Enamel matrix derivative and subgingival reinstrumentation: a pilot study.

OBJECTIVES: To verify the effect of adjunctive enamel matrix derivative (EMD) in subgingival reinstrumentation during supportive periodontal therapy. METHOD AND MATERIALS: Using a split-mouth design, residual periodontal pockets with probing depth (PD) of 5 to 8 mm in 13 patients were treated by subgingival reinstrumentation with (test teeth) and without (control teeth) EMD. At baseline and after 6 and 12 months the clinical variables PD, clinical attachment level (CAL), and bleeding on probing (BOP) were recorded. At the same appointments gingival crevicular fluid (GCF) was collected to analyze for interleukin (IL)-1ß, matrix metalloproteinase (MMP)-8, IL-10, and transforming growth factor (TGF)-ß. RESULTS: Statistically significant improvements in PD, CAL, and BOP occurred in both groups. The reduction of PD was significantly higher in the test group than in the control group after 12 months (P = .005). The change of IL-1ß within 12 months was significantly different between both groups (P = .019). No other significant differences were detected between both groups. CONCLUSION: The study suggests that subgingival reinstrumentation with adjunctive EMD could additionally reduce probing pocket depth and the need for periodontal surgery. (Quintessence Int 2021;52:506-513; doi: 10.3290/j.qi.b1044079).

Flapless application of enamel matrix derivative in periodontal retreatment: A multicentre randomized feasibility trial.

AIM: To investigate the potential benefit of enamel matrix derivative (EMD) as adjunct to re-instrumentation of residual pockets persisting after steps 1 and 2 of periodontal therapy. MATERIAL AND METHODS: 44 adult patients participated in a multicentre feasibility randomized clinical trial with split-mouth design. They had presented at re-evaluation after initial non-surgical periodontal therapy (steps 1 and 2 of periodontal therapy) for generalized periodontitis with at least 2 teeth with residual probing pocket depths (PPD) ≥5 and ≤8 mm, with bleeding on probing (BOP). Two teeth with similar PPD were randomized to receive re-instrumentation either with (test) or without (control) adjunctive flapless administration of EMD. Differences in the changes of PPD and BOP from baseline to 6 and 12 months were analysed, and the frequencies of pocket closure (PPD ≤4 mm and no BOP) compared. RESULTS: For the primary outcome "change of mean PPD after 6 months," a significant additional benefit of 0.79 ± 1.3 mm (p < .0001) could be observed for the test group. At 12 months, this difference could be maintained (0.85 ± 1.1 mm; p < .0001). The frequency of pocket closure in the test group was 69% at 6 and 80% at 12 months and significantly higher than in the control group with 34% and 42%, respectively (p < .01). CONCLUSIONS: The results of the present feasibility study indicate a benefit of adjunctive EMD during non-surgical retreatment (step 3 of periodontal therapy) of residual deep pockets.

Actual Concepts for Individual Interdental Biofilm Removal.

The intraoral biofilm requires mechanical removal due to its physical properties. When exposed to the biofilm, interdental areas need special devices to be used. The most effective ones and the first choice are interdental brushes. However, they may not be adequate in the case of very narrow interdental spaces. Despite the difficulties in handling, dental floss may have some advantage in subgingival cleaning. Data are present for gingivitis and periodontitis, but almost no information has been published on gingivally healthy individuals. With respect to interdental caries there is evidence that floss only has a protective value when used professionally and without sufficient fluoridation. There are no such data available on interdental brushes.

Adjunctive air-polishing with erythritol in nonsurgical periodontal therapy: a randomized clinical trial.

BACKGROUND: This study was aimed to investigate if the adjunctive use of erythritol air-polishing powder applied with the nozzle-system during subgingival instrumentation (SI) has an effect on the outcome of non-surgical periodontal treatment in patients with moderate to severe periodontitis. METHODS: Fourty-two individuals with periodontitis received nonsurgical periodontal therapy by SI without (controls, n = 21) and with adjunctive air-polishing using nozzle + erythritol powder (test, n = 21). They were analyzed for the clinical variables BOP (primary outcome at six months), probing depth (PD), attachment level, four selected microorganisms and two biomarkers at baseline, before SI as well as three and six months after SI. Statistical analysis included nonparametric tests for intra- and intergroup comparisons. RESULTS: In both groups, the clinical variables PD, attachment level and BOP significantly improved three and six months after SI. The number of sites with PD ≥ 5 mm was significantly lower in the test group than in the control group after six months. At six months versus baseline, there were significant reductions of Tannerella forsythia and Treponema denticola counts as well as lower levels of MMP-8 in the test group. CONCLUSIONS: Subgingival instrumentation with adjunctive erythritol air-polishing powder does not reduce BOP. But it may add beneficial effects like reducing the probing depth measured as number of residual periodontal pocket with PD ≥ 5 mm when compared with subgingival instrumentation only. CLINICAL RELEVANCE: The adjunctive use of erythritol air-polishing powder applied with the nozzle-system during SI may improve the clinical outcome of SI and may reduce the need for periodontal surgery. Trial registration The study was retrospectively registered in the German register of clinical trials, DRKS00015239 on 6th August 2018, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL .

Non-Surgical Periodontal Therapy with Adjunctive Amoxicillin/Metronidazole or Metronidazole When No Aggregatibacter actinomycetemcomitans Is Detected-A Randomized Clinical Trial.

BACKGROUND: The aim was to compare two different systemic antibiotics regimens adjunctive to non-surgical periodontal therapy when Aggregatibacter actinomycetemcomitans was not detected in the subgingival biofilm. METHODS: A total of 58 patients with periodontitis and with no A. actinomycetemcomitans in the subgingival biofilm were treated with full-mouth subgingival instrumentation and either metronidazole (MET; n = 29) or amoxicillin/metronidazole (AMX/MET; n = 29). Probing depth (PD), clinical attachment level (CAL) and bleeding on probing (BOP) were recorded at baseline, as well as after three and six months. Subgingival biofilm and gingival crevicular fluid were collected and analyzed for major periodontopathogens and biomarkers. RESULTS: PD, CAL and BOP improved at 3 and 6 months (each p < 0.001 vs. baseline) with no difference between the groups. Sites with initial PD ≥ 6 mm also improved in both groups after 3 and 6 months (p < 0.001) with a higher reduction of PD in the AMX/MET group (p < 0.05). T. forsythia was lower in the AMX/MET group after 3 months (p < 0.05). MMP-8 and IL-1ß were without significant changes and differences between the groups. CONCLUSION: When A. actinomycetemcomitans was not detected in the subgingival biofilm, the adjunctive systemic use of amoxicillin/metronidazole results in better clinical and microbiological outcomes of non-surgical periodontal therapy when the application of systemic antibiotics is scheduled.

Professional tooth cleaning prior to non-surgical periodontal therapy: A randomized clinical trial.

BACKGROUND: This study was aimed to investigate if professional oral prophylaxis before scaling and root planing (SRP) has an effect on the outcome of non-surgical periodontal treatment in patients with chronic periodontitis. METHODS: Fifty-two individuals with chronic periodontitis receiving non-surgical periodontal therapy by SRP with (test) and without (control) two appointments of professional tooth cleaning but with motivation and instruction were monitored for clinical variables, four selected microorganisms and two biomarkers at baseline, before SRP as well as 3 and 6 months after SRP. Statistical analysis included non-parametric tests for intra- and intergroup comparisons. RESULTS: Probing depth (PD), attachment level, bleeding on probing (BOP), and interproximal plaque index (API) were significantly improved in both groups 3 and 6 months after SRP. PD, BOP, API, and the number of sites with PD ≥5 mm were significantly lower in the test group than in the control group at the appointment immediately before SRP. Tannerella forsythia was significantly reduced in both groups at 3 and 6 months, Porphyromonas gingivalis only in the test group. Interleukin-1ß was significantly reduced in the control group 3 and 6 months after SRP, matrix metalloproteinase-8 level decreased in the test group 3 months after SRP. There was no significant difference of any clinical and non-clinical variable between both groups at 3 and 6 months after SRP. CONCLUSIONS: Professional tooth cleaning before the SRP does not improve the clinical results of the SRP. It has no obvious long-lasting effects on major periodontopathogens in the subgingival biofilm as well as on biomarkers in the gingival crevicular fluid after SRP.

Bacteremia after professional mechanical plaque removal in patients with chronic periodontitis.

OBJECTIVE: The aim of this study was to investigate the characteristics of bacteremia caused by professional mechanical plaque removal (PMPR) in two groups of patients with generalized moderate chronic periodontitis. MATERIALS AND METHODS: Venous blood samples were taken at multiple time points for one hour following PMPR in fifty patients with generalized moderate chronic periodontitis. Subjects consisted of two groups, one group was receiving supportive periodontal therapy (SPT, n = 25) and the other group was receiving initial periodontal therapy (IPT, n = 25). Blood samples were processed and analyzed for cultivable microflora. Pertinent clinical parameters were recorded for each patient in both groups. RESULTS: Bacteremia was detected in 10 of 25 SPT and 8 of 25 IPT patients (p = 0.796). In both groups, the prevalence of bacteremia was dependent on the time of blood sampling and varied in magnitude between <102  CFU/ml and 106  CFU/ml. Sixteen different bacterial species were identified in both groups, mostly Actinomyces naeslundii (SPT n = 3, IPT n = 4) and Streptococcus spp. (SPT n = 6, IPT n = 2). In regression models, Grade II furcation involvement (p = 0.004) and Gingival Bleeding Index (p = 0.036) had affected the occurrence of bacteremia but in the SPT group only. CONCLUSION: Professional mechanical plaque removal was associated with bacteremia regardless of whether a patient was receiving SPT or IPT.

Adjunctive use of essential oils following scaling and root planing -a randomized clinical trial.

BACKGROUND: Hitherto no study has been published on the effect of the adjunctive administration of essential oils following scaling and root planing (SRP). This study describes the effect of a mouthrinse consisting of essential oils (Cymbopogon flexuosus, Thymus zygis and Rosmarinus officinalis) following SRP by clinical and microbiological variables in patients with generalized moderate chronic periodontitis. METHODS: Forty-six patients (aged 40-65 years) with moderate chronic periodontitis were randomized in a double-blind study and rinsed their oral cavity following SRP with an essential oil mouthrinse (n  =  23) or placebo (n  =  23) for 14 days. Probing depth (PD), attachment level (AL), bleeding on probing (BOP) and modified sulcus bleeding index (SBI) were recorded at baseline and after 3 and 6 months. Subgingival plaque was taken for assessment of major bacteria associated with periodontitis. RESULTS: AL, PD, BOP and SBI were significantly improved in both groups after three (p   <   0.001) and 6 months (p   ≤   0.015). AL improved significantly better in the test than in the control group after 3 and 6 months (p < 0.001), so did PD after three months in the tendency (p  =  0.1). BOP improved better in the test group after 3 months (p  =  0.065). Numbers of Treponema denticola (p  =  0.044) and Fusobacterium nucleatum (p  =  0.029) decreased more in the test than in the control group after 3 months, those of Tannerella forsythia after 6 months (p  =  0.039). Prevotella micra (p  <  0.001, p  =  0.035) and Campylobacter rectus (p  =  0.002 , p  =  0.012) decreased significantly in both groups after 3 months. CONCLUSIONS: The adjunctive use of a mouthrinse containing essential oils following SRP has a positive effect on clinical variables and on bacterial levels in the subgingival biofilm. TRIAL REGISTRATION: 332-12-24092012, DRKS 00009387, German Clinical Trials Register, Freiburg i. Br., 16.09.2015.

Periodontal Dressing as an Adjunct after Scaling and Root Planing--A Useful Preventive Tool?

PURPOSE: To determine the preventive effect of a periodontal dressing containing colophony, zinc oxide and magnesium oxide applied after scaling and root planing on clinical variables, subgingival bacteria and local immune response in patients with chronic periodontitis. MATERIALS AND METHODS: In this randomised prospective clinical study, 28 volunteers with generalised moderate chronic periodontitis were treated with full-mouth scaling in a split-mouth design. In the test quadrants, the periodontal dressing was applied during the first three days. At baseline and after 6 and 12 weeks, probing pocket depth (PD), attachment level (AL) and bleeding on probing (BOP) were recorded, and subgingival plaque samples were taken for laboratory analysis. RESULTS: In both groups, PD, AL and BOP were significantly reduced (p=0.001). BOP was significantly lower in the control than the test group after 6 weeks (p=0.046). Significantly reduced bacterial counts of Porphyromonas gingivalis were found in the control group after 12 weeks (p=0.013). No differences were found for the microbiological results between the groups. After 12 weeks, interleukin (IL)-8 and matrix metalloproteinase (MMP)-8 were significantly higher in the test group (p=0.023 and p=0.003, respectively). CONCLUSION: The adjunctive application of a periodontal dressing had no additional preventive effect on clinical data 12 weeks after scaling and root planing.

Nonsurgical therapy of chronic periodontitis with adjunctive systemic azithromycin or amoxicillin/metronidazole.

OBJECTIVES: The objective of the present study is to compare the effect of systemic adjunctive use of azithromycin with amoxicillin/metronidazole to scaling and root planing (SRP) in a clinical study. MATERIALS AND METHODS: Data from 60 individuals with chronic periodontitis were evaluated after full-mouth SRP. Antibiotics were given from the first day of SRP, in the test group (n = 29), azithromycin for 3 days and, in the control group (n = 31), amoxicillin/metronidazole for7 days. Probing depth (PD), attachment level (AL), and bleeding on probing (BOP) were recorded at baseline and after 3 and 12 months. Gingival crevicular fluid was analyzed for matrix metalloprotease (MMP)-8 and interleukin (IL)-1beta levels. Subgingival plaque was taken for assessment of the major bacteria associated with periodontitis. RESULTS: In both groups, PD, AL, and BOP were significantly reduced (p < 0.001). A few significant differences between the groups were found; AL and BOP were significantly better in the test than in the control group at the end of the study (p = 0.020 and 0.009). Periodontopathogens were reduced most in the test group. CONCLUSIONS: A noninferiority of the treatment with azithromycin in comparison with amoxicillin/metronidazole can be stated. The administration of azithromycin could be an alternative to the use of amoxicillin/metronidazole adjunctive to SRP in patients with moderate or severe chronic periodontitis; however, a randomized placebo-controlled multicenter study is needed. CLINICAL RELEVANCE: Application of azithromycin as a single antibiotic for 3 days might be considered as an additional adjunctive antibiotic to SRP in selected patients.

Clinical and microbiologic results 12 months after scaling and root planing with different irrigation solutions in patients with moderate chronic periodontitis: a pilot randomized trial.

BACKGROUND: The aim of this study is to determine in a randomized trial the impact on treatment outcome after 12 months of different subgingival irrigation solutions during scaling and root planing (SRP). METHODS: Fifty-one adult volunteers with generalized chronic periodontitis were treated by full-mouth SRP using 0.9% sodium chloride, 0.12% chlorhexidine digluconate, or 7.5% povidone-iodine for subgingival irrigation during SRP. Before SRP and after 3 and 12 months, probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded. Subgingival plaque samples were analyzed for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. RESULTS: PD, CAL, and BOP were significantly improved in all groups after 12 months (P <0.001 to P = 0.044). No significant differences were seen among the groups for all sites and sites with 4 to 6 mm PD at baseline. The povidone-iodine group had the highest clinical improvements. The counts of A. actinomycetemcomitans and P. gingivalis were significantly reduced after 12 months (P = 0.045 and P = 0.002) using povidone-iodine. Significant differences between the groups were seen after 3 months for A. actinomycetemcomitans and P. gingivalis, and after 12 months for T. forsythia. CONCLUSIONS: No differences were seen among the groups in the clinical results after 12 months. Regarding the microbiologic results, a slight benefit seemed to derive from the use of povidone-iodine.

Microbiologic findings 1 year after partial- and full-mouth scaling in the treatment of moderate chronic periodontitis.

OBJECTIVE: To investigate the impact on microbiologic variables of full-mouth scaling (FMS) and conventional scaling and root planing (cSRP) after 12 months. METHOD AND MATERIALS: In a prospective randomized controlled clinical study, 37 volunteers with moderate chronic periodontitis were treated by FMS or by cSRP in two sessions at 4-week intervals. Clinical attachment level, probing depth, and bleeding on probing were recorded at baseline as well as at 6 and 12 months. Four subgingival plaque samples were taken from the deepest sites in premolars and molars at baseline and after 12 months. Pooled sample analysis was performed using real-time polymerase chain reaction for the identification of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. RESULTS: At baseline, the bacterial load of A actinomycetemcomitans was significantly higher in the cSRP group compared to the FMS group (P = .042). In the cSRP group, this load decreased significantly (P = .011), leading to similar quantities of A actinomycetemcomitans in both groups. Further, significant reductions in frequency were found in the FMS group for T forsythia and P gingivalis and in the cSRP group for A actinomycetemcomitans and T denticola. CONCLUSION: The data suggest that both therapy modalities lead to similar effects on target periodontal pathogen species. FMS compared to cSRP was not favorable in reduction of periodontopathogens.

Clinical evaluation of partial- and full-mouth scaling in the treatment of chronic periodontitis.

BACKGROUND: Full-mouth scaling (FMS) is claimed by some researchers to be superior to standard scaling and root planing (SRP). The aim of the present study was to evaluate clinical outcomes of two modalities of non-surgical periodontal therapy for patients with chronic periodontitis. METHODS: In a prospective, randomized, controlled clinical study, 37 subjects with chronic periodontitis were treated by SRP in two quadrants at 4-week intervals (N=20) or by FMS (N=17). Clinical attachment level (CAL), probing depth (PD), and bleeding on probing (BOP) were recorded at premolar and molar teeth at baseline and after 6 and 12 months. RESULTS: Both therapies resulted in significant improvements of all clinical variables. After 12 months, CAL at pockets with PDs of 4 to 6 mm was reduced significantly from 4.5+/-0.8 mm to 3.4+/-1.0 mm with SRP and from 4.7+/-0.9 mm to 3.8+/-1.1 mm with FMS (P<0.001). PD decreased from 4.4+/-0.6 mm to 3.3+/-0.9 mm in the SRP group and from 4.5+/-0.7 mm to 3.5+/-1.0 mm in the FMS group (P<0.001). BOP was reduced from 63.6%+/-45.3% to 29.0%+/-42.6% in the SRP group and from 59.6%+/-43.8% to 28.6%+/-38.3% in the FMS group (P<0.001 and P=0.001, respectively). There were no significant differences between the groups with respect to CAL gain, PD, and BOP reduction. CONCLUSION: Both therapy modalities have the same positive influence on clinical outcome at premolar and molar teeth with PDs of 4 to 6 mm.