyces formed 80% of the cultivable flora on HA in all subjects. Transfer of A. actinomycetemcomitans to HA was not seen in subjects with A. actinomycetemcomitans on teeth only. All 5 subjects with A. actinomycetemcomitans on BECs showed transfer of A. actinomycetemcomitans to HA. In vitro, A. actinomycetemcomitans desorbed from BECs and transferred to SHA. A. actinomycetemcomitans binding to SHA was irreversible and did not transfer to BECs. The adhesin Aae showed specificity for BECs. Fimbrial mutants showed the greatest reduction in binding to SHA. A. actinomycetemcomitans migrated from BECs to HA in vivo and to SHA in vitro; however, A. actinomycetemcomitans movement from teeth and SHA to BECs did not occur. In vivo, A. actinomycetemcomitans colonized HA within 6 h and thus can be considered an early colonizer. BECs are a likely reservoir for A. actinomycetemcomitans tooth colonization.

Short-term benefits of the adjunctive use of metronidazole plus amoxicillin in the microbial profile and in the clinical parameters of subjects with generalized aggressive periodontitis

AIM

The aim of this study was to evaluate the clinical and microbiological effects of scaling and root planing (SRP) alone or combined with metronidazole (MTZ) and amoxicillin (AMX) in the treatment of subjects with generalized aggressive periodontitis (GAgP).

MATERIALS AND METHODS

A double-blind, placebo-controlled, randomized clinical trial was conducted in 30 subjects receiving SRP alone or combined with MTZ (400 mg 3 x per day) and AMX (500 mg 3 x per day) for 14 days. Clinical and microbiological examinations were performed at baseline and 3 months post-SRP. Nine subgingival plaque samples per subject were analysed using checkerboard DNA-DNA hybridization.

RESULTS

Subjects receiving MTZ and AMX showed the greatest improvements in the mean full-mouth probing depth and clinical attachment level and at initially intermediate and deep sites. The most beneficial changes in the microbial profile were also observed in the MTZ+AMX group, which showed the lowest proportions of the red complex as well as a significant decrease in the proportions of the orange complex after treatment. The antibiotic therapy also reduced the levels of Aggregatibacter actinomycetemcomitans at initially deep sites.

CONCLUSION

Subjects with GAgP significantly benefit from the adjunctive use of MTZ and AMX. The short-term advantages are observed in the clinical and microbiological parameters.

Bdellovibrio bacteriovorus attacks Aggregatibacter actinomycetemcomitans

Periodontitis is a polymicrobial infectious disease primarily associated with Gram-negative periodontopathogens. Bdellovibrio and like organisms are predatory bacteria that feed on Gram-negative bacteria. This study investigated whether predatory bacteria can attack Aggregatibacter actinomycetemcomitans. Therefore, A. actinomycetemcomitans was challenged with the predator Bdellovibrio bacteriovorus under conditions simulating the oral cavity. The reduction of planktonic A. actinomycetemcomitans was quantified via bacterial culture, and the development of predatory bacteria was monitored with quantitative real-time PCR. The destruction of A. actinomycetemcomitans biofilms by B. bacteriovorus was quantified by crystal violet staining and visualized by scanning electron microscopy. The in vitro results show that B. bacteriovorus can attack, prey on, and kill A. actinomycetemcomitans and suggest a potential for B. bacteriovorus as a living antibiotic for the prevention and treatment of periodontitis.

Microbiologic changes following administration of locally delivered doxycycline in smokers: a 15-month follow-up

BACKGROUND

Additional clinical benefits have been reported with the use of locally delivered antimicrobials in the treatment of smokers; however, long-term changes in the subgingival microbiota following the use of these drugs in smokers have not been documented. The aim of this study was to evaluate long-term microbiologic changes following locally delivered doxycycline in the treatment of smokers.

METHODS

Sixteen smokers with chronic periodontitis presenting a minimum of four pockets (probing depth>or=5 mm) were selected. Patients were assigned randomly to receive scaling and root planing (SRP) or SRP and local doxycycline (SRP-D). Patients were treated at baseline and 12 months. Subgingival plaque samples were collected at baseline; 3, 6, and 12 months; and 45 and 90 days following retreatment. Polymerase chain reaction and DNA-DNA hybridization analyses were performed to detect the presence of selected periodontal pathogens.

RESULTS

The reduction in the number of sites positive for Porphyromonas gingivalis and Tannerella forsythia (previously T. forsythensis) was statistically significant for SRP-D at 3 months (68% and 41.3%, respectively) and for SRP at 6 months (75% and 52%, respectively) following treatment. The SRP group showed a greater frequency of P. gingivalis than the SRP-D group at 3 months (58% and 25%, respectively). There also was a greater reduction in the frequency of P. gingivalis at 3 months following retreatment with SRP-D compared to SRP (47% and 8%, respectively).

CONCLUSION

In smokers, adjunctive local doxycycline resulted in a greater reduction in the frequency of P. gingivalis following initial and supportive therapy compared to conventional treatment.

Detachment and killing of Aggregatibacter actinomycetemcomitans biofilms by dispersin B and SDS

The periodontopathogen Aggregatibacter actinomycetemcomitans forms tenacious biofilms on abiotic surfaces in vitro. The objective of the present study was to measure the susceptibility of A. actinomycetemcomitans biofilms to detachment and killing by the anionic surfactant sodium dodecyl sulfate (SDS). We found that biofilms formed by a wild-type strain were resistant to detachment by SDS. In contrast, biofilms formed by an isogenic mutant strain that was deficient in the production of PGA (poly-N-acetyl-glucosamine), a biofilm matrix polysaccharide, were sensitive to detachment by SDS. Pre-treatment of wild-type biofilms with dispersin B, a PGA-degrading enzyme, rendered them sensitive to detachment by SDS and resulted in a > 99% increase in SDS-mediated cell killing. We concluded that PGA protects A. actinomycetemcomitans cells from detachment and killing by SDS. Dispersin B and SDS may be useful agents for treating chronic infections caused by A. actinomycetemcomitans and other PGA-producing bacteria.

Demographic, clinical, and microbial aspects of chronic and aggressive periodontitis in Colombia: a multicenter study

BACKGROUND

The microbial profile of periodontal disease varies among different human populations. This study evaluated the demographic, clinical, and microbiologic aspects of periodontitis in a multigeographic sample in Colombia.

METHODS

Three hundred twenty-five patients with chronic periodontitis (CP), 158 patients with aggressive periodontitis (AgP), and 137 healthy-gingivitis controls from five regions of the country were studied. Clinical, microbial, and sociodemographic data were collected. Microbiologic identification was performed using polymerase chain reaction 16S rRNA gene on pooled subgingival samples, and the presence of Gram-negative enteric rods was evaluated by culture. Bivariate and multivariate logistic regression analyses were conducted.

RESULTS

Porphyromonas gingivalis occurred in 71.5% of individuals with periodontitis, Tannerella forsythensis occurred in 58.5%, Campylobacter rectus occurred in 57.5%, Actinobacillus actinomycetemcomitans occurred in 23.6%, and enteric rods occurred in 34.5%. P. gingivalis was more common in CP and AgP than controls. A. actinomycetemcomitans was increased in AgP compared to controls and patients with CP. T. forsythensis, C. rectus, and Eikenella corrodens had a low presence in the West Pacific and Central regions, and enteric rods were increased in the Central region (P <0.05). Other sociodemographic factors were not associated with these microorganisms.

CONCLUSIONS

Geographic regions do not influence the microbiota, but the microbiota may vary by geographic region. P. gingivalis, T. forsythensis, and C. rectus are the most prevalent periodontophatic microorganisms in Colombia. A. actinomycetemcomitans was more common in AgP, and a large percentage of the population studied had enteric rods in the subgingival plaque.

Antimicrobial Photodynamic Therapy in the Non-Surgical Treatment of Aggressive Periodontitis: A Preliminary Randomized Controlled Clinical Study

BACKGROUND

The treatment of aggressive periodontitis has always presented a challenge for clinicians, but there are no established protocols and guidelines for the efficient control of the disease.

METHODS

Ten patients with a clinical diagnosis of aggressive periodontitis were treated in a split-mouth design study to either photodynamic therapy (PDT) using a laser source with a wavelength of 690 nm associated with a phenothiazine photosensitizer or scaling and root planing (SRP) with hand instruments. Clinical assessment of plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and relative clinical attachment level (RCAL) were made at baseline and 3 months after treatment with an automated periodontal probe.

RESULTS

Initially, the PI was 1.0 +/- 0.5 in both groups. At the 3-month evaluation, the plaque scores were reduced and remained low throughout the study. A significant reduction of GI and BOP occurred in both groups after 3 months (P <0.05). The mean PD decreased in the PDT group from 4.92 +/- 1.61 mm at baseline to 3.49 +/- 0.98 mm after 3 months (P <0.05) and in SRP group from 4.92 +/- 1.14 mm at baseline to 3.98 +/- 1.76 mm after 3 months (P <0.05). The mean RCAL decreased in the PDT group from 9.93 +/- 2.10 mm at baseline to 8.74 +/- 2.12 mm after 3 months (P <0.05), and in the SRP group, from 10.53 +/- 2.30 mm at baseline to 9.01 +/- 3.05 mm after 3 months.

CONCLUSION

PDT and SRP showed similar clinical results in the non-surgical treatment of aggressive periodontitis.

Aggregatibacter actinomycetemcomitans as indicator for aggressive periodontitis by two analysing strategies

OBJECTIVE

To compare the subgingival microbiota of aggressive and chronic periodontitis (ChP) using single-site and pooled plaque samples.

METHODS

In 60 patients with aggressive or ChP, subgingival plaque was sampled from the four deepest pockets using two sterile paper points simultaneously. One paper point from each pocket was put in a separate transport vial, the second was pooled with the three other paper points of a respective patient. The content of each vial was analysed for Aggregatibacter actinomycetemcomitans, Tannerella forsythensis, Porphyromonas gingivalis, and Treponema denticola.

RESULTS

Pooled plaque samples detected higher numbers for all tested pathogens than single-site samples. Detection frequencies were similar for both strategies. Using single-site samples, A. actinomycetemcomitans detection rate was statistically significantly a higher in aggressive than in ChP (p=0.01). A. actinomycetemcomitans was found in higher numbers, the other pathogens in lower numbers in aggressive than in ChP. Neither presence nor absence of one of the tested bacteria had sufficient positive or negative predictive value for aggressive periodontitis.

CONCLUSION

A. actinomycetemcomitans was detected in higher numbers and frequency in aggressive than in ChP. Its detection may confirm the clinical diagnosis and influence therapy. As a diagnostic test, its sensitivity and predictive value was low.

Periodontal healing after non-surgical therapy with a new ultrasonic device: a randomized controlled clinical trial

AIM

The aim of this study was to compare the clinical and microbiological healing outcomes following non-surgical periodontal therapy using the new Vector ultrasonic system versus scaling and root planing (S/RP) with Gracey curettes.

MATERIAL AND METHODS

The study comprised 20 chronic periodontitis patients. Using a split-mouth design, both treatment modalities were randomly applied to one quadrant of the upper and the lower jaws each. Clinical and microbiological parameters were assessed at baseline, 4 weeks, and 6 months after treatment. Furthermore, post-operative hypersensitivity was assessed. The Wilcoxon signed rank test (alpha=0.05) was used for statistical analysis.

RESULTS

Both therapies provided statistically significant clinical and microbiological improvements of periodontal conditions after 4 weeks and 6 months. Hypersensitive teeth were found only 4 weeks after S/RP. Besides a significantly better bleeding on probing reduction in deep S/RP sites, no other clinical and microbiological parameters revealed significant differences between the sites treated with the Vector system or S/RP.

CONCLUSION

Both the Vector system and S/RP provided favourable periodontal healing results, although in deep pockets S/RP appeared to achieve a better resolution of inflammation.

Characterizing the specific coaggregation between Actinobacillus actinomycetemcomitans serotype c strains and Porphyromonas gingivalis ATCC 33277

A visual coaggregation study showed specific interspecies coaggregation between an Actinobacillus actinomycetemcomitans serotype c strain and Porphyromonas gingivalis strains ATCC 33277 and 381. We mutagenized A. actinomycetemcomitans SUNYaB 67 (serotype c) with transposon IS903phikan and isolated three transposon insertion mutants that had a reduced ability to aggregate with P. gingivalis ATCC 33277. The three transposon insertions in the mutant strains mapped to the genes at ORF12, ORF13 and ORF16 of the gene cluster responsible for producing serotype c-specific polysaccharide antigen (SPA). Western blot analysis with serotype c-specific antibody showed that these strains did not produce the high-molecular-mass smear of SPA. Furthermore, two SPA-deficient mutants and an SPA-producing mutant were constructed. The two SPA-deficient mutants were deficient for ORF12 and ORF14, which are necessary for the synthesis of serotype c-SPA, and the SPA-producing mutant was deficient for ORF17, which is not related to SPA synthesis. The ORF12- and ORF14-deficient mutants showed reduced ability to aggregate with P. gingivalis ATCC 33277, while the ORF17-deficient mutant aggregated with ATCC 33277 to the same extent as wild-type SUNYaB 67. Our findings suggest that serotype c-SPA of A. actinomycetemcomitans mediates coaggregation with P. gingivalis ATCC 33277.

Two Subgingival Plaque-Sampling Strategies Used With RNA Probes

BACKGROUND

The purpose of this study was to compare the results of microbiological RNA-probe analysis after subgingival plaque sampling applying two different strategies.

METHODS

In 220 patients, clinical examinations were obtained prior to commencement of therapy for aggressive or generalized severe chronic periodontitis (n = 113), after combined mechanical and antibiotic anti-infective periodontal therapy (n = 43), or because of periodontal pockets despite adequate therapy (n = 64). Subgingival plaque samples were obtained from the three pockets with the deepest probing depths. Two sterile paper points were inserted simultaneously into the periodontal pockets. One paper point from each pocket was put into a separate transport vial; the second paper point was pooled (multiple site test [MT3]) with paper points from each of the two other sampling sites from the respective patient into a transport vial. The content of each vial was analyzed separately for Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Porphyromonas gingivalis, and Treponema denticola (Td) with a commercially available RNA-probe test.

RESULTS

For all tested pathogens, log-transformed numbers of bacteria were higher in pooled samples compared to the mean values for the separate samples (P < or =0.01). However, for Td only, statistically significant differences in frequency were seen between the separate samples and MT3. These findings were observed over all samples as well as after evaluation of subgroups separately.

CONCLUSIONS

Pooling of plaque samples increased the bacterial counts per analysis compared to separate samples and thus may increase the probability of detecting existing pathogens. However, this observation only was statistically significant for the frequency of Td.