Evaluation of acceptance and preference of topical lidocaine application versus articaine injection anesthesia after nonsurgical periodontal treatment: A randomized clinical trial.

BACKGROUND: To compare acceptance and preference of topical lidocaine gel anesthesia with articaine injection anesthesia in patients with moderate periodontitis undergoing scaling and root debridement. METHODS: Ninety-one patients completed this randomized multicenter split-mouth controlled study and underwent two separate periodontal treatment sessions on different days, one with a topical intrapocket lidocaine gel application and the other with an articaine injection anesthesia in a different order depending on randomization. Parameters measured were the patients' preference for topical lidocaine gel anesthesia or injection anesthesia with articaine (primary efficacy criterion), their maximum and average pain, and their intensity of numbness as well as experience of side effects; the probing depth; and the dentists' preference and their evaluations of handling/application, onset and duration of anesthetic effect, and patient compliance. RESULTS: After having experienced both alternatives, 58.3% of the patients preferred the topical lidocaine gel instillation into the periodontal pockets. The safety profile of the lidocaine gel differed positively from the safety profile of articaine injection in type and frequency of adverse drug reactions. The dentists' acceptance and preference regarding either anesthetic method studied were balanced. CONCLUSIONS: Instillation of lidocaine gel into the periodontal pocket is a preferred alternative to injection anesthesia for most of the patients and an equivalent alternative for dentists in nonsurgical periodontal therapy.

The Impact of Implant Abutment Angle and Height on Peri-implant Tissue Health: Retrospective Analyses from a Randomized Controlled Clinical Trial.

PURPOSE: To examine the influence of abutment emergence angle and abutment height on marginal peri-implant bone stability in patients not considered susceptible to peri-implantitis. Furthermore, it was analyzed whether titanium-base (Ti-base) abutments lead to wider abutment emergence angles compared to one-piece abutments. MATERIALS AND METHODS: A total of 48 abutments (ie, 24 Ti-base and 24 one-piece abutments in 24 patients) were evaluated at abutment installation, after 1 year, and thereafter on a yearly basis for up to 5 years. Clinical and radiographic outcome variables were assessed. RESULTS: With regard to peri-implant marginal bone stability, only moderately negative, albeit significant, correlations were found on the mesial sides of the one-piece abutments after 4 and 5 years for an abutment emergence angle > 30 degrees. No statistically significant negative correlations were found for distances of ≤ 1.5 mm between the restoration margin and the crestal peri-implant bone level for either Ti-base or for one-piece abutments. Furthermore, abutments bonded to Ti-bases were not associated with larger emergence angles than one-piece abutments. CONCLUSIONS: For patients at low risk of developing peri-implantitis, it can be concluded that neither a larger abutment emergence angle (> 30 degrees) nor a distance of ≤ 1.5 mm between the restoration margin and the crestal peri-implant bone level are associated with marginal peri-implant bone loss. Furthermore, abutments bonded to Ti-bases are not associated with wider emergence angles than one-piece abutments.

Glucose-6-Phosphatase-Dehydrogenase activity as modulative association between Parkinson's disease and periodontitis.

The association between periodontitis (PD) and Parkinson's disease (PK) is discussed due to the inflammatory component of neurodegenerative processes. PK severity and affected areas were determined using the following neuropsychological tests: Unified Parkinson's Disease Rating Score (UPDRS) and Hoehn and Yahr; non-motoric symptoms by Non-Motor Symptoms Scale (NMSS), and cognitive involvement by Mini-Mental State Examination (MMSE). Neuroinflammation and the resulting Glucose-6-Phosphatase-Dehydrogenase (G6PD) dysfunction are part of the pathophysiology of PK. This study aimed to evaluate these associations in periodontal inflammation. Clinical data and saliva-, serum-, and RNA-biobank samples of 50 well-characterized diametric patients with PK and five age- and sex-matched neurologically healthy participants were analyzed for G6PD function, periodontal pathogens (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella intermedia, Campylobacter rectus, Fusobacterium nucleatum, and Filifactor alocis), monocyte chemoattractant protein (MCP) 1, and interleukin (IL) 1-beta. Regression analysis was used to identify associations between clinical and behavioral data, and t-tests were used to compare health and disease. Compared with PK, no pathogens and lower inflammatory markers (p < 0.001) were detectible in healthy saliva and serum, PK-severity/UPDRS interrelated with the occurrence of Prevotella intermedia in serum as well as IL1-beta levels in serum and saliva (p = 0.006, 0.019, 0.034), Hoehn and Yahr correlated with Porphyromonas gingivalis, Prevotella intermedia, RNA IL1-beta regulation, serum, and saliva IL1-beta levels, with p-values of 0.038, 0.011, 0.008, <0.001, and 0.010, while MMSE was associated with Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, serum MCP 1 levels, RNA IL1-beta regulation and G6PD serum activity (p = 0.036, 0.003, 0.045, <0.001, and 0.021). Cognitive and motor skills seem to be important as representative tests are associated with periodontal pathogens and oral/general inflammation, wherein G6PD-saliva dysfunction might be involved. Clinical trial registration: https://www.bfarm.de/DE/Das-BfArM/Aufgaben/Deutsches-Register-Klinischer-Studien/_node.html, identifier DRKS00005388.

Supra and subgingival application of antiseptics or antibiotics during periodontal therapy.

Periodontal diseases (gingivitis and periodontitis) are characterized by inflammatory processes which arise as a result of disruption of the balance in the oral ecosystem. According to the current S3 level clinical practice guidelines, therapy of patients with periodontitis involves a stepwise approach that includes the control of the patient's risk factors and the debridement of supra and subgingival biofilm. This debridement can be performed with or without the use of some adjuvant therapies, including physical or chemical agents, host modulating agents, subgingivally locally delivered antimicrobials, or systemic antimicrobials. Therefore, the main aim of this article is to review in a narrative manner the existing literature regarding the adjuvant application of local agents, either subgingivally delivered antibiotics and antiseptics or supragingivally applied rinses and dentifrices, during the different steps in periodontal therapy performed in Europe.

The impact of implant abutment angle and height on peri-implant tissue health: Retrospective analyses from a randomized, controlled, clinical trial.

PURPOSE: Implant abutment design may influence the predisposition of peri-implant sites to develop peri-implant inflammation, especially peri-implantitis. Therefore, the objectives of the current study were to examine the influence of (1) abutment emergence angle and, (2) abutment height on marginal periimplant bone stability in patients not considered susceptible to peri-implantitis. Furthermore, it was analyzed (3) whether Ti-Base abutments lead to wider abutment emergence angles as compared to onepiece abutments. MATERIALS AND METHODS: 48 abutments (i.e., 24 Ti-base- and 24 one-piece abutments in 24 patients) have been at abutment installation, after one year, and thereafter on a yearly basis for up to five years. Clinical and radiographic outcome variables were assessed. RESULTS: With regard to peri-implant marginal bone stability, (1) only moderately negative, albeit significant, correlations were found on the mesial sides of the one-piece abutments after 4 and 5 years for an abutment emergence angle >30° and no statistically significant negative correlations were found between a distance of less than or equal to versus more than 1.5 mm between the restoration margin and the crestal peri-implant bone level, neither for Ti-Base nor for one-piece abutments. Furthermore, (3) abutments bonded to Ti-bases are not associated with larger emergence angles than one-piece abutments. CONCLUSION: For patients at low risk of developing peri-implantitis it can be concluded, that neither (1) a larger abutment emergence angle (>30°) nor (2) a distance of less than or equal to 1.5 mm between the restoration margin and the crestal peri-implant bone level are per se associated with marginal periimplant bone loss. Furthermore, (3) abutments bonded to Ti-bases are not as such associated with wider emergence angles than one-piece abutments. Int J Prosthodont 2023. doi: 10.11607/ijp.8138.

Clinical, microbiological, and immunological effects of 3- or 7-day systemic antibiotics adjunctive to subgingival instrumentation in patients with aggressive (Stage III/IV Grade C) periodontitis: A randomized placebo-controlled clinical trial.

AIM: To evaluate the clinical non-inferiority of a 3-day protocol of systemic antibiotics adjunctive to subgingival instrumentation (SI) compared with a 7-day-protocol in patients with Stage III/IV Grade C periodontitis. MATERIALS AND METHODS: Fifty systemically healthy patients (32.7 ± 4.3 years) with aggressive periodontitis (AgP; Stage III/IV Grade C periodontitis) were treated by SI and adjunctive amoxicillin and metronidazole and were randomly assigned to Group A: (n = 25) 500 mg antibiotics (AB) 3 times a day for 3 days, followed by placebo 3 times a day for 4 days, or Group B: (n = 25) 500 mg AB 3 times a day for 7 days. Clinical, microbial, and immunological parameters were assessed at baseline, 3 months, and 6 months, and patient-related outcomes were assessed after 2 weeks. The primary outcome variable was the number of residual sites with pocket depth (PD) ≥6 mm at 6 months. RESULTS: For the primary outcome variable (the number of residual sites with PD ≥6 mm at 6 months), the null hypothesis was rejected and non-inferiority of the 3-day AB protocol compared with the 7-day AB protocol was demonstrated (the upper limits of the 95% confidence interval for intention to treat analysis: [-2.572; 1.050] and per protocol analysis: [-2.523; 1.318] were lower than the assumed margin of Δ = 3.1). Comparable clinical improvements were obtained for all parameters with both antibiotic protocols (p > .05). All investigated periodontopathogens and pro-inflammatory host-derived markers were statistically significantly reduced without differences between the treatments (p > .05). CONCLUSIONS: These findings indicate that in patients with AgP (Stage III/IV Grade C periodontitis), a 3-day systemic administration of amoxicillin and metronidazole adjunctive to SI may lead to non-inferior clinical outcomes after 6-months with fewer adverse events compared with a 7-day-protocol.

One-Year Clinical, Microbiological and Immunological Results of Local Doxycycline or Antimicrobial Photodynamic Therapy for Recurrent/Persisting Periodontal Pockets: A Randomized Clinical Trial.

We evaluated, in this study, the clinical, microbiological and immunological effects of local drug delivery (LDD) or photodynamic therapy (PDT), adjunctive to subgingival instrumentation (SI) in persistent or recurrent periodontal pockets in patients enrolled in supportive periodontal therapy (SPT) after one year. A total of 105 patients enrolled in SPT with persistent/recurrent pockets were randomly treated with SI +PDT or SI + LDD or SI (control). The number of treated sites with bleeding on probing (n BOP+), probing pocket depths (PPD), clinical attachment level (CAL), full-mouth plaque and bleeding scores (gingival bleeding index, %bleeding on probing-BOP) was evaluated at baseline and after 12 months. Additionally, eight periodontopathogens and the immunomarkers IL-1ß (interleukin)and MMP-8 (matrix metalloprotease) were quantitatively determined using real-time PCR and ELISA, respectively. All three treatments resulted in statistically significant clinical improvements (p < 0.05) without statistically significant intergroup differences (p > 0.05), which were maintained up to 12 months. The presence of BOP negatively affected the PPD and CAL. Moreover, statistically significantly fewer bleeding sites at 12 months were observed in the test groups (p = 0.049). Several periodontopathogens were reduced after 12 months. In conclusion, the present data indicate that in periodontal patients enrolled in SPT, treatment of persistent/recurrent pockets with SI alone or combined with either PDT or LDD may lead to comparable clinical, microbiological and immunological improvements, which are maintained up to 12 months. Secondly, the presence of BOP directly impacts the PPD and CAL.

Influence of Anti-Infective Periodontal Therapy on Subgingival Microbiota Evaluated by Chair-Side Test Compared to qPCR-A Clinical Follow-Up Study.

A chair-side test (CST) for five periodontal pathogens (Aggregatibacter actinomycetemcomitans, A.a.; Porphyromonas gingivalis, P.g.; Prevotella intermedia, P.i.; Treponema denticola, T.d.; Tannerella forsythia, T.f.) was compared with qPCR in a previous clinical study on 100 periodontitis patients at first diagnosis (T0). Following non-surgical treatment alone (SRP) or in combination with systemic or local antibiotics, 74 patients (57.4 ± 13.5 years) were again tested at the same sites from 14 to 24 months after T0. Bacterial elimination (%; compared to T0) was determined for each single species and compared between both test systems. In all patients, all five pathogens could not be fully eliminated regardless of therapy or test method. Tested with CST, the mean elimination ranged from 90% for SRP + Amoxicillin/Metronidazole to 59.13% for SRP only. The corresponding qPCR values were 30% and 29.6%. Only A.a. was eradicated in 100% by SRP + Amoxicillin/Metronidazole tested by CST, and it was 80% when qPCR was the test method. CST agreed with qPCR in 98.7% in the detection of A.a., and 74.3%, 78.4%, 73.0%, and 48.7% for P.g., P.i., T.d., and T.f., respectively. Neither conventional treatment nor the additional use of antibiotics-even with the correct indication-could completely eradicate the tested pathogens or prevent pocket reinfection.

Long-term effects of titanium-base abutments on peri-implant health: A 5-year randomised controlled trial.

PURPOSE: Titanium bases are used frequently in daily practice for bonding to CAD/CAM abutments or crowns. Due to intimate contact between the adhesive gap of the titanium-base abutment and the peri-implant bone, the physical and chemical characteristics of the bonding material, or the gap itself, may affect peri-implant inflammatory reactions. The present study therefore aimed to examine the long-term effects of individualised abutments bonded to titanium bases on peri-implant health. MATERIALS AND METHODS: A total of 24 patients, each with one test and one control abutment, participated in the present prospective, single-blind, randomised controlled clinical trial. The test abutments were CAD/CAM titanium abutments bonded to titanium bases. As the control abutments were individualised, one-piece CAD/CAM titanium abutments were used. Clinical and radiographic parameters were assessed at abutment insertion and then on a yearly basis over the following 5 years. RESULTS: No significant differences in marginal bone level were observed between the titanium-base and one-piece abutments at any of the follow-up time points; however, when intragroup marginal bone levels were compared to the baseline values, significant differences were found at several follow-up time points. Intergroup differences were only found to be significant for pocket depth at the 4- (P = 0.006) and 5-year follow-ups (P = 0.024), favouring titanium-base abutments. CONCLUSIONS: Within the limitations of the present study, it appears that the peri-implant tissues of this specific patient cohort responded to titanium-base abutments in a rather similar manner to one-piece abutments over a 5-year period; however, no definitive conclusions can be drawn due to the low power of the present study.

Soft Tissue Regeneration at Natural Teeth.

This article provides an overview of the best-documented surgical techniques for recession coverage and draws conclusions for the clinician. Use of a connective tissue graft with either coronally advanced flap (CAF) or tunnel is the most predictable technique for the treatment of single and multiple gingival recessions. Long-term results exist only for CAF with/without connective tissue graft providing evidence for long-term stability with only minor relapses. Soft tissue replacement materials and biologics may represent a valuable modality to additionally improve the clinical outcomes obtained with CAF alone or, in certain clinical situations, to serve as an alternative to autogenous tissue.

Antibacterial Action, Substantivity and Anti-plaque Effect of Different Toothpaste Slurries - A Randomised Controlled Trial.

PURPOSE: This single-center, clinically controlled, double-blinded, randomised, crossover study aimed to evaluate and compare the antibacterial effect, substantivity and patients' acceptance of three toothpaste slurries after a single application on established biofilms observed for 24 h. MATERIALS AND METHODS: Twenty-four participants started a test cycle after refraining from oral hygiene for 48 h, with a baseline plaque sample measuring biofilm vitality (in %; VF0) using vital fluorescence (VF). They were instructed to rinse for 1 min with either an amine fluoride, stannous chloride (ASC), an herbal (SBC) or a sodium fluoride (SFL) toothpaste prepared as slurries. Every two hours up to 12 and after 24 h, plaque samples were harvested (VF2-VF24%). Plaque-covered areas (PA in %) were evaluated after 24 h using digital photographs. Patients' acceptance was determined by visual analogue scale (VAS) questionnaire. RESULTS: All participants (16 women, 8 men; 27.5 ± 7.9 years) completed all cycles. Two hours after application (VF2), all toothpastes showed a statistically significant reduction in bacterial vitality (p < 0.05), maintained up to 12 h. ASC revealed statistically significantly lower vitality values compared to SBC at VF2, VF4, VF8, VF12 and VF24, and at VF4, VF12 and VF24 compared to SFL (p < 0.05), while SBC and SFL did not differ statistically significantly at any time point. The preferred toothpastes were SFL (18/24 participants) and ASC (15/24 participants). CONCLUSIONS: All toothpastes showed statistically significant anti-plaque effects on established plaque biofilm and a substantivity up to 24 h compared to their baseline, while ASC still presented a statistically significant effect after 12 and 24 h compared to SBC and SFL.

Two-year outcomes following the adjunctive use of InGaAsP and Er,Cr:YSGG lasers in nonsurgical periodontal therapy in patients with stages III and IV periodontitis.

OBJECTIVE: To evaluate the clinical outcomes 2 years after the adjunctive use of an InGaAsP diode and Er,Cr:YSGG laser for nonsurgical treatment of severe periodontitis. METHOD AND MATERIALS: Forty-two patients (45.31 ± 9.78 years old, n = 22 females, n = 23 smokers) with stage III or IV grade B periodontitis were randomly treated either with laser (InGaAsP + Er,Cr:YSGG) adjunctive to subgingival debridement (test group, n = 21) or with subgingival debridement alone (control group, n = 21). Subjects in the test group received a second laser treatment in residual sites 2 months after the initial laser therapy. At baseline, and at 12 and 24 months after therapy, periodontal clinical parameters were evaluated. The primary outcome variable was the number of residual deep sites at 12 months (probing depth [PD] ≥ 6 mm). RESULTS: One and two years after nonsurgical periodontal treatment, both groups yielded statistically significant clinical improvements. The adjunctive use of InGaAsP and Er,Cr:YSGG laser to mechanical debridement resulted in statistically significantly higher clinical (PD, clinical attachment level, bleeding on probing, number of sites with PD ≥ 5 mm, PD ≥ 6 mm, PD ≥ 7 mm) improvements (P < .05) compared to subgingival debridement alone both at 12 and 24 months after therapy. CONCLUSION: In patients with stage III or IV grade B periodontitis, InGaAsP and Er,Cr:YSGG used adjunctively to subgingival debridement may additionally improve the clinical outcomes compared to mechanical debridement alone over a period of 24 months.

Dental Biofilm and Saliva Microbiome and Its Interplay with Pediatric Allergies.

Little is known about the interplay and contribution of oral microorganisms to allergic diseases, especially in children. The aim of the clinical study was to associate saliva and dental biofilm microbiome with allergic disease, in particular with allergic asthma. In a single-center study, allergic/asthmatic children (n = 15; AA-Chd; age 10.7 ± 2.9), atopic/allergic children (n = 16; AT/AL-Chd; 11.3 ± 2.9), and healthy controls (n = 15; CON-Chd; age 9.9 ± 2.2) were recruited. After removing adhering biofilms from teeth and collecting saliva, microbiome was analyzed by using a 16s-rRNA gene-based next-generation sequencing in these two mediums. Microbiome structure differed significantly between saliva and dental biofilms (ß-diversity). Within the groups, the dental biofilm microbiome of AA-Chd and AT/AL-Chd showed a similar microbial fingerprint characterized by only a small number of taxa that were enriched or depleted (4) compared to the CON-Chd, while both diseased groups showed a stronger microbial shift compared to CON-Chd, revealing 14 taxa in AA-Chd and 15 taxa in AT/AL-Chd that were different. This could be the first note to the contribution of dental biofilm and its metabolic activity to allergic health or disease.

Clinical and Microbiological Evaluation of Local Doxycycline and Antimicrobial Photodynamic Therapy during Supportive Periodontal Therapy: A Randomized Clinical Trial.

The aim of this study was to evaluate the clinical and microbiological effects of subgingival instrumentation (SI) alone or combined with either local drug delivery (LDD) or photodynamic therapy (PDT) in persistent/recurrent pockets in patients enrolled in supportive periodontal therapy (SPT). A total of 105 patients enrolled in SPT were randomly treated as follows: group A (n = 35): SI +PDT and 7 days later 2nd PDT; group B (n = 35): SI+LDD; group C (n = 35): SI (control). Prior intervention, at 3 and 6 months after therapy, probing pocket depths, clinical attachment level, number of treated sites with bleeding on probing (n BOP), full mouth plaque and bleeding scores (gingival bleeding index, %BOP) were recorded. At the same time points, 8 periodontopathogens were quantitatively determined. All three treatments resulted in statistically significant improvements (p < 0.05) of all clinical parameters without statistically significant intergroup differences (p > 0.05). Several bacterial species were reduced in both test groups, with statistically significantly higher reductions for LDD compared to PDT and the control group. In conclusion, the present data indicate that: (a) In periodontal patients enrolled in SPT, treatment of persistent/recurrent pockets with SI alone or combined with either PDT or LDD may lead to comparable clinical improvements and (b) the adjunctive use of LDD appears to provide better microbiological improvements for some periodontal pathogens than SI alone or combined with PDT.

Oral Mouth Rinses against Supragingival Biofilm and Gingival Inflammation.

Caries and inflammatory periodontal diseases have a high prevalence worldwide. Although improvements in oral health status in our patients have been shown, there is still an increased demand for preventive measurements - especially in view of the systemic influence of the chronic disease periodontitis. The main focus of such measurements lies on an optimal biofilm management which can be divided into professional biofilm management and home care measurements. Since home care mechanical measurements such as toothbrushing and interdental cleaning are often insufficient or not on a regular basis, they can be supported by antibacterial agents which are able to inhibit or kill any oral microorganisms that remain. Besides a proven effect on plaque bacteria and gingival inflammation, agents should have a high substantivity in the oral cavity that outlast the short rinsing period. This chapter aims to present the background and rationale of using antibacterial mouth rinses, their common agents, to show sensible indications, and to evaluate the scientific evidence of their additional effect over toothbrushing alone.

Clinical Evaluation of a New Electronic Periodontal Probe: A Randomized Controlled Clinical Trial.

Precise measurements of periodontal parameters (such as pocket depths: PPD, gingival margins: GM) are important for diagnosis of periodontal disease and its treatment. Most examiners use manual millimeter-scaled probes, dependent on adequate pressure and correct readouts. Electronic probes aim to objectify and facilitate the diagnostic process. This randomized controlled trial compared measurements of a standard manual (MP) with those of an electronic pressure-sensitive periodontal probe (EP) and its influence on patients' acceptance and practicability. In 20 patients (2436 measuring points) PPD and GM were measured either with MP or EP by professionals with different levels of experience: dentist (10 patients), 7th and 10th semester dental students (5 patients each). Time needed was measured in minutes and patients' subjective pain was evaluated by visual analogue scale. Differences were analyzed using the generalized estimating equations approach (GEE) and paired Wilcoxon tests. Mean PPD varied with ΔPPD 0.38 mm between both probes, which was significant (p < 0.001), but GM did not (ΔREC 0.07 mm, p = 0.197). There was a statistically significant correlation of both probes (Spearman's rho correlation coefficient GM: 0.674, PPD: 0.685). Differences can be considered robust (no deviation in either direction). The comparison of time needed and pain sensitivity did not result in statistically significant differences (p > 0.05).

Retrospective analysis of the long-term effect of subgingival air polishing in supportive periodontal therapy.

AIM: Glycine powder air polishing (GPAP) procedure has become popular. Aim of the analysis was to compare the clinical outcomes during supportive periodontal therapy (SPT) of subgingival application of GPAP with those using sole conventional mechanical debridement (SC). MATERIAL AND METHODS: Over a median SPT period of 5.3 years (re-evaluation through last observation), the GPAP cohort (n = 263) received supra- and subgingival biofilm removal with GPAP. Supragingival calculus was removed using curets and sonic scalers here. Patients in the SC cohort (n = 264) were treated with sonic scalers, curets and rubber cup polishing only. Changes in, that is pocket probing depth (PPD) and furcation involvement were assessed retrospectively. A bootstrapping equivalence testing method in line with the principle of the two one-sided tests (TOST) procedure was used to compare clinical outcomes. RESULTS: The GPAP procedure was statistically equivalent to SC regarding the number of sites with stable PPDs (83.3%; IQR 68.8%, 91.0% vs. 84.0%; IQR 77.8%, 90.0%). However, in the GPAP cohort, a trend towards deterioration in furcation status (no equivalence) was noted. CONCLUSIONS: In periodontal maintenance, the use of GPAP instead of mechanical plaque removal does not improve the clinical outcome. It seems to be contraindicated to treat furcation defects with GPAP only.

Influence of Probiotics on the Salivary Microflora Oral Streptococci and Their Integration into Oral Biofilm.

Probiotics' ability to integrate into dental biofilms is not yet clarified. The aim of this trial was to detect probiotic bacteria from probiotic products in dental biofilm and saliva during and after intake. In this parallel, randomized clinical trial, 39 subjects wore customized appliances to build up intra-oral biofilms (72-h periods). The trial was divided into screening (S) to determine baseline biofilm flora, intervention (I), and wash out (WO). During I (28 days), subjects consumed a product containing (a) Enterococcus faecalis (b) Lactobacilluscasei, or (c) Lactobacillus rhamnosus GG. Probiotic bacteria and Streptococci spp. were detected in the biofilms and saliva of the 35 subjects that were included in the analysis. During I and WO, the ratio of probiotics in the biofilm was very low compared to total bacterial load, while saliva had slightly but not significantly higher values. No significant changes of probiotic bacteria (p > 0.05) were found at any visit during I or WO. The proportion of streptococci was significantly reduced (p < 0.05) during I and even lower in WO, compared to S. Probiotic bacteria could neither integrate nor persist in dental biofilm and saliva but did influence the growth of streptococci in biofilm and saliva.

Photodynamic therapy in oral lichen planus: A prospective case-controlled pilot study.

Oral lichen planus (OLP) is a common, chronic relapsing inflammatory disorder of the mucous membranes, which causes major discomfort. Current treatment includes topical/systemic glucocorticoids, immune modulators and systemic immunosuppressants, which may lead to considerable side-effects. The aim of this study was to determine the clinical and immunological efficacy of photodynamic therapy (PDT) in OLP as an alternative, easy-to-use, safe and non-invasive treatment. Twenty patients with OLP were treated with PDT in a prospective case-controlled pilot-study. PDT was performed on the most extensive oral lesion in 4 sessions (day 1, 3, 7, 14). Peripheral blood and lesional T cells were analysed before (day 1) and after PDT treatment (day 28). PDT led to a statistically significant reduction of clinical parameters (lesion size, ABSIS, Thongprasom-score) and improvement of all evaluated quality-of-life (QOL) items. The clinical improvement was accompanied by a significant decrease of the relative number of CD4+ and CD8+ T cells in mucosal OLP-lesions. Furthermore, CXCL10 plasma levels were decreased and the number of activated peripheral CD4 + CD137+ and CD8 + CD137+ T cells and IL-17-secreting T cells was diminished. PDT treatment in OLP leads to lesion reduction and improvement of QOL, and induces local and systemic anti-inflammatory effects. The study identifies PDT as a novel therapeutic option in OLP.

Clinical evaluation of a newly developed chairside test to determine periodontal pathogens.

BACKGROUND: The subgingival microbiota as well as determination of markers such as associated pathogens is still in the focus of dental research. The aim of this controlled clinical trial was to determine clinical applicability of a newly developed chairside bacterial test (CST) for the most relevant periodontal pathogens. METHODS: Within 125 participants (100 with periodontitis, 25 healthy) two sulcus fluid samples each were collected and pooled for further analysis. Samples were analyzed with CST and results (positive signals for every pathogen/control) were visually detected by eye. As a reference quantitative polymerase chain reaction (qPCR) was performed. RESULTS: The detection limit of CST revealed 1.2 × 104 for Treponema denticola (T.d.) and Tannerella forsythia (T.f.), 2.5 × 104 for Porphyromonas gingivalis (P.g.), 5.3 × 103 for Prevotella intermedia (P.i.), and 5.8 × 104 for Aggregatibacter actinomycetemcomitans (A.a.). Based on this maximum potential of positive detections, the sensitivities of CST in reference to qPCR were: T.d. (91.3%); T.f. (86.3%); P.g. (83.8%); P.i. (85.7%), and A.a. (100%). In regard to the clinical diagnosis, the CST assay and the qPCR method reached a sensitivity of 87.82% and 94%, respectively. The specificity for both methods was 100%. CONCLUSION: This newly developed CST can detect five typical periodontal pathogens with a somewhat lower sensitivity towards qPCR that can be classified as "good."