Bacteriome analysis of Aggregatibacter actinomycetemcomitans-JP2 genotype-associated Grade C periodontitis in Moroccan adolescents.

Background: Grade C (previously aggressive) periodontitis (GCP) in adolescents is prevalent in certain parts of Africa where it is associated with JP2 genotype, a highly virulent strain of Aggregatibacter actinomycetemcomitans. The aim of this study was to characterize the subgingival bacteriome in Moroccan subjects with GCP positive to A. actinomycetemcomitans JP2 genotype. Methods: Subgingival plaque samples were collected from shallow and deep pockets of 8 subjects with GCP (17.2 ± 1.5 years) and from gingival sulci of 13 controls with no periodontitis (14.6 ± 1.1 years). Identification and genotyping of A. actinomycetemcomitans was performed using PCR analysis of the ltx operon, while bacteriome profiling was done by 16S rRNA gene sequencing (V1-V3 region). Groups were compared in terms of microbial diversity, abundances, and dysbiosis. Results: The shallow and deep pocket sites from GCP cases had a significantly altered microbial composition compared to controls. Species associated with health included Haemophilus parainfluenzae, Lautropia mirabilis, Streptococcus spp., Gemella spp., and Rothia spp. While known periodontal pathogens, including Porphyromonas gingivalis, Tannerella forsythia, Treponema spp. and Fretibacterium spp., were significantly enriched in GCP, non-conventional taxa, including Pseudomonas oral taxon C61 and Enterobacter cloacae were more abundant and showed stronger association with the disease. Less significant differences in abundances of individual taxa were observed between shallow and deep pockets. Overall dysbiosis measured in terms of Subgingival Microbial Dysbiosis Index (SMDI) differentiated between GCP and no-periodontitis with 95% accuracy. Conclusions: The results suggest that several periodontal pathogens involved in the adult-type periodontitis also play a role in JP2 genotype-associated GCP. The potential role of non-conventional taxa in the pathogenesis of GCP warrants further investigation.

Systemic antibiotic prescribing patterns of dentists in Morocco: A questionnaire study.

Aim: The aim of this study was to describe the use patterns of antibiotics in periodontal therapy among Moroccan dentists. Materials and Methods: It was a cross-sectional study. An online survey among 2440 registered dentists was conducted in public, private, and semi-public sectors in Morocco. Within the interrogated dentists, 255 answer the online survey. Data analysis was done by the laboratory of biostatistics-epidemiology of the Faculty of Medicine of Casablanca. Results: The antibiotics were prescribed for different pathologies. 26.8% of dentists prescribed antibiotics for gingivitis, 91.5% in case of ulcero-necrotizing gingivitis, 92.7% for aggressive periodontitis, 77% to chronic periodontitis patients, and 97.6% in the presence of periodontal abscess. Dentists prescribed penicillin to 37.3% of cases presenting ulcero-necrotizing gingivitis and 62.3% of patients presenting periodontal abscess. Cyclins are prescribed at a rate of 60% to aggressive periodontitis patients. The association of penicillin + metronidazole is prescribed to 37.3% of ulcero-necrotizing gingivitis patients, 47% of patients presenting aggressive periodontitis, 42.5% of chronic periodontitis patients, and 65.5% of cases presenting periodontal abscess. Discussion: There are major discrepancies among dentists in antibiotic prescription patterns. Some dentists prescribe antibiotics to patients with gingivitis or patients undergoing noninvasive oral procedures such as air polishing and scaling which is worrisome. Dentists are prescribing antibiotics when local treatment would have sufficed. Dentists also commonly prescribed antibiotics as an adjunct to mechanical therapy for the treatment of periodontal disease. Conclusion: Systemic antibiotics are prescribed for different conditions according to variable protocols. The appropriateness of antibiotic prescription must be reassessed critically to improve antibiotic stewardship among dentists.

Résumé Objectif: Le but de cette étude était de décrire les modèles d'utilisation des antibiotiques en thérapie parodontale chez les dentistes Marocains. Matériaux et méthodes: C'était une étude transversale. Une enquête en ligne entre 2440 dentistes enregistrées a été menée dans des secteurs public, privé et semi-publique au Maroc. Dans les dentistes interrogés, 255 répondent à l'enquête en ligne. L'analyse des données a été effectuée par le laboratoire de biostatistique - épidémiologie de la Faculté de médecine de Casablanca. Résultats: Les antibiotiques ont été prescrits pour différentes pathologies. 26,8% des dentistes ont prescrit des antibiotiques pour la gingivite, 91,5% en cas de gingivite ulcéro-nécrotante, 92,7% pour la parodontite agressive, 77% aux patients atteints de parodontite chronique et 97,6% en présence d'un abcès parodontal. Les dentistes ont prescrit la pénicilline à 37,3% des cas présentant une gingivite ulcérative 1A8Q7 et 62,3% des patients présentant un abcès parodontal. Les cyclins sont prescrits à un taux de 60% aux patients atteints de parodontite agressive. L'association de la pénicilline + métronidazole est prescrite à 37,3% des patients atteints de gingivite ulcératisants, 47% des patients présentant une parodontite agressive, 42,5% des patients atteints de parodontite chronique et 65,5% des cas présentant un abcès parodontal. Discussion: Il y a des écarts majeurs chez les dentistes dans les modèles de prescription antibiotiques. Certains dentistes prescrivent des antibiotiques aux patients atteints de gingivite ou de patients subissant des procédures orales non invasives telles que le polissage et l'échelle de l'air qui sont inquiétantes. Les dentistes prescrivent des antibiotiques lorsque le traitement local aurait suffi. Les dentistes ont également couramment prescrit les antibiotiques comme complément à la thérapie mécanique pour le traitement des maladies parodontales. Mots-clés: Dentistes, parodontite, antimicrobiens systémiques.

Prevalence of periodontal disease in young Moroccans: A national survey.

BACKGROUND: There are few large surveys of periodontal disease in young age cohorts, and national surveys in Africa do not exist. This study assessed the prevalence and severity of periodontal disease in a national survey of adolescents and young adults in Morocco. METHODS: A multistage probability sampling design was used to draw a sample of 14,667 students 12-25 years old attending 87 schools. The sample was representative of approximately three million Moroccan students in this age group. RESULTS: A total of 27.9%, 11.9%, and 7.7% of the subjects had ≥1 tooth with ≥4, ≥5, and ≥6 mm probing depth, and the population estimates were ≈ 822,436, 349,961, and 226,297 affected subjects, respectively. For attachment loss, the prevalences were: 11.6%, 9.5%, and 6.9% (or ≈ 341,761, 281,043, and 203,977 affected subjects) for ≥4, ≥5, and ≥6 mm, respectively. The rates of probing depth and attachment loss increased significantly with the increase in age (p < 0.01, p < 0.001). Sex and urban status did not show significant effects on the prevalence of periodontal disease (p > 0.05). Similarly, the relationship between the occupation status and periodontal status was modest and not statistically significant (p > 0.05). CONCLUSIONS: Children and young adults attending public schools in Morocco have a high prevalence and severity of periodontal disease compared with other populations of similar age. The rate of periodontal disease reported here may be used as baseline population estimates in the surveillance of disease status in this population.

National survey of periodontal diseases in adolescents and young adults in Morocco.

AIM: National surveys of periodontal diseases in children are rare. This study describes the first national survey of oral health of adolescents attending public schools in Morocco. We report the prevalence and demographic determinants of periodontal diseases, and generate population estimates for this young population. MATERIALS AND METHODS: This study used a multi-stage probability sample comprising 14,667 students in 87 schools and 520 classrooms, representative of students attending grades 6-12 (age 12-18 years) in Morocco. The students were interviewed and then examined clinically to assess their periodontal status, which was classified according to the 2017 World Workshop. In addition, the diagnosis of aggressive periodontitis (AgP) was assessed. RESULTS: Of approximately 3 million students in this age cohort, 12.3% (or approximately 360,894 subjects) had periodontitis and 46.9% (1.4 million) had gingivitis. They comprised 10.8%, 2.9%, and 6.1% subjects with periodontitis stage I, II, and III/IV, respectively; 5.0%, or 148,336 subjects, had AgP. The prevalence rates were not significantly different by gender or urban status. However, the prevalence of AgP was particularly high in certain regions of Morocco. CONCLUSIONS: The prevalence of staged periodontitis and AgP in this young population is among the highest reported in national surveys worldwide.

Regenerative Treatment of Peri-Implantitis: A Systematic Revie.

Objectives: The aim of this systematic review was to assess the clinical efficacy of bone regeneration for treatment of peri-implantitis. Materials and Methods: Electronic search of the literature was performed to identify randomized clinical trials (RCTs) and case series on treatment of peri-implantitis using bone regeneration procedures with at least 6 months of follow-up. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) were applied. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Results: Two RCTs and 16 case series with a total of 520 treated patients (2002 implants) were included. Bone regenerative procedures showed controversial results regarding bone fill. Two studies reported statistically significant bone gain while four studies reported insignificant bone gain. Other studies reported bone gain with no P value. Pocket depth (PD) reduction varied among the studies since four studies reported a significant reduction in PD while four others reported insignificant reduction in PD. Other studies reported a reduction in PD with no P value. Bone regeneration procedures seemed to decrease bleeding on probing (BOP) but they did not seem conducive to increase the width of keratinized gingiva. Increased keratinized gingiva was noted in cases with subepithelial grafts. Conclusion: Evaluation of the effectiveness of bone regeneration techniques in this systematic review presented limitations related to heterogeneity in patient selection (age, history of periodontitis, smoking status and implant system), means of disinfection and decontamination, and variability of the materials used for treatment.

Necrotizing Ulcerative Gingivitis.

Necrotizing ulcerative gingivitis (NUG) is a typical form of periodontal diseases. It has an acute clinical presentation with the distinctive characteristics of rapid onset of interdental gingival necrosis, gingival pain, bleeding, and halitosis. Systemic symptoms such as lymphadenopathy and malaise could be also found. There are various predisposing factors such as stress, nutritional deficiencies, and immune system dysfunctions, especially, HIV infection that seems to play a major role in the pathogenesis of NUG. The treatment of NUG is organized in successive stages: first, the treatment of the acute phase that should be provided immediately to stop disease progression and to control patient's feeling of discomfort and pain; second, the treatment of the preexisting condition such as chronic gingivitis; then, the surgical correction of the disease sequelae like craters. Moreover, finally, maintenance phase that allows stable outcomes. This case report describes the diagnosis approach and the conservative management with a good outcome of NUG in a 21-year-old male patient with no systemic disease and probable mechanism of pathogenesis of two predisposing factors involved.

Effect of Bone Regeneration with Mineralized Plasmatic Matrix for Implant Placement in Aesthetic Zone.

Bone volume is one of the key factors to be considered when evaluating implant placement. When the bone volume is insufficient, implant placement could be conditioned by the necessity of preforming bone grafting procedures to compensate bone loss. Various grafting procedures can be used with different bone substitute. Mineralized Plasmatic Matrix (MPM) is one of these grafting materials, used to maintain or regenerate the socket's volume. In MPM, the autologous blood products highly concentrated in platelets and fibrin in a liquid state are combined with a bone substitute. The fibrin can become bound to bone particles. The filling material is easy to shape and a PRF-type membrane is also generated. In the present case we report the application of MPM in two sites presenting bone crest defects when placing implant in those areas.