Elevated subgingival temperature infers high bacterial pathogen counts in severe periodontitis.

OBJECTIVES: Periodontal inflammation may be assessed by bleeding on probing and subgingival temperature. This pilot study evaluated the intrapatient relationship between subgingival temperature and selected bacterial groups/species in deep periodontal pockets with bleeding on probing. MATERIALS AND METHODS: In each of eight adults, an electronic temperature probe identified three "hot" pockets with elevated subgingival temperature and three "cool" pockets with normal subgingival temperature among premolars/molars with 6‒10 mm probing depths and bleeding on probing. Microbial samples collected separately from the hot and cool periodontal pockets were cultured for selected periodontal pathogens. RESULTS: Hot compared to cool periodontal pockets revealed significantly higher absolute and normalized subgingival temperatures and yielded higher mean proportions of Porphyromonas gingivalis (10.2% for hot vs. 2.5% for cool, p = 0.030) and total red/orange complex periodontal pathogens (48.0% for hot vs. 24.6% for cool, p = 0.012). CONCLUSIONS: Hot versus cool deep periodontal pockets harbored significantly higher levels of major periodontal pathogens. Subgingival temperature measurements may potentially be useful to assess risk of periodontitis progression and the efficacy of periodontal therapy.

Cytological and microbiological investigations of professional hygiene efficiency in patients with generalized periodontitis.

OBJECTIVE: Aim: The purpose of this study is to assess the impact of occupational hygiene procedures for microbiological and cytological contents of periodontal pockets. PATIENTS AND METHODS: Material and Methods: Cytological and microbiological content of the periodontal pockets before treatment and after professional hygiene procedures including scaling with hand instruments and root cementum polishing have been investigated in patients with periodontitis. RESULTS: Results: According to obtained data it can be resumed that in periodontitis patients with the depth of pockets 3-5,5 mm before professional hygiene all the pockets contain great number of Cocci, Spirochetes, Candida Albicans, Flagellated rods and Protozoa species. It was proved by revealing of small amount of Polymorphonuclear leukocytes with active phagocytosis. After scaling and planing of the roots, a decrease in the number of Protozoa and Candida Albicans was observed in 97% and 72% of the investigated cells, respectively. CONCLUSION: Conclusions: Cytological and microbiological content of periodontal pockets before treatment and after professional hygiene procedures including scaling and root planning testify to the level of local protective mechanisms, especially process of phagocytosis and virulence of microbial species in periodontal pockets.

Microbiological Effects of Sodium Hypochlorite/-Amino Acids and Cross-linked Hyaluronic Acid Adjunctive to Non-surgical Periodontal Treatment.

PURPOSE: To investigate the microbiological outcomes obtained with either subgingival debridement (SD) in conjunction with a gel containing sodium hypochlorite and amino acids followed by subsequent application of a cross-linked hyaluronic acid gel (xHyA) gel, or with SD alone. MATERIALS AND METHODS: Forty-eight patients diagnosed with stages II-III (grades A/B) generalised periodontitis were randomly treated with either SD (control) or SD plus adjunctive sodium hypochlorite/amino acids and xHyA gel (test). Subgingival plaque samples were collected from the deepest site per quadrant in each patient at baseline and after 3 and 6 months. Pooled sample analysis was performed using a multiplex polymerase chain reaction (PCR)-based method for the identification of detection frequencies and changes in numbers of the following bacteria: Aggregatibacter actinomycetemcomitans (A.a), Porphyromonas gingivalis (P.g), Tannerella forsythia (T.f), Treponema denticola (T.d), and Prevotella intermedia (P.i). RESULTS: In terms of detection frequency, in the test group, statistically significant reductions were found for P.g, T.f, T.d and P.i (p < 0.05) after 6 months. In the control group, the detection frequencies of all investigated bacterial species at 6 months were comparable to the baseline values (p > 0.05). The comparison of the test and control groups revealed statistically significant differences in detection frequency for P.g (p = 0.034), T.d (p < 0.01) and P.i (p = 0.02) after 6 months, favouring the test group. Regarding reduction in detection frequency scores, at 6 months, statistically significant differences in favour of the test group were observed for all investigated bacterial species: A.a (p = 0.028), P.g (p = 0.028), T.f (p = 0.004), T.d (p <0.001), and P.i (p = 0.003). CONCLUSIONS: The present microbiological results, which are related to short-term outcomes up to 6 months post-treatment, support the adjunctive subgingival application of sodium hypochlorite/amino acids and xHyA to subgingival debridement in the treatment of periodontitis.

The effect of Nigella sativa extracts against Porphyromonas gingivalis isolated from periodontitis patients.

OBJECTIVE: Periodontitis is an inflammatory condition that results in pocket formation, gingival recession, and tooth loss by gradually destroying the periodontium. An alternate therapeutic approach that can address these problems is required due to the prohibitive cost of periodontal therapy, unfavorable antibiotic side effects, the advent of novel bacterial strains, and the resistance of those strains. The primary goal of our study was to assess Nigella sativa's (N. sativa) antibacterial effectiveness against Porphyromonas gingivalis (P. gingivalis) utilizing seed extract. PATIENTS AND METHODS: Six individuals with periodontitis, both male and female, between the ages of 30 and 50, were enrolled in the study. Each patient's medical and dental histories were documented. Then, anaerobic procedures were conducted in the microbiology lab to find P. gingivalis development. The specimens were all then cultured. RESULTS: At 12.5 mg/ml concentration, P. gingivalis did not show any zone of inhibition (ZOI). However, N. sativa, at a concentration of 25 mg/ml, demonstrated a ZOI of 6.2 mm against P. gingivalis. Similarly, at 50 mg/ml, it showed a ZOI of 8.4 mm. Tetracycline as a positive control demonstrated a ZOI of 14.1 mm against P. gingivalis. Although N. sativa samples had somewhat less antibacterial activity than tetracycline samples, it was discovered that N. sativa had noticeable antibacterial activity against P. gingivalis. CONCLUSIONS: This study's findings suggest that N. sativa can be utilized against periodontitis as an adjunct to scaling since it has high antibacterial action against P. gingivalis.

Antineoplastic therapy in childhood cancer patients presents a negative impact in the periodontal tissues: a cohort study.

OBJECTIVES: To investigate the effect of antineoplastic therapy (AT) in the periodontal tissues of childhood cancer (CC) patients. MATERIALS AND METHODS: Seventy-two individuals were divided into CC (n=36) and healthy individuals (control group-CG, n=36). Demographics, hygiene habits, CC type, and AT were collected. Salivary flow and the presence and concentration of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, and Fusobacterium nucleatum were analyzed. Clinical evaluation included plaque (PI) and gingival indexes (GI), periodontal probing depth (PPD), and clinical attachment level (CAL). Patients were classified into periodontal health, gingivitis, or periodontitis. Descriptive statistics, T test, Mann-Whitney test, chi-square, Fisher's exact test, and two-way analysis of variance were used (p<0.05). RESULTS: The mean age of the patients was similar (CC 12.0±3.9 years and CG 12.0±4.0 years). In the CC group, all patients underwent chemotherapy and nine radiotherapy. Color/race, income, and family education showed significant differences between groups. There was no difference between groups in salivary flow. Higher levels of Fusobacterium nucleatum were seen in CC (p=0.02). Significant difference between groups was found for PI (CC: 30.5%, CG: 22.6%), GI (CC: 28.8%, CG: 17.3%), PPD (CC: 1.77 mm, CG: 1.61 mm), and CAL (CC: 1.77 mm, CG: 1.57 mm), periodontal health (CC: 3, CG: 7), gingivitis (CC: 16, CG: 24), or periodontitis (CC: 17, CG: 5). CONCLUSION: AT in CC patients presents a negative impact in the periodontal and microbiological parameters. CLINICAL RELEVANCE: Childhood cancer individuals showed worse periodontal parameters and higher levels of Fusobacterium nucleatum in the saliva when compared to healthy individuals.

Microbiota present in combined endodontic-periodontal diseases and its risks for endocarditis.

INTRODUCTION: Infective endocarditis (IE) is an inflammatory disease usually caused by bacteria that enter the bloodstream and establish infections in the inner linings or valves of the heart, including blood vessels. Despite the availability of modern antimicrobial and surgical treatments, IE continues to cause substantial morbidity and mortality. Oral microbiota is considered one of the most significant risk factors for IE. The objective of this study was to evaluate the microbiota present in root canal (RC) and periodontal pocket (PP) clinical samples in cases with combined endo-periodontal lesions (EPL) to detect species related to IE using NGS. METHODS: Microbial samples were collected from 15 RCs and their associated PPs, also from 05 RCs with vital pulp tissues (negative control, NC). Genomic studies associated with bioinformatics, combined with structuring of a database (genetic sequences of bacteria reported for infective endocarditis), allowed for the assessment of the microbial community at both sites. Functional prediction was conducted using PICRUSt2. RESULTS: Parvimonas, Streptococcus, and Enterococcus were the major genera detected in the RCs and PPs. A total of 79, 96, and 11 species were identified in the RCs, PPs, and NCs, respectively. From them, a total of 34 species from RCs, 53 from PPs, and 2 from NCs were related to IE. Functional inference demonstrated that CR and PP microbiological profiles may not be the only risk factors for IE but may also be associated with systemic diseases, including myocarditis, human cytomegalovirus infection, bacterial invasion of epithelial cells, Huntington's disease, amyotrophic lateral sclerosis, and hypertrophic cardiomyopathy. Additionally, it was possible to predict antimicrobial resistance variants for broad-spectrum drugs, including ampicillin, tetracycline, and macrolides. CONCLUSION: Microorganisms present in the combined EPL may not be the only risk factor for IE but also for systemic diseases. Antimicrobial resistance variants for broad-spectrum drugs were inferred based on PICRUSt-2. State-of-the-art sequencing combined with bioinformatics has proven to be a powerful tool for conducting studies on microbial communities and could considerably assist in the diagnosis of serious infections. CLINICAL RELEVANCE: Few studies have investigated the microbiota in teeth compromised by combined endo-periodontal lesions (EPL), but none have correlated the microbiological findings to any systemic condition, particularly IE, using NGS techniques. In such cases, the presence of apical periodontitis and periodontal disease can increase IE risk in susceptible patients.

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.

Periodontitis is a problem that can make your teeth fall out. It happens when the tissues that hold your teeth start to break down. Scientists have found a way to help treat it by using tiny things called 'nano drug-delivery systems' or NDDS. These NDDS carry medicine to the infected area and stop the germs from growing. They can also help the tissue around your teeth to heal. Some examples of NDDS are liposomes, polymersomes, exosomes, nanomicelles, and more. Regular treatment with antibiotics may not work as well as NDDS. Using NDDS can make a big difference in how well your teeth and gums heal. In the future, scientists hope to use NDDS to prevent the problem from coming back. This new way of treating periodontitis could be a big help for people with this problem.

Clinical and microbiological outcomes of subgingival instrumentation supplemented with high-dose omega-3 polyunsaturated fatty acids in periodontal treatment - a randomized clinical trial.

PURPOSE: This study aimed to evaluate the impact of dietary supplementation with omega-3 polyunsaturated fatty acids (PUFAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) combined with scaling and root planing (SRP) in untreated periodontitis stage III and IV. METHODS: Forty patients were randomly assigned to the test group receiving SRP plus omega-3 PUFAs (n = 20) or control group receiving SRP alone (n = 20). Clinical changes of pocket probing depths (PD), clinical attachment level (CAL), bleeding on probing (BOP) and rates of closed pockets (PPD ≤ 4 mm without BOP) were evaluated at baseline and after 3 and 6 months. Phorphyromonas gingivalis, Tanarella forsythia, Treponema denticola and Aggregatibacter actinomycetemcomitans counts were analysed at baseline and at 6 months. Serum was subjected to lipid gas chromatography/mass spectrometry analysis at baseline and at 6 months. RESULTS: Significant improvement of all clinical parameters at 3 and 6 months was observed in both groups. For the primary outcome "change of mean PD," no significant difference was detected between the groups. Patients treated with omega-3 PUFAs demonstrated significantly lower rates of BOP, higher gain of CAL and higher number of closed pockets at 3 months in comparison to the control group. After 6 months, no clinical differences between the groups were found, with the exception of lower BOP rates. Moreover, in the test group, the number of key periodontal bacteria was significantly lower than in the control group at 6 months. Increased proportions of serum n-3 PUFAs and decreased proportions of n-6 PUFAs were detected at 6 months in the patients from the test group. CONCLUSION: High-dose omega-3 PUFA intake during non-surgical treatment of periodontitis results in short-term clinical and microbiological benefits. The study protocol was approved by the ethical committee of Medical University of Lodz (reference number RNN/251/17/KE) and registered at clinicaltrials.gov (NCT04477395) on 20/07/2020.

Effect of supragingival air polishing on subgingival periodontitis microbiota.

Background: Supragingival air polishing of teeth effectively removes dental plaque and extrinsic stain on coronal tooth surfaces, but its impact on specific periodontal pathogens in adjacent subgingival biofilms is not known. This study assessed the microbiological effect of supragingival air polishing on the subgingival microbiota of individuals with severe periodontitis. Methods: Supragingival air polishing with a sodium bicarbonatebased powder was performed on 15 adult test subjects, with the nozzle of the air polishing device aimed apically at a 45° angle onto tooth surfaces immediately coronal to the entrance of periodontal pockets. Supragingival prophylaxis paste polishing, using a slow-speed handpiece, was carried out on 13 adult control subjects. Subgingival specimens were collected from a single 5 mm to 7 mm periodontal pocket with bleeding on probing in each of the study participants before and immediately after supragingival polishing procedures. Viable bacterial counts and selected putative periodontal pathogens (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia/nigrescens, Fusobacterium nucleatum, Parvimonas micra, Campylobacter species) were quantified by microbial culture, and motile morphotypes (spirochetes and motile rods) by phase-contrast microscopy. Results: Statistically significant decreases were detected after supragingival air polishing in total viable counts (84.9% decrease), in P. intermedia/nigrescens, F. nucleatum, Campylobacter species, total proportions of red/orange complex periodontal pathogens (82.3% decrease), and in motile morphotypes (85.3% decrease). No statistically significant subgingival microbiological changes occurred with supragingival prophylaxis paste polishing. Conclusion: Supragingival air polishing of teeth, but not supragingival prophylaxis paste polishing, may serve as a useful therapeutic adjunct to disrupt and help remove pathogenic biofilms in deep periodontal pockets.

Contexte: Le polissage à air supragingival des dents élimine efficacement la plaque dentaire et les taches extrinsèques sur les surfaces coronaires des dents, mais on ignore son incidence sur les agents pathogènes parodontaux spécifiques des biofilms sous-gingivaux adjacents. Cette étude a évalué l'effet microbiologique du polissage à air supragingival sur le microbiote sous-gingival de clients ayant une parodontite sévère. Méthodologie: Quinze sujets d'essai adultes ont obtenu un polissage à air supragingival à base de poudre de bicarbonate de sodium avec la buse du dispositif de polissage à air orienté à un angle de 45° sur les surfaces immédiatement coronaires à l'entrée des poches parodontales. Treize sujets témoins adultes ont obtenu un polissage prophylactique supragingival à pâte effectué au moyen d'une pièce à main à vitesse lente. Des échantillons sous-gingivaux ont été prélevés d'une seule poche parodontale de 5 mm à 7 mm présentant un saignement au sondage chez chacun des participants de l'étude avant et immédiatement après les procédures de polissage supragingival. Le nombre de bactéries viables et certains pathogènes parodontaux putatifs (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia/nigrescens, Fusobacterium nucleatum, Parvimonas micra, espèces de Campylobacter) ont été quantifiés par culture microbienne, et les morphotypes mobiles (spirochètes et bâtonnets mobiles) par microscopie à contraste de phase. Résultats: Des réductions statistiquement significatives ont été décelées après le polissage à air supragingival dans le compte total de bactéries viables (diminution de 84,9 %), de P. intermedia/nigrescens, F. nucleatum et des espèces de Campylobacter, dans les proportions totales de pathogènes parodontaux du complexe rouge/orange (diminution de 82,3 %) et dans les morphotypes mobiles (diminution de 85,3 %). Aucun changement microbiologique sous-gingival statistiquement considérable n'a eu lieu avec le polissage prophylactique supragingival à pâte. Conclusion: Le polissage à air supragingival des dents, mais pas le polissage prophylactique supragingival à pâte, peut servir à titre de complément thérapeutique utile pour perturber et aider à éliminer les biofilms pathogènes dans les poches parodontales profondes.

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.

Influence of periodontal surgery on the subgingival microbiome-A systematic review and meta-analysis.

OBJECTIVE: The objective of this systematic review and meta-analysis was to evaluate the effect of periodontal surgery on the subgingival microbiome. BACKGROUND: Periodontitis is a chronic inflammation of the tooth supporting tissues caused by the dysbiosis of the subgingival biofilm. It is managed through different non-surgical and surgical treatment modalities. Recent EFP S3 guidelines recommended performing periodontal surgery as part of Step 3 periodontitis treatment after Step 1 and Step 2 periodontal therapy, with the aim to achieve pocket closure of persisting sites. Changes in the sub-gingival microbiome may explain the treatment outcomes observed at different time points. Various microbiological detection techniques for disease-associated pathogens have been evolved over time and have been described in the literature. However, the impact of different types of periodontal surgery on the subgingival microbiome remains unclear. METHODS: A systematic literature search was conducted in Medline, Embase, LILACS and Cochrane Library supplemented by manual search (23DEC2019, updated 21APR2022). RESULTS: From an initial search of 3046 studies, 28 were included according to our specific inclusion criteria. Seven microbiological detection techniques were used to analyse disease-associated species in subgingival plaque samples: optical microscope, culture, polymerase chain reaction (PCR), checkerboard, enzymatic reactions, immunofluorescence and 16S gene sequencing. The included studies exhibited differences in various aspects of their methodologies such as subgingival plaque sample collection or treatment modalities. Clinical data showed a significant decrease in probing pocket depths (PPD) and clinical attachment loss (CAL) after periodontal surgery. Microbiological findings were overall heterogeneous. Meta-analysis was performed on a sub-cohort of studies all using checkerboard as a microbiological detection technique. Random effect models for Treponema denticola (T. denticola), Porphyromonas gingivalis (P. gingivalis) and Tannerella forsythia (T. forsythia) did not show a significant effect on mean counts 3 months after periodontal surgery. Notably, Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) showed a significant increase 3 months after periodontal surgery. 16S gene sequencing was used in one included study and reported a decrease in disease-associated species with an increase in health-associated species after periodontal surgery at 3 and 6 months. CONCLUSION: This systematic review has shown that the effect of periodontal surgery on the changes in subgingival microbiome is heterogeneous and may not always be associated with a decrease in disease-associated species. The variability could be attributed to the microbiological techniques employed for the analysis. Therefore, there is a need for well-designed and adequately powered studies to understand how periodontal surgery influences the subgingival microbiome and how the individual's microbiome affects treatment outcomes after periodontal surgery.

Subgingival host-microbiome metatranscriptomic changes following scaling and root planing in grade II/III periodontitis.

AIM: To assess the effects of scaling and root planing (SRP) on the dynamics of gene expression by the host and the microbiome in subgingival plaque samples. MATERIALS AND METHODS: Fourteen periodontitis patients were closely monitored in the absence of periodontal treatment for 12 months. During this period, comprehensive periodontal examination and subgingival biofilm sample collection were performed bi-monthly. After 12 months, clinical attachment level (CAL) data were compiled and analysed using linear mixed models (LMM) fitted to longitudinal CAL measurements for each tooth site. LMM classified the sites as stable (S), progressing (P), or fluctuating (F). After the 12-month visit, subjects received SRP, and at 15 months they received comprehensive examination and supportive periodontal therapy. Those procedures were repeated at the 18-month visit, when patients were also sampled. Each patient contributed with one S, one P, and one F site collected at the 12- and 18-month visits. Samples were analysed using Dual RNA-Sequencing to capture host and bacterial transcriptomes simultaneously. RESULTS: Microbiome and host response behaviour were specific to the site's progression classification (i.e., S, P, or F). Microbial profiles of pre- and post-treatment samples exhibited specific microbiome changes, with progressing sites showing the most significant changes. Among them, Porphyromonas gingivalis was reduced after treatment, while Fusobacterium nucleatum showed an increase in proportion. Transcriptome analysis of the host response showed that interleukin (IL)-17, TNF signalling pathways, and neutrophil extracellular trap formation were the primary immune response activities impacted by periodontal treatment. CONCLUSIONS: SRP resulted in a significant "rewiring" of host and microbial activities in the progressing sites, while restructuring of the microbiome was minor in stable and fluctuating sites.

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.

Clinical Evaluation of Diode Laser-Assisted Surgical Periodontal Therapy: A Randomized Split-Mouth Clinical Trial and Bacteriological Study.

Background: Stage 3 grade C periodontitis (S3GCP) has always been a challenge for clinicians. However, it is proposed that the use of lasers in addition to periodontal therapy can result in a more efficient therapy outcome. Objective: The aim of this clinical study was to determine the effects of additional application of diode laser (DL, 810 nm ±5) on clinical and microbiological values during Modified Widman Flap (MWF) periodontal surgery in the S3GCP patients. Methods: A total of 18 patients were randomly assigned to the test site (MWF + activeDL) and the control site (MFW alone). Clinical parameters and microbial samples were taken preoperatively, and postoperatively at 6 weeks, 3 months, and 6 months. Visual analog scale (VAS), tissue edema (TE), tissue color (TC), and pain medication (PM) consumption, were evaluated postoperatively at 10th day. Results: All bacteria were significantly decreased at follow-up times compared with preoperative amounts in both therapy sites (p < 0.05). Bacterial amounts of Treponema denticola, Prevotella intermedia, Tannerella forsythia, and Aggregatibacter actinomycetemcomitans at 6 weeks, Porphyromonas gingivalis and T. denticola at 3 months, T. denticola and A. actinomycetemcomitans at 6 months were statistically lower in the test site than the control site. All clinical parameters significantly improved after MWF surgery at follow-up times compared with preoperative values in intragroup comparisons, but a significant difference was not detected in the intergroup comparison. No differences were found in terms of VAS, PM, TE, and only TC was statistically more pink in the test site than the control site. Conclusions: The present study findings suggest that the use of DL together with MWF may have positive effects in the therapy of S3GCP patients by reducing the microbial load. Clinical Trial.org: NCT05108727.

Correlation of marker periodontopathogenic bacteria with the immune component sCD14 secretion level in inflammatory periodontal diseases.

Lipopolysaccharide of the cell wall of gram-negative bacteria is a highly active biological substance: its interaction with toll-like receptors-4 (TLR-4) of myeloid cells leads to the activation of a cascade of inflammatory reactions, which is accompanied by the release of the soluble CD14 receptor (sCD14), which can be considered not only as a marker of cell activation by endotoxin, but also as a marker of microbial translocation. The aim of the work was to assess the prognostic significance of the sCD14 level in the samples of the periodontal pocket in inflammatory periodontal diseases and the relationship of its secretion with marker periodontopathogens. For the study, washes were obtained from the periodontal pocket (88 samples in total) from patients with chronic periodontitis and intact periodontium. The sCD14 content was determined by ELISA; during real-time PCR, the marker periodontopathogens Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Treponema denticola, Porphyromonas gingivalis, Prevotella intermedia, and Candida albicans were isolated. The study revealed differences in the level of sCD14 secretion by groups: in chronic periodontitis, its content was 8,5 times higher than in the control group and amounted to 17,2±4,06 ng/ml (p=0,006). The frequency of detecting genes of periodontal pathogenic bacteria was 89,3% in patients with periodontitis and 31,25% in the group with intact periodontium. An interesting dependence of the detection of periodontal pathogenic bacteria in the group of patients with chronic periodontitis was established depending on the content of sCD14. Thus, at high concentrations of soluble coreceptor, a greater number of periodontopathogenic bacteria of the I and II orders were released. Thus, in inflammatory periodontal diseases, the processes of sCD14 synthesis change, which is probably due to the colonization of periodontal pathogenic bacteria and the action of their toxins and aggression factors. The relationship of marker periodontopathogens with the level of secretion of the immune component sCD14 and its effect on the structure of the periodontal index reflect shifts in the processes of reparative regeneration of the oral mucosa and the regulation of local immunity in response to microbial invasion.

Periodontal status and the incidence of selected bacterial pathogens in periodontal pockets and vascular walls in patients with atherosclerosis and abdominal aortic aneurysms.

The aim of the study was to examine the periodontal status of patients with atherosclerosis and abdominal aortic aneurysms. The occurrence of 5 periodontopathogens was evaluated in periodontal pockets and atheromatous plaques together with specimens from pathologically changed vascular walls of aortic aneurysms. The study comprised 39 patients who qualified for vascular surgeries. Patients with periodontitis and concomitant atherosclerosis or aneurysms were enrolled in the study. Periodontal indices were evaluated, and subgingival plaque samples were examined together with atheromatous plaques or specimens from vascular walls to identify, by polymerase chain reaction (PCR), the following periodontopathogens: Porphyromonas gingivalis, Tanarella forsythia, Aggregatibacter actinomycetemcomitans, Prevotella intermedia and Treponema denticola. The majority of patients had chronic severe generalized periodontitis in stages III and IV. Laboratory investigations showed the occurrence of one or more of the five targeted periodontopathogens in 94.6% of the periodontal pockets examined. Of the examined periodontopathogens, only Porphyromonas gingivalis was confirmed in 1 atheromatous plaque sample collected from the wall of an aortic aneurysm. Therefore, the occurrence of this bacterium in these vessels was considered to be occasional in patients with chronic periodontitis.

Clinical and microbiological effects of a single application of sodium hypochlorite gel during subgingival re-instrumentation: a triple-blind randomized placebo-controlled clinical trial.

OBJECTIVES: The aim of this study is to assess the clinical and microbiological effects of a single subgingival administration of sodium hypochlorite gel (NaOCl) and compare it with 1% chlorhexidine (CHX) gel and a placebo gel following mechanical re-instrumentation during supportive periodontal therapy (SPT). MATERIALS AND METHODS: Sixty-two patients who had been treated for stage III-IV periodontitis and enrolled in SPT were included in the study based on following criteria: (1) active periodontal therapy completed at least 6 months before enrollment in the study, (2) presence of at least 4 non-adjacent sites with probing pocket depths (PPDs) ≥ 4 mm with bleeding on probing (BOP), or presence of 5-8 mm PPDs with or without BOP. All sites presenting PPD ≥ 4 mm and BOP at baseline and 3-, 6-, and 9-month follow-up timepoints were subgingivally re-instrumented with ultrasounds. Selected patients were randomly assigned into three groups and treated additionally with a single subgingival administration of NaOCl gel (group A); 1% CHX gel (group B); and placebo gel (group C). Main outcome variable was pocket closure at 12 months. Secondary outcome variables were changes in mean PPD, BOP, and clinical attachment level (CAL) along with changes in the numbers of the following five keystone bacterial pathogens: Aggregatibacter actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), Prevotella intermedia (P.i.), Tannerella forsythia (T.f.), and Treponema denticola (T.d.). RESULTS: At 12 months, pocket closure was obtained in 77.5% in the NaOCl treated sites. The reduction in PPD was higher with CHX than with NaOCl, although a statistically significant adjunctive effect for NaOCl (P = 0.028) was only observed in comparison with placebo only. Mean CAL improved in all groups and at all timepoints, compared to the baseline (P < 0.05). However, after 6 months, CAL gain was statistically significantly higher in the NaOCl treated group than following application of CHX (P = 0.0026). CONCLUSION: In SPT patients, a single adjunctive use of a NaOCl gel may provide benefits in controlling inflammation and residual pockets. TRIAL REGISTRATION: ISRCTN Registry of Clinical Trials (ISRCTN11387188). CLINICAL RELEVANCE: A baseline single application of NaOCl gel in conjunction with mechanical debridement may achieve substantial pocket closure in patients enrolled in SPT; treatment time, cost, and applicability considerations should be taken into account when selecting this therapy.

Chloro-aluminum phthalocyanine-mediated photodynamic therapy in the treatment of stage-II chronic periodontitis among smokers.

PURPOSE: To assess the clinical periodontal, bacterial, and immunological outcomes of chloro-aluminum phthalocyanine-mediated photodynamic therapy (PDT) as an adjunct to dental scaling (DS) versus DS alone among cigarette smokers (CS) and never-smokers (NS). METHODS: A total of 26 patients (13 CS and 13 NS) with clinical and radiographic diagnosis of stage-II chronic periodontitis were recruited. Each patient from both groups were subjected with two parallel therapies (split-mouth): PDT + DS (test side) and DS alone (control side). Periodontal parameters were investigated by evaluating plaque scores (PS), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL), and alveolar bone loss (ABL). Subgingival plaque was collected to detect and quantify Porphyromonas gingivalis and Tannerella forsythia using real-time quantitative polymerase chain reaction (RT-qPCR) assay. Gingival crevicular fluid was sampled for the quantification of interleukin (IL)-1ß and tumor necrosis factor-alpha (TNF-α) using enzyme linked immunosorbent assay. All assessments were performed at baseline, 3 months, and 6 months. RESULTS: Bleeding on probing was significantly reduced at 6 months after PDT + DS in CS groups (p < .05). Mean PD and CAL significantly reduced after both PDT + DS and DS subgroups and among NS and CS groups (p < .05). At 6 months follow-up, the copy number of both P. gingivalis and T. forsythia remained significantly high in CS group (p < .01). Only PDT + DS subgroup in CS significantly reduced the counts of P. gingivalis and T. forsythia at 3 months and 6 months (p < .05). Only at 6 months did PDT + DS showed statistically significantly reduced IL-1ß levels in the NS group (p < .01). TNF-α levels significantly reduced in CS group with PDT + DS and DS alone at both 3 months and 6 months follow-up (p < .01). CONCLUSION: Chloro-aluminum phthalocyanine-mediated PDT helped to improve the non-surgical periodontal therapy outcomes among stage-II chronic periodontitis patients among smokers and never-smokers.

[The assessment of a role of muramyl peptides in the treatment of patients with aggressive form of periodontitis]. / Izuchenie roli kompozitsii muramilpeptidov pri lechenii patsientov s agressivnoi formoi parodontita.

THE AIM OF THE STUDY: Was to determine the effect of the drug based on the composition of muramyl peptides isolated from the cell walls of gram-negative bacteria on the production of α-defensins and the detectability of Porphyromonas gingivalis in patients with an aggressive form of periodontitis. MATERIAL AND METHODS: 60 patients aged 28 to 40 years with an aggressive form of periodontitis were randomized into two equal groups, the main and control. In both groups, patients were removed dental deposits and taught the rules of oral hygiene, followed by three-fold control. In the main group, 200 micrograms of the drug based on the composition of muramyl peptides were additionally administered intramuscularly daily for 7 days. Initially and after 7, 21, 90 days, the level of human neutrophil peptides (hnp1-3) in blood serum and periodontal pockets was determined by the enzyme immunoassay, as well as the presence of P. gingivalis in periodontal pockets by polymerase chain reaction (PCR). RESULTS: In patients of the control group, the concentration of hnp1-3 in periodontal pockets and blood serum did not change significantly during the entire study. The use of PM in the main group caused an increase in the local and systemic levels of hnp1-3, which correlated with a persistent decrease in the detectability of P. gingivalis. CONCLUSION: The drug based on the composition of muramyl peptides of the cell wall of gram-negative bacteria potentiates the eradication of P. gingivalis by stimulating the production of hnp1-3 in patients with an aggressive form of periodontitis.

The efficacy of the adjunct use of subgingival air-polishing therapy with erythritol powder compared to conventional debridement alone during initial non-surgical periodontal therapy.

AIM: To assess the efficacy of the adjunct use of a subgingival erythritol powder air-polishing device (EPAP) in comparison to conventional subgingival instrumentation alone during initial non-surgical periodontal therapy. MATERIALS AND METHODS: Twenty-one patients with generalized Stages 2 and 3 grade B periodontitis were included in this single centre, single blinded, split-mouth, randomized clinical trial. Teeth on the control side were treated with conventional hand and ultrasonic instrumentation, while those on the contralateral test side was treated using EPAP as adjunct to conventional subgingival instrumentation with hand and ultrasonic instruments. Three months after initial instrumentation, persisting pockets of ≥4 mm were re-treated, in both control and test sides, again with the respective treatment approach-subgingival instrumentation alone on control, and subgingival instrumentation + EPAP on test side. Clinical parameters such as probing pocket depth (PPD), bleeding on probing, and relative attachment level were recorded at baseline and 3 and 6 months following the initial instrumentation. Subgingival plaque samples were collected at baseline, immediately post surgery, as well as at 1 week, 1 month, 3 months, and 6 months after initial instrumentation. RESULTS: In the test group after 6 months, a significantly larger number of initially deep pockets (PPD ≥ 5.5 mm) were reduced to shallow (PPD ≤ 3.4 mm), and a larger attachment gain was observed. No statistically significant microbiological differences could be found between test and control group. CONCLUSIONS: The results of the present study indicate that the adjunct use of subgingival airflow therapy with EPAP during initial non-surgical periodontal therapy might be beneficial in initially deep pockets (PPD ≥ 5.5 mm).