Longitudinal changes in subgingival biofilm composition following periodontal treatment.

BACKGROUND: Current periodontal treatment involves instrumentation using hand and/or ultrasonic instruments, which are used either alone or in combination based on patient and clinician preference, with comparable clinical outcomes. This study sought to investigate early and later changes in the subgingival biofilm following periodontal treatment, to identify whether these changes were associated with treatment outcomes, and to investigate whether the biofilm responded differently to hand compared with ultrasonic instruments. METHODS: This was a secondary-outcome analysis of a randomized-controlled trial. Thirty-eight periodontitis patients received full-mouth subgingival instrumentation using hand (n = 20) or ultrasonic instrumentation (n = 18). Subgingival plaque was sampled at baseline and 1, 7, and 90 days following treatment. Bacterial DNA was analyzed using 16S rRNA sequencing. Periodontal clinical parameters were evaluated before and after treatment. RESULTS: Biofilm composition was comparable in both (hand and ultrasonics) treatment groups at all time points (all genera and species; p[adjusted] > 0.05). Large-scale changes were observed within groups across time points. At days 1 and 7, taxonomic diversity and dysbiosis were reduced, with an increase in health-associated genera including Streptococcus and Rothia equating to 30% to 40% of the relative abundance. When reassessed at day 90 a subset of samples reformed a microbiome more comparable with baseline, which was independent of instrumentation choice and residual disease. CONCLUSIONS: Hand and ultrasonic instruments induced comparable impacts on the subgingival plaque microbiome. There were marked early changes in the subgingival biofilm composition, although there was limited evidence that community shifts associated with treatment outcomes.

Evaluating ultrasonic instrumentation curricular change: an observational comparison study.

Background: Ultrasonic instrumentation (USI) has evolved, but it is unclear if dental hygiene curricula have kept pace. This study compares 2 dental hygiene cohorts with differing USI curricula to investigate if a contemporary USI curriculum enhanced students' USI preparation, use, and confidence. Methods: A 2-group observational study compared a "traditional" USI curriculum (TC) cohort to a later "contemporary" USI curriculum cohort (CC). The new curriculum introduced USI earlier, with more and different inserts, and greater USI philosophical emphasis. Questionnaires were administered to students at the onset (T1) and conclusion (T2) of clinical programming. Ethical approval was received from the Multi-College Ethics Review Process. Statistical calculations included frequencies, proportions, means, and Welch's 2-sample, 2-tailed t-test statistics describing and comparing the cohorts' preparation, use of, and confidence in USI (significance threshold 0.05). Results: Sample size fluctuated due to student attrition; response rate ranged from 21.5% (17/79) to 52.9% (36/68). Earlier in programming, CC students were significantly more prepared with water control, fulcruming, and curved inserts than TC students. No significant differences emerged between groups in use of ultrasonic versus hand instruments (USI approximately 60% of clinical time; p > 0.05). Initially, TC students had significantly greater confidence than CC students (p < 0.05). While there was no difference between groups at Time 2, CC cohort's confidence increased statistically significantly from T1 to T2 (p < 0.05). Discussion & Conclusions: Both cohorts demonstrated similar use of USI. The CC cohort was better prepared in some aspects of USI and use of curved inserts. Results reveal an ongoing need for program evaluation to best implement USI curriculum.

Contexte: L'instrumentation ultrasonique (IUS) a évolué, mais il n'est pas clair si les programmes d'études en hygiène dentaire ont tenu le rythme. Cette étude vise à examiner si un programme d'études contemporain sur l'IUS améliore la préparation, l'utilisation et la confiance des étudiants en matière de l'IUS, en comparant 2 cohortes de programmes d'hygiène dentaire ayant un cursus différent sur l'IUS. Méthodologie: Une étude par observation comprenant 2 groupes a comparé une cohorte du programme « conventionnel ¼ (PCV) d'IUS à une cohorte du programme « contemporain ¼ (PC) d'IUS. Le nouveau programme a présenté l'IUS plus tôt, avec une plus grande variété d'embouts, ainsi qu'une plus grande emphase philosophique sur l'IUS. Les étudiants devaient répondre à un questionnaire au début (T1) et à la fin (T2) du programme clinique. L'examen des principes d'éthique du Multi-Collège a donné son approbation éthique. Les calculs statistiques comprenaient les fréquences, les proportions, les moyennes et les statistiques du test t bilatéral à 2 échantillons de Welch décrivant et comparant comment les cohortes préparent et utilisent les IUS et leur niveau de confiance en celles-ci (seuil critique de 0,05). Résultats: Il y a eu une fluctuation de la taille de l'échantillon en raison de l'attrition des étudiants : le taux de réponse était de 21,5 % (17/79) à 52,9 % (36/68). Plus tôt dans la programmation, les étudiants de la cohorte du PC étaient considérablement mieux préparés en matière de contrôle de l'eau, de point d'appui et d'embouts courbés que les étudiants du PCV. Aucune différence significative n'est apparue entre les groupes à l'égard de l'utilisation des instruments à ultrasons par rapport aux instruments manuels (IUS environ 60 % du temps clinique; p > 0,05). Initialement, les étudiants de la cohorte du PCV étaient significativement plus confiants que les étudiants de la cohorte du PC (p < 0,05). Bien qu'il n'y eût aucune différence entre les groupes au temps 2, la confiance de la cohorte du PC a augmenté de manière statistiquement significative entre le T1 et le T2 (p < 0,05). Discussion et conclusions: Les 2 cohortes ont démontré une utilisation similaire de l'IUS. La cohorte du PC était mieux préparée à certains aspects de l'IUS et à l'utilisation d'embouts courbés. Les résultats révèlent un besoin continu d'évaluation de programme pour une meilleure mise en œuvre du programme d'études d'IUS.

Aerosol reduction efficacy of different intra-oral suction devices during ultrasonic scaling and high-speed handpiece use.

BACKGROUND: The COVID-19 pandemic led to significant changes in the provision of dental services, aimed at reducing the spread of respiratory pathogens through restrictions on aerosol generating procedures (AGPs). Evaluating the risk that AGPs pose in terms of SARS-CoV-2 transmission is complex, and measuring dental aerosols is challenging. To date, few studies focus on intra-oral suction. This study sought to assess the effectiveness of commonly used intra-oral suction devices on aerosol mitigation. METHODS: Ultrasonic scaling and high-speed handpiece procedures were undertaken to generate aerosol particles. Multiple particle sensors were positioned near the oral cavity. Sensor data were extracted using single board computers with custom in-house Bash code. Different high-volume and low-volume suction devices, both static and dynamic, were evaluated for their efficacy in preventing particle escape during procedures. RESULTS: In all AGPs the use of any suction device tested resulted in a significant reduction in particle counts compared with no suction. Low-volume and static suction devices showed spikes in particle count demonstrating moments where particles were able to escape from the oral cavity. High-volume dynamic suction devices, however, consistently reduced the particle count to background levels, appearing to eliminate particle escape. CONCLUSIONS: Dynamic high-volume suction devices that follow the path of the aerosol generating device effectively eliminate aerosol particles escaping from the oral cavity, in contrast to static devices which allow periodic escape of aerosol particles. Measuring the risk of SARS-CoV-2 transmission in a dental setting is multi-factorial; however, these data suggest that the appropriate choice of suction equipment may further reduce the risk from AGPs.

The systemic inflammatory response following hand instrumentation versus ultrasonic instrumentation-A randomized controlled trial.

OBJECTIVE: This study sought to investigate whether the immediate systemic inflammatory response following full-mouth debridement differs following use of hand compared with ultrasonic instruments. METHODS: Thirty-nine periodontitis patients were randomized to treatment with full-mouth debridement using either hand or ultrasonic instrumentation completed within 24 hr. Serum and periodontal clinical parameters were collected at baseline, day 1, day 7 and day 90 post-treatment. Differences in systemic inflammatory markers were assessed using general linear models at each timepoint, corrected for age, gender, smoking status, body mass index and baseline levels of each marker. RESULTS: Across all patients, serum C-reactive protein increased at day 1, with no differences between hand and ultrasonic groups (p(adjusted) = .22). There was no difference between groups in interleukin-6 (p(adjusted) = .29) or tumour necrosis factor α (p(adjusted) = .53) at day 1. Inflammatory markers returned to baseline levels by day 7. Treatment resulted in equal and marked improvements in clinical parameters in both groups; however, total treatment time was on average shorter for ultrasonic instruments (p(adjusted) = .002). CONCLUSIONS: Ultrasonic instrumentation resulted in shorter treatment time with comparable clinical outcomes. Levels of serum C-reactive protein at day 1 were similar following debridement with hand or ultrasonic instruments.

Clinical and patient-centered outcomes post non-surgical periodontal therapy with the use of a non-injectable anesthetic product: A randomized clinical study.

AIM: The aim of this study was to determine the impact of different full-mouth decontamination (FMD) protocols on the effectiveness of an intrapocket anesthetic gel in periodontal maintenance patients. METHODS: Patients undergoing the periodontal maintenance program and with the need for FMD participated in this study. Patients were randomly allocated to non-surgical periodontal therapy (NSPT) with either a preparatory 15-day decontamination phase, including chlorhexidine mouth rinse and domiciliary hygiene instructions (modified FMD: test group), or without it (FMD: control group). In both groups, NSPT was performed with the aid of a non-injectable anesthetic gel. Clinical and patient-related outcomes were recorded during a 6-month follow-up period. RESULTS: Sixty patients completed the 6-month study. Both groups experienced relevant clinical improvements after NSPT, but the test group showed a significant change in periodontal parameters already after the initial 15-day preparatory period, and overall significantly better results in periodontal outcomes when compared with the control group at the last 6-month follow up: the gingival index was 2.07 ± 1.25 in the control group and 1.13 ± 0.51 in the test group. Less pain and dental-related anxiety were perceived by patients in the test group showing a 6-month mean visual analog scale of 2.13 ± 1.25 in the control group and 1.13 ± 0.83 in the test group. CONCLUSION: The present study suggested that the modification of the standard FMD could improve the clinical efficacy of non-injectable anesthetic, along with patients' short- and mid-term appreciation and compliance.