Clinical Use of Paraprobiotics for Pregnant Women with Periodontitis: Randomized Clinical Trial.

Periodontal disease is very common in pregnant women. Paraprobiotics are a subset of probiotics. They can be defined as inactivated microbial cells providing health benefits to the host and are considered particularly safe. The aim of this study was to compare the periodontal health of pregnant women and puerperae after 6 months of home use of paraprobiotics. A total of 30 pregnant women were enrolled and divided into two groups: the test group, who had to use a paraprobiotic-based toothpaste (Biorepair Peribioma Pro, Coswell S.p.A., Funo di Argelato, BO, Italy) and mousse (Mousse Mouthwash Biorepair Peribioma, Coswell S.p.A.) twice a day, and the control group, who had to use only the paraprobiotic-based toothpaste. The time frames of the study were: 1 month (T1), 3 months (T2) and 6 months (T3), and data were collected during pregnancy and in the period immediately following delivery. The following indices were evaluated at T0, T1, T2 and T3: clinical attachment loss (CAL), probing pocket depth (PPD), bleeding on probing (BOP), plaque control record (PCR), modified marginal gingival index (mMGI), papillary marginal gingival index (PMGI) and recessions (R). All data were subjected to statistical analysis. PCR decreased significantly from T0 to T1 in the control group and from T0 to T2 and from T0 to T3 in the test group. BOP tended to decrease in both groups, but a significant reduction was observed only in the test group. CAL, PPD, PMGI and mMGI tended to decrease gradually in both groups without significant differences between or within groups. The combination of the paraprobiotic-based toothpaste and the paraprobiotic-based mousse significantly reduced BoP and plaque control over time, although there were no significant differences with the use of the paraprobiotic-based toothpaste alone. In addition, the combination of the two products promoted a trend towards the better stabilization of recessions.

Ozonized gels vs chlorhexidine in non-surgical periodontal treatment: A randomized clinical trial.

OBJECTIVE: To evaluate the efficacy of newly introduced ozonated gels compared with conventional chlorhexidine gel in the home management of periodontal patients. MATERIALS AND METHODS: 30 patients with bilateral periodontal disease (severity I, complexity II) were enrolled (split-mouth study design). After nonsurgical mechanical periodontal debridement, the teeth were randomly divided into two groups: teeth in the Control group were treated with a chlorhexidine-based gel to aid oral hygiene maneuvers for 2 weeks after the first visit, while teeth in the Test group were treated in the same way with ozone-based gels. After the baseline assessment, the follow-up included assessments at 1, 2, and 6 months. The variables evaluated were clinical attachment loss (CAL), probing pocket depth (PPD), bleeding on probing (BoP), plaque control record (PCR), recession (R), and tooth mobility (TM). RESULTS: For CAL, PPD, BoP, and PCR, significant intragroup differences were found for both groups (p < 0.05), in contrast to intergroup differences (p > 0.05). No significant differences were found for R and TM. CONCLUSION: Nonsurgical mechanical periodontal debridement with adjunctive use of ozone and chlorhexidine was found to be effective in periodontal treatment. Ozone could be suggested as an alternative to chlorhexidine.

Neutrophils' Contribution to Periodontitis and Periodontitis-Associated Cardiovascular Diseases.

Neutrophils represent the primary defense against microbial threats playing a pivotal role in maintaining tissue homeostasis. This review examines the multifaceted involvement of neutrophils in periodontitis, a chronic inflammatory condition affecting the supporting structures of teeth summarizing the contribution of neutrophil dysfunction in periodontitis and periodontal-related comorbidities. Periodontitis, a pathological condition promoted by dysbiosis of the oral microbiota, is characterized by the chronic inflammation of the gingiva and subsequent tissue destruction. Neutrophils are among the first immune cells recruited to the site of infection, releasing antimicrobial peptides, enzymes, and reactive oxygen species to eliminate pathogens. The persistent inflammatory state in periodontitis can lead to aberrant neutrophil activation and a sustained release of proinflammatory mediators, finally resulting in tissue damage, bone resorption, and disease progression. Growing evidence now points to the correlation between periodontitis and systemic comorbidities. Indeed, the release of inflammatory mediators, immune complexes, and oxidative stress by neutrophils, bridge the gap between local and systemic immunity, thus highlighting neutrophils as key players in linking periodontal inflammation to chronic conditions, including cardiovascular diseases, diabetes mellitus, and rheumatoid arthritis. This review underscores the crucial role of neutrophils in the pathogenesis of periodontitis and the complex link between neutrophil dysfunction, local inflammation, and systemic comorbidities. A comprehensive understanding of neutrophil contribution to periodontitis development and their impact on periodontal comorbidities holds significant implications for the management of oral health. Furthermore, it highlights the need for the development of novel approaches aimed at limiting the persistent recruitment and activation of neutrophils, also reducing the impact of periodontal inflammation on broader health contexts, offering promising avenues for improved disease management and patient care.

Periodontitis in Pregnant Women: A Possible Link to Adverse Pregnancy Outcomes.

BACKGROUND: Periodontitis develops in 11% of pregnant women, and it is independently linked to severe complications during pregnancy such as preterm birth, low birth weight, and gestational diabetes. METHODS: A literature search (Pubmed/MEDLINE, and Scopus) from 2003 to 2023 was conducted to analyze studies focused on periodontitis and adverse pregnancy outcomes. RESULTS: 16 articles have been included. Most of the studies showed adverse outcomes, like preterm birth and the low weight of the unborn child, are among the most frequent consequences (respectively 62.5% and 68.7% of articles); pre-eclampsia is also linked to this condition (12.5% of articles); and perinatal mortality (12.5% of articles). CONCLUSIONS: Periodontal disease appears to be associated with adverse events in pregnancy due to the transport of biofilm bacteria into the bloodstream and into placental tissue; what would cause adverse events is the body's immune response to infection.

A Retrospect of the Special Issue "Advances in Oral Implant Health".

Research on modern dental implantology focuses on the development of increasingly more advanced techniques with the aim of improving the reliability of dental implants while reducing patient morbidity [...].

Alveolar bone exostoses following orthodontic treatment. Diagnostic considerations and clinical management.

Alveolar bone exostoses (ABE) are benign localized convex outgrowths of buccal or lingual bone, which could be delineated from the surrounding cortical plate, also known as a buttress bone formation. Our review and case series demonstrate the development of alveolar bone exostoses during orthodontic therapy. It is crucial to keep in mind that every case presented had a history of palatal tori. In our clinical observations, higher precedence of ABE development was seen in participants during incisor retraction, especially with preexisting palatal tori. Additionally, we have successfully demonstrated surgical techniques to eliminate ABE in the event that self-remission does not occur once orthodontic forces are discontinued.

Personalized Treatment of Periodontitis in a Patient with McArdle's Disease: The Benefits from Probiotics.

Introduction: McArdle's disease is a severe glycogen storage disease characterized by intolerance to exercise; patients have a syndrome of muscle intolerance to stress, associated with myalgia, cramps, fatigue, and muscle weakness. Periodontal disease is a multifactorial pathology of the supporting tissues of the teeth: one of the main factors is the formation of bacterial biofilm; its control favors the prevention and the maintenance of good health of the oral cavity; and some systemic pathologies can worsen the periodontal disease and hinder its therapy. This case report concerns a woman with McArdle's disease diagnosed with periodontal disease. Material and Methods. A 54-year-old female patient with McArdle's disease has been diagnosed with Stage 3 generalized periodontitis, Grade B. At the baseline, the patient had 82 pockets with probing pocket depth (PPD) equal to or greater than 4 mm. The patient was instructed in the correct methods of oral hygiene and was advised toothpaste and mouthwash based on probiotics; subsequently, a debridement was performed to remove etiological factors using Dental-Biofilm Detection Topographic Technique (D-BioTECH). Results: After 60 days, the number of pockets was reduced from 82 to 14 overall with PPD ≥ 4 mm and from 50 to 2 pockets with PPD ≥ 5 mm. Full mouth bleeding score (FMBS) increased from 48% to 15% and full mouth plaque score (FMPS) from 73% to 15%. Conclusions: In this case, the use of a correct brushing method combined with the D-BioTECH has reduced the disease state, with the use of probiotics at home to restore and maintain a healthy oral microbiome.

Evaluation of the Efficacy of Low-Particle-Size Toothpastes against Extrinsic Pigmentations: A Randomized Controlled Clinical Trial.

Stain-removing domiciliary protocols are focused on the elimination of dental extrinsic pigmentations by the application of abrasive toothpastes, extensively available in commerce. The goal of the present study is to evaluate the efficacy of two different stain removal molecule-formulated toothpastes by the reduction of clinical parameters: the micro-cleaning crystals and activated charcoal. A total of 40 participants with extrinsic dental pigmentations were enrolled and divided into two groups: a Control group, assigned to a toothpaste with micro-cleaning crystals (Colgate Sensation White); and a Trial group, with microparticle-activated charcoal toothpaste (Coswell Blanx Black). At T0 (baseline), T1 (10 days), T2 (1 month), and T3 (3 months), clinical parameters, including Lobene stain index calculated for intensity and extension, plaque control record, and bleeding on probing, were measured. Statistically significant differences were found in both groups (p < 0.05): a reduction of extrinsic pigmentation, both in intensity and extension, was obtained in the Control group, but their total elimination could be achieved only in the Trial group with the activated charcoal molecule, though without significant difference between the groups (p > 0.05). No intergroup differences were found for each timeframe for PCR, BoP, LSI-I, and LSI-E. Both tested toothpastes can be recommended for domiciliary oral hygiene of patients with extrinsic pigmentations.

Consensus Report of the Technical-Scientific Associations of Italian Dental Hygienists and the Academy of Advanced Technologies in Oral Hygiene Sciences on the Non-Surgical Treatment of Peri-Implant Disease.

BACKGROUND: The recent publication of the new classification of periodontal and peri-implant disease has given clear indications on the parameters to be taken into consideration to correctly diagnose the different phases of these diseases. To date, however, there are no equally clear indications on the treatments to be implemented to solve these diseases. The objective of this Consensus Report is to provide guidance for the non-surgical management of peri-implant mucositis and peri-implantitis. For the drafting of the consensus, the most recent scientific literature was analysed. MATERIALS AND METHODS: A group of 15 expert Italian dental hygienists were selected by the Italian technical-scientific societies (AIDI, UNID and ATASIO) and, starting from the literature review, they formulated indications according to the GRADE method (Grading of Recommendations, Assessment, Development, and Evaluation, a tool for rating the quality of evidence, used to draw up systematic reviews and clinical guidelines) on the treatment of peri-implant mucositis, peri-implantitis and on management of the various implanting surfaces. CONCLUSIONS: in accordance with the international literature, non-surgical therapy alone can resolve peri-implant mucositis, but not peri-implantitis. Several adjunctive therapies have been considered and some appear to be helpful in managing inflammation.

Ozonized Hydrogels vs. 1% Chlorhexidine Gel for the Clinical and Domiciliary Management of Peri-Implant Mucositis: A Randomized Clinical Trial.

Peri-implant mucositis consists of a reversible inflammation of peri-implant tissues characterized by bleeding on gentle probing in the absence of bone loss. Ozone therapy is being extensively studied for its efficacy in treating different dental conditions. To date, few studies have evaluated ozone as an adjunct to the oral hygiene measures of peri-implant mucositis patients. The aim of the present study is to assess the efficacy of an ozonized gel (Trial group) compared to chlorhexidine (Control group) after a domiciliary protocol of oral hygiene in a 6-month study. According to a split-mouth study design, patients were divided into Group 1 for the application of chlorhexidine gel in peri-implant mucositis sites of quadrants Q1 and Q3, whereas in quadrants Q2 and Q4, the ozonized gel was in-office administered. For Group 2, the quadrants were inverted. At baseline (T0), and after 1 (T1), 2 (T2), and 3 (T3) months, Probing Depth (PD), Plaque Index (PI), SI Suppuration Index (SI), Bleeding Score (BS) and Marginal Mucosa Condition (MMC) were measured. A statistically significant decrease was found for all the variables assessed in each group (p < 0.05), whereas significant intergroup differences were found only for PI, BoP, and BS. Accordingly, both agents tested in this study showed an efficacy in treating peri-implant mucositis. The ozonized gel deserves particular attention, considering the better outcome than chlorhexidine on specific clinical periodontal parameters, as well as its lesser shortcomings.

Biomimetic hydroxyapatite paste for molar-incisor hypomineralization: A randomized clinical trial.

OBJECTIVES: The aim of this randomized clinical trial was to evaluate the desensitizing and remineralizing effect of a new zinc-hydroxyapatite-based paste in sites affected by molar-incisor hypomineralization (MIH), by assessing dental sensitivity, tooth wear, and periodontal indexes. MATERIALS AND METHODS: Twenty-five patients with presence of 1 enamel demineralization of permanent molars and incisors in two different quadrants were recruited. After professional dental hygiene, a domiciliary hydroxyapatite-based paste was assigned and recommended to be applied on 2 MIH teeth in one random quadrant (test group), while the 2 contralateral MIH teeth did not undergo paste application (control group). The following primary outcomes were assessed: Plaque Control Record (PCR), Bleeding Index (BI), MIH Treatment Need Index (MIH-TNI), and Schiff Air Index (SAI). RESULTS: No significant inter- and intragroup differences were found for PI and BI, except for both intragroup T0-T1. For MIH-TNI, significant intergroup differences were detectable in the test group after 9 months of treatment. For SAI values, no significant differences were found in the control group, while in the test group, significant lower values were found after 1 and 3 months since baseline, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Biomimetic zinc-hydroxyapatite showed a desensitizing effect when used to treat MIH.

Correction: Preda et al. The Efficacy of Powered Oscillating Heads vs. Powered Sonic Action Heads Toothbrushes to Maintain Periodontal and Peri-Implant Health: A Narrative Review. Int. J. Environ. Res. Public Health 2021, 18, 1468.

There was an error in the original article [...].

Home Oral Care Domiciliary Protocol for the Management of Dental Erosion in Rugby Players: A Randomized Clinical Trial.

People performing regular physical activity are at high risk of dental erosion especially in cases of high sport drinks intake. Biomimetic hydroxyapatite-based oral hygiene products, like toothpastes and mouthwashes, have been investigated in recent years for their remineralizing activity on the teeth. The aim of the present study was to evaluate the efficacy of two different oral hygiene protocols, respectively consisting of the combination of a hydroxyapatite-based toothpaste plus mouthwash (Trial group) or toothpaste alone (Control Group). At baseline (T0), as well as at 15 days (T1), 30 days (T2) and 90 days (T3), the following clinical indexes were assessed: Basic Erosive Wear Examination (BEWE), Schiff Air Index (SAI), Visual Analogue Scale (VAS), Plaque Index (PI) and Bleeding Index (BI). In general, for all the indexes assessed, a progressive intragroup reduction was noticed from the baseline to the subsequent timepoints, with no intergroup differences. Accordingly, the use of the hydroxyapatite-based toothpaste, alone or in combination with the mouthwash containing hydroxyapatite as well, is an effective method for the domiciliary management of dental erosion in physically active individuals like rugby players.

Dental Erosion Evaluation with Intact-Tooth Smartphone Application: Preliminary Clinical Results from September 2019 to March 2022.

Dental erosion is a process of deterioration of the dental hard tissue; it is estimated that about 30% of permanent teeth are affected in adolescence. The Intact-Tooth application allows for the better estimation of the problem, inserting itself in the diagnosis process, and better care and prevention for the patient. It provides him with scientifically validated protocols, which the patient can consult at any time. The purpose of this report was to conduct an initial evaluation on the use of the application, which has been available since September 2019: the analysis of the collected data allowed the first investigation of the incidence of the problem and the degree of susceptibility in the registered patients. Photos of 3894 patients with dental erosion were uploaded, through which the degree of susceptibility and the BEWE (basic erosive wear examination index) index could be assessed; of these, 99.72% had a susceptibility grade of 0 to 8, while 0.28% had a medium-high susceptibility grade; this result is related to the age and sex of the patients. The management of patients through the help of the application could promote the diagnosis and treatment of enamel diseases and encourage the self-learning of the learning machine, thanks to the number of clinical cases uploaded.

Assessment of the Bacterial Loads of Vacuum-Thermoformed Removable Retainers (VTRR) in Patients under Retention Therapy: A Randomized Clinical Trial.

Retention devices are essential after orthodontic treatment in order to avoid the risk of relapse. For this goal, vacuum-thermoformed removable retainers (VTRRs) are useful tools in clinical practice. The main limitation related to them is the accumulation of plaque. The aim of this study was to investigate the bacterial loads present on VTRRs (Essix ACE Plastic, Dentsply Sirona) in patients under retention therapy. Patients were randomly divided into three groups, depending on the product used for the cleansing of the VTRR: Geldis, Polident tablets, and simple water, respectively. Microbiological samples were taken from the retainers at the baseline, after 1 and after 2 months, with the collection of Bleeding on Probing (BoP), Plaque Index (PI), Basic Erosive Wear Examination (BEWE) and Schiff Air Sensitivity test (SAI). A total of 15 patients were recruited and for each product, 5 patients were allocated. No significant intragroup and intergroup differences were observed at any time point for PI, SAI, BoP, Red Complex, Total Pathogen and Total Saprophyte loads. A significant intragroup and intergroup difference was assessed at T1 and T2 for BEWE in the control group. According to the results of this study, the bacterial load on VTRR retainers is not influenced by the cleaning methods tested.

Home Oral Care with Biomimetic Hydroxyapatite vs. Conventional Fluoridated Toothpaste for the Remineralization and Desensitizing of White Spot Lesions: Randomized Clinical Trial.

Introduction: Biomimetic hydroxyapatite-based toothpastes have been investigated in recent years for their remineralizing activity on dental surfaces. The aim of the present study was to evaluate the efficacy of toothpaste containing biomimetic hydroxyapatite versus a 1450 pppm fluoride one in promoting the remineralization and desensitization of white spot lesions. Methods: 40 patients were randomly assigned to two different domiciliary oral hygiene treatments: toothpaste containing 1450 ppm of fluoride (control group) and toothpaste containing biomimetic hydroxyapatite (experimental group). Dental sensitivity/pain and dental erosion were assessed at baseline and after 15, 30, and 90 days using the following indexes: Schiff Air Index (SAI), Visual Analogue Scale (VAS), and Basic Erosive Wear Examination (BEWE). Results: Data were submitted for statistical analysis. SAI significantly decreased after 3 months (T3) of treatment only in the Trial group (p < 0.05). VAS values significantly decreased at T2 in the trial group (p < 0.05) with a further significant reduction at T3 (p < 0.05). BEWE scores did not significantly vary during the follow up neither in the trial nor in the control group. Conclusions: The hydroxyapatite-based toothpaste tested caused a reduction of hypersensitivity/pain values higher than conventional fluoride toothpaste.

Evaluation of Adjuvant Systems in Non-Surgical Peri-Implant Treatment: A Literature Review.

Can the use of lasers, ozone, probiotics, glycine and/or erythritol, and chlorhexidine in combination with non-surgical peri-implant treatment have additional beneficial effects on the clinical parameters? Objectives: The non-surgical treatment of peri-implant pathologies is based on mechanical debridement to eliminate bacterial biofilm and reduce tissue inflammation; some additional therapies have been studied to achieve more detailed clinical results. Materials and methods: A literature search for publications until January 2022 was conducted. The research question is formulated following the Problem, Intervention, Comparison/Control, and Outcome. Studies investigating adjunctive therapies were included. Results: In total, 29 articles were included. Most of the studies did not show any additional benefit of these therapies in the evaluation of bleeding on probing, probing pocket depth, or plaque index; among the proposed treatments, the use of laser was the one most studied in the literature, with the achievement of a reduction of bleeding and pocket depth. More studies would be needed to assess the benefit of other therapies. Conclusions: This review showed no significant improvements in the state of health in support of mechanical debridement therapy. However, the few benefits found would deserve to be considered in new clinical studies.

Customized Minimally Invasive Protocols for the Clinical and Microbiological Management of the Oral Microbiota.

In recent years, the personalization of periodontal clinical practice has led to the study of protocols with a proactive approach [...].

Paraprobiotics in Non-Surgical Periodontal Therapy: Clinical and Microbiological Aspects in a 6-Month Follow-Up Domiciliary Protocol for Oral Hygiene.

Periodontal disease represents a progressive destruction of tooth-supporting tissues. Recently, paraprobiotics are regarded as an adjunctive therapy to the non-surgical Scaling-and-Root-Planing (SRP). The aim of this study is to evaluate the efficacy of two new formulations of paraprobiotics, a toothpaste and a mouthwash, respectively, for the domiciliary hygiene. A total of 40 patients were randomly assigned to the following domiciliary treatments: Group 1 (SRP + Curasept Intensive Treatment 0.2% chlorhexidine) (control) and Group 2 (SRP + Biorepair Peribioma toothpaste + Biorepair Peribioma Mousse mouthwash) (trial). At baseline (T0) and after 3 and 6 months (T1-T2), periodontal clinical (Bleeding on Probing, Probing Pocket Depth, Clinical Attachment Loss, Bleeding Score, Sulcus Bleeding Index, Plaque Index, Approximal Plaque Index, Adherent Gingiva, Gingival Recession, and Pathological Sites) and microbiological parameters (Pathological Bacteria, Saprophytic Bacteria, Enlarged Red Complex, Red Complex, Orange Complex, and counts of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythensys, Treponema denticola, Prevotella intermedia, and Fusobacterium nucleatum). The use of the experimental products resulted in a significant reduction of most of the clinical indices assessed, which occurred at a major degree with respect to the conventional chlorhexidine considered as control. Additionally, after 6 months of use, the abovementioned products significantly decreased the percentage of pathological bacteria and the counts of those bacteria constituting the "Red Complex", more related to the periodontal disease. Accordingly, the paraprobiotics-based products tested in this study seem to represent a valid support to SRP with a benefit on both clinical indices and on specific periodontopathogens.

Evaluation of Children Caries Risk Factors: A Narrative Review of Nutritional Aspects, Oral Hygiene Habits, and Bacterial Alterations.

Dental caries is one of the most common diseases-both in adults and children-that occurs due to the demineralization of enamel and dentine by the organic acids formed from bacteria present in dental plaques through anaerobic metabolism of dietary sugars. The aim of this article is to provide a guideline to assess the risk of caries by looking for the main factors involved. Literature research was performed for studies that analyzed the factors most involved in the development of child caries, such as poor oral hygiene, bad eating habits (or food disorders), and an alteration of the oral bacterial flora-with an increase of Streptococci spp., Lactobacilli spp., Candida albicans, Cryptococcus neoformans, and Candida sake. It is therefore essential to assess the risk of caries in children, based on the assessment of risk factors, in order to be able to establish preventive and/or therapeutic approaches that will reduce or stop the development of dental caries. The use of fluoride products, products made from casein phosphopeptide-amorphous calcium phosphate, substituted zinc biomimetic hydroxyapatite products, or products containing self-assembling oligopeptide SAP-P11-4 are useful. In terms of the clinical approach, a communicative approach should be added to learn about the eating habits and the oral hygiene habits of the child and parents; in addition, the use of a simple method to frame the factors involved, and subsequently establish the risk of carious lesions in the child, allows the reduction of the DMFT (Decayed Missing Filled Teeth) or ICDAS (International Caries Detection and Assessment System) index on large scales.