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Werner N, Pitchika V, Heck K, Ern C, Heym R, Al-Ahmad A, Cieplik F, Schwendicke F, Bumm CV, Folwaczny M. A retrospective study on the impact of different antibiotic regimens in non-surgical periodontal therapy on microbial loads and therapy outcomes. FRONTIERS IN ORAL HEALTH 2025; 6:1578484. [PMID: 40438085 PMCID: PMC12116549 DOI: 10.3389/froh.2025.1578484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Accepted: 04/28/2025] [Indexed: 06/01/2025] Open
Abstract
Introduction This study aimed to analyse the impact of different antibiotic regimens during non-surgical periodontal therapy on the microbial load of selected periodontitis-associated bacteria (PAB) and the primary therapy outcomes. Methods For this aim, 259 patients received steps I and II of periodontal therapy and were included in this clinical trial. 202 patients were treated without the adjunctive use of systemic antibiotics, 18 received amoxicillin (AMOX) as well as metronidazole (MET) and 39 only MET. Subgingival biofilm samples were quantitatively analysed for selected PAB using DNA-DNA-hybridisation-based detection assays for microbial loads of PAB before and 6 months after treatment. Changes in the microbial load of PAB and achievement of a "treat-to-target" endpoint (T2T) (≤4 sites with probing depth ≥5 mm) were analysed. Patients' subgingival microbial load was significantly reduced following therapy. Results 38.2% of the patients achieved T2T. Binary logistic regression adjusted for confounders indicated a relationship between residual PAB levels and not achieving T2T. In patients not receiving systemic antibiotics a 2.4-fold increased risk of not reaching T2T after steps I and II therapy was observed (none vs. MET aOR = 2.38 p = 0.44). Linear regression analysis adjusted for T0 PAB concentration and confounders revealed an increased reduction of PAB levels in patients with systemic antibiotics. No difference in PAB reduction or chance of achieving T2T was observed between MET and MET + AMOX. Discussion Microbial loads of PAB were found directly associated with periodontal status. As antibiotic treatment with both MET and MET + AMOX similarly reduced microbial loads of PAB, treatment with MET alone may be sufficiently effective as adjunctive to non-surgical periodontal treatment. To confirm this, further prospective studies with bigger sample size are needed.
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Affiliation(s)
- Nils Werner
- Department of Conservative Dentistry and Periodontology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Vinay Pitchika
- Department of Conservative Dentistry and Periodontology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Katrin Heck
- Department of Conservative Dentistry and Periodontology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christina Ern
- Department of Conservative Dentistry and Periodontology, LMU University Hospital, LMU Munich, Munich, Germany
- Private Practice, Munich, Germany
| | - Richard Heym
- Department of Conservative Dentistry and Periodontology, LMU University Hospital, LMU Munich, Munich, Germany
- Private Practice, Munich, Germany
| | - Ali Al-Ahmad
- Department of Operative Dentistry and Periodontology, Center for Dental Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Cieplik
- Department of Operative Dentistry and Periodontology, Center for Dental Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Falk Schwendicke
- Department of Conservative Dentistry and Periodontology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Caspar Victor Bumm
- Department of Conservative Dentistry and Periodontology, LMU University Hospital, LMU Munich, Munich, Germany
- Private Practice, Munich, Germany
| | - Matthias Folwaczny
- Department of Conservative Dentistry and Periodontology, LMU University Hospital, LMU Munich, Munich, Germany
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Fernandez MDS, Martins TM, Meza-Mauricio J, Ribeiro MC, Silva FH, Casarin M, Muniz FWMG. Clinical efficacy of adjunctive use of coenzyme Q10 in non-surgical periodontal treatment: A systematic review. Eur J Oral Sci 2025; 133:e70002. [PMID: 39920883 DOI: 10.1111/eos.70002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 01/25/2025] [Indexed: 02/09/2025]
Abstract
This systematic review evaluated the effects of coenzyme Q10 (CoQ10) in non-surgical periodontal treatment (PROSPERO: CRD42022311286). Five databases were screened (up to May/2024). It included only randomized controlled trials (RCTs) of subgingival scaling root planing (SRP) with or without adjunct use of the antioxidant CoQ10 in adults with periodontitis. The risk of bias and the certainty of the evidence were assessed. Meta-analyses were conducted to estimate mean differences for probing depth (PD) and clinical attachment level (CAL) between baseline and follow-up. Ten studies were included, of which four administered CoQ10 locally (topical [n = 1]; intra-pocket [n = 3] modalities), and six used oral supplementation. There was no significant effect of local use of CoQ10 on reduction of PD and gain in CAL. Daily oral supplementation (120 mg/day) with CoQ10 resulted in a greater mean reduction of PD by 0.41 mm (95% CI: 0.02-0.80) and a greater mean CAL gain by 0.52 mm (95% CI: 0.26-0.78) than seen in controls. Based on very low certainty of evidence, there was no significant effect of locally delivered Q10 gel on PD/CAL, but daily oral supplementation with CoQ10 resulted in better periodontal health after 12 weeks.
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Affiliation(s)
| | | | | | | | | | - Maísa Casarin
- Department of Periodontology, Federal University of Pelotas, Pelotas, Brazil
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Firoozi P, Ghaznavi D, Fekrazad R. The Effect of Photobiomodulation on Periodontal Clinical Status of Patients with Cancer During Chemotherapy: A Randomized Clinical Trial. Photobiomodul Photomed Laser Surg 2025; 43:124-132. [PMID: 39950255 DOI: 10.1089/photob.2024.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2025] Open
Abstract
Objective: This interventional prospective double-blind randomized study investigated the adjunctive inflammation-modulatory effects of photobiomodulation therapy on the periodontal clinical parameters of patients undergoing chemotherapy. Methods: Twenty diagnosed patients with cancer were enrolled in this split-mouth trial. Patients were randomized to implantation with either SRP alone in one quadrant or with five sessions of adjunctive photobiomodulation using a diode laser (density of energy = 2 J/cm2 | wavelength = 635 nm | power = 50 mW | spot diameter = 4 mm | exposure time = 5 s | continuous mode) on the other quadrant. The gingiva was radiated buccally and lingually. The laser beam was positioned 3 mm vertically away from the gingival surface and at a right angle to it. Before chemotherapy, all participants were given oral hygiene training and received SRP. In the same session, the patient's baseline clinical measures were taken immediately after the beginning of one chemotherapy session, interventions for each side were started and clinical parameters including gingival index (GI), plaque index (PI), clinical attachment level (CAL), and pain/burning sensation after one chemotherapy session were obtained. Results: Regarding GI and PI, both control and test groups showed favorable results compared with baseline. However, the adjunctive photobiomodulation group outperformed the control group in one chemotherapy session regarding both abovementioned indices (p < 0.05). The photobiomodulation+scaling and root planing (SRP) group showed promising results in terms of gingival discomfort reduction and SRP alone was not effective. No significant effect was observed regarding CAL in both groups (p > 0.05). Conclusion: Based on the results of this study, it can be concluded that photobiomodulation promotes gingival health and reduces PI and GI indices. Photobiomodulation also alleviates pain or burning in the gingiva. Accordingly, adjunctive photobiomodulation therapy may be suggested as a supplementary treatment in patients with cancer.
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Affiliation(s)
- Parsa Firoozi
- Radiation Sciences Research Centre, Laser Research Centre in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran
| | - Dara Ghaznavi
- Department of Periodontics, School of Dentistry, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Reza Fekrazad
- Professor of Radiation Sciences Research Centre, Laser Research Centre in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran
- International Network for Photo Medicine and Photo Dynamic Therapy (INPMPDT), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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Kabwe M, Tucci J, Darby I, Dashper S. Oral bacteriophages and their potential as adjunctive treatments for periodontitis: a narrative review. J Oral Microbiol 2025; 17:2469890. [PMID: 40013014 PMCID: PMC11864011 DOI: 10.1080/20002297.2025.2469890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Revised: 01/29/2025] [Accepted: 01/31/2025] [Indexed: 02/28/2025] Open
Abstract
Background There is no specific cure for periodontitis and treatment is symptomatic, primarily by physical removal of the subgingival plaque biofilm. Current non-surgical periodontal therapy becomes less effective as the periodontal pocket depth increases and as such new adjunctive treatments are required. The development of antibiotic resistance has driven a recent resurgence of interest in bacteriophage therapy. Methods Here we review the published literature with a focus on the subgingival phageome, key oral pathobionts and the dysbiotic nature of periodontitis leading to the emergence of synergistic, proteolytic and inflammophilic bacterial species in subgingival plaque. We discuss the opportunities available, the barriers and the steps needed to develop bacteriophage therapy as an adjunctive treatment for periodontitis. Results The oral phageome (or virome) is diverse, featuring abundant bacteriophage, that could target key subgingival bacteria. Yet to date few bacteriophages have been isolated and characterised from oral bacterial species, although many more have been predicted by genomic analyses. Bacteriophage therapy has yet to be tested against chronic diseases that are caused by dysbiosis of the endogenous microbial communities. Conclusion To be effective as an adjunctive treatment for periodontitis, bacteriophage therapy must cause the collapse of the dysbiotic bacterial community, thereby resolving inflammation and enabling the reestablishment of a health-associated mutualistic subgingival bacterial community. The isolation and characterisation of novel oral bacteriophage is an essential first step in this process.
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Affiliation(s)
- Mwila Kabwe
- Department of Rural Clinical Sciences, La Trobe Rural Health School & La Trobe Institute for Molecular Science, La Trobe University, Bendigo, Victoria, Australia
| | - Joseph Tucci
- Department of Rural Clinical Sciences, La Trobe Rural Health School & La Trobe Institute for Molecular Science, La Trobe University, Bendigo, Victoria, Australia
| | - Ivan Darby
- Melbourne Dental School, University of Melbourne, Parkville, Victoria, Australia
| | - Stuart Dashper
- Melbourne Dental School, University of Melbourne, Parkville, Victoria, Australia
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Vajrabhaya LO, Benjasupattananan S, Sappayatosok K, Dechosilpa V, Korsuwannawong S, Sirikururat P. Efficacy of a Herbal Toothpaste During Active Periodontal Treatment: A Clinical Study. Dent J (Basel) 2024; 12:378. [PMID: 39727435 DOI: 10.3390/dj12120378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 11/14/2024] [Accepted: 11/19/2024] [Indexed: 12/28/2024] Open
Abstract
Backgound/Objectives: This study investigated the efficacy of a herbal toothpaste containing Aloe vera (test group) compared with a sodium bicarbonate toothpaste (active control group) and a standard toothpaste (benchmark group) on periodontitis treatment outcomes. Methods: Fifty-four periodontitis patients were randomly allocated into three groups. The patients received mechanical instrumentation and instruction on oral hygiene using a toothbrush with the toothpastes and dental floss. The patients were evaluated at baseline (T0), week 4 (T1), and week 12 (T2) after complete scaling and root planing. During the visits, the plaque score (PS), bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL) were assessed and analyzed. Results: The comparison groups had similar PS and BOP means at baseline. At T1 and T2, both scores were reduced; however, there was no significant difference in PS among the three groups. A significant reduction in BOP among the groups was observed (p < 0.01) at T1. The PDs in all groups were significantly reduced after treatment. The CAL reduction was greater in the test group compared with the benchmark and the active control group. Furthermore, there was no significant difference in the mean CAL among time points in the benchmark and the active control groups. Conclusions: The herbal toothpaste containing Aloe vera significantly decreased gingival inflammation, PD, and CAL over the standard and active control toothpaste in periodontitis patients during active periodontal treatment.
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Arnett MC, Costalonga M, Chanthavisouk P, Evans MD, Paulson DR. Effect of scaling and root planing with and without minocycline hydrochloride microspheres on serum biomarkers and acute phase reactants: A randomized clinical trial and 9- and 12-month follow-up. JADA FOUNDATIONAL SCIENCE 2024; 3:100040. [PMID: 40206298 PMCID: PMC11981608 DOI: 10.1016/j.jfscie.2024.100040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/11/2025]
Abstract
Background This study tests the effects of scaling and root planing (SRP) vs SRP with minocycline hydrochloride microspheres (MMs) (SRP with MM) on serum biomarkers interleukin (IL)-1β, IL-6, tumor necrosis factor-α, and matrix metalloproteinase-8 and acute phase reactants hemoglobin A1c (HbA1c), high-sensitivity C-reactive proteins and haptoglobin (Hp) in patients with stage II-IV grade B periodontitis. Methods Seventy participants were randomized to receive SRP (n = 35) or SRP+MM (n = 35). Serum was collected at baseline (before SRP), 1-month reevaluation visit, and 3- and 6-month periodontal maintenance visits. MMs were delivered to pockets 5 mm or larger immediately after SRP and immediately after the 3-month periodontal maintenance visit. Serum for acute phase reactants only was collected at the 9- and 12-month posttreatment follow-up. All outcomes were summarized using estimated marginal means back-transformed to the original response scale with 95% CIs. Results At 6 months, no statistical significance was yielded in either group for IL-6 (P = .91), tumor necrosis factor-α (P = .34), or matrix metalloproteinase-8 (P = .34). IL-1β (P = .06) was slightly higher in the SRP-alone group, suggesting a clinical impact with the addition of MM. Acute phase reactants were not statistically significant for high-sensitivity C-reactive proteins (P = .59), HbA1c (P = .46), or haptoglobin (P = .22) for either group. These outcomes continued at the 9- and 12-month posttreatment follow-up. Conclusions SRP alone and SRP+MM minimally reduced levels of cytokine biomarkers and acute phase reactants in self-reported systemically healthy patients with advanced stages of periodontitis. Thresholds for resolution of local clinical inflammation may not have been achieved in this study to result in a reduction of systemic inflammation.
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Affiliation(s)
- Michelle C Arnett
- Division of Dental Hygiene, Department of Primary Dental Care, School of Dentistry, University of Minnesota, Minneapolis, MN
| | - Massimo Costalonga
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN
| | - Phonsuda Chanthavisouk
- Division of Dental Therapy, Department of Primary Dental Care, School of Dentistry, University of Minnesota, Minneapolis, MN
| | - Michael D Evans
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Danna R Paulson
- Division of Dental Hygiene, Department of Primary Dental Care, School of Dentistry, University of Minnesota, Minneapolis, MN
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Werner N, Frasheri I, Heck K, Ern C, Heym R, Bumm CV, Folwaczny M. The association between periodontal microbial biomarkers and primary therapy outcome. Clin Oral Investig 2024; 28:523. [PMID: 39269543 PMCID: PMC11399289 DOI: 10.1007/s00784-024-05904-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/27/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVE This study aims to analyse the association between the baseline microbial load of selected periodontopathogenic bacteria collected from gingival crevicular fluid (GCF) and the primary outcome of steps I and II therapy. MATERIALS AND METHODS 222 patients with stage III periodontitis were included into this retrospective analysis that received steps 1 and 2 periodontal therapy without adjunctive systemic antibiotics. Baseline GCF samples were quantitatively analysed using ELISA-based kits for levels of periodontopathogens (Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans (Aa), Prevotella intermedia (Pi), Fusobacterium nucleatum (Fn), Treponema denticola (Td), and Tannerella forsythia (Tf)) and associated with the primary therapy outcome using a "treat-to-target" therapy endpoint (TE) defined as ≤ 4 sites with PD ≥ 5 mm six months after therapy. RESULTS 38.2% of the patients achieved TE. Patients failing to achieve TE revealed significantly increased levels of Pg, Fn, and Tf at baseline (Pg: p = 0.010, Fn: p = 0.008 Tf: p = 0.004). Multivariate binary logistic regression adjusted for sex, mean probing depth, diabetes, and current smoking status showed an independent relationship between Tf and the TE (aOR 2.570, p = 0.023). CONCLUSION Increased microbial load is associated with decreased responsiveness to therapy. The findings suggest that specifically baseline Tf levels are associated with poorer treatment outcomes and might improve the accuracy of periodontal diagnosis. CLINICAL RELEVANCE The findings of this study support the concept of a critical biomass that is sufficient to induce and maintain an immune response within the periodontal pocket, which ultimately leads to irreversible tissue destruction. However, calculating this level in advance may serve as an early indicator for intervention. KEY FINDING Baseline Tannerella forsythia levels are associated with poorer treatment outcome.
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Affiliation(s)
- Nils Werner
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Goethestr. 70, 80336, Munich, Germany.
| | - Iris Frasheri
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Goethestr. 70, 80336, Munich, Germany
| | - Katrin Heck
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Goethestr. 70, 80336, Munich, Germany
| | - Christina Ern
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Goethestr. 70, 80336, Munich, Germany
- Private practice, Munich, Germany
| | - Richard Heym
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Goethestr. 70, 80336, Munich, Germany
- Private practice, Munich, Germany
| | - Caspar Victor Bumm
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Goethestr. 70, 80336, Munich, Germany
- Private practice, Munich, Germany
| | - Matthias Folwaczny
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Goethestr. 70, 80336, Munich, Germany
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Al-Sharqi AJB, Abdulkareem A. Microbiological and Salivary Biomarkers Successfully Predict Site-Specific and Whole-Mouth Outcomes of Nonsurgical Periodontal Treatment. J Clin Med 2024; 13:4256. [PMID: 39064296 PMCID: PMC11277870 DOI: 10.3390/jcm13144256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 07/14/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: Nonsurgical periodontal treatment (NSPT) is the gold-standard technique for treating periodontitis. However, an individual's susceptibility or the inadequate removal of subgingival biofilms could lead to unfavorable responses to NSPT. This study aimed to assess the potential of salivary and microbiological biomarkers in predicting the site-specific and whole-mouth outcomes of NSPT. Methods: A total of 68 periodontitis patients exhibiting 1111 periodontal pockets 4 to 6 mm in depth completed the active phase of periodontal treatment. Clinical periodontal parameters, saliva, and subgingival biofilm samples were collected from each patient at baseline and three months after NSPT. A quantitative PCR assay was used to detect the presence of Fusobaterium nucleatum and Porphyromonas gingivalis in the biofilm samples. Salivary biomarkers including matrix metalloproteinase (MMP)-9, glutathione S-transferase (GST), and Annexin-1 were assayed both qualitatively (Western blot analysis) and quantitively (ELISA). Results: NSPT yielded significant improvements in all clinical parameters, including a reduction in bacterial load and decreased levels of MMP-9 together with increased concentrations of GST and Annexin-1. The binary logistic regression suggested that the overall accuracy of P. gingivalis identification, probing pocket depth, and interproximal sites was 71.1% in predicting successful site-specific outcomes. The salivary biomarker model yielded an overall accuracy of 79.4% in predicting whole-mouth outcomes following NSPT. Conclusions: At baseline, the presence of shallow periodontal pockets at interdental locations with a lower abundance of P. gingivalis is predictive of a favorable response to NSPT at the site level. Decreased salivary MMP-9 associated with increased GST and Annexin-1 levels can predict successful whole-mouth outcomes following NSPT.
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Affiliation(s)
| | - Ali Abdulkareem
- Department of Periodontics, College of Dentistry, University of Baghdad, Bab Al Mudam, Baghdad P.O. Box 1417, Iraq;
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Prasanth T, Singh H, Krishna A, Saravanan S, Satisha T, Anand K, Bahal V. Clinico-immunological evaluation of use of omega-3 fatty acids as nutraceutical approach in management of patients with chronic periodontitis: A randomized clinical trial. Med J Armed Forces India 2024; 80:449-457. [PMID: 39071748 PMCID: PMC11280262 DOI: 10.1016/j.mjafi.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/12/2024] [Indexed: 07/30/2024] Open
Abstract
Background Subgingival bacterial colonization and biofilm formation are known to be the main etiology of periodontal disease progression. This biofilm elicits host response and the interaction between host defence mechanisms with plaque microorganisms and their products results in periodontal disease. Host modulatory therapy (HMT) is a form of treatment of periodontitis that focuses on treatment of the host in the host-bacteria interaction. Omega-3 fatty acids have emerged as a potential HMT agent to treat inflammation associated with periodontal disease. Methods A total of 60 cases of chronic periodontitis were allocated into two groups; the test group (n = 30) were treated with scaling and root planing (SRP) and given a dietary supplementation of omega-3 fatty acid while the control group were treated with SRP alone. Clinical parameters carried out were plaque index (PI), gingival bleeding index (GBI), pocket probing depth (PPD) and clinical attachment level (CAL) and immunological parameter included interleukin-1β level in saliva at baseline, 3 months and 6 months after therapy. Results At 6 months, both the groups showed significant improvements with regards to all clinical and immunological parameters compared to baseline (all p < 0.05). However, test group presented with more favourable statistically significant results. Conclusion The use of omega-3 fatty acid as nutraceutical agent to conventional method acted as beneficial therapeutic measures and effective in patients with chronic periodontitis when compared with SRP alone.
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Affiliation(s)
- T. Prasanth
- Senior Specialist & Professor (Periodontology), Army Dental Centre (Research & Referral), New Delhi, India
| | - H. Singh
- Associate Professor (Periodontology), Army Dental Centre (Research & Referral), New Delhi, India
| | - A. Krishna
- Resident, Department of Dental Surgery, Armed Forces Medical College, Pune, India
| | - S.P. Saravanan
- Assistant Professor (Periodontology), Army Dental Centre (Research & Referral), New Delhi, India
| | - T.S. Satisha
- Classified Specialist (Periodontology), Command Military Dental Centre, Lucknow, India
| | - K.B. Anand
- Professor, Department of Microbiology, Armed Forces Medical College, Pune, India
| | - V.A. Bahal
- Professor (Pathology), Army Hospital (Research & Referral), New Delhi, India
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Ashique S, Hussain A, Khan T, Pal S, Rihan M, Farid A, Webster TJ, Hassan MZ, Asiri YI. Insights into Intra Periodontal Pocket Pathogenesis, Treatment, In Vitro-In Vivo Models, Products and Patents, Challenges and Opportunity. AAPS PharmSciTech 2024; 25:121. [PMID: 38816555 DOI: 10.1208/s12249-024-02842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/15/2024] [Indexed: 06/01/2024] Open
Abstract
Periodontal disease is a multifactorial pathogenic condition involving microbial infection, inflammation, and various systemic complications. Here, a systematic and comprehensive review discussing key-points such as the pros and cons of conventional methods, new advancements, challenges, patents and products, and future prospects is presented. A systematic review process was adopted here by using the following keywords: periodontal diseases, pathogenesis, models, patents, challenges, recent developments, and 3-D printing scaffolds. Search engines used were "google scholar", "web of science", "scopus", and "pubmed", along with textbooks published over the last few decades. A thorough study of the published data rendered an accurate and deep understanding of periodontal diseases, the gap of research so far, and future opportunities. Formulation scientists and doctors need to be interconnected for a better understanding of the disease to prescribe a quality product. Moreover, prime challenges (such as a lack of a vital testing model, scarcity of clinical and preclinical data, products allowing for high drug access to deeper tissue regions for prolonged residence, lack of an international monitoring body, lack of 4D or time controlled scaffolds, and lack of successful AI based tools) exist that must be addressed for designing new quality products. Generally, several products have been commercialized to treat periodontal diseases with certain limitations. Various strategic approaches have been attempted to target certain delivery regions, maximize residence time, improve efficacy, and reduce toxicity. Conclusively, the current review summarizes valuable information for researchers and healthcare professional to treat a wide range of periodontal diseases.
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Affiliation(s)
- Sumel Ashique
- Department of Pharmaceutics, School of Pharmacy, Bharat Institute of Technology (BIT), Meerut, 250103, UP, India
| | - Afzal Hussain
- Department of Pharmaceutics, College of Pharmacy, King Saud University, 11451, Riyadh, Saudi Arabia.
| | - Tasneem Khan
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Sejuti Pal
- School of Pharmacy, College of Health and Medicine, University of Tasmania, Churchill Ave, Sandybay, Hobart, TAS- 7005, Australia
| | - Mohd Rihan
- Department of Pharmacology, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, Punjab, 160062, India
| | - Arshad Farid
- Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, 29050, Pakistan
| | - Thomas J Webster
- Division of Pre-college and Undergraduate Studies, Brown University, Providence, Rhode Island, 02912, USA.
| | - Mohd Zaheen Hassan
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Khalid University, Asir, Saudi Arabia
| | - Yahya I Asiri
- Department of Pharmacology, College of Pharmacy, King Khalid University, Asiri, Saudi Arabia
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Najm KK, Gul SS, Abdulkareem AA. Efficacy of Non-Surgical Periodontal Therapy with Adjunctive Methylene Blue and Toluidine Blue O Mediated Photodynamic in Treatment of Periodontitis: A Randomized Clinical Trial. Clin Pract 2024; 14:954-964. [PMID: 38804408 PMCID: PMC11130800 DOI: 10.3390/clinpract14030076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND This study aimed to examine the efficacy of methylene blue (MB) and toluidine blue O (TBO) photodynamic therapy (PDT) as adjuncts to root surface debridement (RSD). METHODS This split-mouth, randomized, controlled clinical trial included eighteen patients, and a total of 332 sites (control = 102, MB = 124 and TBO = 106) were examined. Two sessions of PDT were completed at baseline and two weeks after RSD. Clinical parameters of bleeding on probing (BOP), plaque index (PI), probing pocket depth (PPD), and clinical attachment level (CAL) were measured pre- and post-treatment. RESULTS PPD and BOP reductions in sites treated by RSD with adjunctive photosensitizers (MB and TBO) were significantly higher than in control sites. RSD with MB showed higher efficacy in improving moderately deep pockets (OR 3.350), while adjunctive TBO showed better results in treating deeper pockets (OR 4.643). CONCLUSIONS Results suggested that adjunctive use of MB and TBO to RSD could significantly improve periodontal pocket closure and reduce signs of inflammation. In addition, TBO seems to be more efficient in treating deep periodontal pockets than MB, which is more effective in resolving shallower pockets.
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Affiliation(s)
- Kashan Kamal Najm
- Department of Periodontics, College of Dentistry, University of Sulaimani, Sulaymaniyah 46001, Iraq;
| | - Sarhang Sarwat Gul
- Department of Periodontics, College of Dentistry, University of Sulaimani, Sulaymaniyah 46001, Iraq;
- Medical Laboratory Department, College of Health and Medical Technology, Sulaimani Polytechnic University, Sulaymaniyah 46001, Iraq
| | - Ali Abbas Abdulkareem
- Department of Periodontics, College of Dentistry, University of Baghdad, Baghdad 10011, Iraq;
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Atieh MA, Shah M, Hakam A, Alghafri M, Tawse-Smith A, Alsabeeha N. Systemic azithromycin versus amoxicillin/metronidazole as an adjunct in the treatment of periodontitis: a systematic review and meta-analysis. Aust Dent J 2024; 69:4-17. [PMID: 37875345 DOI: 10.1111/adj.12991] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND The use of systemic azithromycin (AZT) and amoxicillin/metronidazole (AMX/MTZ) as adjuncts provided additional clinical and microbiological benefits over subgingival instrumentation alone. However, the superiority of one antibiotic regimen over another has not been proven. Therefore, the aim of this systematic review and meta-analyses was to evaluate the clinical efficacy and safety of subgingival instrumentation (SI) in conjunction with the systemic use of AZT or AMX/MTZ for the treatment of periodontitis from current published literature. METHODS Electronic databases were searched to identify randomized controlled trials (RCTs), controlled clinical trials, prospective and retrospective human studies that compared the adjunctive use of systemic AZT to AMX/MTZ with SI in the treatment of periodontitis. The eligibility criteria were defined based on the participant (who had periodontitis), intervention (SI with adjunctive use of systemic AZT), comparison (SI with adjunctive use of systemic AMX/MTZ), outcomes (primary outcome: changes in probing pocket). The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Data were analysed using a statistical software program. RESULTS Five studies with 151 participants with periodontitis were included in the present review. Of these, 74 participants received adjunctive AZT, while the remaining participants received AMX/MTZ as an adjunct to SI. The adjunctive use of AZT and AMX/MTZ had comparable changes in probing pocket depths at 1-3 months with no statistically significant difference (mean difference (MD) 0.01; 95% CI -0.20 to 0.22; P = 0.94). The adjunctive use of AZT had significantly fewer number of residual sites with probing pocket depths of ≥5 mm at 1-3 months compared to the adjunctive use of AMX/MTZ (MD -3.41; 95% CI -4.73 to -2.10; P < 0.0001). The prevalence rates of adverse events among participants who received AZT and AMX/MTZ were 9.80% and 14.8%, respectively. The meta-analysis showed that the difference between the two groups was not statistically significant (risk ratio 0.69; 95% CI 0.28 to 1.72; P = 0.43). CONCLUSIONS Within the limitation of this review, there was no superiority between AZT and AMX/MTZ in terms of mean changes in probing pocket depths, clinical attachment level, bleeding on probing at 1-3 months. AZT seem to be associated with less sites with residual probing pocket depths of ≥5 mm at 1-3 months and fewer adverse events compared with AMX/MTZ. © 2023 Australian Dental Association.
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Affiliation(s)
- M A Atieh
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
- School of Dentistry, University of Jordan, Amman, Jordan
| | - M Shah
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - A Hakam
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - M Alghafri
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - A Tawse-Smith
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Nhm Alsabeeha
- Department of Dental Services, Emirates Health Services, Dubai, United Arab Emirates
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Koidou VP, Hagi-Pavli E, Nibali L, Donos N. Elucidating the molecular healing of intrabony defects following non-surgical periodontal therapy: A pilot study. J Periodontal Res 2024; 59:53-62. [PMID: 38010805 DOI: 10.1111/jre.13207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To elucidate the molecular healing of intrabony defects following non-surgical periodontal therapy (NSPT) using gingival crevicular fluid (GCF). BACKGROUND DATA Currently limited information is available regarding the GCF of intrabony defects and the change in biomarker levels in the GCF at early time points following treatment interventions. METHODS Twenty-one patients (Periodontitis Stage III or IV) who have received NSPT, contributing one intrabony defect and one healthy site were included in this study. GCF sampling was performed at baseline, 1 day, 5 days and 3 months after NSPT. Multiplex bead immunoassays allowed the profiling of GCF for 27 markers, associated with inflammation and repair/regeneration. A mixed effects model with Bonferroni correction for multiple comparisons was employed to compare the changes in the levels of GCF markers over time. RESULTS Following NSPT, changes were observed for several GCF markers, marked by significant increases 1 day post-intervention, before returning to baseline levels by 3 months. Specifically, GCF concentrations of IL-2, IL-4, IL-6, IL-8, MMP-1, MMP-3, TIMP-1 and FGFb significantly increased 1 day after NSPT. Signs of activation of cellular senescence were observed 1 day following treatment of intrabony defects, rapidly regressing by 5 days. CONCLUSION Significant molecular changes are observed as early as 1 day following NSPT in intrabony defects, along with activation of cellular senescence.
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Affiliation(s)
- Vasiliki P Koidou
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- Centre for Immunobiology and Regenerative Medicine, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Eleni Hagi-Pavli
- Centre for Immunobiology and Regenerative Medicine, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Luigi Nibali
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- Periodontology Unit, Centre for Host Microbiome Interactions, King's College London, London, UK
| | - Nikolaos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- Centre for Immunobiology and Regenerative Medicine, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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Vadvadgi VH, Gulati R, Wankhede A, Amrita, Mehra P, Charan Yadav KS. Comparing the Effectiveness of Traditional Periodontal Surgery Versus Non-Surgical Therapy: A Randomized Controlled Trial. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S936-S938. [PMID: 38595436 PMCID: PMC11000990 DOI: 10.4103/jpbs.jpbs_956_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 04/11/2024] Open
Abstract
Background Periodontal disease, characterized by inflammation and infection of the supporting structures of teeth, poses a significant oral health challenge. Traditional periodontal surgery and non-surgical therapy, such as scaling and root planing, are established treatment approaches for addressing periodontal disease. Materials and Methods The study enrolled 120 adult patients diagnosed with moderate to severe periodontal disease. Participants were randomly allocated to one of two groups: the traditional surgery group (TSG) or the non-surgical therapy group (NSTG). In the TSG, patients underwent traditional periodontal surgery, which included flap surgery and grafts when deemed necessary. The surgical procedures were performed by experienced periodontal surgeons. In contrast, the NSTG received non-surgical therapy in the form of scaling and root planing administered by trained dental hygienists. Outcome measures encompassed clinical parameters and patient-centered outcomes. Periodontal pocket depth and clinical attachment level, both measured in millimeters, were assessed at baseline, 3 months, and 6 months. Patient-reported outcomes, including pain, discomfort, and satisfaction, were collected through standardized questionnaires at each follow-up visit. Results Patients in the TSG experienced a notable reduction in pocket depth from a baseline of 6.8 mm to 3.7 mm at the 6-month mark, resulting in a change of -3.1 mm. Conversely, the NSTG exhibited a reduction from 6.7 mm to 4.0 mm, with a change of -2.7 mm. In the TSG, the baseline attachment level of 7.2 mm decreased to 5.1 mm at 6 months, indicating a change of -2.1 mm. In the NSTG, the attachment level decreased from 7.1 mm to 5.5 mm, resulting in a change of -1.6 mm. Patients in the TSG reported an average pain score of 3.6 on a 1-10 scale, discomfort of 4.2, and satisfaction of 7.8. In contrast, patients in the NSTG reported lower pain (2.1) and discomfort (2.9) scores but similar satisfaction levels (8.4). Conclusion In this randomized controlled trial (RCT), both traditional periodontal surgery and non-surgical therapy demonstrated improvements in clinical parameters and patient-reported outcomes. Traditional surgery resulted in greater reductions in periodontal pocket depth and clinical attachment loss at the 6-month follow-up.
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Affiliation(s)
- Vinay H Vadvadgi
- Department of Periodontology, Rural Dental College, Pravara Institute of Medical Sciences, Deemed to be University, Ahmednagar, Maharashtra, India
| | - Ruchi Gulati
- Department of Dentistry, Atal Bihari Vajpayee Government, Medical College, Vidisha, Madhya Pradesh, India
| | - Anand Wankhede
- Department of Periodontology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed To Be University), Sawangi (Megha), Wardha, Maharashtra, India
| | - Amrita
- Department of Periodontology and Implantology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Parth Mehra
- Department of Periodontology and Implantology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - K Shiva Charan Yadav
- Department of Periodontology and Implantology, Malak, Al Rahma Polyclinic, Saudi Arabia
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15
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Chew RJJ, Goh CE, Sriram G, Preshaw PM, Tan KS. Microbial biomarkers as a predictor of periodontal treatment response: A systematic review. J Periodontal Res 2023; 58:1113-1127. [PMID: 37724467 DOI: 10.1111/jre.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/30/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023]
Abstract
To evaluate the prognostic accuracy of microbial biomarkers and their associations with the response to active periodontal treatment (APT) and supportive periodontal therapy (SPT). Microbial dysbiosis plays a crucial role in the disease processes of periodontitis. Biomarkers based on microbial composition may offer additional prognostic value, supplementing the limitations of current clinical parameters. While these microbial biomarkers have been clinically evaluated, there is a lack of consensus regarding their prognostic accuracy. A structured search strategy was applied to MEDLINE (PubMed), Cochrane Library, and Embase on 1/11/2022 to identify relevant publications. Prospective clinical studies involving either APT or SPT, with at least 3-month follow-up were included. There were no restrictions on the type of microbial compositional analysis. 1918 unique records were retrieved, and 13 studies (comprising 943 adult patients) were included. Heterogeneity of the studies precluded a meta-analysis, and none of the included studies had performed the sequence analysis of the periodontal microbiome. Seven and six studies reported on response to APT and SPT, respectively. The prognostic accuracy of the microbial biomarkers for APT and SPT was examined in only two and four studies, respectively. Microbial biomarkers had limited predictive accuracy for APT and inconsistent associations for different species across studies. For SPT, elevated abundance of periodontal pathogens at the start of SPT was predictive of subsequent periodontal progression. Similarly, persistent high pathogen loads were consistently associated with progressive periodontitis, defined as an increased pocket probing depth or clinical attachment loss. While there was insufficient evidence to support the clinical use of microbial biomarkers as prognostic tools for active periodontal treatment outcomes, biomarkers that quantify periodontal pathogen loads may offer prognostic value for predicting progressive periodontitis in the subsequent supportive periodontal therapy phase. Additional research will be required to translate information regarding subgingival biofilm composition and phenotype into clinically relevant prognostic tools.
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Affiliation(s)
- Ren Jie Jacob Chew
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Charlene Enhui Goh
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Gopu Sriram
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
- Oral Care Health Innovations and Designs Singapore, National University of Singapore, Singapore, Singapore
| | | | - Kai Soo Tan
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
- Oral Care Health Innovations and Designs Singapore, National University of Singapore, Singapore, Singapore
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Sahu SA, Panda S, Das AC, Mishra L, Rath S, Sokolowski K, Kumar M, Mohanty R, Nayak R, Satpathy A, Lapinska B. Efficacy of Sub-Gingivally Delivered Propolis Nanoparticle in Non-Surgical Management of Periodontal Pocket: A Randomized Clinical Trial. Biomolecules 2023; 13:1576. [PMID: 38002260 PMCID: PMC10669236 DOI: 10.3390/biom13111576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
Naturally sourced products like propolis are commonly employed for the non-surgical treatment of periodontal pockets. The use of nanoparticle formulations of these natural remedies has the potential to improve treatment outcomes. The aim of the present study was to evaluate the efficacy of sub-gingivally delivered propolis nanoparticles in the non-surgical management of periodontal pockets. Forty patients diagnosed with periodontitis presenting at least one periodontal pocket with a probing pocket depth between 4 and 6 mm were selected. Patients were randomly assigned into the control group (n = 20), which received scaling and root planing (SRP) and saline (SRP + Saline), and the test group (n = 20), which received SRP and sub-gingivally delivered propolis nanoparticles (PRO) into the periodontal pocket (SRP + PRO). The clinical parameters recorded were plaque index (PI), gingival index (GI), relative attachment loss (RAL), probing pocket depth (PPD), and bleeding on probing (BOP). They were assessed at baseline, one month, and three months post therapy. The results indicated that there was a significant improvement in clinical parameters (p < 0.05) in the test sites compared with the control sites at the end of the study. The gingival index at one month and three months was found to be significantly better in the SRP + PRO group than the SRP + Saline group, with a p value of <0.001. The BOP, PPD, and RAL showed significant improvement with the SRP + PRO group at the end of the 3-month follow-up with p values of 0.0001, 0.001, and 0.05, respectively. The subgingival delivery of propolis nanoparticles showed promising results as an adjunct to SRP in patients with periodontitis presenting periodontal pockets.
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Affiliation(s)
- Sushree Ambika Sahu
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India; (S.A.S.); (A.C.D.); (M.K.); (R.M.); (R.N.); (A.S.)
| | - Saurav Panda
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India; (S.A.S.); (A.C.D.); (M.K.); (R.M.); (R.N.); (A.S.)
| | - Abhaya Chandra Das
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India; (S.A.S.); (A.C.D.); (M.K.); (R.M.); (R.N.); (A.S.)
| | - Lora Mishra
- Department of Conservative Dentistry & Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India;
| | - Satchidananda Rath
- Department of Physics, School of Basic Sciences, Indian Institute of Technology, Bhubaneswar 752050, Odisha, India;
| | - Krzysztof Sokolowski
- Department of Conservative Dentistry, Medical University of Lodz, 251 Pomorska St., 92-213 Lodz, Poland;
| | - Manoj Kumar
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India; (S.A.S.); (A.C.D.); (M.K.); (R.M.); (R.N.); (A.S.)
| | - Rinkee Mohanty
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India; (S.A.S.); (A.C.D.); (M.K.); (R.M.); (R.N.); (A.S.)
| | - Rashmita Nayak
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India; (S.A.S.); (A.C.D.); (M.K.); (R.M.); (R.N.); (A.S.)
| | - Anurag Satpathy
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India; (S.A.S.); (A.C.D.); (M.K.); (R.M.); (R.N.); (A.S.)
| | - Barbara Lapinska
- Department of General Dentistry, Medical University of Lodz, 251 Pomorska St., 92-213 Lodz, Poland
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Marcattili D, Mancini L, Tarallo F, Casalena F, Pietropaoli C, Marchetti E. Efficacy of two diode lasers in the removal of calculus from the root surface: An in vitro study. Clin Exp Dent Res 2023; 9:757-763. [PMID: 37649328 PMCID: PMC10582223 DOI: 10.1002/cre2.769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/12/2023] [Accepted: 07/15/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Scaling and root planning (SRP) is still the gold standard of nonsurgical periodontal therapy, and it has been accompanied by several supportive therapies in recent years. One of the most studied methods is the diode laser, thanks to its thermal and bactericidal properties. Our trial intended to verify whether it could influence the chemical bond between calculus and the root surface. OBJECTIVES The aim of the study was to assess the efficacy of the diode laser prior the mechanical removal of calculus in an in vitro application. The reduction in time and the number of strokes required to clean the untreated root surfaces were evaluated as primary outcomes. The pressure was considered as a secondary outcome. METHODS A total of 75 extracted human teeth with subgingival calculus were assigned equally among three treatment groups (n = 25) according to the size of the occupied areas, which were classified by evaluating the pixel numbers. The groups were assigned to either no pretreatment application (A), Laser Diode Fox III (Sweden & Martina) (B) or Wiser Laser Evolution (Doctor Smile) (C). The weight for instrumentation was calibrated for an After Five curette (Hu-Friedy, Chicago). A new set of tools was used for each group, and the curettes were sharpened after each use with the Sidekick sharpener (Hu-Friedy, Chicago). RESULTS A Kruskal-Wallis test was used to assess the significance for each considered parameter. The results were statistically significant for each parameter for the two groups where the laser was used compared to the control group. CONCLUSIONS Despite the limitations of an in vitro study, data showed that the diode laser had an overall positive effect on root debridement, facilitating SRP in terms of stroke count, time, and pressure.
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Affiliation(s)
- Domenico Marcattili
- Department of Life, Health & Environmental SciencesUniversity of L'AquilaL'AquilaItaly
| | - Leonardo Mancini
- Department of Life, Health & Environmental SciencesUniversity of L'AquilaL'AquilaItaly
| | - Francesco Tarallo
- Department of Life, Health & Environmental SciencesUniversity of L'AquilaL'AquilaItaly
| | - Fabio Casalena
- Department of Life, Health & Environmental SciencesUniversity of L'AquilaL'AquilaItaly
| | - Carla Pietropaoli
- Department of Life, Health & Environmental SciencesUniversity of L'AquilaL'AquilaItaly
| | - Enrico Marchetti
- Department of Life, Health & Environmental SciencesUniversity of L'AquilaL'AquilaItaly
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Aoki A, Mizutani K, Mikami R, Ohsugi Y, Kobayashi H, Akizuki T, Taniguchi Y, Takeuchi Y, Katagiri S, Sasaki Y, Komaki M, Meinzer W, Izumi Y, Iwata T. Er:YAG laser-assisted comprehensive periodontal pocket therapy for residual periodontal pocket treatment: A randomized controlled clinical trial. J Periodontol 2023; 94:1187-1199. [PMID: 37015852 DOI: 10.1002/jper.22-0552] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND This study evaluated the effectiveness of a novel pocket therapy (Er:YAG laser-assisted comprehensive periodontal pocket therapy [Er-LCPT]) for residual pocket treatment, compared with conventional mechanical treatment alone, in a randomized controlled clinical trial. METHODS Two sites in 18 patients having residual periodontal pockets of ≥5 mm depth, extant following initial active therapy, or during supportive therapy, were randomized into two groups in a split mouth design: the control group received scaling and root planing (SRP) by curette, and the test group received Er-LCPT using curette and laser. With Er-LCPT, after root debridement, inflamed connective tissue on the inner gingival surface and on the bone surface/within extant bone defects was thoroughly debrided. Furthermore, removal of proximate oral epithelium and coagulation of the blood clot in the pocket entrance were performed with laser. Clinical parameters were evaluated, before and after treatment, through 12 months. RESULTS Both groups showed significant improvements in clinical parameters. With Er-LCPT, pocket debridement was thoroughly and safely performed, without any adverse side effects and complications, and favorable healing was observed in most of the cases. At 12 months, Er-LCPT demonstrated significantly higher probing pocket depth reduction (2.78 mm vs. 1.89 mm on average; p = 0.012, Wilcoxon signed-rank test), clinical attachment gain (1.67 mm vs. 1.06 mm; p = 0.004) as primary outcomes, and reduced BOP value (0.89 vs. 0.56; p = 0.031), compared with SRP alone. CONCLUSION The results of this study indicate that Er-LCPT is more effective for residual pocket treatment, compared with SRP alone.
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Affiliation(s)
- Akira Aoki
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Koji Mizutani
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Risako Mikami
- Department of Lifetime Oral Health Care Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yujin Ohsugi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hiroaki Kobayashi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tatsuya Akizuki
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yoichi Taniguchi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Taniguchi Dental Clinic, Sapporo, Japan
| | - Yasuo Takeuchi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Sayaka Katagiri
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yoshiyuki Sasaki
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Motohiro Komaki
- Department of Periodontology, Kanagawa Dental University (KDU), Yokosuka, Japan
| | - Walter Meinzer
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yuichi Izumi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Oral Care Periodontics Center, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Koriyama, Japan
| | - Takanori Iwata
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Brinar S, Skvarča A, Gašpirc B, Schara R. The effect of antimicrobial photodynamic therapy on periodontal disease and glycemic control in patients with type 2 diabetes mellitus. Clin Oral Investig 2023; 27:6235-6244. [PMID: 37672083 PMCID: PMC10560165 DOI: 10.1007/s00784-023-05239-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVES This study is aimed at determining the effect of concomitant antimicrobial photodynamic therapy (aPTD) on periodontal disease and glycaemic control in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS Twenty-four patients with T2DM were enrolled in the study. Periodontal clinical parameters were assessed by measuring probing pocket depth (PPD), clinical attachment loss (CAL), gingival recession (GR), full-mouth bleeding score (FMBS), full-mouth plaque score (FMPS), and full-mouth sulcus bleeding score (FMSBS). Glycated haemoglobin A1c (HbA1c) was measured. To determine the presence of the following periodontal pathogenic bacteria, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola, subgingival plaque samples were taken from two periodontal pockets per jaw with the greatest PPD using paper tips. Patients were randomly divided into the test and control group. In the test group, full-mouth disinfection was performed in combination with aPTD. In the control group, only full-mouth disinfection was performed. RESULTS The results showed an improvement in periodontal clinical parameters in both groups. The difference between the groups in favour of the test group was statistically significant for BOP. The HbA1c level decreased in both groups. The difference was not statistically significant. The results of the microbiological analysis suggest that the presence of periodontal pathogenic bacteria is lower with additional antimicrobial photodynamic therapy with statistically significant difference for T. forsythia. CONCLUSIONS Additional aPDT causes a significant reduction in BoP in the proportion of positive sites for periodontal pathogens. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05816941. CLINICAL RELEVANCE aPTD is a noninvasive adjunctive therapy that can positively influence the periodontal treatment outcome.
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Affiliation(s)
- Sara Brinar
- Department of Oral Medicine and Periodontology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Community Health Centre Murska Sobota, Murska Sobota, Slovenia
| | - Aleš Skvarča
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Boris Gašpirc
- Department of Oral Medicine and Periodontology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Rok Schara
- Department of Oral Medicine and Periodontology, University Medical Center Ljubljana, Ljubljana, Slovenia.
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Arnett MC, Chanthavisouk P, Costalonga M, Blue CM, Evans MD, Paulson DR. Effect of scaling and root planing with and without minocycline HCl microspheres on periodontal pathogens and clinical outcomes: A randomized clinical trial. J Periodontol 2023; 94:1133-1145. [PMID: 37191955 PMCID: PMC10525010 DOI: 10.1002/jper.23-0002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/15/2023] [Accepted: 04/24/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND This study tests the effects of scaling and root planing (SRP) versus SRP plus minocycline hydrochloride microspheres (SRP+MM) on 11 periodontal pathogens and clinical outcomes in Stage II-IV Grade B periodontitis participants. METHODS Seventy participants were randomized to receive SRP (n = 35) or SRP+MM (n = 35). Saliva and clinical outcomes were collected for both groups at baseline before SRP, 1-month reevaluation, and at 3- and 6-month periodontal recall. MM were delivered to pockets ≥5 mm immediately after SRP and immediately after the 3-month periodontal maintenance in the SRP+MM group. A proprietary saliva test* was utilized to quantitate 11 putative periodontal pathogens. Microorganisms and clinical outcomes were compared between groups using generalized linear mixed-effects models with fixed effects and random effects terms. Mean changes from baseline were compared between groups via group-by-visit interaction tests. RESULTS Significant reduction in Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum, Prevotella intermedia, Parvimonas micra, and Eikenella corrodens were identified at the 1-month reevaluation after SRP+MM. Six months after SRP with a re-application of MM 3 months after SRP, Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus, and Eikenella corrodens were significantly reduced. SRP+MM participants had significant clinical outcome reductions in pockets ≥5 mm at the reevaluation, 3- and 6-month periodontal maintenance, and clinical attachment loss gains at the 6-month periodontal maintenance. CONCLUSION MM delivered immediately after SRP and reapplication at 3 months appeared to contribute to improved clinical outcomes and sustained decreased numbers of Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus, and Eikenella corrodens at 6 months.
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Affiliation(s)
- Michelle C. Arnett
- Department of Primary Dental Care, Division of Dental Hygiene, University of Minnesota School of Dentistry, Minneapolis, Minnesota
| | - Phonsuda Chanthavisouk
- Department of Primary Dental Care, Division of Dental Therapy, University of Minnesota School of Dentistry, Minneapolis, Minnesota
| | - Massimo Costalonga
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, Minnesota
| | - Christine M. Blue
- Department of Primary Dental Care, Division of Dental Hygiene, University of Minnesota School of Dentistry, Minneapolis, Minnesota
| | - Michael D. Evans
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota
| | - Danna R. Paulson
- Department of Primary Dental Care, Division of Dental Hygiene, University of Minnesota School of Dentistry, Minneapolis, Minnesota
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21
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Guha Biswas P, Mohan A, Kandaswamy E. Treatment of Periodontitis Affecting Human Primary Teeth-A Systematic Review. Dent J (Basel) 2023; 11:171. [PMID: 37504237 PMCID: PMC10378644 DOI: 10.3390/dj11070171] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023] Open
Abstract
The aim of this systematic review is to report the treatment options (Intervention) and outcomes (O) for primary teeth affected by periodontitis (Population) and if the treatment of primary teeth can prevent the spread of periodontitis to permanent teeth (Outcomes). The following databases were searched for papers published before December 2022: PubMed, Embase, Web of Science, and Ebscohost. Studies on children affected by periodontitis involving the primary teeth were included and those on children who presented with periodontitis as a manifestation of systemic disease were excluded. Narrative synthesis and methodological quality assessments were performed for the included studies. Three interventional studies (without a control group) that evaluated treatments involving scaling and root planing (SRP with antibiotics) and extraction were included (total n = 60 patients). Additionally, twelve case reports/case series articles (n = 19 patients) were identified. The diagnoses ranged from aggressive periodontitis to juvenile periodontitis and pre-pubertal periodontitis. Based on a limited number of published studies, it was found that the early treatment of periodontitis affecting the primary teeth using SRP and systemic antibiotics resulted in favorable improvements in PD and CAL. Limited evidence suggests that SRP and the extraction of the primary teeth involved have the potential to prevent periodontitis affecting permanent teeth. Future trials are required to standardize the treatment protocols and to confirm these findings.
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Affiliation(s)
- Protyusha Guha Biswas
- Department of Oral Pathology and Microbiology, Meenakshi Ammal Dental College and Hospital, Chennai 600095, India
| | | | - Eswar Kandaswamy
- Department of Periodontics, Louisiana State University Health Sciences Center, School of Dentistry, New Orleans, LA 70119, USA
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22
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Soancă A, Leucuța DC, Roman A, Ciurea A, Negucioiu M, Pascu LC, Picoș A, Delean AG, Micu IC, Popa Wagner A, Rusu D. The Treatment of Severe Periodontitis Using a Local Antiseptic Desiccant and Subgingival Mechanical Instrumentation: A Pilot Study. J Clin Med 2023; 12:4286. [PMID: 37445321 DOI: 10.3390/jcm12134286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
This randomized, split-mouth, controlled clinical study assessed the additional clinical benefits of a local desiccant antimicrobial agent (HY) combined with subgingival mechanical instrumentation (SRP) vs. SRP alone in treating severe periodontitis. Patients with stages III and IV periodontitis received full-mouth periodontal examinations at baseline and after a three-month follow-up. Two randomly selected hemiarches in each periodontitis patient were treated with SRP plus HY and were included in the test group, while the other two hemiarches received only SRP and were included in the control group. In thirty patients, the analyses of the evolution of the periodontal parameters over time showed statistically significant mean differences for the probing depths and clinical attachment level values resulting from all the examined sites, as well as from the interproximal sites (p < 0.001) in both the test and control groups. The intergroup comparisons of the same four parameters showed no significant differences (p = 0.322, p = 0.36, p = 0.516, and p = 0.509, respectively). Based on these study results, no additional benefits were obtained after HY subgingival applications.
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Affiliation(s)
- Andrada Soancă
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babes St., No. 15, 400012 Cluj-Napoca, Romania
| | - Daniel Corneliu Leucuța
- Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Louis Pasteur St., No. 6, 400349 Cluj-Napoca, Romania
| | - Alexandra Roman
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babes St., No. 15, 400012 Cluj-Napoca, Romania
| | - Andreea Ciurea
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babes St., No. 15, 400012 Cluj-Napoca, Romania
| | - Marius Negucioiu
- Department of Prosthodontics, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Clinicilor St., No. 32, 400006 Cluj-Napoca, Romania
| | - Laurențiu Cătălin Pascu
- Department of Prosthodontics, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Clinicilor St., No. 32, 400006 Cluj-Napoca, Romania
| | - Andrei Picoș
- Department of Prevention in Dental Medicine, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Avram Iancu St., No. 31, 400347 Cluj-Napoca, Romania
| | - Ada Gabriela Delean
- Department of Cariology, Endodontics and Oral Pathology, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Motilor St., No. 33, 400001 Cluj-Napoca, Romania
| | - Iulia Cristina Micu
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babes St., No. 15, 400012 Cluj-Napoca, Romania
| | - Aurel Popa Wagner
- Vascular Neurology and Dementia Center, University of Medicine, Essen, Hufeland St., No. 55, 45122 Essen, Germany
- Experimental Research Center in Normal and Pathological Aging (ARES), University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
| | - Darian Rusu
- Department of Periodontology, Anton Sculean Research Center of Periodontal and Peri-Implant Diseases, Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Bulevardul Revolutiei din 1989, No. 9, 300230 Timisoara, Romania
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23
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Madruga D, Garcia MM, Martino L, Hassan H, Elayat G, Ghali L, Ceballos L. Positive correlational shift between crevicular antimicrobial peptide LL-37, pain and periodontal status following non-surgical periodontal therapy. A pilot study. BMC Oral Health 2023; 23:335. [PMID: 37246231 DOI: 10.1186/s12903-023-03023-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 05/06/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Periodontitis has a high prevalence and uncertain recurrence. Unlike the pro-inflammatory cytokine profile, little is known about the anti-inflammatory cytokine and antimicrobial peptide overview following treatment. The present study aimed to evaluate if any of the antimicrobial peptide LL-37, interleukin (IL) 4, 10 and 6 together with the volume of gingival crevicular fluid (GCF) and total protein concentration in GCF could be used as correlative biomarkers for the severity in periodontitis as well as prognostic factors in the management of the disease. METHODS Forty-five participants were recruited and allocated to the healthy (15), Stage I-II (15) or Stage III-IV periodontitis (15) group. Along with periodontal examination, GCF samples were obtained at baseline and 4-6 weeks following scaling and root planing (SRP) for the periodontitis groups. GCF samples were analyzed by ELISA kits to quantify LL-37 and IL-4, -6 and - 10. One-way ANOVA followed by Dunnett's test was used to determine differences among the three groups at baseline. Two-way ANOVA followed by Sidak's post-hoc test was used to compare between pre- and post-SRP in the two periodontitis groups. RESULTS The amount of GCF volume was significantly correlated to the severity of periodontitis and decreased following SRP, particularly in the Stage III-IV group (p < 0.01). The levels of LL-37, IL-6, and pain and periodontal clinical parameters were significantly correlated to the severity of periodontitis. IL-4 and IL-10 in the periodontitis groups were significantly lower than the healthy group (p < 0.0001) and barely improved following SRP up to the level of the healthy group. CONCLUSIONS With the limitations of this study, crevicular LL-37 may be a candidate for a biomarker of periodontitis and the associated pain upon probing. TRIAL REGISTRATION The study was registered in clinical trials.gov, with number NCT04404335, dated 27/05/2020.
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Affiliation(s)
- David Madruga
- Area of Stomatology, Department of Nursing and Stomatology, Faculty of Health Sciences, Universidad Rey Juan Carlos (URJC), Avda. de Atenas s/n, Alcorcón, E-28922, Spain
| | - Miguel M Garcia
- Area of Pharmacology, Nutrition and Bromatology, Department of Basic Health Sciences, Faculty of Health Sciences, Universidad Rey Juan Carlos (URJC), Unidad Asociada I+D+i Instituto de Química Médica (IQM) CSIC-URJC, Avda. de Atenas s/n, Alcorcón, E-28922, Spain.
- High Performance Experimental Pharmacology Research Group, Universidad Rey Juan Carlos (PHARMAKOM), Alcorcón, Spain.
- Grupo Multidisciplinar de Investigación y Tratamiento del Dolor (i+DOL), Universidad Rey Juan Carlos (URJC), Alcorcón, Spain.
| | - Luca Martino
- Area of Signal Theory and Communications, Department of Signal Theory and Communications and Telematics Systems and Computing, Higher Technical School of Telecommunications Engineering, Universidad Rey Juan Carlos (URJC), Cam. del Molino, 5, Fuenlabrada, E-28942, Spain
- High Performance Data Science and Signal Processing for Networks and Society research group, Universidad Rey Juan Carlos (DSSP), Fuenlabrada, Spain
| | - Haidar Hassan
- Academic Plastic Surgery, School of Medicine and Dentistry, Blizard Institute, Barts and The London, Queen Mary University of London, London, E1 2AD, UK
- Department of Natural Sciences, Faculty of Science and Technology, Middlesex University, London, NW4 4BT, UK
| | - Ghada Elayat
- Department of Natural Sciences, Faculty of Science and Technology, Middlesex University, London, NW4 4BT, UK
- Department of Pathology, Faculty of Medicine, Tanta University, El Bahr St, Tanta, 31111, Egypt
| | - Lucy Ghali
- Department of Natural Sciences, Faculty of Science and Technology, Middlesex University, London, NW4 4BT, UK
| | - Laura Ceballos
- Area of Stomatology, Department of Nursing and Stomatology, Faculty of Health Sciences, Universidad Rey Juan Carlos (URJC), Avda. de Atenas s/n, Alcorcón, E-28922, Spain
- High Performance Development and Innovation in Dental Biomaterials Research Group, Universidad Rey Juan Carlos (IDIBO), Alcorcón, Spain
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Zhang Q, Chu F, Xu Y, Wu X, Yu J, Cong B, Wu Y. Osteogenesis promotion by injectable methacryloylated gelatin containing psoralen and its bacteriostatic properties. IET Nanobiotechnol 2023. [PMID: 37191270 DOI: 10.1049/nbt2.12136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/17/2023] Open
Abstract
The treatment of periodontitis focuses on controlling the progression of inflammation, reducing plaque accumulation, and promoting bone tissue reconstruction. Among them, the reconstruction of irregular bone resorption caused by periodontitis is a long-standing challenge. At present, the local drug treatment of periodontitis is mainly anti-inflammatory and antibacterial drugs. In this study, psoralen (Pso), a Chinese herbal medicine with anti-inflammatory, antibacterial, and osteogenic effects, was selected for the local treatment of periodontitis. Meanwhile, an injectable methacrylate gelatin (GelMA) platform loading with Pso was constructed. Pso-GelMA had the properties of fluidity, light cohesion, self-healing, and slow release, which could be better used in the deep and narrow structure of the periodontal pocket, and greatly increased the effectiveness of local drug delivery. The pore size of Gelma hydrogel did not change after loading Pso by SEM. In vitro, Pso-GelMA effectively upregulated the expression of osteogenic genes and proteins, increased alkaline phosphatase activity, promoted the mineralisation of rat bone marrow mesenchymal stem cells (BMSCs) extracellular matrix, and had significant antibacterial effects on Staphylococcus aureus and Fusobacterium nucleatum. Therefore, Pso-GelMA has immense promise in the adjuvant treatment of periodontitis.
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Affiliation(s)
- Qi Zhang
- School of Stomatology, Qingdao University, Qingdao, China
| | - Fuhang Chu
- Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao, China
| | - Yingjie Xu
- Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao, China
| | - Xiaonan Wu
- Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao, China
| | - Jie Yu
- School of Stomatology, Qingdao University, Qingdao, China
| | - Beibei Cong
- Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao, China
| | - Yingtao Wu
- Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao, China
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25
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Al-Khalifa KS, Alam BF, Alhumaidan AA, Aljoghaiman EA, Alhassan MM, Ali S. Bibliometric analysis on research trends for contribution of photodynamic therapy in periodontitis. Photodiagnosis Photodyn Ther 2023; 42:103594. [PMID: 37156454 DOI: 10.1016/j.pdpdt.2023.103594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/09/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND The objective of this bibliometric was to ascertain the research trend regarding the application of photodynamic therapy as a treatment modality for periodontal disease. METHODS An online search was administered using the Scopus database to retrieve all the relevant research literature published from 2003 till 26th Dec 2022. After applying the inclusion criteria articles pertinent to the topic were manually selected. Data was saved as CSV. Data was read using VOSviewer software and further analysis was performed using Microsoft excel. RESULTS From a total of 545 articles, 117 scientific papers relevant to the field were evaluated. The keen interest of researchers was identified by an increase in the number of publications over the course of time, with the highest citations n=827 attained during the year 2009. Brazil, India, and USA made significant contribution by publishing highest number of papers. Organizations from the USA produced the highest publications which attained high citations. Author Sculean A. published the highest number of papers. Journal of periodontology was the leading journal, by publishing highest number of papers (n=15), followed by Journal of Clinical Periodontology. CONCLUSION This bibliometric analysis provided detailed information regarding the total number of publications from 2003 to 2022 and the number of citations attained. Brazil has been identified as the leading country, whilst all the leading organizations which contributed significantly, were from USA. The Journal of Periodontology published the highest number of papers which had been highly cited. Sculean A, affiliated with University of Bern, Switzerland published the highest number of papers.
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Affiliation(s)
- Khalifa S Al-Khalifa
- Department of preventive dental sciences, College of Dentistry Imam Abdulrahman bin Faisal University, Saudi Arabia.
| | | | - Abdulkareem Abdullah Alhumaidan
- Department of preventive dental sciences, division of periodontics, Imam Abdulrahman bin Faisal University, College of dentistry. Saudi Arabia.
| | - Eman Ahmed Aljoghaiman
- Department of preventive dental sciences, division of periodontics, Imam Abdulrahman bin Faisal University, College of dentistry. Saudi Arabia.
| | | | - Saqib Ali
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
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Adjunctive Nd:YAG laser irradiation in the treatment of stage III/IV periodontitis: a 12-month, randomized, controlled trial. Clin Oral Investig 2023:10.1007/s00784-023-04908-4. [PMID: 36795248 DOI: 10.1007/s00784-023-04908-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the clinical efficacy of the adjunctive use of Nd:YAG laser (1064 nm) to full-mouth scaling and root planning (FMS), in stage III/IV periodontitis patients. MATERIALS AND METHODS Sixty stage III/IV periodontitis patients were randomly assigned to three groups. The control group received FMS, laser 1 group received combined FMS/single Nd:YAG laser irradiation (3 W, 150 mJ, 20 Hz,100 μs), and laser 2 group received combined FMS/double Nd:YAG laser irradiation with 1-week interval (2.0 W, 200 mJ, 10 Hz, 100 μs). PD, CAL, FMPS, GI, FMBS, and GR were evaluated at baseline, 6 weeks, 3, 6, and 12 months after treatment. Patient-reported outcomes were evaluated 1 week after treatment. RESULTS A significant improvement (p < 0.001) for all clinical parameters was observed during the entire study period, with the exception of mean CAL gain for the laser 2 group at 12 months. The percentage of pockets ≤ 4 mm was significantly higher compared to baseline for all groups throughout the study, with no inter-group differences at any time point. Patient-reported analgesic consumption was higher for laser 1 group. CONCLUSIONS The adjunctive use of Nd:YAG laser irradiation was similarly effective to FMS alone, during the entire study period. A slightly higher, though not statistically significant improvement was reported for PD at 6 and 12 months after a single post-FMS application of Nd:YAG laser for pocket epithelium removal and coagulation. CLINICAL RELEVANCE Additional Nd:YAG laser application for sulcular epithelium removal and coagulation may provide minor long-term improvements compared to FMS or laser irradiation for pocket disinfection and detoxification. TRIAL REGISTRATION ISRCTN26692900. Registration date: 09/06/2022.
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Ilyes I, Rusu D, Rădulescu V, Vela O, Boariu MI, Roman A, Surlin P, Kardaras G, Boia S, Chinnici S, Jentsch HFR, Stratul SI. A Placebo-Controlled Trial to Evaluate Two Locally Delivered Antibiotic Gels (Piperacillin Plus Tazobactam vs. Doxycycline) in Stage III-IV Periodontitis Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020303. [PMID: 36837504 PMCID: PMC9961827 DOI: 10.3390/medicina59020303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023]
Abstract
Background and objectives: this study aims to evaluate the clinical and microbiological effects of a single subgingival administration of a locally delivered antibiotic gel containing piperacillin plus tazobactam and compare it with a slow-release doxycycline (14%) gel and a placebo gel, following subgingival instrumentation (SI) in patients with severe periodontitis. Materials and methods: sixty-four patients diagnosed with stage III-IV periodontitis were enrolled, were randomly assigned into three groups, and were treated additionally with a single subgingival administration of piperacillin plus tazobactam gel (group A); doxycycline gel (group B); and placebo gel (group C). The primary outcome variable was the change in mean probing pocket depth (PPD) 6 months after the intervention. Secondary outcome variables were changes in mean full-mouth bleeding score (FMBS); full-mouth plaque score (FMPS); overall bleeding index (BOP); pocket closure; and clinical attachment level (CAL), along with changes in the numbers of five keystone bacteria: Aggregatibacter actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), Prevotella intermedia (P.i.), Tannerella forsythia (T.f.), and Treponema denticola (T.d.). Intergroup and intragroup differences were evaluated at 3 and 6 months. Results: at baseline, the three groups were comparable. An improvement in clinical parameters such as PPD, CAL, and BOP between groups was observed at 3 and 6 months, but without statistical significance (p > 0.05). At 6 months, the intragroup analysis showed a significant reduction in clinical parameters. Even though the piperacillin plus tazobactam group showed slightly higher PPD reduction, this was not statistically significant when compared to both control groups. Conclusions: The groups had similar results, and subgingival instrumentation can be executed without adjunctive antimicrobials, reducing the costs for the patient and the working time/load of the professional.
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Affiliation(s)
- Ioana Ilyes
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Darian Rusu
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence:
| | - Viorelia Rădulescu
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Octavia Vela
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Marius Ion Boariu
- Department of Endodontics, Faculty of Dental Medicine, TADERP Research Center, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Alexandra Roman
- Department of Periodontology, Faculty of Dental Medicine, Applicative Periodontal Regeneration Research Unit, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Petra Surlin
- Department of Periodontology, Faculty of Dental Medicine, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Giorgios Kardaras
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Simina Boia
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Salvatore Chinnici
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Holger Friedrich Rudolf Jentsch
- Department of Cariology, Endodontology and Periodontology, Centre for Periodontology, University Hospital of Leipzig, 04103 Leipzig, Germany
| | - Stefan-Ioan Stratul
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Regenerative Potential of Granulation Tissue in Periodontitis: A Systematic Review and Meta-analysis. Stem Cells Int 2023; 2023:8789852. [PMID: 36926181 PMCID: PMC10014158 DOI: 10.1155/2023/8789852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/27/2022] [Accepted: 02/15/2023] [Indexed: 03/12/2023] Open
Abstract
Methods Electronic searches were conducted in five databases including CENTRAL, MEDLINE, EMBASE, Web of Science, and Dentistry & Oral Sciences Source using a combination of MeSH terms and keywords up to 21 June 2022. Human studies including patients aged over 18 years with all forms of periodontitis were included. Following the risk of bias assessment, both qualitative and quantitative analyses were performed. Results A total of twelve studies were included in qualitative analysis and six of them in quantitative analyses. The evidence suggested that cells derived from periodontitis granulation tissue have osteogenic, adipogenic, chondrogenic, neurogenic, and angiogenic differentiation abilities as well as immunoregulatory properties. In particular, CD44+, CD73+, CD90+, CD105+, and CD146+ cells were found widely in granulation tissue whilst the only meta-analysis confirmed that CD90+ cells were present in lower numbers within the granulation tissue when compared with healthy periodontal tissue (WMD = -23.43%, 95% CI -30.43 to -16.44, p < 0.00001). Conclusions This review provided further evidence that granulation tissue from patients with periodontitis can be a potential stem cell source for regenerative therapy.
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Clinical efficacy of hand and power-driven instruments for subgingival instrumentation during periodontal surgical therapy: a systematic review. Clin Oral Investig 2023; 27:1-13. [PMID: 36565370 PMCID: PMC9789306 DOI: 10.1007/s00784-022-04759-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 10/15/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This systematic review aims to assess the available literature on the clinical efficacy of hand versus power-driven instruments for subgingival instrumentation during surgical periodontal therapy (ST). MATERIALS AND METHODS A search of the literature was carried out on MEDLINE via Ovid, Embase, Web of Science, the Cochrane Database, LILACS, and Scopus. RCTs comparing the use of powered instruments (test) to hand scalers (control) for subgingival instrumentation in terms of changes in probing pocket depth (PPD) after surgical periodontal treatment were included and screened in duplicate. Descriptive synthesis of the data and risk of bias assessment were undertaken. RESULTS Four RCTs met the inclusion criteria and were included in this systematic review. ST in all studies was performed by means of open flap debridement. Gracey curettes were the most commonly used hand instruments, while sonic and ultrasonic devices were used in the test group. Sites with initial PPD ≥ 6 mm had pocket reduction ranging from 2.93 to 4.89 mm in the control group and from 2.77 to 3.86 mm in the test group. All studies found no significant difference between the different types of instruments/devices in terms of PPD reduction. CONCLUSIONS Despite the limited number of studies, both manual and power-driven instruments appear to be effective in reducing PPD after surgical treatment of periodontitis. CLINICAL RELEVANCE Based on the findings of this systematic review, the clinician may make a decision whether to use manual or powered instruments during ST on a case-by-case basis and considering other factors, such as the risk of creating high concentrations of aerosols.
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Skalerič E, Petelin M, Gašpirc B. Antimicrobial photodynamic therapy in treatment of aggressive periodontitis (stage III, grade C periodontitis): A comparison between photodynamic therapy and antibiotic therapy as an adjunct to non-surgical periodontal treatment. Photodiagnosis Photodyn Ther 2022; 41:103251. [PMID: 36587861 DOI: 10.1016/j.pdpdt.2022.103251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Treatment of aggressive periodontitis (stage III, grade C periodontitis) represents a challenge. The aim of the study was to compare the long-term results of antimicrobial photodynamic therapy (aPDT) and antibiotic therapy as an adjunct to conventional non-surgical therapy in patients with aggressive periodontitis. MATERIALS AND METHODS Twenty subjects with untreated aggressive periodontitis (stage III, grade C periodontitis) were divided into two groups: the test group (TG) received non-surgical therapy and two sessions of aPDT using a laser (HELBO TheraLite laser) with a wavelength of 670 nm associated with HELBO Blue photosensitizer, and the control group (CG) received non-surgical therapy and antibiotics (amoxicillin 500 mg and metronidazole 400 mg, 7 days). Clinical parameters of probing depth, clinical attachment level and bleeding on probing (BOP) were assessed at baseline, 3, 6, 9 and 12 months after treatment. RESULTS The mean probing pocket depths at baseline were 3.68 mm in TG and 3.51 mm in CG. These values decreased to 2.77 mm (p < 0.05) and 2.54 mm (p < 0.05) 3 months after treatment and stayed decreased after 12 months. Clinical attachment levels at baseline were 3.88 mm in TG and 3.70 mm in CG. These values decreased to 3.06 mm (p < 0.05) and 2.80 mm (p < 0.05) after 3 months and stayed decreased after 12 months. We also found a decrease in BOP after 3, 6, 9 and 12 months in TG and in CG. CONCLUSIONS aPDT and antibiotics as an adjunct to non-surgical periodontal treatment lead to a comparable improvement in long term periodontal parameters.
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Affiliation(s)
- Eva Skalerič
- Department of Oral Medicine and Periodontology, Faculty of Medicine and University Medical Center, Ljubljana, Slovenia.
| | - Milan Petelin
- Department of Oral Medicine and Periodontology, Faculty of Medicine and University Medical Center, Ljubljana, Slovenia.
| | - Boris Gašpirc
- Department of Oral Medicine and Periodontology, Faculty of Medicine and University Medical Center, Ljubljana, Slovenia.
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Roy S, Singh DK, Manohar B. Comparative evaluation of postoperative pain and tissue response in patients undergoing conventional flap surgeries with or without 940 nm diode laser exposure - A randomized clinical study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:417. [PMID: 36824074 PMCID: PMC9942145 DOI: 10.4103/jehp.jehp_568_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/07/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Over the past few years, a growing body of evidence has allowed us to ascertain that the initiation of periodontitis stems from the existence of oral microbial biofilm and that this requires definitive treatment. Owing to its exceptional usability, affordability, and antibacterial activity, the "diode laser" (DL) has increasingly become a popular and important tool in a dentist's armamentarium. However, there is a scarcity of scientific evidence on the utility and advantages of using "diode laser" in periodontal flap surgery. The study aimed to determine the efficacy of 940 nm diode laser exposure in combination with conventional periodontal flap surgery for the treatment of chronic periodontitis to evaluate postoperative discomfort and clinical parameters. MATERIALS AND METHODS A total of 10 subjects (7 males and 3 females) with generalized chronic periodontitis were recruited and completed the study without any dropouts. For this split-mouth study, 40 sample sites with pocket probing depth (PPD) 5-7 mm post periodontal Phase I therapy were selected. The quadrants were randomly allocated to Groups A, B, C, and D using the fish bowl lottery method. Kirkland flap surgery with laser and modified Widman flap (MWF) with laser were performed in Group A and C, respectively, while Kirkland flap surgery and MWF surgery were performed in Group B and Group D. Clinical parameters including visual analog scale (VAS) score and gingival inflammation were determined at 3rd and 7th day postoperatively while PPD, clinical attachment level (CAL), and sulcus bleeding index (SBI) were recorded at baseline and 6 months following treatment. Wilcoxon signed-rank test and Kruskal-Wallis test were used for intra-group and inter-group comparison of parameters, respectively. RESULTS Statistically significant difference was attained with postoperative discomfort in laser-assisted groups on 1st and 3rd day postoperatively (P < 0.001). There was no significant difference in the proportion of subjects with gingival inflammation. A statistically significant reduction in mean PPD at 6 months postoperatively was seen among all study groups (P < 0.05) but the inter-group difference was not statistically significant. SBI score reduced significantly from baseline to 6 months follow-up among all four groups (P < 0.05). However, we did not find the inter-group difference to be statistically non-significant. CONCLUSION Diode laser as an adjunct to the surgical procedure can demonstrate appreciable benefits by increasing the CAL and minimizing the postoperative pain and the probing pocket, but such additional effects were not observed with gingival inflammation.
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Affiliation(s)
- Sonali Roy
- Department of Periodontology and Oral Implantology, Kalinga Institute of Dental Sciences- KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Dhirendra K. Singh
- Department of Periodontology and Oral Implantology, Kalinga Institute of Dental Sciences- KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Balaji Manohar
- Department of Periodontology and Oral Implantology, Kalinga Institute of Dental Sciences- KIIT Deemed to be University, Bhubaneswar, Odisha, India
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Bagheri R, Bohlouli S, Maleki Dizaj S, Shahi S, Memar MY, Salatin S. The Antimicrobial and Anti-Biofilm Effects of Hypericum perforatum Oil on Common Pathogens of Periodontitis: An In Vitro Study. Clin Pract 2022; 12:1009-1019. [PMID: 36547112 PMCID: PMC9777146 DOI: 10.3390/clinpract12060104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
The antibacterial and anti-biofilm effects of Hypericum perforatum oil against the common pathogens of periodontitis (Escherichia coli, Streptococcus mutans, Staphylococcus aureus, Enterococcus faecalis, Porphyromonas gingivalis) was investigated. Disk diffusion (DD), minimum inhibitory concentration (MIC), and minimum bactericidal concentration (MBC) approaches were applied to test the antimicrobial effects. In order to determine the anti-biofilm effects, the amount of bacterial biofilm formation was assessed using the microtiter plate technique. The anti-biofilm effects were then confirmed by determining the minimum biofilm inhibitor concentration (MBIC). The MIC, MBC, MBIC, and DD values were 64, 256, 512 μg/mL, and 14 mm for Staphylococcus aureus; 128, 256, 512 μg/mL, and 16 mm for Streptococcus mutans; 256, 512, 256 μg/mL, and 20 mm for Escherichia coli; 32, 128, 512 µg/mL, and 16 mm for Enterococcus faecalis; and 64, 128, 256 µg/mL, and 15 mm for Porphyromonas gingivalis, respectively. According to our results, Hypericum perforatum oil has antibacterial and anti-biofilm properties against the common bacteria associated with periodontitis.
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Affiliation(s)
- Reza Bagheri
- Department of Oral Medicine, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz 51548-53431, Iran
| | - Sepideh Bohlouli
- Department of Oral Medicine, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz 51548-53431, Iran
| | - Solmaz Maleki Dizaj
- Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz 51548-53431, Iran
- Correspondence: (S.M.D.); (M.Y.M.)
| | - Shahriar Shahi
- Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz 51548-53431, Iran
| | - Mohammad Yousef Memar
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz 51548-53431, Iran
- Correspondence: (S.M.D.); (M.Y.M.)
| | - Sara Salatin
- Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz 51548-53431, Iran
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Chatzopoulos GS, Doufexi AE, Zarenti S, Anastasopoulos M, Kouvatsi A. Periodontal disease progression and gene polymorphisms: results after 3 years of active periodontal treatment. Minerva Dent Oral Sci 2022; 71:329-338. [PMID: 35686958 DOI: 10.23736/s2724-6329.22.04709-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although non-surgical periodontal treatment is considered the gold standard, a subgroup of patients displays recurrence/progression of periodontitis after treatment. The aim of the present prospective study was to assess the effect of IL-6 -572 G/C and IL-10 -592 C/A gene polymorphisms on the risk of disease recurrence/progression at 3 years following non-surgical periodontal treatment. METHODS Thirty-seven patients diagnosed with chronic periodontitis received oral hygiene instructions and non-surgical periodontal treatment and were monitored for 3 years. All individuals were clinically evaluated for PPD, CAL and BOP at baseline and 3 years. Based on the clinical findings at 3 years, all subjects were considered either "at risk" or "not at risk" of periodontal disease progression based on specific criteria. Blood samples were collected at baseline and genotyping of the polymorphisms in IL-6 (rs1800796) and IL-10 (rs1800872) genes were performed by PCR. RESULTS Following DNA separation and genotyping, 70.3% of the patients were homozygous carriers of the IL-6 -572G and 45.9% were carriers of the IL-10 -592A allele. Individuals at risk of disease progression ranged from 16.2% to 56.8% based on the criteria used. IL-6 -572 G/C and IL-10 -592 C/A polymorphisms were not associated with an increased risk of further disease progression (P>0.05) when the three criteria were examined. All examined periodontal clinical measures were significantly improved (P<0.05) after treatment. Males showed a significantly higher risk of disease progression than females when full-mouth BOP ≥30% was considered (P=0.008). CONCLUSIONS Within the limitations of this 3-year prospective study, individuals susceptible to periodontal disease as determined by the presence of the IL-6 -572GG genotype or the IL-10 -592A allele were not associated with an increased risk of further disease progression and the potential need for further treatment following non-surgical periodontal treatment. Males were more prone to be at risk of disease progression than females.
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Affiliation(s)
- Georgios S Chatzopoulos
- Division of Periodontology, Department of Developmental and Surgical Sciences, University of Minnesota, Minneapolis, MN, USA - .,Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece -
| | - Aikaterini-Elisavet Doufexi
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Private practitioner, Thessaloniki, Greece
| | - Sofia Zarenti
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Menelaos Anastasopoulos
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Kouvatsi
- Department of Genetics, Development and Molecular Biology, School of Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Oza RR, Sharma V, Multani P, Balsara K, Bajaj P, Dhadse P. Comparing the Effectiveness of Ultrasonic Instruments Over Manual Instruments for Scaling and Root Planing in Patients With Chronic Periodontitis: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e31463. [PMID: 36532917 PMCID: PMC9750238 DOI: 10.7759/cureus.31463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/13/2022] [Indexed: 11/15/2022] Open
Abstract
Periodontal disease is a chronic, complex, and infectious condition that affects the periodontium. Its progressive form can be identified by the loss and destruction of the periodontal ligament and the alveolar bone, respectively. Periodontal disease, one of the most prevalent oral cavity diseases, is responsible for tooth loss. Scaling and root planing (SCRP) is a standard, non-invasive periodontal therapy for treating patients with periodontitis. However, there have also been connections to disputed results. According to reports, SCRP alone is ineffective in removing pathogenic microorganisms and their by-products from periodontal pockets. In light of this, our current study aims to determine if using manual or ultrasonic instruments for SCRP in patients with a clinical diagnosis of chronic periodontitis is preferable. This systematic evaluation compares the effectiveness of manual and ultrasonic devices for SCRP, a line of therapy for individuals with a clinical diagnosis of chronic periodontitis. The databases searched were Prospero, PubMed, MEDLINE, CENTRAL, ClinicalTrials.gov, and Cochrane Library, which exclusively included English-language papers. The articles were also manually searched for any information missed during the search process.
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Affiliation(s)
- Ranu R Oza
- Periodontics and Implantology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Varsha Sharma
- Periodontics and Implantology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Priyanka Multani
- Periodontics and Implantology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Khushbu Balsara
- Periodontics and Implantology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Pavan Bajaj
- Periodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Prasad Dhadse
- Periodontics and Implantology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Harrel SK, Cobb CM, Sheldon LN, Rethman MP, Sottosanti JS. Calculus as a Risk Factor for Periodontal Disease: Narrative Review on Treatment Indications When the Response to Scaling and Root Planing Is Inadequate. Dent J (Basel) 2022; 10:195. [PMID: 36286005 PMCID: PMC9600378 DOI: 10.3390/dj10100195] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Based on the 2018 classification of periodontal disease, a series of articles have been published describing the decision points of periodontal therapy and how the findings collected at those decision points can be used as guidelines for periodontal therapy. The articles are reviewed with a focus on the finding of inadequate calculus removal at the decision points and how that finding impacts treatment outcomes. METHODS A narrative review of the literature discussing the influence of calculus on inflammation was performed and the effects of inadequate removal of calculus during periodontal therapy were analyzed in light of the 2018 classification of periodontal disease, the decision points of periodontal therapy, and the guidelines of periodontal therapy. RESULTS The published literature supports that calculus is a major risk factor for periodontal inflammation. Recent studies indicate that the pathologic risk of calculus goes beyond the retention of biofilm and may represent a different pathophysiologic pathway for periodontal disease separate from the direct action of biofilm. The inadequate removal of calculus is a factor in the failure of periodontal therapy. CONCLUSIONS The inadequate removal of calculus plays an important role in the frequent failure of non-surgical periodontal therapy to eliminate inflammation.
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Affiliation(s)
- Stephen K. Harrel
- Department of Periodontics, Texas A&M College of Dentistry, 3302 Gaston Avenue, Dallas, TX 75246, USA
| | - Charles M. Cobb
- Department of Periodontics, School of Dentistry, University of Missouri-Kansas City, 650 East 25th Street, Kansas City, MO 64108, USA
| | - Lee N. Sheldon
- Private Practice, 2223 Sarno Road, Melbourne, FL 32935, USA
| | - Michael P. Rethman
- School of Dental Medicine, University of Maryland, Baltimore, MD 21201, USA
- College of Dentistry Columbus, The Ohio State University, OH 1233 S. Lakeview Drive, Prescott, AZ 86301, USA
| | - John S. Sottosanti
- Private Practice, 8899 University Center Lane, Suite 100, San Diego, CA 92122, USA
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Ma YH, Hsu HT, Chang PC. The influence of fixed prosthesis placement on the clinical effectiveness of non-surgical periodontal therapy. J Dent Sci 2022; 18:674-680. [PMID: 37021245 PMCID: PMC10068573 DOI: 10.1016/j.jds.2022.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Background/purpose Fixed prostheses are essential for restoring teeth with compromised structures. However, the margins of prosthesis potentially create an interface that interferes with proper cleaning. This study evaluated whether the fixed prosthesis placement influenced the clinical effectiveness of non-surgical periodontal therapy (NSPT). Materials and methods Clinical records from 202 patients with generalized chronic periodontitis receiving NSPT at the National Taiwan University Hospital in 2012-2014 were included. The change and improvement ratio (IR) of clinical parameters following NSPT in the entire dentition or posterior region, and all or periodontitis-affected teeth/crowns (T/C) and sites were evaluated. The differences among natural teeth (NT), prosthetic crowns (PC), and abutments (AB) were compared by using Kruskal-Wallis tests followed by Dunn's post-hoc test. Results Gingival recession (REC) was greater in PC and AB groups than in the NT group before NSPT, while tooth mobility was also lower in the AB group. REC gain was lower in the AB group after NSPT, while mobility reduction was inferior in the PC and AB groups for all or periodontitis-affected T/C and sites. In periodontitis-affected T/C, IRs in probing pocket depth reduction and clinical attachment gain were lower in the PC group, and mobility reduction was lower in the AB group. The tendency in the posterior region is similar but was less pronounced than in the entire dentition. Conclusion The effectiveness of NSPT and the improvement of periodontal parameters are reduced when fixed prostheses present. MB reduction is inferior in AB teeth relative to NT.
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Affiliation(s)
- Yun-Han Ma
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Hao-Ting Hsu
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Po-Chun Chang
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Chatzopoulos GS, Karakostas P, Kavakloglou S, Assimopoulou A, Barmpalexis P, Tsalikis L. Clinical Effectiveness of Herbal Oral Care Products in Periodontitis Patients: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10061. [PMID: 36011693 PMCID: PMC9408146 DOI: 10.3390/ijerph191610061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The use of herbal products in oral cavity has shown an increased popularity and potential benefits due to their additional anti-inflammatory and antioxidant properties as well as the lack of side effects related to their use. OBJECTIVE To assess the clinical effectiveness of herbal dental products (mouthwash, dentifrice, gel) when compared to conventional products or placebo in periodontitis patients. MATERIAL AND METHODS A systematic review with 22 studies was carried out using MEDLINE/Pubmed, EMBASE and Web of Science databases in addition to hand searches. Randomized and non-randomized clinical trials that evaluated the effect of any herbal dental product and compared it with conventional products or placebo in periodontitis patients and published up to March 2022, were screened. RESULTS Herbal products used as adjuncts to scaling and root planing (SRP) or supragingival debridement (SPD) led to superior clinical outcomes than placebo or no adjuncts (8 studies). In conjunction with SRP, these products showed comparable outcomes with chlorhexidine (6 studies) or better (4 studies). When used as adjuncts to SPD, herbal oral care products demonstrated comparable outcomes with chlorhexidine and conventional products (4 studies). CONCLUSIONS Within the limitations of this systematic review, herbal oral care products may play a key role in the management of periodontal disease. Further well-designed studies are needed to establish their efficacy.
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Affiliation(s)
- Georgios S. Chatzopoulos
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Department of Developmental and Surgical Sciences, Division of Periodontology, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA
| | - Panagiotis Karakostas
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Stefania Kavakloglou
- Faculty of Dentistry, Medical University of Sofia, 1431 Sofia, Bulgaria
- 424 General Military Training Hospital, 56429 Thessaloniki, Greece
| | - Andreana Assimopoulou
- School of Chemical Engineering, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Panagiotis Barmpalexis
- Department of Pharmaceutical Technology, School of Pharmacy, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Lazaros Tsalikis
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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The Effect of Photodynamic Therapy on the Early Outcome of Implants Placed on Patients with Periodontitis. PHOTONICS 2022. [DOI: 10.3390/photonics9070480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Immediate implant is a subtype of implant that is placed following tooth extraction within the socket without further delay. These implants are known to preserve the alveolar bone and minimize the total number of surgical interventions in a patient. 4 Photodynamic therapy (PDT) augments nonsurgical periodontal therapy using antibacterial mechanisms. PTD can be more effective in conjunction with scaling and root planing (SRP). The aim of this study is to assess the effects of PDT on the early outcomes of implants placed on patients with periodontitis with and without SRP at 9 months of follow-up. Materials and methods: A total of 23 implants were placed in 14 patients, with 11 in the test group and 12 in the control group. SRP was carried out prior to immediate implant placement in control sites, and PDT adjunctive to SRP (SRP + PDT) was performed in test sites before immediate implant placement. Plaque index, gingival index, probing pocket depth, clinical attachment level, and radiovisiographs were procured at baseline, 3 months, 6 months, and 9 months. Primary stability was examined at the time of implant placement, and the healing index was recorded a week later. Results: At the end of the 9 months of the study period, (SRP + PDT) group had a mean marginal bone loss of 0.95 mm, and the control group had 1.08 mm. Clinical parameters such as plaque index, gingival index, clinical attachment level, and probing depth showed definitive improvement after 9 months, compared with the baseline, but when the test and control groups were compared, the difference was statistically significant for plaque index and probing depth. The implants in both groups were followed up for a period of 9 months. There was an improvement in marginal bone loss but was not statistically significant. The survival of immediate implants in the PDT group was not different from those in the scaling and root planing group. Conclusion: The effect of PTD can be beneficially used as an adjunct to SRP. However, the effects were not significant. Photodynamic therapy can be effectively used as an adjunct to SRP owing to the better outcomes using PDT.
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Chatzopoulos GS, Koidou VP, Wolff LF. Expression of Wnt signaling agonists and antagonists in periodontitis and healthy subjects, before and after non-surgical periodontal treatment: A systematic review. J Periodontal Res 2022; 57:698-710. [PMID: 35719081 DOI: 10.1111/jre.13029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 12/15/2022]
Abstract
Periodontitis is a preventable and treatable multifactorial chronic inflammatory disease that can lead to irreversible periodontal destruction and tooth loss. Wnt signaling and its regulators play an important role in periodontal inflammation, destruction, regeneration, and reconstruction. This systematic review aimed at investigating the involvement of Wnt signaling agonists and antagonists in periodontitis and healthy subjects, before and after periodontal treatment. Electronic searches were carried out using MEDLINE/PubMed, EMBASE, and Cochrane Library databases in addition to hand searches. Studies having different designs assessing the levels of Wnt signaling antagonist and agonist levels in gingival crevicular fluid, serum, and tissue in patients diagnosed with periodontitis or gingivitis, compared with healthy individuals were included. In addition, studies compared these levels in periodontitis patients before and after non-surgical periodontal therapy were also eligible. Sixteen studies met the eligibility criteria. Sclerostin (SOST) has been mainly investigated in the literature (8 publications). Sclerostin (5 studies), Wnt-5a (2 studies), secreted frizzled-related protein 1 (SFRP1) (3 studies), and β-catenin (3 studies) show increased levels in periodontitis compared with periodontal health. Strong correlations between marker levels and periodontal clinical parameters were identified for SOST (5 studies), SFRP1 (2 studies), and β-catenin (2 studies). SOST (3 studies) and SFRP1 (1 study) levels significantly decrease following non-surgical periodontal treatment. The present systematic review demonstrated an association between Wnt signaling agonist and antagonist levels and periodontitis. Wnt agonists and antagonists may serve as valuable diagnostic and prognostic markers for periodontitis onset and progression. Further case-control and longitudinal studies should be conducted for different Wnt signaling agonists and antagonists.
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Affiliation(s)
- Georgios S Chatzopoulos
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasiliki P Koidou
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA.,Centre for Oral Immunobiology and Regenerative Medicine and Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University London (QMUL), London, UK
| | - Larry F Wolff
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA
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Kim HN. Changes in salivary matrix metalloproteinase-3, -8, and -9 concentrations after 6 weeks of non-surgical periodontal therapy. BMC Oral Health 2022; 22:175. [PMID: 35562715 PMCID: PMC9101994 DOI: 10.1186/s12903-022-02185-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background Studies using salivary inflammatory biomarkers for diagnosing and monitoring the progression of periodontal disease have garnered increased attention in recent years. The present study aimed to identify changes in clinical parameters and concentrations of salivary matrix metalloproteinases (MMPs) following 6 weeks of non-surgical periodontal therapy (NSPT). Methods A 6-week NSPT program was applied to 51 adults aged ≥ 20 years. The program involved scaling, root planing, and professional toothbrushing for healthy participants and those with periodontal disease. Patients with periodontal disease underwent professional toothbrushing during all three visits. Periodontal pocket depth (PD) and gingival bleeding were assessed at week 0, week 3, and week 6, and saliva samples were collected to measure the concentrations of MMP-3, -8, and -9. Results All clinical parameters were improved in the periodontal disease groups following the NSPT course. Compared with healthy participants, the patients with periodontal disease showed increased concentrations of salivary MMP-3, -8, and -9. During the 6-week program, patients with periodontal disease also showed significant reductions in PD and gingival bleeding during the third week; no significant reduction was found during the sixth week. Significant reductions in the concentrations of salivary MMP-3, -8, and -9 were also noted in the periodontal disease group at week 3. The sensitivity and specificity of MMP-3 for predicting periodontitis were 81.8% and 55.5%, respectively. Conclusion The present study found that NSPT resulted in reductions of salivary MMP-3, -8, and -9, and identified the potential of MMP-3 as a biomarker in the diagnosis of periodontal disease. These findings may serve as foundational data for future studies into the development of diagnostic kits for periodontal disease.
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Affiliation(s)
- Han-Na Kim
- Department of Dental Hygiene, College of Health and Medical Sciences, Cheongju University, Cheonju, 28503, Korea.
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Alkan İİ, Akkaya HÜ, Sağlam M. The effectiveness of scaling and root planing with combined application of air polishing and Nd:YAG laser in periodontal pockets of stage III grade C periodontitis patients: a single-blinded randomized clinical trial. Clin Oral Investig 2022; 26:5459-5469. [PMID: 35505199 DOI: 10.1007/s00784-022-04513-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/24/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Evaluating the efficiency of combined air polishing and Nd:YAG laser application in addition to scaling and root planning (SRP) in treatment of periodontal pockets of stage III grade C periodontitis patients was the aim of this clinical trial. MATERIALS AND METHODS Twenty-four systemically healthy, stage III grade C periodontitis patients were recruited for this clinical trial. In this split-mouth study, the quadrants were randomly allocated to either SRP with combined air polishing (erythritol/chlorhexidine powder) and Nd:YAG laser (2 W, 200 mJ/pulse, 10 Hz) therapy (test group) or SRP alone (control group). A masked examiner recorded clinical parameters such as plaque index (PI), gingival index (GI), bleeding on probing (%) (BOP %), probing depth (PD), and clinical attachment level (CAL) on periodontal charts at baseline, 1 month and 3 months after treatment. RESULTS The clinical parameters had significantly reduced 1 and 3 months after treatment compared to baseline for both study groups (p < 0.05). Considering PI, GI, and BOP (%) parameters, there were no significant differences between the study groups at any time points (p > 0.05). While PD and CAL reductions were similar in study groups for moderately deep pockets (5 to 6 mm) (p > 0.05), PD and CAL reductions were significantly greater in test group compared to control group for deep pockets (PD ≥ 7 mm) (p < 0.05). CONCLUSIONS The present clinical trial demonstrated that SRP with combined application of air polishing and Nd:YAG laser may be advantageous in sites where mechanical debridement alone cannot access, such as deep pockets in the short term. Long-term, well-designed future studies including clinical, biochemical, and microbiological analyses are needed to determine the effectiveness of this procedure. CLINICAL RELEVANCE SRP with combined application of air polishing and Nd:YAG laser provided more reductions in probing depth and clinical attachment level parameters in deep pockets compared to SRP alone.
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Affiliation(s)
- İsmet İlke Alkan
- Department of Periodontology, Faculty of Dentistry, Izmir Katip Çelebi University, Izmir, Turkey.,Private Practice, Karabağlar, İzmir, Turkey
| | - Hazal Üstünel Akkaya
- Department of Periodontology, Faculty of Dentistry, Izmir Katip Çelebi University, Izmir, Turkey
| | - Mehmet Sağlam
- Department of Periodontology, Faculty of Dentistry, Izmir Katip Çelebi University, Izmir, Turkey.
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KUNDAK K, YARAT A, DOĞAN B, KURU L. Effect of Non-surgical Periodontal Therapy on Salivary Melatonin Levels. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.1053211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: Melatonin, a hormone secreted predominantly by pineal gland in a circadian manner, has antioxidant and anti-inflammatory effects. The current research is conducted to explore the influence of non-surgical periodontal therapy (NSPT) on levels of salivary melatonin in subjects with gingivitis and periodontitis. Methods: Sixty systemically healthy participants were included in this study; the groups are as follows: gingivitis (G), chronic periodontitis (CP), generalized aggressive periodontitis (GAP) and periodontally healthy (H). NSPT was applied to G group patients for 2 sessions, to CP and GAP group patients for 4 sessions. Plaque and gingival indices, probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL) were documented at baseline and 3 months post – treatment and early morning salivary samples were collected. ELISA was used to detect melatonin levels in saliva. Pittsburgh Sleep Quality Index (PSQI) questionnaire was performed to evaluate of sleep quality of patients. Results: At baseline, significant difference in gingival index, PD, BOP and CAL values was detected among all groups (p
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Affiliation(s)
- Kübra KUNDAK
- MARMARA UNIVERSITY, INSTITUTE OF HEALTH SCIENCES
| | - Ayşen YARAT
- MARMARA ÜNİVERSİTESİ, DİŞ HEKİMLİĞİ FAKÜLTESİ
| | - Başak DOĞAN
- MARMARA ÜNİVERSİTESİ, DİŞ HEKİMLİĞİ FAKÜLTESİ
| | - Leyla KURU
- MARMARA ÜNİVERSİTESİ, DİŞ HEKİMLİĞİ FAKÜLTESİ
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Gul SS, Zardawi FM, Abdulkareem AA, Shaikh MS, Al-Rawi NH, Zafar MS. Efficacy of MMP-8 Level in Gingival Crevicular Fluid to Predict the Outcome of Nonsurgical Periodontal Treatment: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053131. [PMID: 35270821 PMCID: PMC8910039 DOI: 10.3390/ijerph19053131] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 02/01/2023]
Abstract
Purpose: To explore whether baseline matrix metalloproteinase (MMP)-8 level in gingival crevicular fluid (GCF) (exposure) can predict the outcome (reduction in probing pocket depth (PPD) (outcome)) of nonsurgical periodontal therapy (NSPT) (manual or ultrasonic or both) in patients with periodontitis (population/problem) after 3 months. Methods: Six databases (PubMed, Cochrane library, ProQuest, Ovid, Scopus, EBSCO) were searched for relevant articles published until 30 July 2021. Retrieved articles were passed through a three-phase filtration process on the basis of the eligibility criteria. The primary outcome was the change in PPD after 3 months. Quality of the selected articles was assessed using Cochrane Risk of Bias tool (RoB2) and Risk of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tools. Results: From 1306 articles, five were selected for analysis. The results showed high variations in the level of GCF MMP-8 level at baseline. The average amount of reduction in PPD was 1.20 and 2.30 mm for pockets with initial depth of 4−6 mm and >6 mm, respectively. Conclusion: On the basis of available evidence, it was not possible to reach a consensus on the ability of baseline GCF MMP-8 to forecast the outcome of NSPT. This could have been due to variation in clinical and laboratory techniques used. However, consistency in mean PPD reduction after 3 months was shown.
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Affiliation(s)
- Sarhang Sarwat Gul
- Department of Periodontics, College of Dentistry, University of Sulaimani, Sulaymaniyah 46001, Iraq;
- Correspondence:
| | - Faraedon Mostafa Zardawi
- Department of Periodontics, College of Dentistry, University of Sulaimani, Sulaymaniyah 46001, Iraq;
| | - Ali Abbas Abdulkareem
- Department of Periodontics, College of Dentistry, University of Baghdad, Baghdad 10011, Iraq;
| | - Muhammad Saad Shaikh
- Department of Oral Biology, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi 75510, Pakistan;
| | - Natheer Hashim Al-Rawi
- Department of Oral & Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates;
| | - Muhammad Sohail Zafar
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madina, Al Munawwarra 41311, Saudi Arabia;
- Department of Dental Materials, Islamic International Dental College, Riphah International University, Islamabad 44000, Pakistan
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Chatzopoulos GS, Anastasopoulos M, Zarenti S, Doufexi AE, Tsalikis L. Flapless application of enamel matrix derivative in non-surgical periodontal treatment: A systematic review. Int J Dent Hyg 2022; 20:422-433. [PMID: 35143704 DOI: 10.1111/idh.12591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/23/2021] [Accepted: 02/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE To assess the effects of the flapless application of enamel matrix derivative (EMD) in combination with non-surgical periodontal treatment (NSPT) when compared to non-surgical periodontal treatment alone in adult patients. MATERIAL AND METHODS An electronic literature search was conducted in MEDLINE, Scopus and Cochrane Library up to March 2021 complemented by a manual search. Human longitudinal studies of >5 participants and at least 3 months follow-up were eligible for inclusion in the review. Clinical outcomes were extracted and pooled. Meta-analysis of the included studies was not possible due to methodological differences. RESULTS A total of 1199 publications were identified and reviewed for eligibility. Nine of them fulfilled the inclusion criteria. Eight studies were randomized clinical trials. The clinical findings of the majority of the included studies demonstrated that the adjunctive use of EMD with NSPT could lead to significantly improved treatment outcomes including higher PPD reduction, more CAL gain, more robust BOP reduction, higher number of sites with PPD < 5 mm and more frequent pocket closure which reduces the need for further periodontal surgical treatment. Limited biological, microbiological and histological findings were reported. Minimal adverse events were observed. CONCLUSION The flapless application of EMD during NSPT leads to an improved clinical outcome in regards to CAL gain and PPD reduction when compared to conventional treatment alone. The potential effect on the biological and microbiological outcome is unclear.
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Affiliation(s)
- Georgios S Chatzopoulos
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Greece
| | - Menelaos Anastasopoulos
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Greece
| | - Sofia Zarenti
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Greece
| | - Aikaterini-Elisavet Doufexi
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Greece.,Private Practice Limited to Periodontics and Implant Dentistry, Thessaloniki, Greece
| | - Lazaros Tsalikis
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Greece
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Singh G, Chauhan S, Sinha A, Sharma S. Clinical study evaluating the effectiveness and efficiency of Metrohex Plus Gel and diode laser therapy along with standard mechanical debridement for managing chronic periodontitis. JOURNAL OF ORAL RESEARCH AND REVIEW 2022. [DOI: 10.4103/jorr.jorr_69_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Nagarakanti S, Kolamala N, Chava V. Effect of diode laser as an adjunct to open flap debridement in treatment of periodontitis – A randomized clinical trial. J Indian Soc Periodontol 2022; 26:451-457. [PMID: 36339386 PMCID: PMC9626786 DOI: 10.4103/jisp.jisp_213_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/02/2021] [Accepted: 10/03/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The goals of periodontal therapy are to prevent the disease, arrest the disease progression, and regeneration of lost periodontium. Diode laser gained popularity in periodontal practice with a wide range of potential benefits. Aim: This study aims to evaluate and compare the clinical effects of laser-assisted open flap debridement (OFD) versus conventional OFD for the periodontitis treatment. Materials and Methods: A split-mouth, randomized clinical trial was conducted on fifteen participants with periodontitis having probing pocket depths (PPD) ≥5 mm. A total of 30 sites, two sites in each patient, were randomly divided into two groups. Group A received conventional OFD, and Group B received laser-assisted OFD. The assessment of PPD, relative attachment level (RAL), modified sulcular bleeding index (mSBI) was done at baseline, 3 months, and 6 months. Wound healing index (WHI) was assessed at 3rd and 7th day postsurgery, patient response to pain using visual analog scale (VAS) was assessed immediately, 1 day, and 1 week after surgery. Results: The results revealed a significant reduction in PPD, mSBI, and gain in RAL within the groups from baseline to 3 months and 6 months. Intergroup comparison showed a significant difference in PPD, RAL, mSBI, WHI and VAS scores. Conclusions: The use of 980 nm diode laser provided additional benefits over conventional flap therapy.
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Vivek B, Ramesh KSV, Gautami PS, Sruthima GNVS, Dwarakanath C, Anudeep M. Effect of periodontal treatment on oral health-related quality of life - A randomised controlled trial. J Taibah Univ Med Sci 2021; 16:856-863. [PMID: 34899130 PMCID: PMC8626792 DOI: 10.1016/j.jtumed.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/18/2021] [Accepted: 07/06/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives Periodontal disease is a chronic, infectious gum disease, which eventually leads to tooth loss, adversely affecting quality of life (QoL). Most of the research in this area focuses on evaluating clinical parameters rather than patient-based outcomes. Currently, these parameters are gaining importance along with treatment outcomes of chronic diseases and QoL. This study evaluates the impact of periodontal disease and its treatment on oral health-related quality of life (OHRQoL). Methods We recruited 90 participants who were divided into two groups. One was the test group (n = 45) that underwent non-surgical periodontal therapy (NSPT) followed by periodontal flap surgery (SurgPT). Second was the control group (n = 45) that underwent only NSPT. Clinical parameters, plaque index, gingival index, periodontal/probing pocket depth (PPD), clinical attachment level (CAL), and mobility were recorded. An OHRQoL questionnaire was used to assess the functional, physical, social, and psychological domains at baseline, three, and six months. Results The mean PPD in the test group was 6.9 ± 0.38, 3.2 ± 0.36, 3.5 ± 0.5, and 5.8 ± 0.67, 3.13 ± 0.21, 3.73 ± 0.45 in the NSPT group at baseline, 3, and 6 months, respectively. The mean CAL in the SurgPT group was 7.07 ± 0.41, 3.56 ± 0.27, 3.74 ± 0.30, and 6.08 ± 0.16, 4.02 ± 0.17, 4.16 ± 0.19 in the NSPT group at baseline, 3, and 6 months, respectively. Both treatments resulted in reduction in all clinical parameters and were statistically significant in the SurgPT group (p < 0.001). Oral Health Impact Profile scores substantially decreased in the SurgPT group (mean difference-25.0) compared to the NSPT group (mean difference-5.0) (p-0.001). Conclusions In this study, NSPT and SurgPT had a positive impact on OHRQoL by improving clinical parameters, but SurgPT had substantially better outcomes in terms of improved QoL.
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Affiliation(s)
- Bypalli Vivek
- Department of Periodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - Konathala S V Ramesh
- Department of Periodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - Penmetsa S Gautami
- Department of Periodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | | | | | - Mopidevi Anudeep
- Department of Periodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
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Alwan AM, Mousa HA, Talib HJ, Jassim TK. Impact of Air and Manual Scaling on Dental Anxiety and Blood Glucose Level among Diabetic Patients. J Int Soc Prev Community Dent 2021; 11:510-515. [PMID: 34760794 PMCID: PMC8533038 DOI: 10.4103/jispcd.jispcd_411_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/14/2021] [Accepted: 04/06/2021] [Indexed: 11/05/2022] Open
Abstract
Aims: The current study aimed at describing the short-term effect of nonsurgical periodontal treatment on dental anxiety and blood glucose level change among diabetic patients. Materials and Methods: One hundred and fifty patients with diabetes participated in a cross-sectional study design. All of them were divided into two groups, with 75 patients in each group. The first group was treated with air scaling, whereas the second group was treated with manual scaling. The determination of treatment needs and the evaluation of periodontal health status were achieved by using Community Periodontal Index for Treatment Need (CPITN). The level of dental anxiety was assessed by using Visual Analogue Scale (VAS). The glucose change was calculated by subtracting the glucose level before treatment from the glucose level straight after treatment. Results: No significant difference in glucose level was observed between manual scaling and air scaling after treatment (P = 0.076), and the level of glucose was significantly lower after scaling treatment within the treatment groups (P = 0.000). The level of glucose change between the groups was significantly lower for the manual scaling treatment group (P = 0.013), and it was significantly correlated with VAS (P = 0.000). Multiple regression analysis showed a significant association between the treatment groups (P = 0.007). Conclusions: Scaling reduced blood glucose and dental anxiety levels in patients with diabetes. Manual scaling was associated with reduced glucose level change less than air scaling after treatment.
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Affiliation(s)
- Alyamama M Alwan
- Department of Periodontal Dentistry, College of Dentistry, University of Mustansiriyah, Baghdad, Iraq
| | - Hussein A Mousa
- Department of Periodontal Dentistry, College of Dentistry, University of Mustansiriyah, Baghdad, Iraq
| | - Haider J Talib
- Department of Periodontal Dentistry, College of Dentistry, University of Mustansiriyah, Baghdad, Iraq
| | - Tameem K Jassim
- Department of Prosthetic Dentistry, College of Dentistry, University of Mustansiriyah, Baghdad, Iraq
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Shenbakam, Rao RJ, Prabhu S, Srirangarajan S, Rudresh V. Influence of antibacterial effects of tetracycline, laser, and photodynamic therapy on cell viability, cell damage, and virulence of Porphyromonas gingivalis. Photodiagnosis Photodyn Ther 2021; 36:102617. [PMID: 34740837 DOI: 10.1016/j.pdpdt.2021.102617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/18/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION This study compares and evaluates the efficacy of tetracycline, laser and photodynamic therapy on bacterial counts, cell damage, cell viability and neutralization of gingipains. MATERIAL AND METHODS P.gingivalis (ATCC 33,277) was cultured anaerobically. The minimal inhibitory concentration (MIC) for 50% inhibition of P.gingivalis by tetracycline, laser, and toluidine blue (TB) was determined using spectrophotometry. The antibacterial effects, cell viability, cell damage and neutralization of gingipains of the treated groups was evaluated by microbial culture and counting, 2,3 Bis 2 Methyloxy-4 Nitro-5 Sulphophenyl 2 H tetrazolium-5-Carboxaanilide (MTT) assay, lactate dehydrogenase (LDH) assay, and gingipain assay (BAPNA). RESULTS The MIC of tetracycline, toulidine, diode laser (810nmm; 0.5 Watts) is 1 µg/mL, 50 µg/mL and 15 s respectively. Comparative analysis for bacterial colony reduction was highest in tetracycline followed by PDT and then laser group at p < 0.01. MTT assay shows a significantly lesser number of viable cells in the tetracycline and PDT group when compared to laser group p < 0.01. Comparative analysis for cell damage using LDH shows the highest results for PDT followed by tetracycline and laser at p < 0.01. The highest neutralization of the gingipains is seen in the PDT group followed by tetracycline and laser groups at p < 0.01. CONCLUSION PDT shows highest antibacterial activity, gingipain neutralization, cell damage, and least number of viable cells in comparison with tetracycline and laser.
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Affiliation(s)
- Shenbakam
- Department of Periodontics, Bangalore Institute of Dental Sciences and Postgraduate research center, 5/3, Hosur road; Next to NIMHANS Convention center, Bangalore, Karnataka 560089, India
| | - Ravi J Rao
- Department of Periodontics, Bangalore Institute of Dental Sciences and Postgraduate research center, 5/3, Hosur road; Next to NIMHANS Convention center, Bangalore, Karnataka 560089, India
| | - Srikumar Prabhu
- Department of Periodontics, Bangalore Institute of Dental Sciences and Postgraduate research center, 5/3, Hosur road; Next to NIMHANS Convention center, Bangalore, Karnataka 560089, India
| | - S Srirangarajan
- Department of Periodontics, Bangalore Institute of Dental Sciences and Postgraduate research center, 5/3, Hosur road; Next to NIMHANS Convention center, Bangalore, Karnataka 560089, India.
| | - Vinaya Rudresh
- Department of Periodontics, Bangalore Institute of Dental Sciences and Postgraduate research center, 5/3, Hosur road; Next to NIMHANS Convention center, Bangalore, Karnataka 560089, India
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Isola G, Polizzi A, Santonocito S, Dalessandri D, Migliorati M, Indelicato F. New Frontiers on Adjuvants Drug Strategies and Treatments in Periodontitis. Sci Pharm 2021; 89:46. [DOI: 10.3390/scipharm89040046] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Causes of the progression of periodontitis such as an imbalance between the immune response by the host by the release of inflammatory mediators in the response of the oral pathogenic dysbiotic biofilm have been identified. New insights on specific cell signaling pathways that appear during periodontitis have attracted the attention of researchers in the study of new personalised approaches for the treatment of periodontitis. The gold standard of non-surgical therapy of periodontitis involves the removal of supra and subgingival biofilm through professional scaling and root planing (SRP) and oral hygiene instructions. In order to improve periodontal clinical outcomes and overcome the limitations of traditional SRP, additional adjuvants have been developed in recent decades, including local or systemic antibiotics, antiseptics, probiotics, anti-inflammatory and anti-resorptive drugs and host modulation therapies. This review is aimed to update the current and recent evolution of therapies of management of periodontitis based on the adjunctive and target therapies. Moreover, we discuss the advances in host modulation of periodontitis and the impact of targeting epigenetic mechanisms approaches for a personalised therapeutic success in the management of periodontitis. In conclusion, the future goal in periodontology will be to combine and personalise the periodontal treatments to the colonising microbial profile and to the specific response of the individual patient.
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Affiliation(s)
- Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95123 Catania, Italy
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95123 Catania, Italy
| | - Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95123 Catania, Italy
| | - Domenico Dalessandri
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Marco Migliorati
- Department of Orthodontics, School of Dentistry, University of Genova, Largo Rossana Benzi 10, 16132 Genova, Italy
| | - Francesco Indelicato
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95123 Catania, Italy
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