Effect of periodontal treatment on peak serum levels of inflammatory markers.

BACKGROUND AND OBJECTIVE: Some subjects with untreated periodontitis exhibit elevated levels of distinct inflammatory markers in serum. The aim of the study was to assess whether nonsurgical periodontal therapy changes the levels of these markers and lowers these peaks. METHODS: Forty periodontally diseased subjects received nonsurgical periodontal therapy (full-mouth scaling and root planing within 48 h) with either adjunctive systemic amoxicillin and metronidazole (n = 19) or placebo (n = 21). Serum samples, obtained at baseline (BL) and 3 months after treatment (M3), were evaluated for 15 cytokines and 9 acute-phase proteins using the Bio-Plex bead array multianalyte detection system. For each analyte, peak values were defined as greater than the mean + 2 standard deviations (SD) of measurements found in 40 periodontally healthy persons. Proportions were compared using Fisher's exact test. RESULTS: At M3, a significantly better primary clinical outcome (persisting pockets of >4 mm with bleeding on probing) was obtained in patients treated with scaling and root planing plus antibiotics compared to those receiving placebo (3.3 ± 5.1 vs. 6.8 ± 7.8 pockets per patient, p < 0.05). The levels of cytokines and acute-phase proteins of periodontitis patients were usually below the mean + 2 SD threshold of healthy persons. However, values above threshold were found in some individuals. Eleven patients showed a peak value of one analyte, and seven patients showed two peaks. In the remaining 12 patients, between three and ten analytes showed peak values. Therapy greatly reduced the number of subjects with four or more peaks (BL, 11 subjects; M3, 1 subject, p = 0.003). With regards to the reduction of peaks, no specific benefit of adjunctive antibiotics could be seen. CONCLUSION: Subjects with untreated periodontitis may show high peaks for several inflammatory markers in serum simultaneously. Nonsurgical periodontal treatment with or without antibiotics reduced most of these peak levels.

Are there specific benefits of amoxicillin plus metronidazole in Aggregatibacter actinomycetemcomitans-associated periodontitis? Double-masked, randomized clinical trial of efficacy and safety.

BACKGROUND: It has been suggested that prescription of amoxicillin plus metronidazole in the context of periodontal therapy should be limited to patients with specific microbiologic profiles, especially those testing positive for Aggregatibacter actinomycetemcomitans. The main purpose of this analysis is to determine if patients positive for A. actinomycetemcomitans with moderate to advanced periodontitis benefit specifically from amoxicillin plus metronidazole given as an adjunct to full-mouth scaling and root planing. METHODS: This is a double-masked, placebo-controlled, randomized longitudinal study including 41 participants who were positive for A. actinomycetemcomitans and 41 participants who were negative for A. actinomycetemcomitans. All 82 patients received full-mouth periodontal debridement performed within 48 hours. Patients then received either systemic antibiotics (375 mg amoxicillin and 500 mg metronidazole, three times daily) or placebo for 7 days. The primary outcome variable was persistence of sites with a probing depth (PD) >4 mm and bleeding on probing (BOP) at the 3-month reevaluation. Using multilevel logistic regression, the effect of the antibiotics was analyzed according to the following factors (interaction effect): A. actinomycetemcomitans-positive or -negative at baseline, sex, age, smoking, tooth being a molar, and interdental location. RESULTS: At reevaluation, participants in the test group had significantly fewer sites with a persisting PD >4 mm and BOP than control patients (P <0.01). Being A. actinomycetemcomitans-positive or -negative did not change the effect of the antibiotics. Patients benefited from the antibiotics irrespective of sex, age, or smoking status. Molars benefited significantly more from the antibiotics than non-molars (P for interaction effect = 0.03). CONCLUSIONS: Patients who were positive for A. actinomycetemcomitans had no specific benefit from amoxicillin plus metronidazole. Sites on molars benefited significantly more from the antibiotics than non-molar sites.

Microbial profiles of patients seeking treatment for periodontitis. Influence of origin, smoking and age?

PURPOSE: We assessed the potential influence of the origin, the smoking status and the age on subgingival microbial profiles of subjects seeking periodontal care in Switzerland today. MATERIAL AND METHODS: Subgingival samples were obtained from 182 subjects originating from 44 countries (56 native Swiss, 64 other European, 43 African, 19 others), seeking periodontal treatment at the School of Dental Medicine at the University of Geneva. Four periodontal microorganisms were quantified by direct hybridization with specific RNA probes. RESULTS: Tannerella forsythia and Treponema denticola were ubiquitous (95.6%, 93.9%), and Porphyromonas gingivalis was frequently detected (89%). Counts correlated with the size of the microbial sample (total load). Aggregatibacter actinomycetemcomitans was detected in only 70 (38.4%) subjects. Counts were highly variable and unrelated to total load. Subjects less than 46.8 years old (median age) had a higher risk to be positive than older subjects. Detection frequencies and counts of all four organisms were unrelated to the origin or the smoking status. CONCLUSIONS: Based on a clinical diagnosis of untreated periodontitis, positive outcomes of tests for T. forsythia, T. denticola and P. gingivalis could be predicted with high confidence irrespective of a patient;'s origin, smoking status or age. Detection of A. actinomycetemcomitans was less frequent and depended on the age of the subject.

The characteristics of biofilms in peri-implant disease.

AIM: To describe the microbiota associated with peri-implant disease, with a specific emphasis on the differential diagnosis of the condition. MATERIAL AND METHODS: The potentially relevant literature was preliminarily assessed via scoping searches to find the most appropriate search terms and the most efficient Boolean search algorithm. We identified 29 reports on subjects with osseointegrated implants, with a pathological condition compatible with the definition of "peri-implant disease", and reporting microbiological data from samples taken in affected sites. RESULTS AND CONCLUSIONS: In most studies bacterial samples were obtained by methods that destroy the three-dimensional structure of the biofilm. The samples therefore describe mixtures of bacteria from unspecified districts of biofilm associated with peri-implant diseases. Analyses of such samples with various methods indicate that peri-implant disease maybe viewed as a mixed anaerobic infection. In most cases the composition of the flora is similar to the subgingival flora of chronic periodontitis that is dominated by Gram-negative bacteria. Peri-implant infections may occasionally be linked to a different microbiota, including high numbers of peptostreptococci or staphylococci. Beneficial effects of mechanical and chemical interventions to disrupt the peri-implant biofilm demonstrate that microorganisms are involved in the disease process, even if they may not always be the origin of the condition.

[Efficient, minimally invasive periodontal therapy. An evidence based treatment concept]. / Effiziente, minimal-invasive Parodontitistherapie. Ein evidenzbasiertes Behandlungskonzept.

A large number of reports indicate beneficial effects of systemic antibiotics for patients with periodontal diseases. Although these advantages are clear in general, the specific relationship of benefit and risk in various clinical situations remains a subject of debate. Uncertainties persist regarding the individual prescription and combination with other procedures. Since the early 1990s it has been pointed out that systemic antibiotics given in the context of non-surgical subgingival debridement may reduce the need for periodontal surgery. Recent studies confirm these findings especially with regard to the combination of amoxicillin and metronidazole. However, these antibiotics should not be viewed as a substitute for thorough debridement, or as a means to compensate for improper oral hygiene. In addition, current evidence does not provide evidence for the indiscriminate use of just any antibiotic in any periodontal patient. A treatment protocol implementing the recent evidence is shown. It is noteworthy to realize that chronic and aggressive periodontitis today can be treated successfully with simple and cost-effective means in most instances.

Subgingival plaque removal using a new air-polishing device.

BACKGROUND: The purpose of this study is to evaluate the safety, patient acceptance, and short-term microbiologic effect of a new air-polishing device in subjects in maintenance care with residual pockets > or =5 mm. METHODS: This was an examiner-masked, randomized, split-mouth clinical trial. A new disposable nozzle, allowing the subgingival application of amino acid glycine powder at a limited pressure, was compared to scaling and root planing (SRP) in 50 subjects with residual pockets during the maintenance phase. After removing supragingival deposits, the spray was applied for 4 to 5 seconds in all sites > or =5 mm in the test quadrant, whereas SRP was used in the control quadrant. Microbiologic samples were taken from one treated test and one control site 2 days before and 7 days after treatment. Total bacterial counts and the counts of six periodontal pathogens were determined by real-time polymerase chain reaction. RESULTS: No adverse event was noted in any subject for the test or control treatment. Using a visual analog scale, the patients perceived the test treatment to be significantly less painful/uncomfortable than the hand instrumentation (P <0.001). Significantly less time was used by the operator for the test procedure (P <0.001). The reduction in bleeding on probing was significant for the treated sites in the test and control quadrants (P = 0.019 and P <0.001, respectively), but traditional SRP reduced the bleeding tendency significantly more than air polishing (P = 0.045). The differences in the total bacterial load and the counts of six periodontal pathogens between the test and control sites did not reach statistical significance. The longitudinal reduction was significant in control sites for total bacteria load (P <0.001), Porphyromonas gingivalis (P = 0.01), Treponema denticola (P <0.001), and Tannerella forsythia (previously T. forsythensis) (P <0.001). CONCLUSION: Subgingival air polishing with a new device was safe (no adverse events were noted), perceived to be more acceptable by the patients, and was more time-efficient than SRP; however, on a microbiologic level, it was not superior to conventional SRP.

[Subgingival air-polishing: new perspectives for periodontal maintenance?]. / L'aéro-polissage sous-gingival: Nouvelles perspectives pour le maintien parodontal?

After completion of comprehensive periodontal therapy, the main objective is to maintain gingival tissues in a clinically healthy state. Traditional methods like curettes and ultrasonic devices used during maintenance are responsible of irreversible hard tissue damages ensuing from repeated mechanical scraping of tooth surfaces. A new approach to clean root surfaces without inducing these damages may be the air-polishing technology. Original air-polishing systems are highly abrasive to root cementum and dentin and cannot be used safely in the subgingival area (risk of inducing hard and soft tissue lesions and emphysema). New low abrasive powders and nozzles were designed in order to allow access to root surfaces and to permit the use of the air-polishing devices safely. Recent clinical studies have shown the short-term clinical efficacy of such devices in residual pockets and their safety when used on root surfaces. The new subgingival air-polishing devices are perceived more acceptable by the patients and are more time efficient than scaling and root planning during maintenance. Long-term studies are still lacking to prove their clinical and microbiological efficacy.