Association of active oxygen-releasing gel and photodynamic therapy in the treatment of residual periodontal pockets in type 2 diabetic patients: A randomized controlled clinical study

BACKGROUND

The aim of this study was to evaluate the effect of active oxygen-releasing gel as an adjuvant, with and without antimicrobial photodynamic therapy (aPDT), in the treatment of residual pockets in periodontal patients with type 2 diabetes mellitus (DM2).

METHODS

Patients with residual pockets with probing depth (PD) ≥4 mm and bleeding on probing (BOP) were divided into the following groups: SI (n = 17)-subgingival instrumentation in a single session; BM (n = 17)-SI followed by local application of active oxygen-releasing gel inside the periodontal pocket for 3 min; BM + aPDT (n = 17)-SI followed by application of BM for 3 min and pocket irrigation with methylene blue, and 660-nm diode laser irradiation at 100 mW for 50 s. The periodontal clinical parameters, serum levels of glycated hemoglobin, and immunological analysis of crevicular fluid were evaluated. All data were submitted to statistical analysis (α = 5%).

RESULTS

A significant reduction in BOP was verified at 90 and 180 days in the BM + aPDT group. The percentage of sites with PD ≥ 4 mm was significantly reduced at 90 days in BM + aPDT and BM, whereas after 180 days only BM showed a significant reduction. In the BM + aPDT group, there was a significant reduction in tumor necrosis factor α levels at 90 days. There were no differences between the treatments.

CONCLUSION

The use of adjuvant active oxygen-releasing gel, with or without aPDT, resulted in the same clinical benefits as SI in the treatment of residual pockets in poorly controlled DM2 patients.

Personalized antibiotic selection in periodontal treatment improves clinical and microbiological outputs

Introduction

Periodontitis is a biofilm-mediated disease that is usually treated by non-surgical biofilm elimination with or without antibiotics. Antibiotic treatment in periodontal patients is typically selected empirically or using qPCR or DNA hybridization methods. These approaches are directed towards establishing the levels of different periodontal pathogens in periodontal pockets to infer the antibiotic treatment. However, current methods are costly and do not consider the antibiotic susceptibility of the whole subgingival biofilm.

Methods

In the current manuscript, we have developed a method to culture subgingival samples ex vivo in a fast, label-free impedance-based system where biofilm growth is monitored in real-time under exposure to different antibiotics, producing results in 4 hours. To test its efficacy, we performed a double-blind, randomized clinical trial where patients were treated with an antibiotic either selected by the hybridization method (n=32) or by the one with the best effect in the ex vivo growth system (n=32).

Results

Antibiotic selection was different in over 80% of the cases. Clinical parameters such as periodontal pocket depth, attachment level, and bleeding upon probing improved in both groups. However, dental plaque was significantly reduced only in the group where antibiotics were selected according to the ex vivo growth. In addition, 16S rRNA sequencing showed a larger reduction in periodontal pathogens and a larger increase in health-associated bacteria in the ex vivo growth group.

Discussion

The results of clinical and microbiological parameters, together with the reduced cost and low analysis time, support the use of the impedance system for improved individualized antibiotic selection.

An injectable photopolymerizable chitosan hydrogel doped anti-inflammatory peptide for long-lasting periodontal pocket delivery and periodontitis therapy

Periodontitis is a common chronic inflammatory disease caused by plaque that leads to alveolar bone resorption and tooth loss. Inflammation control and achieving better tissue repair are the key to periodontitis treatment. In this study, human β-Defensin 1 short motif Pep-B with inflammation inhibition and differentiation regulation properties, is firstly used in the treatment of periodontitis, and an injectable photopolymerizable Pep-B/chitosan methacryloyl composite hydrogel (CMSA/Pep-B) is constructed. We confirm that Pep-B improves inflammation, and restores osteogenic behavior and function of injured stem cells. CMSA/Pep-B has good injectability, fluidity and photopolymerizability, and can sustainably release Pep-B to maintain drug concentration in periodontal pockets. Furthermore, animal experiments showed that CMSA/Pep-B significantly ameliorated the inflammation of the periodontium and reduced the alveolar bone loss by decreasing inflammatory infiltration, osteoclast formation and collagen destruction. In conclusion, CMSA/Pep-B is envisaged to be a novel bioactive material or therapeutic drug for treating periodontitis.

Superhydrophobic Tipped Antimicrobial Photodynamic Therapy Device for the In Vivo Treatment of Periodontitis Using a Wistar Rat Model

Limited options exist for treatment of periodontitis; scaling and root planing (SRP) are not sufficient to eradicate P. gingivalis and the resulting inflammatory disease. Chlorhexidine (CHX), used as an adjuvant to SRP, may reduce bacterial loads but leads to pain and staining, while evidence for its efficacy is lacking. Antibiotics are effective but can lead to drug-resistance. The rising concern of antibiotic resistance limits the future use of this treatment approach. This study evaluates the efficacy of a novel superhydrophobic (SH) antimicrobial photodynamic therapy (aPDT) device as an adjuvant to SRP for the treatment of periodontitis induced in a Wistar rat in vivo model relative to CHX. The SH-aPDT device comprises an SH silicone rubber strip coated with verteporfin photosensitizer (PS), sterilized, and secured onto a tapered plastic optical fiber tip connected to a red diode laser. The superhydrophobic polydimethylsiloxane (PDMS) strips were fabricated by using a novel soluble template method that creates a medical-grade elastomer with hierarchical surface roughness without the use of nanoparticles. Superhydrophobicity minimizes direct contact of the PS-coated surface with bacterial biofilms. Upon insertion of the device tip into the pocket and energizing the laser, the device generates singlet oxygen that effectively targets and eliminates bacteria within the periodontal pocket. SH-aPDT treatment using 125 J/cm2 of red light on three consecutive days reduced P. gingivalis significantly more than SRP-CHX controls (p < 0.05). Clinical parameters significantly improved (p < 0.05), and histology and stereometry results demonstrated SH-aPDT to be the most effective treatment for improving healing and reducing inflammation, with an increase in fibroblast cells and extracellular matrix and a reduction in vascularization, inflammatory cells, and COX-2 expression. The SH-aPDT approach resulted in complete disease clearance assessed 30 days after treatment initiation with significant reduction of the periodontal pocket and re-formation of the junctional epithelium at the enamel-cementum junction. PS isolation on a SH strip minimizes the potential for bacteria to develop resistance, where the treatment may be aided by the oxygen supply retained within the SH surface.

Antibiotic resistance genes in the subgingival microbiome and implications for periodontitis therapy

BACKGROUND

Antibiotic resistance is emerging as a global public threat. However, it remains poorly investigated in the context of periodontal therapy. The aim of the study was to investigate the complete diversity of antibiotic resistance genes in a German population.

METHODS

Thirty-nine volunteers with periodontitis contributed to the present study with one to four periodontal pockets for a total of 124 subgingival samples. Samples were analyzed using shotgun metagenomics.

RESULTS

A total of 19 antibiotic resistance genes from six antibiotic classes were detected in subgingival biofilm. Two thirds of the volunteers (n = 26/39) showed antibiotic resistance genes for at least one of the antibiotic classes used for periodontal treatment in dental practice or research: beta-lactam, lincosamide, macrolide, nitroimidazole, and tetracycline. Macrolide was the most abundant class detected (21/39 patients).

CONCLUSIONS

Findings from our study suggest a high prevalence of antibiotic resistance genes in periodontal pockets from German volunteers. We recommend the development and broader use of molecular diagnostic tests for antibiotic resistance in dental practice to ensure treatment success and to minimize antibiotic resistance.

Efficacy of Sub-Gingivally Delivered Propolis Nanoparticle in Non-Surgical Management of Periodontal Pocket: A Randomized Clinical Trial

Naturally sourced products like propolis are commonly employed for the non-surgical treatment of periodontal pockets. The use of nanoparticle formulations of these natural remedies has the potential to improve treatment outcomes. The aim of the present study was to evaluate the efficacy of sub-gingivally delivered propolis nanoparticles in the non-surgical management of periodontal pockets. Forty patients diagnosed with periodontitis presenting at least one periodontal pocket with a probing pocket depth between 4 and 6 mm were selected. Patients were randomly assigned into the control group (n = 20), which received scaling and root planing (SRP) and saline (SRP + Saline), and the test group (n = 20), which received SRP and sub-gingivally delivered propolis nanoparticles (PRO) into the periodontal pocket (SRP + PRO). The clinical parameters recorded were plaque index (PI), gingival index (GI), relative attachment loss (RAL), probing pocket depth (PPD), and bleeding on probing (BOP). They were assessed at baseline, one month, and three months post therapy. The results indicated that there was a significant improvement in clinical parameters (p < 0.05) in the test sites compared with the control sites at the end of the study. The gingival index at one month and three months was found to be significantly better in the SRP + PRO group than the SRP + Saline group, with a p value of <0.001. The BOP, PPD, and RAL showed significant improvement with the SRP + PRO group at the end of the 3-month follow-up with p values of 0.0001, 0.001, and 0.05, respectively. The subgingival delivery of propolis nanoparticles showed promising results as an adjunct to SRP in patients with periodontitis presenting periodontal pockets.

Clinical benefits of systemic amoxicillin/metronidazole may depend on periodontitis stage and grade: An exploratory sub-analysis of the ABPARO trial

AIM

Assessment of treatment response after systemic amoxicillin/metronidazole adjunctive to subgingival instrumentation (SI) according to stages and grades of the 2018 classification of periodontal diseases.

MATERIALS AND METHODS

We carried out exploratory re-analysis of the placebo-controlled, multi-centre ABPARO trial (52; 45/60 years of age; 205 males, 114 active smokers). Patients were randomized to SI with systemic amoxicillin 500 mg/metronidazole 400 mg (three times a day for 7 days, n = 205; ANTI) or placebo (n = 200; PLAC) and maintenance therapy every 3 months. Patients were reclassified according to the 2018 classification (stage/extent/grade). Treatment effect was the percentage of sites per patient with new attachment loss ≥1.3 mm (PSAL ≥ 1.3 mm) at 27.5 months post-baseline/randomization.

RESULTS

All patients were assigned according to the stage (n = 49 localized stage III, n = 206 generalized stage III, n = 150 stage IV). Because of missing radiographs, only 222 patients were assigned to grades (n = 73 B, n = 149 C). Treatment (PLAC/ANTI) resulted in PSAL ≥ 1.3 mm (median; lower/upper quartile) in localized stage III (PLAC: 5.7; 3.3/8.4% vs. ANTI: 4.9; 3.0/8.3%; p = .749), generalized stage III (8.0; 4.5/14.3% vs. 4.7; 2.4/9.0%; p < .001), stage IV (8.5; 5.1/14.4% vs. 5.7; 3.3/10.6%; p = .008), grade B (4.4; 2.4/6.7% vs. 3.6; 1.9/4.7%; p = .151) and grade C (9.4; 5.3/14.3% vs. 4.8; 2.5/9.4%; p < .001).

CONCLUSIONS

In generalized periodontitis stage III/grade C, a clinically relevant lower percentage of disease progression after adjunctive systemic amoxicillin/metronidazole was observed compared to placebo (PLAC: 9.7; 5.8/14.3% vs. ANTI: 4.7; 2.4/9.0%; p < .001).

Nanomaterials: an intra-periodontal pocket drug-delivery system for periodontitis

Periodontitis is a microbiological condition that affects the tissues supporting the teeth. The fundamental to effective periodontal therapy is choosing the suitable antimicrobial and anti-inflammatory agent, together with the proper route of drug administration and delivery system. Intra-periodontal pocket approach with nano drug-delivery systems (NDDS) such as polymeric nanoparticles, gold nanoparticles, silica nanoparticles, magnetic nanoparticles, liposomes, polymersomes, exosomes, nano micelles, niosome, solid lipid nanoparticles, nano lipid carriers, nanocomposites, nanogels, nanofibers, scaffolds, dendrimers, quantum dots, etc., will be appropriate route of drug administration and delivery system. This NDDS delivers the drugs at the site of infection to inhibit growth and promote tissue regeneration. The present review focused on providing comprehensive information on the NDDS for periodontitis, which enhanced therapeutic outcomes via intra-periodontal pocket delivery.

A Placebo-Controlled Trial to Evaluate Two Locally Delivered Antibiotic Gels (Piperacillin Plus Tazobactam vs. Doxycycline) in Stage III-IV Periodontitis Patients

Background and objectives: this study aims to evaluate the clinical and microbiological effects of a single subgingival administration of a locally delivered antibiotic gel containing piperacillin plus tazobactam and compare it with a slow-release doxycycline (14%) gel and a placebo gel, following subgingival instrumentation (SI) in patients with severe periodontitis. Materials and methods: sixty-four patients diagnosed with stage III-IV periodontitis were enrolled, were randomly assigned into three groups, and were treated additionally with a single subgingival administration of piperacillin plus tazobactam gel (group A); doxycycline gel (group B); and placebo gel (group C). The primary outcome variable was the change in mean probing pocket depth (PPD) 6 months after the intervention. Secondary outcome variables were changes in mean full-mouth bleeding score (FMBS); full-mouth plaque score (FMPS); overall bleeding index (BOP); pocket closure; and clinical attachment level (CAL), along with changes in the numbers of five keystone bacteria: Aggregatibacter actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), Prevotella intermedia (P.i.), Tannerella forsythia (T.f.), and Treponema denticola (T.d.). Intergroup and intragroup differences were evaluated at 3 and 6 months. Results: at baseline, the three groups were comparable. An improvement in clinical parameters such as PPD, CAL, and BOP between groups was observed at 3 and 6 months, but without statistical significance (p > 0.05). At 6 months, the intragroup analysis showed a significant reduction in clinical parameters. Even though the piperacillin plus tazobactam group showed slightly higher PPD reduction, this was not statistically significant when compared to both control groups. Conclusions: The groups had similar results, and subgingival instrumentation can be executed without adjunctive antimicrobials, reducing the costs for the patient and the working time/load of the professional.

Near-Infrared-Enhanced Dual Enzyme-Mimicking Ag-TiO2-x@Alginate Microspheres with Antibactericidal and Oxygeneration Abilities to Treat Periodontitis

The effective treatment for periodontitis is to completely and sustainedly eradicate the bacterial pathogens from the complex periodontal pockets. Local sustained-release antibiotics as a complementary treatment after scaling and root planning can sustainedly combat bacterial pathogens in the periodontal pockets to help treat the disease, but the increasing concern of bacterial resistance limits its future use. Here, we reported a local antibacterial system based on microsized multifunctional Ag-TiO_2-x encapsulated in alginate (ATA) microspheres. We confirmed that ATA displayed strong photothermally enhanced dual enzyme-mimicking (peroxidase-like and catalase-like) activities and weak photocatalytic activity under 808 nm near-infrared (NIR) irradiation, which could boost the generation of reactive oxygen species (ROS) and O₂ in the presence of low-level H₂O₂. As a result, the ATA/H₂O₂/NIR system exhibited efficient antibacterial activity against Porphyromonas gingivalis and Streptococcus gordonii in both planktonic and biofilm forms. With the help of ROS, ATA could release Ag⁺ in concentrations sufficient to inhibit periodontal pathogens as well. Moreover, the in situ-generated oxygen was supposed to alleviate the local hypoxic environment and would help downregulate the lipopolysaccharide-mediated inflammatory response of periodontal stem cells. The in vivo rat periodontitis treatment results demonstrated that the ATA/H₂O₂/NIR system reduced the bacterial load, relieved inflammation, and improved tissue healing. Our work developed a new local prolonged bactericidal and oxygenation system for enhanced periodontitis. Avoiding the usage of antibiotics and nanomaterials, this strategy showed great promise in adjunctive periodontitis treatment and also in other biomedical applications.

Assessment of Attachment Level by Laser in Pocket Therapy

BACKGROUND

Scaling and root planing is the gold standard non-surgical therapy in patients with periodontitis. However, mechanical debridement alone may not eradicate all periopathogens from subgingival niches. Adjunctive use of diode laser in pocket therapy may improve tissue healing by its bactericidal and detoxification effects in subgingival areas. The objective of this study was to evaluate and compare effectiveness of scaling and root planing alone and scaling and root planing along with diode laser in chronic periodontitis patients.

METHODS

This is a prospective comparative study conducted in which 30 chronic periodontitis patients with at least one site with clinical attachment loss ?3mm in each contralateral quadrant were included and divided into Site A (control) scaling and root planing only and Site B (test) scaling and root planing with diode laser therapy. Clinical parameters (Plaque Index, Gingival Index, Probing Pocket Depth and Clinical Attachment Level) were recorded at baseline, one month and three months postoperatively and compared. Student's t-test was used to analyze intra and inter site mean variation.

RESULTS

Site A and Site B showed significant improvements in clinical parameters at three months postoperatively (p ?0.05) with better improvement observed in Site B (p ?0.05).   Conclusions: The use of diode laser as an adjunct to scaling and root planing can be considered as an effective treatment modality for the management of chronic periodontitis than scaling and root planing alone.

Controlled release of iodine from cross-linked cyclodextrin metal-organic frameworks for prolonged periodontal pocket therapy

Effective therapeutic system to periodontitis was designed using cross-linked cyclodextrin metal-organic framework (COF) as carrier for iodine and further suspended in hydroxyethyl cellulose gel as I2@COF-HEC hydrogel. Inclusion of iodine within the COF was demonstrated by SR-FTIR spectral and characteristic DSC and TGA changes. Molecular modelling identified the interaction of iodine with both COF central cavity and individual cyclodextrin moieties of COF. In vitro results of study demonstrated that iodine release in artificial saliva from I2@COF-HEC hydrogel could be extended up to 5 days, which was slower than I2@COF particles. Using an in vivo rat model of periodontitis, micro-computed tomography of alveolar bone morphology demonstrated that I2@COF-HEC hydrogel showed similar effects in decreasing periodontal pocket depth and alveolar bone resorption to minocycline ointment, a periodontitis antibiotic. The I2@COF-HEC hydrogel is a novel local delivery device of iodine as a broad spectrum antimicrobial use for treatment of periodontitis.

Photodynamic therapy (PDT) in non-surgical treatment of periodontitis

Periodontitis represents a major problem for patients, since it is not possible to eliminate the bacteria that are responsible for this pathology with a pharmacological treatment. The present study included forty-four patients with periodontitis, who had undergone disinfection via photodynamic therapy (PDT) using a laser source having a 635 nm wavelength associated with a photoactivable substance (methylene blue). Clinical assessment of plaque index (PI), bleeding on probing (BOP), probing depth (PD), calculus index (CI), gingival recession (REC) and clinical attachment level (CAL) were recorded at base line, 1 month (4 weeks) after treatment and again 3 months (12 weeks) after treatment, while site radiography (RX) and microbiological test (MT) were recorded at base line and 3 months (12 weeks) after treatment. The outcomes show a good efficacy of the PDT in the elimination of the periodontal pathogenic microflora and in the improvement of the clinical parameters considered: from the base line to the final check after 12 weeks it has been observed a reduction in REC of about 16.9%, a reduction of CAL of about 17.85%, a reduction of the BoP of about 93.3%, a reduction of the PD of about 17%, a reduction of the CI of about 66.3%, a reduction of PI of about 44%, and microbiologically a reduction of the total amount of bacteria with proven parodontopathic properties (red complex bacteria) of about 58.74%. Within the limits of the present study, PDT can be reasonably considered as a good carrier that leads to significant improvements in the parameters (clinical and microbiological) considered.

Effects on clinical outcomes of adjunctive moxifloxacin versus amoxicillin plus metronidazole in periodontitis patients harboring Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythia: exploratory analyses from a clinical trial

<p>Objective: Considering the etiopathogenesis of periodontitis, it is relevant to evaluate the efficacy of the adjunctive use of systemic antimicrobials based on microbial occurrence. This report explores whether patients harboring Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), or Tannerella forsythia (Tf) at baseline could receive greater clinical benefits from adjunctive moxifloxacin (MXF) and amoxicillin plus metronidazole (AM+MT) in comparison to patients without the presence of these microorganisms before therapy for generalized periodontitis. A control group was established that received subgingival debridement (SD) alone.<br /> Method and materials: Thirty-six patients younger than 30 years of age were randomly allocated to one of three treatment groups: SD plus placebo, systemic MXF with SD, or AM+MT combined with SD. Subgingival samples were studied. The effects of the therapies on probing depth and clinical attachment level, including interactions with Aa, Pg, or Tf at baseline, were explored using regression models.<br /> Results: At 6 months, all treatment groups showed improved clinical outcomes in patients harboring Aa, Pg, or Tf at baseline compared to the patients who did not harbor these microorganisms at baseline. Indeed, in the presence of Aa, Pg, or Tf at baseline, the patients receiving antimicrobial protocols showed the most significant gains compared to the control group. Furthermore, the percentage of sites ≥ 6 mm was reduced in the test groups, compared to the control group; these periodontopathogens were not present in sites with probing depth ≥ 6 mm in the MXF group. The interactions of Aa, Pg, and Tf with the test groups significantly improved clinical parameters at 6 months (P &lt; .001). Interestingly, the R2 value in the models that explored clinical attachment gain produced a high degree of correlation (&gt; 0.75), indicating that a high percentage (&gt; 75%) of the total variation in clinical attachment level gain can be explained by the independent variables.<br /> Conclusions: Although all patients benefited from the treatments, patients harboring Aa, Pg, or Tf at baseline showed improved clinical benefits at 6 months, suggesting that Aa, Pg, or Tf at baseline may change the effects of systemic MXF and AM+MT in generalized periodontitis. After 6 months, Aa, Pg, and Tf were not present in sites with probing depth ≥ 6 mm in the MXF group.</p>.

Efficacy ozone therapy in reducing oral infection of periodontal disease: a randomized clinical trial

Periodontal diseases are among the most common infectious diseases in the world, caused by pathogenic bacteria that trigger innate, inflammatory, and adaptive immune responses, leading to the destruction of supporting periodontal tissues and, if untreated, tooth loss. The objective of this study was to explore the efficacy of medical device that produced ozonized water (Medica S.r.l. Bologna, Italy) in the treatment of chronic periodontitis of adult patients. A randomized controlled split-mouth study was carried out in ten patients (5 men and 5 women age 42-73 mean 55 ± 7) with a diagnosis of chronic periodontitis. None of these patients received any surgical or non-surgical periodontal therapy and demonstrated radiographic evidence of moderate bone loss. The mouth has been divided into upper right and left quadrants. The upper and lower right quadrants were treated with ultrasonic scaler, the left quadrants with ultrasonic scaler with ozonated water. Ten microbiological samples were collected from upper left quadrants and 10 from upper right quadrants from each patient. Microbiological samples were collected from the sites of the patients at baseline and at the 7th day. Twenty localized chronic periodontitis sites were selected (10 in left quadrants and 10 in right quadrants). After the treatment with ozonized water, a remarkable decrease in bacteria amount, both for some species and for the total count was observed in the left quadrants respect to right ones. Our study demonstrated the efficacy of the ozonized water in the management of moderate to severe chronic periodontitis.

Moxifloxacin versus amoxicillin plus metronidazole as adjunctive therapy for generalized aggressive periodontitis: a pilot randomized controlled clinical trial

OBJECTIVE

Adjunctive antimicrobials improve probing depth and clinical attachment loss compared with subgingival debridement (SD) alone in patients with aggressive periodontitis. The microbiologic and clinical effectiveness of moxifloxacin (MOX) and amoxicillin plus metronidazole (AMOX+ME) as adjunctive therapies for generalized aggressive periodontitis were compared.

METHOD AND MATERIALS

This pilot randomized controlled clinical trial included 36 patients who were assigned to one of three therapy groups: SD plus systemic MOX (400 mg QD for 7 days), SD plus systemic AMOX+ME (500 mg TID each for 7 days), or SD plus placebo. Probing depth, clinical attachment loss, bleeding on probing, and plaque were recorded at baseline and 3 and 6 months after treatment. Subgingival plaque samples were analyzed.

RESULTS

All treatments resulted in significant probing depth and clinical attachment loss reduction compared with the baseline values (P < .0001 for all), with the effects still present at 6 months posttreatment, but the patients taking antibiotic protocols presented the most significant gains (P < .0001). There was a significant reduction in the occurrence of gingival pockets ≥ 6 mm at 6 months in all treatment groups (P < .0001), favoring the MOX and AMOX+ME groups. Adjunctive MOX diminished subgingival Aggregatibacter actinomycetemcomitans to unnoticeable stages, after the follow-up period. Adverse events were noted only in some patients of the AMOX+ME group.

CONCLUSIONS

This pilot clinical trial proposes that using MOX and AMOX+ME as adjuncts to SD improves the clinical and microbiologic parameters in comparison to mechanical therapy alone; however, the MOX protocol did not cause adverse events and decreased subgingival A actinomycetemcomitans to imperceptible levels.

The use of ozone therapy for treatment of periodontal disease: a split-mouth, randomized, controlled clinical trial

Periodontal treatment has the aim to reduce oral infection and prevent the progression of the disease. The potential benefits of new therapy with Ozonline® for periodontal treatment, include improved patient compliance and an easier access to periodontal pocket. The objective of this study was to explore the efficacy of Ozonline® in the treatment of chronic periodontitis in adult patients. A randomized controlled split-mouth study was carried out in ten patients (5 men and 5 women age 42-73 mean 55 ±7) with a diagnosis of chronic periodontitis. None of these patients received any surgical or non-surgical periodontal therapy and demonstrated radiographic evidence of moderate bone loss. The mouth has been divided into upper right and left quadrants. The upper and lower right quadrants were treated with ultrasonic scaler, the left quadrants with ultrasonic scaler with ozonated water (Ozonline®). 10 microbiological samples were collected from upper left quadrants and 10 from upper right quadrants from each patient. Microbiological samples were collected from the sites of the patients at baseline and at the 7th day. 20 localized chronic periodontitis sites were selected (10 in left quadrants and 10 in right quadrants). After the treatment with Ozonline®, a remarkable decrease in bacteria amount, both for some species and for the total count was observed in the left quadrants respect to right ones. Specifically, T. forsythia and T. denticola were eradicated whereas Total Bacteria Loading and Fusobacterium nucleatum showed a reduction of 38% and 55%, respect to right quadrants. Our study demonstrated the efficacy of the Ozonline® in the management of moderate to severe chronic periodontitis. .

Effectiveness of Simvastatin 1% oral gel and mouthwash used as an adjunct treatment of scaling and root planning in the treatment of periodontal diseases

Simvastatin is an anti-hyperlipidemic drug which reduces the cholesterol synthesis and also has anti-inflammatory, immunomodulatory and anti-microbial action against the bacteria. This develops the interest of periodontologist to use it in combination with conventional treatment to treat periodontal diseases. The objective of the study was to develop the gel and mouthwash of simvastatin and use it locally to treat gingivitis and periodontitis as an adjunct to scaling and root planning. The patients were randomly allocated into three groups that were standard treatment group, gel treatment group and mouthwash treatment group. Results indicated that simvastatin gel and mouthwash in 1% preparation showed favorable results by significantly reducing periodontal parameters and inflammatory biomarkers (p<0.001) as compared to standard treatment. Thus, we strongly suggest the use of simvastatin by local drug delivery system as an adjunct treatment of scaling and root planning.

Chlorhexidine gel used as antiseptic in periodontal pockets

The aim of this study was to evaluate the adjunctive benefit offers by the administration of a chlorhexidine based local drug deliver (Chlo-SITE) into periodontal socket after a full mouth disinfection session. The study design was a randomized, crossover, clinical trial conducted on 60 non-smokers subjects with chronic periodontitis. Each volunteer was subjected to a one-stage full mouth disinfection session and, immediately after that, test product (Chlo-SITE) was inserted in 1 pocket in 2 quadrant. The 1° and 4° quadrant were used for the study with the application of antiseptic (Test); the 2° and 3° as a control. Periodontal probe (PD), bleeding on probing (BOP) and plaque index (PI) was collected at baseline (T0), after 7 days (T1), after 4 weeks (T2). The results of this study suggest that the application of xanthan-based chlorhexidine gel (Xan-CHX) offers a great benefit in improving of the indices in chronic periodontitis.

The effect of local and systemic statin use as an adjunct to non-surgical and surgical periodontal therapy-A systematic review and meta-analysis

OBJECTIVES

To evaluate the effect of local and/or systemic statin use as an adjunct to non-surgical and/or surgical periodontal therapy.

DATA

Literature search according to PRISMA guidelines with the following eligibility criteria: (a) English or German language; (b) interventional studies; (c) statins as monotherapy or as an adjunct to non-surgical and/or surgical treatment of periodontitis; (d) clinical and/or radiographic treatment effect size of statin intake reported.

SOURCES

Medline (PubMed), Embase (Ovid), CENTRAL (Ovid).

STUDY SELECTION

Thirteen clinical studies regarding local application and 2 with systemic administration of statins as an adjunct to non-surgical treatment (SRP) and 4 studies regarding intrasurgical statin application with a maximum follow-up of 9 months could be included; simvastatin, atorvastatin, and rosuvastatin were used. Local but not systemic statin application as an adjunct to SRP yielded significantly larger probing pocket depth (PD), radiographic defect depth (RDD), and bleeding index reduction, and larger clinical attachment level gain, and less residual PD and RDD (p≤0.016); rosuvastatin appeared as the most efficacious. Three of 4 studies reported a significant positive effect of intrasurgical statin application. No adverse events were reported after statin use. The vast majority of the included studies were from the same research group.

CONCLUSIONS

Significant additional clinical and radiographic improvements are obtained after local, but not systemic, statin use as an adjunct to SRP in deep pockets associated with intrabony defects and seemingly with furcation defects; intrasurgical statin application seems similarly beneficial. Confirmation of these results, and especially of the effect size, from other research groups is warranted.

Two-Year Randomized Clinical Trial of Adjunctive Minocycline Microspheres in Periodontal Maintenance

Purpose: The purpose of this study was to evaluate the effects of repeated scaling and root planing (SRP), with or without locally-delivered minocycline microspheres (MM) on residual pockets in patients undergoing periodontal maintenance (PMT).Methods: Patients on PMT were randomized into two groups for treatment of one posterior interproximal inflamed pocket (≥5 mm) with a history of bleeding on probing every 6 months: SRP plus MM (n=30) or exclusively SRP (n=30). Baseline and 24-month measurements included radiographic interproximal alveolar bone height, probing depths (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival crevicular fluid (GCF), and salivary interleukin (IL) - 1β, (24 month only). Results were analyzed for baseline data or change in measurements after 24 months of treatment between different treatment groups, as well as whether significant changes occurred after 24 months of treatment for each treatment group individually.Results: Alveolar bone height and GCF IL-1β remained stable over the 24 months. The SRP + MM and SRP groups each demonstrated reduced PD (0.8 ± 0.9 mm and 1.1 ±0.6 mm, respectively, p < 0.001 each), CAL (0.8 ± 0.9 mm and 1.0 ± 0.6 mm, respectively, p < 0.001 each) and BOP (55% and 48%, respectively, p = 0.001 each). However, there were no differences between groups over the 24-month study period.Conclusion: Scaling and root planning alone, of moderately inflamed periodontal pockets at 6-month intervals, produced stable interproximal alveolar bone height as well as sustained improvements in probing depths, clinical attachment level, bleeding on probing over 24 months; minocycline microspheres were not shown to enhance these results.

Clinical Efficacy of Subgingivally Delivered 1.2 mg Simvastatin in the Treatment of Patients with Aggressive Periodontitis: A Randomized Controlled Clinical Trial

Simvastatin (SMV) is a specific competitive inhibitor of 3-hydroxy-2-methylglutaryl coenzyme A reductase that promotes bone formation. The present clinical trial was designed to investigate the effectiveness of 1.2 mg SMV as a local drug delivery system and as an adjunct to scaling and root planing (SRP) in the treatment of aggressive periodontitis (AgP). A total of 68 intrabony defects from 24 patients with AgP were treated either with 1.2 mg SMV gel or placebo gel. The subjects were randomly assigned to SRP + placebo (group 1; n = 12) or SRP + SMV (group 2; n = 12). Clinical parameters were recorded at baseline and at 3 and 6 months and included bleeding index, Plaque Index, probing depth (PD), and clinical attachment level (CAL). At baseline and after 6 months, radiologic assessment of bone defect fill was done. The mean decrease in PD at 6 months was 1.14 ± 0.04 mm and 3.78 ± 0.62 mm in groups 1 and 2, respectively. Significant gain in mean CAL was found between the groups (P < .05). Furthermore, significantly greater mean percentage of bone fill was found in group 2 (34.01%) compared to group 1 (2.62%). Locally delivered SMV provides a comfortable method to improve clinical parameters and promotes bone formation.

Zinc plus octenidine: a new formulation for treating periodontal pathogens. A single blind study

Periodontal treatment has the aim to reduce oral infection, and prevent the progression of the disease. The potential benefits of new chemical devices for periodontal therapy, include improved patient compliance, an easier access to periodontal pocket and a lower dosage of antimicrobial agent. The objective of this study was to explore the efficacy of a chemical device containing zinc and octenidine in the treatment of chronic periodontitis in adult patients. Ten patients with a diagnosis of chronic periodontitis (20 localized chronic periodontitis sites) in the age group of 35 to 55 were selected. None of these patients received any surgical or non-surgical periodontal therapy and demonstrated radiographic evidence of moderate bone loss. The chemical device zinc plus octenedine was used by each patient after daily oral hygiene. Microbial analysis were analyzed at baseline and on the 15th day. After the treatment, a remarkable decrease in bacteria amount, both for some species and for the total count was observed in the study group. Specifically T. Forsythia and T. Denticola were eradicated whereas Total Bacteria Loading and Fusobacterium Nucleatum showed a reduction of 38&#x0025; and 55&#x0025;, respectively. Our study demonstrated the efficacy of the new chemical device containing zinc and octenidine in a sustained release drug delivery system in the management of moderate to severe chronic periodontitis.

Evaluation of antioxidant capacity and clinical assessment of patients with chronic periodontitis treated with non-surgical periodontal therapy and adjunctive systemic antibiotherapy

This study aims to evaluate the oxidative stress changes in patients with chronic periodontitis (CP) undergoing non-surgical periodontal therapy alone, compared with non-surgical periodontal therapy with adjunctive systemic antibiotic therapy. Sixteen patients with CP, randomly assigned into two equal groups, were treated either with scaling and root planing (SRP) + Amoxicillin + Metronidazole, each 500 mg, three times daily, for seven days (test group), or with SRP + placebo for seven days (control group). Venous blood and unstimulated saliva samples were collected. Non-surgical periodontal therapy was performed simultaneously with antibiotics administration. Oxidative stress balance was evaluated by measuring derivatives of reactive oxygen metabolites (d-ROMs) and the biological antioxidant potential (BAP) in plasma. After the microscopic evaluation of the pathological aspect of the epithelial cells (ECs), their number, viability and the presence of C-reactive protein (CRP) were reevaluated from saliva at seven days, while reduced glutathione (GSH) level, d-ROMs and BAP at three months. Wilcoxon and Kruskal-Wallis rank-tests were used for statistics. At three months, statistical significant reductions of mean periodontal pocket depth (PPD) and clinical attachment level (CAL) gains (both p=0.01) were found in test group. Full-mouth plaque score (FMPS) decreased statistically significant in control group (p=0.02), d-ROMs decreased statistically significant in test group (mean difference 116.24±107.6 U CARR, p=0.01). Mean GSH, BAP level, number of ECs, their viability and CRP were statistically non-significant. In test group patients, oxidative stress status changed from a very high level to a medium one, suggesting that adjunctive use of antibiotics could have contributed to the reduction of reactive oxygen metabolites, along with significant clinical improvements.

The use of hyaluronic acid as an adjuvant in the management of peri-implantitis

It is well known in dentistry that there are numerous chronic conditions that require ongoing and constant management over time, the most noteworthy being periodontal disease, gingivitis and periodontitis. Yet, in recent years, with the increase in the number of implants being placed, mucositis and peri-implantitis have become more and more prevalent pathologies. The results of the statistical analysis demonstrate that there was a slight difference between the pocket depth as measured in the treated sites at time 0 (pre-treatment) and time 1 (15 days post-treatment), although the difference was so small as to render it statistically irrelevant. Bleeding on probing as measured at time 0 and time 1 indicated an improvement on both sides, but with no greater improvement noted on the side treated with HA.

Doxycycline hyclate-loaded bleached shellac in situ forming microparticle for intraperiodontal pocket local delivery

Bleached shellac (BS) is a water-insoluble polyester resin made up of sesquiterpenoid acids esterified with hydroxy aliphatic acids. In this study, BS dissolved in N-methyl pyrrolidone (NMP), dimethyl sulfoxide (DMSO) and 2-pyrrolidone was used as the internal phase of oil in oil emulsion using olive oil emulsified with glyceryl monostearate (GMS) as the external phase of in situ forming microparticles (ISM). Doxycycline hyclate (DH)-loaded BS ISMs were tested for emulsion stability, viscosity, rheology, transformation into microparticles, syringeability, drug release, surface topography, in vitro degradation and antimicrobial activities against Staphylococcus aureus, Streptococcus mutans and Porphyromonas gingivalis. All emulsions exhibited pseudoplastic flow and notably low syringeability force. Slower transformation from emulsion into microparticles of ISM prepared with 2-pyrrolidone was owing to slower solvent exchange of this solvent which promoted less porous structure of obtained BS matrix microparticles. The system containing 2-pyrrolidone exhibited a higher degradability than that prepared with DMSO. Developed DH-loaded BS ISMs exhibited a sustainable drug release for 47days with Fickian diffusion and effectively inhibited P. gingivalis, S. mutans and S. aureus. Therefore a DH-loaded BS ISM using olive oil containing GMS as the external phase and 2-pyrrolidone as a solvent was a suitable formulation for periodontitis treatment.

Effect of Subgingival Irrigation with Different Substances in the Treatment of Periodontal Disease. A Histometric Study in Rats

The aim of this study was to evaluate the histometric effects of subgingival irrigation with different solutions as adjuvant for the treatment of periodontal disease in rats. Periodontal disease was induced by ligature in the first lower molars of 91 Wistar rats over the course of 28 days. After removal of the ligatures, the animals were subjected to scaling and root planing, followed by subgingival irrigation with different solutions (0.9% saline, 0.2% chlorhexidine, 0.1% and 0.5% sodium hypochlorite and 11% propolis extract). The animals were sacrificed 7 and 14 days after the treatment and tissue was processed for histometric analysis for evaluation of bone support and epithelial migration. The histometric analysis showed no statistically significant differences between the group treated with scaling and groups treated with subgingival irrigation (p > 0.05) regarding bone support and epithelial migration. Similarly, significant differences were not found among the different solutions used for subgingival irrigation. This study agrees with the position of the American Academy of Periodontology, which states that there is insufficient evidence to indicate the routine use of subgingival irrigation as adjuvant to periodontal treatment.

[Sensitivity of microbial associations of periodontal lesions to antibacterial agents]

The aim of the study was the development of approaches to improve the effectiveness of antibiotic therapy in dental practice on the basis of determining the sensitivity of pathogenic microorganisms to antibiotics of different groups.

MATERIAL AND METHODS

The study included determination of the sensitivity of the microbial complexes from wound exudate of periodontal pocket and apical abscess to macrolides, quinolones, penicillins, lincosamides and 5-nitroimidazole. A survey of dentists and dental clinics patients to identify the cause and frequency of use of antibiotics and to identify possible adverse reactions was also conducted.

RESULTS

Dentists prefer macrolide antibiotics, protected penicillins, and fluoroquinolone combined with 5-nitroimidazole. All patients have taken antibiotics themselves at least once a year. Microbial complexes in patients with acute and exacerbated apical periodontitis in 79% of cases are susceptible to amoxicillin/clavulanic acid, to azithromycin - 52%, lincomycin - 36%, 5-nitroimidazole - 68%, ciprofloxacin - 73.7%. In patients with apical abscess high rates of resistance of microbial complexes to all types of antibiotics was revealed (33% for lincomycin 76,1% for ciprofloxacin, 28,6% for 5-nitroimidazole). Patients with moderate to severe periodontitis in 90.5% are sensitive to amoxicillin/clavulanic acid and azithromycin, in 62.4% to lincomycin. Sensitivity to ciprofloxacin was detected in 85.7% of patients, in 14.3% - moderate resistance.

[THE MOLECULAR GENETIC CHARACTERISTIC OF SPECIES CONTENT OF SALIVA AND GINGIVAL RECESS UNDER PERIODONTITIS]

The examination was carried out of samplings of 110 patients with periodontitis (observation group) and 60 patients without pathology of periodont (comparison group). The polymerase chain reaction was used to analyze samples of saliva and contents of periodontal recesses for detecting species-specific DNA fragments of Porphymmonas gigngivalis, Streptococcus macacae, S. mutans, S. oralis, S. salivarius, S. sangis, S. sobrinus, Treponema denticola. In patients with periodontitis S. mutans, S. oralis S. sobrinus were reliably more often detected in the content of periodontal recesses and S. mutans, S. sobrinus i in saliva. In the observation group the rate of detection of association S. mutans--S. oralis--S. sangis--S. sobrinus was significantly exceeded (up to 15.6%, X2 = 9.1, p = 0.004). In ten days of effective treatment of periodontitis reliable decreastng of rate of detection of S. wasoralis, S. sobrinus was observed in contents of periodontal recesses but not in of saliva. The detection of S.sobrinus using technique of polymerase chain reaction in contents of periodontal recesses and/or saliva of patients with periodontitis has a diagnostic value. The detection of S.sobrinus in contents of periodontal recesses is significant both in monoculture and in association S. mutans--S. oralis--S. sangis--S.sobrinus. The absence of S. sobrinus in contents of periodontal recesses testifies effectiveness of treatment of main disease (periodontitis).

Efficacy of Subgingivally Delivered Satranidazole in the Treatment of Type 2 Diabetes Subjects with Chronic Periodontitis: A Randomized Controlled Clinical Trial

BACKGROUND

The present clinical trial was designed to investigate the effectiveness of subgingivally delivered satranidazole (SZ) gel as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis.

METHODS

Sixty-four subjects with probing depth (PD) ≥ 5 mm and who were diagnosed with type 2 diabetes were selected. Thirty-two subjects each were randomly assigned to SRP + placebo (Group 1) and SRP + SZ (Group 2). The clinical outcomes evaluated were plaque index (PI), gingival index (GI), clinical attachment level (CAL) and PD at baseline, 1 month, 3-months and 6 months.

RESULTS

At 6 months, Group 2 had greater mean reduction (4.73 mm) in PD as compared to Group 1 (2.09 mm; p < 0.05) and also a greater mean CAL gain (3.92 mm versus 1.64 mm; p < 0.05).

CONCLUSION

The use of 3% SZ gel, when used as an adjunct to non-surgical periodontal therapy in subjects with periodontitis, achieves significantly better clinical results than initial periodontal treatment alone.

Case Series Report of 66 Refractory Maintenance Patients Evaluating the Effectiveness of Topical Oxidizing Agents

OBJECTIVE

To evaluate the clinical effects of a prescription tray application of hydrogen peroxide gel as an adjunct to frequent maintenance appointments for refractory periodontal patients.

METHODS

Case series data were analyzed from 66 failing periodontal maintenance patients who had exhausted treatment options before using prescription trays with a 1.7% hydrogen peroxide gel once or twice daily for two-and-a-half to five years. Data included pocket probing depths (PPD), bleeding on probing (BOP), smoking status, and compliance with tray usage. Data were collected prior to tray usage and after tray delivery at six months, one year, and annual intervals.

RESULTS

A clinical and statistical reduction in BOP was maintained over the length of the study (p ≤ 0.01). No differences were seen in patients who used trays two times or one time a day or in patients who smoked or did not smoke. The 1.7% peroxide delivered via a prescription tray was most effective in shallow pockets. Aggregate PPD distribution did not change significantly. Of clinical relevance, only one tooth out of 1,745 teeth studied was lost due to periodontal disease during the study period.

CONCLUSION

Prescription tray application of peroxide gel, as an adjunct to frequent periodontal maintenance appointments for refractory patients, demonstrated significant reductions in BOP'for smokers and non-smokers who used tray delivery once or twice a day.

[The clinical effectiveness of long-term azithromycin in patients with chronic generalized periodontitis]

The purpose of the study was to compare the clinical response to two regimes of azithromycin use in the complex of non-surgical periodontal therapy. After initial periodontal therapy of chronic generalized periodontitis (CGP), 60 patients were randomly assigned to three groups. In group I patients underwent standard medical care; In group II - patients underwent standard medical care and azithromycin: 500 mg once per day, during 3 days; In group III: 500 mg once per day, during 7 days, followed by 500 mg once per week during 12 weeks. Clinical periodontal indices were recorded before treatment and after 1, 3, 6, and 12 months. In group I after 3 months of treatment the clinical effect was lost in 65% of patients. In group III after 12 months clinical effect persisted in 80% of cases. CGP exacerbations frequency was significantly lower in group III compared with group I (χ2=8,03; р=0,0046). The long-term azithromycin at the CGP results in significantly clinical benefit of 80% patients for at least one year and satisfactorily tolerated.

Metronidazole alone or with amoxicillin as adjuncts to non-surgical treatment of chronic periodontitis: a secondary analysis of microbiological results from a randomized clinical trial

AIM

To evaluate the changes occurring in the subgingival microbial profile of subjects with generalized chronic periodontitis (ChP) treated by scaling and root planing (SRP) alone or with metronidazole (MTZ) or MTZ + amoxicillin(AMX). A secondary aim was to examine a possible added effect of chlorhexidine(CHX) to these therapies.

METHODS

One hundred and eighteen subjects were randomly assigned to receive SRP-only or with MTZ [400 mg/thrice a day (TID)] or MTZ + AMX (500 mg/TID) for 14 days. Half of the subjects in each group rinsed with 0.12% CHX twice a day (BID) for 2 months. Nine subgingival plaque samples/subject were analysed by checkerboard DNA–DNA hybridization for 40 bacterial species at baseline, 3, 6 and 12 months post-therapy.

RESULTS

At 12 months, the antibiotic-treated groups harboured lower mean counts and proportions of key periodontal pathogens than the SRP group (p < 0.05). These benefits were observed at initially deep and shallow sites. Initial reductions in periodontal pathogens obtained with SRP partially rebound after 12 months. CHX rinsing enhanced the microbiological effects of the MTZ + AMX treatment in shallow sites.

CONCLUSION

The adjunctive use of MTZ and MTZ + AMX results in a greater reduction in the levels of periodontal pathogens in generalized ChP subjects compared to SRP alone.

Comparative study to investigate the effect of meloxicam or minocycline HCl in situ gel system on local treatment of periodontal pockets

In situ gelling formulations allow easy application to the target area. Gelation is induced by physiological stimuli at the site of application where the formula attains semisolid properties and exerts sustained drug release. In situ gelling formulations containing either 3% meloxicam (Mx) or 2% minocycline HCl (MH) were prepared for local application into the periodontal pockets. Gel formulations were based on the thermosensitive Pluronic(®) (Pl) and the pH-sensitive Carbopol(®) (C) polymers. C gels were prepared in combination with HPMC (H) to decrease its acidity. The total percent drug released from Pl formulae was 21.72% after 1 week for Mx and 85% after 3 days for MH. Their release kinetics data indicated anomalous non-Fickian behavior that could be controlled by both diffusion and chain relaxation. Addition of MH to C/H gels (1:2.5) resulted in liquefaction, followed by drug precipitation. Regarding C/H gel containing Mx, it showed a prolonged release rate up to 7 days with an initial burst effect; the kinetics data revealed Fickian-diffusion mechanism. The in vitro antibacterial activity studies for MH gel in Pl revealed that the drug released exceeded the minimum inhibitory concentration (MIC) of MH against Staphylococcus aureus ATCC 6538; placebo gel showed no effect on the microorganism. Clinical evaluation of Pl gels containing either Mx or MH showed significant improvement in chronic periodontitis patients, manifested by decrease in pocket depth and gingival index and increase in bone density.

Clinical and microbiological effects of levofloxacin in the treatment of Aggregatibacter actinomycetemcomitans-associated periodontitis: a randomized placebo-controlled clinical trial

AIM

To evaluate the clinical and microbiological effects of systemic levofloxacin (LFX) in subjects with Aggregatibacter actinomycetemcomitans-associated chronic periodontitis (AA-ACP).

MATERIALS AND METHODS

Subjects with severe periodontitis with subgingival detection of A. actinomycetemcomitans were randomly divided into two treatment groups; a test group (n = 35) that received scaling and root planing (SRP) and LFX (500 mg o.d.) and a control group (n = 34) that received SRP and placebo (o.d.) for 10 days. Plaque index (PI), gingival index (GI), percent of sites with bleeding on probing (% BoP), probing depth (PD) and clinical attachment level (CAL) were recorded and subgingival plaque samples were cultivated for detection of A. actinomycetemcomitans at baseline to 6 months at various intervals.

RESULTS

Subjects receiving LFX showed the greatest improvements in mean PD and CAL. The difference in the reduction of PD and CAL in the two groups was significant at 1, 3 and 6 months for PD and 3 and 6 months for CAL (p < 0.05). The inter-group difference in PI, GI and % BoP was not significant at any interval. Detectable levels of A. actinomycetemcomitans were significantly less in the test group 3 and 6 months post-therapy.

CONCLUSION

Systemic LFX as an adjunct to SRP improves clinical outcomes and suppresses A. actinomycetemcomitans below detectable levels.

[Antimicrobial efficacy of systemic antibiotics of different groups in the complex treatment of patients with chronic periodontal disease]

Among microorganisms found in the oral cavity there are several kinds of periodontopathogenic bacteria having higher adhesive, invasive and toxic properties. Eighty patients with moderate and severe chronic generalized periodontitis were included in the study. The choice of treatment regimen depended on real-time PCR values of pathogenic microorganisms in periodontal pockets. Data on composition of periodontal pockets microflora by moderate and severe periodontal disease allow prompt target antimicrobial therapy.

Local drug delivery agents as adjuncts to endodontic and periodontal therapy

In the treatment of intracanal and periodontal infections, the local application of antibiotics and other therapeutic agents in the root canal or in periodontal pockets may be a promising approach to achieve sustained/controlled drug release, high antimicrobial activity and low systemic side effects. The conventional method for the elimination of subgingival microbial infection includes mechanical debridement, irrigation with antimicrobial agents or surgical access. But, the effectiveness of conventional nonsurgical treatment is limited by lack of accessibility to bacteria in deeper periodontal pockets, and/or does not completely eliminate intracanal microorganisms. Surgical intervention may be beneficial but cannot be done in all cases, medically compromised cases and also in patients not willing to be subjected to surgical therapy. Development of local drug delivery systems provides an answer to all such difficulties. This comprehensive review tries to cover the detailed information about the latest advances in the various local drug delivery systems, their indications, contraindications and their advantages over systemic drug therapy.

Bioactive glass and connective tissue graft used to treat intrabony periodontal defects

Different techniques and materials can be used to treat intrabony periodontal defects caused by periodontal diseases. This case report presents an intrabony periodontal defect with bioactive glass and connective tissue graft used as a barrier. Probing depth and clinical attachment gain were reduced at 6 and 12 months post-treatment.

A randomized controlled clinical trial on the clinical and microbiological efficacy of systemic satranidazole in the treatment of chronic periodontitis

OBJECTIVE

The present clinical trial was designed to investigate the effectiveness of systemic satranidazole (SZ) as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis.

METHODS

Sixty-six subjects presenting with at least twelve teeth with probing depth (PD) > or = 4 mm were selected. Thirty-three subjects were randomly assigned to full-mouth SRP + placebo (Group 1) and 33 subjects were assigned to full-mouth SRP + SZ (Group 2). The clinical outcomes evaluated were plaque index (PI), gingival index (GI), clinical attachment level (CAL) and PD at baseline, 1 month, 3 months and 6 months. Also, microbial analysis of dental plaque using polymerase chain reaction was done at baseline, 3 and 6 months to estimate the number of sites harboring periodontopathogens.

RESULTS

Sixty subjects were evaluated up to 6 months. At 6 months, Group 2 showed greater mean reduction (3.84 +/- 1.31 mm) in PD as compared to Group 1 (1.42 +/- 1.01 mm; p < 0.05) and there was a greater mean CAL gain (3.22 +/- 1.01 mm) in Group 2 as compared to Group 1 (1.15 +/- 1.49 mm; p < 0.05). These subjects also showed significant reductions in the number of certain periodontopathogens, such as Tannerella forsythia, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans.

CONCLUSION

The systemic use of SZ, when used as an adjunct to non-surgical periodontal therapy in subjects with periodontitis, achieves significantly better clinical and microbiological results than scaling and root planing alone.

Nonsurgical treatment of aggressive periodontitis with photodynamic therapy or systemic antibiotics. Three-month results of a randomized, prospective, controlled clinical study

The aim of this randomized, controlled clinical study was to compare the short-term effects of nonsurgical periodontal therapy with the additional administration of systemic antibiotics (AB) and the same therapy with additional photodynamic therapy (PDT) in the treatment of patients with aggressive periodontitis (AP). Thirty-six patients with AP received full-mouth nonsurgical periodontal treatment (SRP) and were then randomly divided into two groups of 18 subjects each. Group AB received amoxicillin and metronidazole three times a day for 7 days. Group PDT received two applications of PDT on the day of SRP as well as at follow-up after 7 days. The following clinical parameters were measured at baseline and 3 months after therapy: plaque index (PLI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). After 3 months, PD was significantly reduced in both groups (from 5.0±0.8 mm to 3.2±0.4 mm with AB, and 5.1±0.5 mm to 4.0±0.8 mm with PDT; both p<0.001), while AB revealed significantly lower values compared to PDT (p = 0.001). In both groups, GR was not significantly changed. CAL was significantly reduced in both groups (PDT: 5.7±0.8 mm to 4.7±1.1 mm; p=0.011; AB: 5.5±1.1 mm to 3.9±1.0 mm; p<0.001) and differed significantly between the groups (p=0.025). The number of residual pockets (PD ≥4 mm) and positive BOP was reduced by AB from 961 to 377, and by PDT from 628 to 394. Pockets with PD ≥7 mm were reduced by AB from 141 to 7, and by PDT from 137 to 61. After 3 months, both treatments led to statistically significant clinical improvements. The systemic administration of antibiotics, however, resulted in significantly higher reduction of PD and a lower number of deep pockets compared to PDT.

The evaluation of enamel matrix derivative on subgingival microbial environment in non-surgical periodontal therapy

INTRODUCTION AND OBJECTIVE

Recent in vitro studies indicate that enamel matrix derivative (EMD) could modulate the growth of periodontopathogens. The aim of the presented study was an analysis of the influence of EMD on the presence of Porphyromonas and Prevotella bacteria in the periodontal pockets of patients with chronic periodontitis in non-surgical periodontal therapy.

MATERIALS AND METHODS

The studies were conducted on 20 patients. The condition of the periodontium was evaluated by clinical indexes: API. SBI. PD. CAL before and 3 months after the therapy in two selected quadrants. The material was collected for investigation. The periodontopathogens were cultured and identified. Two days after EMD-scaling root planing (SRP) was applied into the pockets.

RESULTS

In the group of patients under investigation before the EMD application the presence of P. gingivalis was found in 6 patients and P. intermedia in 8 patients. After root planing and EMD application no periodontopathogens were identified in those patients either in the periodontal pockets treated with EMD or in the periodontal pockets free from EMD (control). In the statistical analysis of changes in clinical indexes, the application of SRP and SRP combined with EMD was proved to significantly influence the improvement of the clinical state. However, no significant differences between the individual parameters were found in either group.

CONCLUSIONS

The SRP is an effective method of limiting the development of periopathogens in periodontal pockets. The non-surgical therapy with EMD does not change the clinical parameters significantly, compared with the SRP. Simultaneously, the application of EMD inhibits the development of periopathogens, such as Porphyromonas gingivalis and Prevotella.

The adjunctive use of light-activated disinfection (LAD) with FotoSan is ineffective in the treatment of peri-implantitis: 1-year results from a multicentre pragmatic randomised controlled trial

PURPOSE

To evaluate possible benefits of the adjunctive use of light-activated disinfection (LAD) in the treatment of peri-implantitis.

MATERIALS AND METHODS

A total of 80 patients with at least one implant affected by peri-implantitis defined as at least 3 mm of bone loss on baseline radiographs in the presence of signs of infection (pus exudation and/or soft tissue swelling and/or soft tissue redness) were non-surgically or surgically treated for peri-implantitis and 50% of them were randomly allocated to receive an additional LAD treatment (FotoSan) according to a parallel group design at four different centres. Only one implant per patient was considered. Outcome measures were implant failures, recurrence of peri-implantitis, complications, peri-implant marginal bone level (RAD) changes, probing pocket depth (PPD) changes and number of re-treatment sessions recorded by blinded assessors. Patients were followed up for 1 year after treatment.

RESULTS

Five treated patients did not fit the original inclusion criteria: 4 because they were not affected by the present definition of peri-implantitis and 1 due to being treated with antibiotics. However, they were included according to an intention-to-treat-analysis concept. Nine patients of the LAD group were treated surgically versus 10 control patients. After 1 year, 3 patients dropped out, all from the LAD group. One implant treated with the LAD therapy failed versus none of the control group. Four complications occurred: 3 in 3 patients of the LAD group and 1 in the control group. Recurrence of peri-implantitis defined as 2 mm of peri-implant bone loss or more recorded on standardised periapical radiographs was observed in 6 patients, 3 from each group. In total, 29 implants were re-treated 1 to 4 times in the LAD group versus 33 implants 1 to 4 times in the control group; the difference was not statistically significant. Peri-implant marginal bone levels remained stable up to 1 year with no statistically significant differences between groups (0.13 mm favouring LAD therapy; 95% CI of difference -0.47 to 0.72; P = 0.68). PPD significantly reduced in both groups, and at 1 year there were no significant differences between groups (difference 0.19 mm favouring LAD therapy; 95% CI of difference -0.70 to 1.07; P = 0.68). There were significant differences between centres for the number of re-treatment sessions delivered, PPD changes, plaque and marginal bleeding 1 year after treatment, but not for implant failures, complications, RAD changes and recurrence of peri-implantitis. The results did not change when removing the 5 patients who did not match the original inclusion criteria.

CONCLUSIONS

Adjunctive use of LAD therapy (FotoSan) with mechanical cleaning of implants affected by peri-implantitis did not improve any clinical outcomes when compared to mechanical cleaning alone up to 1 year after treatment.

Treatment of peri-implantitis using nonsurgical debridement with bioresorbable nanospheres for controlled release of doxycycline: case report

Peri-implantitis treatment is often surgical; however, in this case report, an alternative approach has been documented using a combination of nonsurgical debridement with the local controlled release of doxycycline by bioresorbable nanospheres in the peri-implant defect. After 15 months, remission on clinical inflammatory parameters of bleeding and suppuration on probing, as well as reduction of probing depths, was observed. This alternative approach may enhance clinical parameter improvements in some cases of peri-implantitis without the need for a surgical approach for implant decontamination.

Comparative evaluation of the efficacy of turmeric and curcumin as a local drug delivery system: a clinicomicrobiological study

When host defense mechanisms fail to contain or eliminate pathogenic periodontal microflora, an exaggerated host response releases inflammatory mediators, which in turn destroy soft and hard tissue components of the periodontium. This in vitro and in vivo study comparatively evaluated the adjunctive efficacy of turmeric, curcumin, and traditional nonsurgical methods for treating periodontal pockets. Turmeric and curcumin chips were prepared and the in vitro release pattern was estimated using a Keshary-Chien diffusion reaction. At 24 hours, the in vitro release pattern showed that 70% of turmeric was released, compared to 78% for curcumin chips. At 72 hours, these levels had increased to 78% of turmeric and 80% of curcumin. By the end of 80 hours, 100% of drug release had taken place. Plaque index and gingival index scores showed significant improvement from baseline through the end of the study.

The effectiveness of scaling and root planing with adjunctive time-release minocycline using an open and closed approach for the treatment of periodontitis

The purpose of this study was to determine the effectiveness of scaling and root planing using a closed and open approach (papilla reflection) with and without a locally delivered antibiotic (minocycline hydrochloride microspheres) in the treatment of moderate to advanced chronic periodontitis. Twenty-five periodontal recall patients with four or more probing depths of 5.0 to 9.0 mm and bleeding on probing (BOP) participated in this double-blind trial. Each of four sites per patient was randomly assigned a different treatment: scaling/root planing only; scaling/root planing followed by minocycline placement; gingival papilla reflection followed by scaling/root planing and flap closure; and gingival papilla reflection, scaling/root planing, minocycline placement, and flap closure. At baseline and each subsequent appointment, probing depth, BOP, and clinical crown length were recorded. Patients returned at three months for measurements and supportive periodontal therapy, and at six months for final measurements. Patients followed their usual oral hygiene regimens. Data were analyzed for significant differences using a repeated measure ANOVA and a Student t-test. All treatments resulted in reduction of probing depths (average of 1.76 mm) and a marked reduction in BOP at six months. While the papilla reflection plus minocycline showed the greatest reduction in probing depth (1.91 mm) and the greatest decrease in BOP (20% at three months and 28% at six months), the differences were not significant (p > 0.05). Clinical crown lengths did not change significantly in the treatment sites; therefore, improvements in probing depth can be attributed to improved clinical attachment levels (long junctional epithelium). The combination therapies did not differ significantly from scaling/root planing alone in decreasing probing depths and BOP.

Efficacy of lycopene as a locally delivered gel in the treatment of chronic periodontitis: smokers vs nonsmokers

OBJECTIVE

The present study was carried out as a multicenter, randomized controlled, split-mouth clinical trial to evaluate the efficacy of locally delivered lycopene on periodontal health and gingival crevicular fluid (GCF) levels of 8-hydroxydeoxyguanosine (8-OHdG) in smokers and nonsmokers compared with periodontally healthy control subjects.

METHOD AND MATERIALS

One hundred ten subjects including 50 smokers, 50 nonsmokers, and 10 controls participated in this study. Subjects in the smoker and nonsmoker groups had contralateral sites treated with lycopene gel and a placebo. Clinical parameters included recording site-specific measures of plaque, gingivitis, probing depth, and clinical attachment level. GCF 8-OHdG values were analyzed using a commercially available ELISA kit.

RESULTS

Compared with the placebo, lycopene-treated sites in smokers and nonsmokers showed significant reductions in probing depths and gain in the clinical attachment levels. However, there was no statistically significant difference in the clinical parameters when lycopene-treated sites in smokers and nonsmokers were compared, except for the reduction in the 8-OHdG levels. The 8-OHdG levels at 1 week and 3 months in sites treated with lycopene in the smoker and nonsmoker group were comparable with those in the periodontally healthy control group.

CONCLUSION

The gel formulation was effective in increasing clinical attachment and reducing gingival inflammation, probing depth, and oxidative injury compared with the placebo in smoking and nonsmoking subjects.

Benefits of additional courses of systemic azithromycin in periodontal therapy

The use of systemic antimicrobials such as doxycycline, metronidazole, and azithromycin in conjunction with debridement has achieved results superior to those produced by debridement alone. The purpose of the present study was to determine if previous results could be improved upon by administering repeated doses of azithromycin during the hygiene phase. One hundred patients with moderate to advanced periodontitis were treated with scaling and root planing plus three courses of azithromycin during the hygiene phase. All patients then were re-evaluated and periodontal surgery and/or extractions involving 96 teeth were performed in 32 patients. All patients then entered a maintenance program that lasted up to 192 weeks, with four-month recalls. Clinical parameters were recorded at baseline, at re-evaluation (week 6 after baseline), and at 96 and 192 weeks into maintenance. The results indicated that probing depths, bleeding upon probing, and suppuration were reduced significantly at re-evaluation. In addition, 14 teeth that displayed a Class III mobility at baseline improved to either Class I or Class II . There was no relapse during the maintenance phase. Multivariate analysis after 192 weeks indicated no change in the number of sites that bled upon probing, or had pockets that were 5.0-6.0 mm or ≥ 7 mm. Ninety-five percent of the sites that initially bled upon probing did not do so four years post-treatment. The results indicate that three courses of azithromicin in conjunction with root instrumentation during the hygiene phase led to long-lasting beneficial effects on all clinical parameters for at least 192 weeks.

Reduction of two red complex bacteria by sustained-release doxycycline and correlation to improvement in mean pocket depth

OBJECTIVE

The objective was to evaluate the effects of an 8.5% sustained-release doxycycline-containing polymer formulation (SRDF) on deep pockets (pocket depth [PD] ≥ 7 mm) in chronic periodontitis. Total bacterial counts were used to estimate the number of viable bacteria present before treatment and for up to 6 months posttreatment.

METHODS

All sites had PD ≥ 5 mm and bled on probing in 23 subjects who received treatment with SRDF. There was an average of 8.7 teeth or 23 sites for each subject. One deep pocket (≥ 7 mm) in each subject was selected for monitoring. This site was sampled prior to treatment and at 7, 21, 91, and 182 days after SRDF placement. The primary endpoints were changes in the viable counts of two red complex species, Porphyromonas gingivalis and Tannerella forsythia. Secondary endpoints were changes in the number of total anaerobic bacteria recovered and changes in PD.

RESULTS

Relative to baseline, SRDF reduced the proportions of P. gingivalis and T. forsythia by 88% and 99%, respectively, at day 7. At the conclusion of the monitoring period--182 days--P. gingivalis and T. forsythia were present but at 19% to 20% of the pretreatment values. Total anaerobic counts were reduced by 96% at day 7; by 87% at day 21; and by 75% and 68% at days 91 and 182, respectively. Mean PD for the sample sites (initially ≥ 7 mm) was reduced 2 mm by day 21, and this difference persisted throughout the study.

CONCLUSIONS

This study demonstrates SRDF has a significant effect, not only statistically but also microbially and clinically, on deep periodontal sites in patients with chronic periodontitis. SRDF significantly reduced the number of red complex bacteria P. gingivalis and T. forsythia, as well as the number of total anaerobic bacteria. By day 21, PD was reduced by 2 mm, and this reduction was maintained for at least 6 months posttherapy.

Subgingival delivery of oral debriding agents: a proof of concept

OBJECTIVE

This study is a proof of concept to determine the efficacy of a custom-fabricated tray in placing antimicrobial and debriding agents in the periodontal pockets of persons with active gingival infections. Localized subgingival delivery of antimicrobial and antibiotic agents is routinely employed as adjunctive therapy for the treatment and management ofperiopathogens associated with periodontal disease. Because these delivery techniques often face time constraints and impose temporary restrictions on patient brushing and flossing, a custom-formed prescription dental tray can be used to deliver and maintain medications in periodontal pockets between office visits and without brushing or flossing restrictions. The ability of this tray to maintain sufficient concentrations of medication in the periodontal pockets to have a therapeutic effect is evaluated here with theoretical modeling and practical application.

METHODS

Hydrogen peroxide is an oral debriding agent and oral wound cleanser with antimicrobial properties. The debriding effect of 1.7% hydrogen peroxide gel was tested in vitro on Streptococcus mutans biofilm using glass carriers for collection. Diffusion modeling tested the potential of the customized tray to place hydrogen peroxide gel into the sulcus in the presence of crevicular fluid flow. Changes in periodontal microflora with scanning electron microscopy analysis of in vivo paper point site sampling were analyzed before and after a thin ribbon of 1.7% hydrogen peroxide gel (approximately 0.7 gm) and a subtherapeutic dose (three drops) of Vibramycin (50 mg/5 ml) were placed via Perio Trays into periodontal pockets, ranging from 4-8 mm at daily prescribed intervals for two to five weeks.

RESULTS

In vitro results indicate that 1.7% hydrogen peroxide gel breaks down the exopolysaccharide slime and cell walls ofS. mutans, and begins to debride the cells from glass carriers within 10 minutes. Diffusion modeling indicates that hydrogen peroxide can penetrate into the deeper pockets (9 mm), but also its concentration in these deep pockets will increase over wearing time in the absence of degradation by peroxidases and catalase. Site sampling data confirm diffusion modeling results, with evidence that medication delivered with the prescription tray reduced subgingival bacterial loads and enhanced healing of corresponding oral tissues.

CONCLUSION

The prescription Perio Tray effectively placed medication in the gingival sulcus. Mathematical modeling indicated Perio Tray placement of hydrogen peroxide gel in periodontal pockets with depths up to 9 mm over 15 minutes treatment time was theoretically possible. Pathology reports reveal reductions in subgingival bacterial loads and improvements in pretreatment pocket depths of up to 8 mm after 1.7% hydrogen peroxide and Vibramycin Syrup were prescribed for use with the Perio Tray. The in vitro analysis indicating that hydrogen peroxide is the active and effective oral debriding agent needs to be confirmed with additional studies.

[Characteristics of paradontal recesses microbiocenosis and immune homeostasis in patients of elderly and senile age with chronic generalized periodontitis]

The microbiocenosis of periodontal recesses was studied and an assessment of the innate immunity mechanisms, as well as profiles of inflammatory cytokines were carried out in 114 people of middle, elderly and senile age with chronic generalized periodontitis (CGP). It was found that periodontal recesses mikrobiocenosis of patients with CGP of various ages was mainly presented by conditionally pathogenic bacterial and fungal microflora. There were identified the inefficient mechanisms of immune inflammation in case of conditionally pathogenic microflora, the reduction of neutrophils functional properties, and the increasing part of destructed phagocytazing neutrophils in patients of elderly and senile age. The immunosuppression in patients of elderly and senile age appears in insufficient production of IL-1beta, IL-8, resulting in reduced activity of phagocytosis mechanisms and lymphoid cells functional activity. Thus, the differences in etiopatogenetic microflora, immune homeostasis status in patients with CGP in middle, elderly and senile age, complexity in the application of antibacterial drugs require the development of new criteria for the selection of antibacterial drugs.