Waterline Disinfectants Reduce Dental Bioaerosols: A Multitracer Validation.

Oral microbes are dispersed during dental treatment and reduction methods have been proposed, but dental unit waterline (DUWL) disinfectants have received little attention; specifically, the effect on viruses has not been studied. This study aims to 1) investigate the effect of DUWL disinfectants on viral dispersion in dental bioaerosols and 2) establish a dual-tracer system using live bacteriophage and fluorescein supported by optical particle measurement. Bacteriophage MS2 was used as a viral tracer and fluorescein as a fluorescent tracer. Validation experiments were conducted to exclude interference of one tracer with the other or of DUWL disinfectants on detection methods. Simulated "saliva" containing the tracers was infused into the mouth of a dental mannequin during 10-min dental procedures with an air turbine handpiece (n = 3 replicates). Aerosols and droplets were sampled in an enclosed dental operatory using air samplers and settlement onto sterile filter papers. Bacteriophage was quantified using plaque assays and reverse transcription quantitative polymerase chain reaction (RT-qPCR). Fluorescein was quantified fluorometrically. The effect of DUWL disinfectants on total aerosol concentration was assessed in separate experiments using an optical particle counter. DUWL disinfectants reduced bacteriophage viability, and interference between tracers was not observed. In simulated clinical procedures, the disinfectant ICX reduced bacteriophage detection substantially (P < 0.001; 2-way analysis of variance). MS2 RNA was detected in all experimental samples but not negative controls. Samples positive on RT-qPCR but not plaque assays may indicate that virions at distant sites are nonviable. Fluorescein tracer showed good agreement with the bacteriophage tracer. DUWL disinfectants designed for continuous presence in irrigants reduce the dispersion of viable virus in dental bioaerosols during simulated procedures. Their use may therefore be important for routine infection control and as a mitigation factor during infectious disease outbreaks. Future studies should explore this using a range of viruses and other microbes.

The Clinical Effectiveness of Calcium Hydroxide in Root Canal Disinfection of Primary Teeth: A Meta-Analysis.

BACKGROUND The aim of this research was to systematically analyze the effectiveness of calcium hydroxide compared to formocresol (FC) and camphor phenol (CP) in root canal disinfection of primary teeth. MATERIAL AND METHODS The meta-analysis was based on the participants, interventions, control, outcome (PICO) study design principle and 16 randomized-controlled clinical trials published from January 2000 to August 2018. The data heterogeneity of each study was assessed by the Q-test. The odds ratio and 95% confidence interval (CI) were calculated based on the heterogeneity results by Revman software. RESULTS Sixteen randomized-controlled clinical trials of 3047 primary teeth were included in this meta-analysis. There were significant differences of clinical effectiveness between calcium hydroxide and FC in root canal disinfection of primary teeth (OR=3.37; 95% CI range: 2.54-4.48, P<0.01) and endodontic inter-appointment emergencies (EIAE) after disinfection for 7 days (OR=0.26; 95% CI range: 0.16-0.42, P<0.01). However, there was no statistical difference of EIAE, after disinfection of primary teeth for 48 hours, between calcium hydroxide and FC (OR=0.62; 95% CI range: 0.34-1.11, P=0.11). There were significant differences of clinical effectiveness between the calcium hydroxide and CP in root canal disinfection of primary teeth (OR=5.50; 95% CI range: 3.36-8.98, P<0.01). CONCLUSIONS This meta-analysis indicated that the effectiveness of calcium hydroxide as root canal disinfectant in primary teeth was more effective than that of FC and CP.

Effectiveness of the ozone application in two-visit indirect pulp therapy of permanent molars with deep carious lesion: a randomized clinical trial.

OBJECTIVES: The aim of this randomized, three-arm parallel, single-blinded clinical trial was to evaluate the clinical and microbiological effectiveness of the ozone application in two-visit indirect pulp therapy. MATERIALS AND METHODS: One hundred five lower first molar teeth with deep caries lesion were included and randomly assigned three groups to apply the two-visit indirect pulp therapy. Treatment procedure was applied without any disinfectant (control), with 60-s 2% chlorhexidine digluconate (CHX) or 60-s ozone application. In four different stages (after initial excavation, ozone/CHX application before the temporary restoration, 4 months later immediately after removing temporary restoration, and final excavation), dentin humidity, consistency, and color properties were recorded to evaluate the clinical characteristics of the tissue, and standard dentin samples were collected for the microbiological analysis of mutans streptococci, lactobacilli, and the total number of colony-forming units. The data were analyzed by using Mann-Whitney U test for multiple comparisons. RESULTS: The remaining dentin became harder, drier, and darker after 4 months in all groups. However, CHX and ozone application were statistically better than the control group (p < 0.05). There was a gradual decrease in the total number of microorganisms in all groups. While cavity disinfectant applications were improved the antibacterial efficacy (control, 79.11%; CHX, 98.39%; ozone, 93.33%), CHX application exhibited a greater significant reduction than both groups (p = 0.000). CONCLUSION: The two-visit indirect pulp therapy yielded successful results for all study groups. However, CHX would be conveniently preferable due to improving the treatment success. CLINICAL RELEVANCE: The two-visit indirect pulp therapy applied with cavity disinfectant is a proper alternative treatment procedure in deep carious lesions, instead of conventional technique.

[Clinical and laboratory grounding of using medication based on the antiseptic troklosene to treat patients with chronic generalized periodontitis of the ii and iii degrees of severity].

OBJECTIVE: Introduction: Periodontal diseases take second place in the world among dental diseases and tend to be ubiquitous regardless of age, sex and place of residence. According to the modern point of view inflammatory periodontal diseases refer to infectious chronic inflammatory diseases, therefore, the normalization of the microflora of the oral cavity is an essential condition for their rational therapy. The aim: To increase the effectiveness of conservative treatment of chronic generalized periodontitis of the II-nd and III-rd severity using the medication based on the antiseptic Troklosene. PATIENTS AND METHODS: Materials and methods: 34 patients of age 45 to 55 years who were diagnosed with chronic generalized periodontitis of the IIInd and IIIrd degree of severity were examined and treated. All patients reported signs of the disease for 3-15 years. Patients of the study group by simple randomization were divided into two subgroups, depending on the therapeutic treatment performed. The I-st subgroup -16 patients treated with the additional use of the medication based on the antiseptic Troklosene, the IInd subgroup - 18 patients who were treated without using this drug. RESULTS: Results: Analyzing the results after the treatment in the patients of the I -st and II -nd subgroup, they noted a decrease in PMA index, Green-Vermillion index, bleeding index. Pathological mobility of teeth decreased to the I degree. The hygienic condition of the oral cavity was characterized in patients of both subgroups after treatment as satisfactory. In patients of the Ist subgroup (with the additional use of the medication based on the antiseptic Troklosene), after the 5th visit there were signs of remission, and in the IInd subgroup (using standard base therapy), after 7 visits, there were signs of clinical remission. With the additional use of the drug based on the antiseptic Troklosene, in contrast to the traditional therapy, a change in the bacterial ratio of microorganisms occurred, which influenced a significant decrease in the total bacterial mass. CONCLUSION: Conclusion: The best results were obtained in the Ist subgroup, where along with the standard base therapy, the supplement of based on the antiseptic Troklosene was used additionally. Introduction to the treatment regimen for patients with chronic generalized periodontitis with II and III severity of the drug based on the antiseptic Troklosene contributed to a stable clinical effect, as evidenced by the dynamics of clinical indicators and the reduction in the number of visits. Also, a change in the bacterial ratio of microorganisms with a significant decrease due to Enterobacterium spp. is noted. To maintain this result, it is recommended to continue the use of the drug based on the antiseptic Troklosene with a frequency of 4 times per day within 7 days after the end of treatment.

Evaluation of the Efficacy of Different Mixing Techniques and Disinfection on Microbial Colonization of Polyether Impression Materials: A Comparative Study.

AIM: This study aims to determine the role of mixing techniques of polyether impression materials and efficacy of disinfection on microbial colonization of these impression materials. MATERIALS AND METHODS: Polyether impression material was mixed using two methods: First by hand mixing (group I) and second using an automixer (group II) with a total of 100 samples. Four microbial strains were studied, which included Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans. After incubation, the bacterial colonies were counted, and then, disinfectant solution was applied. The effect of disinfection solution was evaluated for each specimen. RESULTS: The surface of polyether impression materials mixed with an automixer has less number of voids and overall a smoother surface as compared with the hand-mixed ones. On comparing the disinfection procedures, i.e., specimens without any disinfection and specimens after disinfection, statistically highly significant difference was seen between all the groups. CONCLUSION: We can conclude that impression mixing procedures are important in determining the surface characteristics of the impression and ultimately the colonization of bacteria and also determine the importance of disinfection on microbial colonization. CLINICAL SIGNIFICANCE: This study emphasises the deleterious role of nosocomial infections and specific measures that should be taken regarding the prevention of such diseases. Dental impressions are proved to be a source of such infections and may lead to transmission of such diseases. Thus, proper measures should be taken right from the first step of impression taking to minimizing and preventing such kind of contaminations in clinical practice.

Novel Endodontic Disinfection Approach Using Catalytic Nanoparticles.

INTRODUCTION: The aim of this study was to test a new disinfection technology using biomimetic iron oxide nanoparticles (IO-NPs) with peroxidaselike activity to enhance antibacterial activity on root canal surfaces and in dentinal tubules. METHODS: The canal surfaces and dentinal tubules of single-rooted intact extracted teeth were infected by growing Enterococcus faecalis biofilms for 3 weeks. The samples were divided into 6 treatment groups: (1) phosphate-buffered saline (PBS) (negative control), (2) 3% hydrogen peroxide (H2O2) (test control), (3) IO-NPs (0.5 mg/mL) (test control), (4) IO-NPs (0.5 mg/mL) + 3% H2O2, (5) 3% sodium hypochlorite (positive control), and (6) 2% chlorhexidine (positive control). Environmental scanning electron microscopy coupled with energy-dispersive spectroscopy was used to confirm IO-NPs binding to the canal surface after a single treatment. Specimens were labeled with fluorescent staining for live/dead cells, and confocal laser scanning microscopy was used for the quantification of dead bacteria relative to the negative control (PBS). RESULTS: Both biofilm formation and dentinal tubule infection were successfully recapitulated using the in vitro model. IO-NPs were capable of binding to the infected canal surfaces despite a single, short-term (5-minute) treatment. IO-NP activation of H2O2 killed significantly more E. faecalis present on the canal surfaces and at different depths of dentinal tubules when compared with all other experimental groups (P < .05-.0005). CONCLUSIONS: The results reveal the potential to exploit nanocatalysts with enzymelike activity as a potent alternative approach for the treatment of endodontic infections.

Phosphate buffer-stabilized 0.1% chlorine dioxide oral rinse for managing medication-related osteonecrosis of the jaw.

PURPOSE: This is a review of the literature on nonsurgical treatment of non-healing medication related osteonecrosis of the jaw (MRONJ) utilizing a phosphate buffer-stabilized 0.1% chlorine dioxide mouthrinse. METHODS: A literature search in PubMed revealed only six case reports. MRONJ lesion site description, patient's medication history, the healing time, and the MRONJ treatment protocol followed by those authors were recorded. Additional literature review of the scientific mechanism, risks and benefits, safety and efficacy of the phosphate buffer-stabilized 0.1% chlorine dioxide mouthrinse was also performed and discussed. RESULTS: Many of the authors of the published case reports utilized 0.12% chlorhexidine as the initial mouthrinse, but the lesions did not decrease in size. After switching to a phosphate buffer-stabilized 0.1% chlorine dioxide mouthrinse for a duration ranging from 1-12 months, there was complete healing of the MRONJ lesions in all of the cases. The phosphate buffer-stabilized 0.1% chlorine dioxide mouthrinse can be helpful in the management of active MRONJ lesions as well as the prevention of recurrent MRONJ lesions in the susceptible patient population. CLINICAL SIGNIFICANCE: This literature review supports the use of phosphate buffer-stabilized 0.1% chlorine dioxide mouthrinse in the management of MRONJ lesions either as a first line of therapy or after 0.12% chlorhexidine had not been effective.

Bacterial Contamination of the Internal Cavity of Dental Implants After Application of Disinfectant or Sealant Agents Under Cyclic Loading In Vitro.

The aim of this in vitro study was to evaluate the influence of two sealants (Kiero Seal, Kuss Dental, and Berutemp 500, Carl-Bechem) and a disinfectant agent (Chlorhexamed gel, GlaxoSmithKline) on bacterial colonization of the implant-abutment interface. Implants were pretreated with the substances or left without sealing before standard abutments were fixed. Half the specimens were subjected to cyclic loading, and the others were not loaded. Following 7 days of incubation in a bacterial solution, bacterial counts of the internal part of the implants were determined by real-time polymerase chain reaction. All pretreatments lowered bacterial counts, but no substance could guarantee sterility of the implants' internal portion.

Contamination Controls for Analysis of Root Canal Samples by Molecular Methods: An Overlooked and Unsolved Problem.

INTRODUCTION: It has been almost 20 years since molecular methods were first described for the analysis of root canal microbial flora. Contamination control samples are essential to establish DNA decontamination before taking root canal samples, and this review assessed those studies. METHODS: Using PubMed, a search was conducted for studies using molecular microbial analysis for the investigation of endodontic samples. Studies were grouped according to the cleaning protocol, acquisition methods, and processing of control samples taken to check for contamination. RESULTS: Of 136 studies applying molecular analysis to root canal samples, 21 studies performed surface cleaning and checking nucleotide decontamination with contamination control samples processed by polymerase chain reaction. Only 1 study described disinfection, sampling from the access cavity, and processing by polymerase chain reaction and reported the result; that study reported that all samples contained contaminating bacterial DNA. CONCLUSIONS: Cleaning, disinfection, and checking for contamination are basic scientific prerequisites for this type of investigation; yet, this review identifies it as an overlooked issue. On the basis of this review, we call for improved scientific practice in this field.

Effectiveness of chemical disinfection on biofilms of relined dentures: A randomized clinical trial.

PURPOSE: To evaluate the effect of disinfection with sodium perborate or chlorhexidine (when combined with brushing) on the removal of biofilm in relined dentures. METHODS: Swabs were collected 48 hours after the relining procedure and at the follow-up time intervals of 7, 15, 30, 90, and 180 days. The dentures' surface roughness was measured at the same times. 45 subjects were randomly divided into three groups of 15 subjects each. The control group brushed with coconut soap and a soft toothbrush. The sodium perborate group followed the same procedure and also disinfected with sodium perborate solution for 5 minutes per day. The chlorhexidine group followed the control group procedure and disinfected with 2% chlorhexidine digluconate solution for 5 minutes per day. The number of colony forming units and the surface roughness were evaluated statistically by 2-way repeated-measure ANOVA (α = 0.05). RESULTS: The control group dentures exhibited similar levels of microbial cells throughout the experiment. However, after 15 days, no microbial growth was observed on the dentures for which either disinfection agent was used. There were no statistically significant differences in superficial roughness between the groups (P = 0.298). The disinfection agents used, combined with brushing, were able to remove the relined dentures' biofilm after 15 days of disinfection. Roughness was not a predominant factor in CFU reduction.

Should Surgical Burs Be Used as Single-Use Devices to Avoid Cross Infection? A Case-Control Study.

OBJECTIVE: The purpose of this study was to evaluate and compare the rate of bacterial contamination of reused and new unused burs after different sterilization sessions. MATERIALS AND METHODS: The test group consisted of 40 used fissure burs, and the control group of 40 unused new fissure burs (total n = 80). The burs from both groups were precleaned according to standard protocols and then subjected to two sterilization sessions (high- and low-steam pressure autoclaving). After each sterilization session, the burs were transferred into incubation tubes which contained thioglycollate culture medium and were monitored daily for a period of 48 h to detect any bacterial growth. Data were collected and statistical analysis was done using Fisher's exact test. RESULTS: Of the 40 burs of the test group, 2 burs (5%) showed positive bacterial growth, whereas no bur from the control group showed any sign of bacterial growth after high-pressure autoclaving. The colony structure and Gram staining were compatible with the growth of Staphylococcus epidermis. After a second sterilization session at low-pressure steam autoclaving, no bacterial growth was observed for the test group, but 1 bur (2.5%) from the control group showed bacterial growth and Gram-positive staining matched well with the growth of Brevibacterium species. CONCLUSIONS: The new and unused burs were 100% sterile after high-pressure steam autoclaving, whereas 5% of the reused burs appeared positive with bacterial contamination. After low-pressure steam autoclaving, reused burs were 100% sterile, but 1 new bur demonstrated bacterial contamination.

Reconstruction of Peri-implant Osseous Defects: A Multicenter Randomized Trial.

There is a paucity of data for the effectiveness of reconstructive procedures in the treatment of peri-implantitis. The objective of this study was to compare reconstruction of peri-implant osseous defects with open flap debridement (OFD) plus porous titanium granules (PTGs) compared with OFD alone. Sixty-three patients (36 female, 27 male; mean age 58.4 y [SD 12.3]), contributing one circumferential peri-implant intraosseous defect, were included in a multinational, multicenter randomized trial using a parallel-group design. After OFD and surface decontamination using titanium brushes and hydrogen peroxide, 33 defects received PTGs. The implants were not submerged. All patients received adjunctive perioperative systemic antibiotics. The primary outcome variable (defect fill) was assessed on digitalized radiographs. Clinical measurements of probing depth (PPD), bleeding on probing (BoP), suppuration, and plaque were taken by blinded examiners. After 12 mo, the test group (OFD plus PTG) showed a mean radiographic defect fill (mesial/distal) of 3.6/3.6 mm compared with 1.1/1.0 in the control group (OFD). Differences were statistically significant in favor of the test group (P < 0.0001). The OFD plus PTG group showed a mean reduction in PPD of 2.8 mm compared with 2.6 mm in the OFD group. BoP was reduced from 89.4% to 33.3% and from 85.8% to 40.4% for the test and control groups, respectively. There was no significant difference in complete resolution of peri-implantitis (PPD ≤4 mm and no BoP at six implant sites and no further bone loss), because this finding was accomplished at 30% of implants in the test group and 23% of implants in the control group. Reconstructive surgery using PTGs resulted in significantly enhanced radiographic defect fill compared with OFD. However, limitations in the lack of ability to discern biomaterial from osseous tissue could not be verified to determine new bone formation. Similar improvements according to clinical measures were obtained after both surgical treatment modalities (ClinicalTrials.gov NCT02406001).

Sterilizing elastomeric chains without losing mechanical properties. Is it possible?

OBJECTIVE: To investigate the effects of different sterilization/disinfection methods on the mechanical properties of orthodontic elastomeric chains. METHODS: Segments of elastomeric chains with 5 links each were sent for sterilization by cobalt 60 (Co60) (20 KGy) gamma ray technology. After the procedure, the elastomeric chains were contaminated with clinical samples of Streptococcus mutans. Subsequently, the elastomeric chains were submitted to sterilization/disinfection tests carried out by means of different methods, forming six study groups, as follows: Group 1 (control - without contamination), Group 2 (70°GL alcohol), Group 3 (autoclave), Group 4 (ultraviolet), Group 5 (peracetic acid) and Group 6 (glutaraldehyde). After sterilization/disinfection, the effectiveness of these methods, by Colony forming units per mL (CFU/mL), and the mechanical properties of the material were assessed. Student's t-test was used to assess the number of CFUs while ANOVA and Tukey's test were used to assess elastic strength. RESULTS: Ultraviolet treatment was not completely effective for sterilization. No loss of mechanical properties occurred with the use of the different sterilization methods (p > 0.05). CONCLUSION: Biological control of elastomeric chains does not affect their mechanical properties.

Differences in disinfection protocols for root canal treatments between general dentists and endodontists: A Web-based survey.

BACKGROUND: The purpose of this study was to determine whether differences exist in disinfection protocols between endodontists and general dentists. METHODS: The authors sent an invitation to participate in a Web-based survey to 950 dentists affiliated with the Spanish Board of Dentistry. Participants responded to 9 questions about irrigation protocols and other factors related to disinfection during root canal therapy. RESULTS: A total of 238 (25.05%) study participants successfully completed and returned the surveys. Among these participants, 50% were general dentists and 50% were endodontists. The authors found no statistically significant differences in respondents' first choice of an irrigant solution (that is, sodium hypochlorite), but they noted statistically significant differences in the protocols used by general dentists and by endodontists in relation to the concentration of sodium hypochlorite (P = .0003), the use and type of irrigant used to remove the smear layer (P = 5.39 × 10(-10)), the use of adjuncts to irrigation (P = 5.98 × 10(-8)), the enlargement of the apical preparation when shaping a necrotic tooth (P = .001), and the maintenance of apical patency throughout the debridement and shaping procedure (P = .04). CONCLUSIONS: General dentists and endodontists embrace different disinfection protocols. The results of the survey demonstrated that endodontists keep up to date with protocols published in the literature, whereas general dentists use protocols learned during their dental training. Both groups of clinicians should be aware of the importance of disinfection techniques and their relationship to treatment outcomes. PRACTICAL IMPLICATIONS: Controlling microorganisms during a root canal treatment, especially in cases with necrotic pulp, is essential to improve treatment outcomes. Clinicians should update their protocols and also consider referring patients to a specialist when their protocols are based on traditional techniques, especially in those cases with necrotic pulp.

Sterilizing elastomeric chains without losing mechanical properties. Is it possible?

OBJECTIVE: To investigate the effects of different sterilization/disinfection methods on the mechanical properties of orthodontic elastomeric chains. METHODS: Segments of elastomeric chains with 5 links each were sent for sterilization by cobalt 60 (Co60) (20 KGy) gamma ray technology. After the procedure, the elastomeric chains were contaminated with clinical samples of Streptococcus mutans. Subsequently, the elastomeric chains were submitted to sterilization/disinfection tests carried out by means of different methods, forming six study groups, as follows: Group 1 (control - without contamination), Group 2 (70°GL alcohol), Group 3 (autoclave), Group 4 (ultraviolet), Group 5 (peracetic acid) and Group 6 (glutaraldehyde). After sterilization/disinfection, the effectiveness of these methods, by Colony forming units per mL (CFU/mL), and the mechanical properties of the material were assessed. Student's t-test was used to assess the number of CFUs while ANOVA and Tukey's test were used to assess elastic strength. RESULTS: Ultraviolet treatment was not completely effective for sterilization. No loss of mechanical properties occurred with the use of the different sterilization methods (p > 0.05). CONCLUSION: Biological control of elastomeric chains does not affect their mechanical properties. .

OBJETIVO: verificar os efeitos de diferentes métodos de esterilização/desinfecção nas propriedades mecânicas de elásticos ortodônticos em cadeia. MÉTODOS: segmentos de elástico em cadeia com 5 elos cada foram enviados para esterilização em radiação gama com cobalto 60 (20 KGy). Após esterilização, esses foram contaminados com amostras clínicas de Streptococcus mutans. Passado esse período, foram submetidos aos testes de esterilização/desinfecção por diferentes métodos, formando seis grupos de estudo, assim denominados: Grupo 1 (controle - sem ter sido contaminado), Grupo 2 (álcool 70°GL), Grupo 3 (autoclave), Grupo 4 (ultravioleta), Grupo 5 (ácido peracético) e Grupo 6 (glutaraldeído). Após esterilização/desinfecção, avaliou-se a efetividade desses métodos, por meio de contagem de unidades formadoras de colônias por mL (UFC/mL), e as propriedades mecânicas desses materiais. Utilizou-se o teste t de Student para avaliar o número de UFC, além do ANOVA e, posteriormente, do teste de Tukey para avaliação da força. RESULTADOS: verificou-se que o ultravioleta não obteve eficácia total quanto à esterilização. E não ocorreu perda das propriedades mecânicas dos elásticos, com os diferentes métodos de esterilização utilizados (p > 0,05). CONCLUSÃO: o controle biológico de elásticos em cadeia não interfere nas suas propriedades mecânicas. .

Dental unit waterline contamination: a review of research and findings from a clinic setting.

The interior of small-diameter tubing in dental unit waterlines (DUWLs) creates an attractive environment for the growth of biofilm and bacteria. Substantial research shows that troublesome and potentially pathogenic bacteria have been found in DUWLs, and scant peer-reviewed information from which to evaluate chemical treatment options has been historically available. The authors' research compares three DUWL cleaners-an alkaline peroxide product, a freshly mixed chlorine dioxide product, and a buffer-stabilized chlorine dioxide product-in 16 dental units with self-contained water systems over a 10-day working period to determine the optimal chemical treatment option. The study found chlorine dioxide waterline cleaners to be most effective in containing DUWL contaminations.

Treatment of periimplant mucositis: a systematic review of randomized controlled trials.

OBJECTIVE: To determine the most effective treatment for periimplant mucositis in patients with dental implants compared with a control group. MATERIALS AND METHODS: A PubMed (MEDLINE) literature search was made of articles published up until October 2013. Randomized controlled trials (RCTs) were stratified according to their level of quality using the Jadad scale and levels of evidence (University of Oxford). RESULTS: The combinations of search terms resulted in a list of 371 titles. Of these, 114 references were finally reviewed. Finally, 7 RCTs fulfilled the inclusion criteria and were thus selected for inclusion in the systematic review. Chlorhexidine, the administration of azithromycin, and glycine powder air polishing are not effective for the treatment of periimplant mucositis. The only effective treatment seems to be the use of toothpaste with 0.3% triclosan. CONCLUSION: Definitions of periimplant mucositis vary in the literature, and no clear criteria have been established regarding the diagnosis and treatment of this disorder. It highlights our lack of uniform treatment and need to establish additional research to fully provide effective treatments for this common condition. More, larger, and longer-term RCTs are needed in this periimplant disease.

The effect of the local use of chlorhexidine in surgical treatment of experimental peri-implantitis in dogs.

AIM: To evaluate the effect of surgical treatment of experimental peri-implantitis at implants with different surface characteristics using different anti-infective procedures. MATERIAL AND METHODS: Four implants with different surface characteristics (A: TiOblast, B: OsseoSpeed, C: AT-I, D: TiUnite) were installed in a randomized order in each side of the mandible in 6 labrador dogs 3 months after tooth extraction. Experimental peri-implantitis was induced 3 months later. Surgical treatment of peri-implantitis was performed. The implants were cleaned with gauze soaked in either saline (control) or chlorhexidine (test). Clinical and radiographical examinations were performed and microbiological samples were taken during a 6-month period after surgery. Biopsies were obtained and prepared for histological analysis. RESULTS: Clinical signs of soft tissue inflammation were reduced after surgical therapy in most test and control sites. While the analysis of bone level alterations in radiographs together with histological and microbiological assessments of resolution of peri-implantitis lesions failed to demonstrate statistically significant differences between test and control procedures, the evaluations disclosed significant differences between implant D and implants A, B and C on treatment outcome. CONCLUSION: It is suggested that (i) the local use of chlorhexidine has minor influence on treatment outcome, (ii) resolution of peri-implantitis following surgical treatment without the adjunctive use of local and systemic antimicrobial agents is possible and (iii) the results are influenced by implant surface characteristics.

Significance of biofilms in dentistry.

In the past decades significant scientific progress has taken place in the knowledge about biofilms. They constitute multilayer conglomerates of bacteria and fungi, surrounded by carbohydrates which they produce, as well as substances derived from saliva and gingival fluid. Modern techniques showed significant diversity of the biofilm environment and a system of microbial communication (quorum sensing), enhancing their survival. At present it is believed that the majority of infections, particularly chronic with exacerbations, are a result of biofilm formation, particularly in the presence of biomaterials. It should be emphasised that penetration of antibiotics and other antimicrobial agents into deeper layers of a biofilm is poor, causing therapeutic problems and necessitating sometimes removal of the implant or prosthesis. Biofilms play an increasing role in dentistry as a result of more and more broad use in dental practice of plastic and implantable materials. Biofilms are produced on the surfaces of teeth as dental plaque, in the para-nasal sinuses, on prostheses, dental implants, as well as in waterlines of a dental unit, constituting a particular risk for severely immunocompromised patients. New methods of therapy and prevention of infections linked to biofilms are under development.

Tratamiento no quirúrgico en el tratamiento de periimplantitis. Revisión narrativa / Non-surgical therapy in treating peri-implantitis

Existen una gran variedad de protocolos terapéuticos a la hora de tratar la periimplantitis, desde tratamientos desinfectantes, desbridación mecánica hasta procedimientos quirúrgicos. Estudios han demostrado discordancias en sus resultados con respecto a cual es el método ideal para tratar una periimplantitis. El uso de instrumentos de desbridamiento mecánico, el método láser, antibioterapia, enfoques quirúrgicos ya sean resectivas o regenerativas muestran resultados heterogéneos. Al presente, no existe suficiente evidencia científica para poder valer un tratamiento específico no quirúrgico a la hora de enfrentarnos a una periimplantitis. El objetivo de esta revisión narrativa será analizar la literatura actual sobre el tratamiento no quirúrgico de la periimplantitis y sus indicaciones y eficacia como tratamiento. No se ha visto que tratando una la lesión periimplantaria mediante un enfoque terapéutico no quirúrgico haya dado resultados efectivos y el uso de antisépticos locales como auxiliar sólo ha mostrado efectos limitados sobre las variables clínicas y microbiológicas. Se necesitan más estudios randomizados y controlados con resultados a largo plazo para poder validar el protocolo de terapia no quirúrgico de la periimplantitis

There are multitude of treatment regimens for the peri-implant lesion, including anti-infective therapy, mechanical debridement, and surgical procedure. The laser model, the mechanical devise and the antibiotic regimens varied between studies as the different types of surgical therapies, ressective or regenerative approach. The outcomes following the treatment of peri-implantitis are highly variable and there are no data available to support specific treatment protocols in non-surgical therapy of peri-implantitis. The aim of this review is analyze the literature on non-surgical treatment of peri-implantitis and find the possible indications and the efficacy of this therapy. In peri-implantitis lesions non-surgical therapy was not found to be effective and the adjunctive use of local antiseptic had only limited effects on clinical and microbiological parameters. It is necessary to develop more randomized-controlled clinical studies evaluating treatment protocols of non-surgical therapy of peri-implantitis