Influence of gender on periodontal outcomes: A retrospective analysis of eight randomized clinical trials.

AIMS: To explore the influence of gender on periodontal treatment outcomes in a dataset of eight RCTs conducted in Brazil, United States, and Germany. METHODS: Clinical parameters were compared between men and women with stages III/IV grades B/C generalized periodontitis at baseline and 1-year post-therapy, including scaling and root planing with or without antibiotics. RESULTS: Data from 1042 patients were analyzed. Men presented a tendency towards higher probing depth (p = .07, effect size = 0.11) and clinical attachment level (CAL) than women at baseline (p = .01, effect size = 0.16). Males also presented statistically significantly lower CAL gain at sites with CAL of 4-6 mm at 1-year post-therapy (p = .001, effect size = 0.20). Among patients with Grade B periodontitis who took antibiotics, a higher frequency of women achieved the endpoint for treatment (i.e., ≤4 sites PD ≥5 mm) at 1 year than men (p < .05, effect size = 0.12). CONCLUSION: Men enrolled in RCTs showed a slightly inferior clinical response to periodontal therapy in a limited number of sub-analyses when compared to women. These small differences did not appear to be clinically relevant. Although gender did not dictate the clinical response to periodontal treatment in this population, our findings suggest that future research should continue to explore this topic.

Alveolar Ridge Preservation Using a Bovine derived Bone Graft in Association with Titanium Foil - A Prospective Case Series.

AIMS: To estimate the change in the alveolar ridge by means of a new alveolar ridge preservation (ARP) approach, using an anodized titanium foil (Tseal) associated with a bovine bone graft (BBG) by cone-beam computerized tomography. MATERIALS AND METHODS: Sixteen patients, each presenting one hopeless tooth, were selected and these teeth were carefully extracted. The alveolar socket was filled with BBG and the Tseal was trimmed and adapted to the bone crest. The primary outcome variable was the change in the alveolar dimension (AD) measurements between baseline (T1) and 6 months (T2) 1mm below the palatal bone. RESULTS: Imaging assessment of AD demonstrated a decreased value in all subjects. The absolute rate and percentage of absorption between T1 and T2 time point showed statistically significant differences. The mean AD varied from 9.88 ± 2.04 mm (T1) to 8.85 ± 1.92 mm (T2). On average, this ARP procedure maintained 89.55% ± 6.11% of the distance of between the buccal and palatal wall. No differences were observed between the maxilla and mandible (p greater than 0.05). CONCLUSION: The application of a bovine bone graft covered with Tseal resulted in clinically important horizontal preservation of the alveolar ridge at 6 months after extraction.

Microbiome changes in young periodontitis patients treated with adjunctive metronidazole and amoxicillin.

BACKGROUND: To our knowledge, to date, no studies have comprehensively assessed the changes occurring in the subgingival microbiome of young patients with periodontitis treated by means of mechanical and antibiotic therapy. Thus, this study aimed to use next-generation sequencing to evaluate the subgingival microbial composition of young patients with severe periodontitis treated with scaling and root planing and systemic metronidazole and amoxicillin. METHODS: Subgingival samples from healthy individuals and shallow and deep sites from periodontitis patients were individually collected at baseline and 90 days post-treatment. The samples were analyzed using 16S rRNA-gene sequencing (MiSeq-Illumina) and QIIME pipeline. Differences between groups for the microbiological data were determined using principal coordinate analysis (PCoA), linear mixed models, and the PERMANOVA test. RESULTS: One hundred samples were collected from 10 periodontitis patients and seven healthy individuals. PCoA analysis revealed significant partitioning between pre-and post-treatment samples. No major differences in the composition of the subgingival microbiota were observed between shallow and deep sites, at baseline or at 90-days post-treatment, and the microbiome of both site categories after treatment moved closer in similarity to that observed in periodontal health. Treatment significantly improved all clinical parameters and reduced the relative abundance of classical periodontal pathogens and of Fretibacterium fastidiosum, Eubacterium saphenum, Porphyromonas endodontalis, Treponema medium, Synergistetes, TM7, and Treponema spp, and increased that of Actinomyces, Rothia, Haemophilus, Corynebacterium, and Streptococci spp. CONCLUSION: Mechanical treatment associated with metronidazole and amoxicillin promoted a beneficial change in the microbiome of young individuals with severe periodontitis.

The effect of systemic antibiotics administered during the active phase of non-surgical periodontal therapy or after the healing phase: a systematic review.

OBJECTIVE: The aim of this systematic review was to compare the clinical effectiveness of systemic antibiotics administered in the active stage of periodontal treatment or after the healing phase. MATERIAL AND METHODS: An electronic search was performed in the databases EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL), in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. A manual search of the reference list of selected studies and of review articles was also performed up to November 2013. Randomized Clinical Trials (RCT) that evaluated the systemic administration of antibiotics as adjuvants to scaling and root planning (SRP) at different phases of periodontal treatment were included. Systematic reviews and studies that evaluated subjects with systemic diseases and those that used subantimicrobial doses of antibiotics were excluded. RESULTS: The initial search identified 1,039 articles, of which seven were selected, and only one met the inclusion criteria. This study showed that subjects taking metronidazole and amoxicillin at the initial phase of treatment exhibited statistically significantly greater reduction in pocket depth and gain in clinical attachment level in initially deep sites (PD≥7 mm) than subjects taking antibiotics after healing (p<0.05). This comparison was conducted 2 months after antibiotic intake, at the healing phase. CONCLUSION: To date, only one short-term RCT has directly compared different moments of systemic antibiotics administration, as adjuncts to SRP, in the treatment of periodontitis. Although the results of this study suggested some benefits for antibiotics intake during the active phase of therapy, these findings need to be confirmed by larger placebo-controlled randomized clinical trials with longer follow-up periods.

The effect of systemic antibiotics administered during the active phase of non-surgical periodontal therapy or after the healing phase: a systematic review

Objective The aim of this systematic review was to compare the clinical effectiveness of systemic antibiotics administered in the active stage of periodontal treatment or after the healing phase. Material and Methods An electronic search was performed in the databases EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL), in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. A manual search of the reference list of selected studies and of review articles was also performed up to November 2013. Randomized Clinical Trials (RCT) that evaluated the systemic administration of antibiotics as adjuvants to scaling and root planning (SRP) at different phases of periodontal treatment were included. Systematic reviews and studies that evaluated subjects with systemic diseases and those that used subantimicrobial doses of antibiotics were excluded. Results The initial search identified 1,039 articles, of which seven were selected, and only one met the inclusion criteria. This study showed that subjects taking metronidazole and amoxicillin at the initial phase of treatment exhibited statistically significantly greater reduction in pocket depth and gain in clinical attachment level in initially deep sites (PD≥7 mm) than subjects taking antibiotics after healing (p<0.05). This comparison was conducted 2 months after antibiotic intake, at the healing phase. Conclusion To date, only one short-term RCT has directly compared different moments of systemic antibiotics administration, as adjuncts to SRP, in the treatment of periodontitis. Although the results of this study suggested some benefits for antibiotics intake during the active phase of therapy, these findings need to be confirmed by larger placebo-controlled randomized clinical trials with longer follow-up periods. .

Assessment of tissue oxygenation of periodontal inflammation in smokers using optical spectroscopy.

BACKGROUND: We have recently developed a periodontal diagnostic tool that was validated in non-smokers with periodontitis. Tobacco smoking is a recognized risk factor for periodontal diseases that can mask gingival bleeding and lead to a false negative diagnosis. Therefore, the purpose of current study is to further validate this instrument in smokers with periodontal diseases. METHODS: Using a portable optical near-infrared spectrometer, optical spectra were obtained, processed and evaluated from healthy (n = 108), gingivitis (n = 100), and periodontitis (n = 79) sites of 54 systemically healthy smokers. A modified Beer-Lambert unmixing model that incorporates a non-parametric scattering loss function was used to determine the relative contribution of deoxygenated haemoglobin (Hb) and oxygenated haemoglobin (HbO2 ) to the overall spectrum. The balance between tissue oxygen delivery and utilization in periodontal tissues was then assessed. RESULTS: Tissue oxygen saturation was significantly decreased in the gingivitis (p = 0.016) and periodontitis (p = 0.007) sites, compared to the healthy sites. There was a trend towards increased concentration of Hb and decreased concentration of HbO2 from healthy to diseased sites, without statistical significance (p > 0.05). CONCLUSIONS: Optical spectroscopy can determine tissue oxygenation profiles of healthy and diseased sites in smokers. The spectral profile of periodontal sites in smokers generally resembles those from non-smoking patients.

The effects of adjunctive metronidazole plus amoxicillin in the treatment of generalized aggressive periodontitis: a 1-year double-blinded, placebo-controlled, randomized clinical trial.

AIM: To evaluate the clinical effects of the adjunctive use of metronidazole (MTZ) and amoxicillin (AMX) in the treatment of generalized aggressive periodontitis (GAgP). METHODS: Thirty subjects were randomly assigned to receive scaling and root planing (SRP) alone or combined with MTZ (400 mg/TID) and AMX (500 mg/TID) for 14 days. Subjects were clinically monitored at baseline, 6 months and 1 year post-therapies. RESULTS: Both therapies led to a statistically significant improvement in all clinical parameters at 1 year post-therapy (p < 0.05). Subjects receiving MTZ plus AMX exhibited the deepest reductions in mean probing depth (PD) and gain in clinical attachment between baseline and 1 year post-therapy in the full-mouth analysis and in initially intermediate (PD 4-6 mm) and deep (PD ≥ 7 mm) sites (p < 0.01). In addition, the antibiotic group presented lower mean number of residual sites with PD ≥ 5 or 6 mm as well as fewer subjects still presenting nine or more sites with PD ≥ 5 mm or three or more sites with PD ≥ 6 mm at the end of the study period. CONCLUSION: The non-surgical treatment of GAgP is markedly improved by the adjunctive use of MTZ+AMX, up to 1 year post-treatment.

Prevalência de Archaea em indivíduos com doença periodontal e saúde periodontal / Prevalence of Archaea in subjets with periodontal disease and periodontally healthy

Apesar de micro-organismos do domínio Archaea já terem sido detectados em amostras de biofilme subgengival de indivíduos com periodontite, nenhum estudo comparou diretamente a associação de Archaea com as periodontites crônica e agressiva. Assim sendo, o objetivo desse estudo foi avaliar a prevalência do domínio Archaea em indivíduos com periodontite crônica generalizada (PCrG), periodontite agressiva generalizada (PAgG) e indivíduos com saúde periodontal (SP), e correlacionar os achados microbiológicos com o aumento da profundidade de sondagem (PS). Foram selecionados 15 indivíduos com PCrG, 15 com PAgG e 15 com SP. Inicialmente, os indivíduos foram submetidos ao exame clínico-periodontal. Em seguida, amostras de biofilme subgengival foram coletadas de 9 sítios nos indivíduos do grupo SP e de 9 sítios (PS <3mm, 3 PS 4-6mm e 3 PS >7mm) nos indivíduos dos grupos PCrG e PAgG. Após a extração do DNA, as amostras foram submetidas à reação de amplificação do gene 16S rRNA de Archaea. A presença de Archaeafoi detectada em 11/15 indivíduos do grupo PCrG, em 9/15 indivíduos com PAgG e 12/15 indivíduos com SP (p>0,05). Em relação ao número de amostras positivas, foram 21 no grupo SP, 39 no PAgG e 43 no PCrG observados. Não foram observadas diferenças estatísticas entre os diferentes grupos experimentais (p>0,05) e também não houve correlação entre a presença de Archaea e as diferentes categorias de profundidade de sondagem. Em conclusão, sugere-se ausência de associação entre a detecção de Archaea e a periodontite.

Archaea has been detected in subgingival biofilm samples from individuals with periodontitis, however, no studies were found to enable a direct comparison of the association of Archaea with chronic and aggressive periodontitis. Therefore, the aim of the present study was to evaluate the prevalence of the Archaea domine in individuals with generalized chronic periodontitis (GCrP), generalized aggressive periodontitis (GAgP) and periodontal healthy (PH) and correlation these finding with the increase of probing depth (PD). Fifteen individuals with GCrP, fifteen individuals with GAgP and fifteen individuals with PH were selected. The individuals were submitted a clinical periodontal examination. Subgingival biofilm samples were collected from 9 sites in the PH group and 9 sites (3 PD ¡Ü3mm, 3 PD 4-6mm and 3 PD ¡Ý7mm) in the 30 individuals in the GAgP and GCrP groups. After the DNA extraction, the presence of Archaea was analyzed by polymerase chair reaction (PCR). The occurrence of Archaea was detected in 11/15 individuals in the GCrP group, 9/15 individuals with GAgP and 12/15 individuals with SP (p>0.05). Among the individuals of with SP, PAgG and PCrG, 21, 39 and 43 samples were positive for Archaea, respectively. However, there were no statistical differences observed among experimental groups (p>0.05). There was no correlation between the presence of Archaea and the different probing depth categories. In conclusion, these results suggest the absence of association between the detection of Archaeaand periodontitis.