Non-Surgical Periodontal Therapy Reduces Saliva Adipokine and Matrix Metalloproteinase Levels in Periodontitis.

PubMed

Özcan, Erkan; Işıl Saygun, N; Serdar, Muhittin A; Umut Bengi, V; Kantarcı, Alpdoğan

2016-08-01

Adipokines enhance the synthesis of proinflammatory cytokines and matrix metalloproteinases (MMPs), which play a role in extracellular matrix degeneration. The aim of this study is to determine the levels of some adipokines, proinflammatory cytokines, and MMPs in the saliva of patients with periodontitis and healthy individuals and to evaluate the changes after non-surgical periodontal therapy (NSPT). Of 32 individuals included in the study, 17 had periodontitis and 15 had healthy gingiva. Saliva samples were obtained from all individuals. In patients with periodontitis, samples were recollected 3 and 6 months after NSPT. Visfatin, chemerin, progranulin, interleukin (IL)-1β, IL-8, MMP-8, and MMP-13 levels were measured using enzyme-linked immunosorbent assay. In patients with periodontitis, all of the parameters measured in the saliva were higher than those of healthy individuals. At 3 months, visfatin, progranulin, IL-8, and MMP-8 levels were significantly decreased compared with baseline values. The levels of other biochemical parameters, chemerin and IL-1β, were significantly decreased compared with baseline values at 6 months, and the levels became similar to those in healthy individuals. In the periodontitis group, positive correlations were found among visfatin and IL-8 (r = 0.909, P <0.01), MMP-8 (r = 0.702, P = 0.02), and MMP-13 (r = 0.781, P = 0.01); chemerin and IL-8 (r = 0.913, P <0.01), MMP-8 (r = 0.770, P <0.01), and MMP-13 (r = 0.788, P <0.01); and progranulin and IL-8 (r = 0.762, P <0.01), MMP-8 (r = 0.845, P <0.01), and MMP-13 (r = 0.813, P <0.01). Adipokines may contribute to the breakdown of periodontal tissue in periodontitis by stimulating the expression of proinflammatory cytokines and MMPs.

Effectiveness of a diode laser in addition to non-surgical periodontal therapy: study of intervention.

PubMed

Crispino, Antonio; Figliuzzi, Michele Mario; Iovane, Claudio; Del Giudice, Teresa; Lomanno, Simona; Pacifico, Delfina; Fortunato, Leonzio; Del Giudice, Roberto

2015-01-01

Chronic periodontitis affects 47% of adult population over the age of 30. The first phase of periodontal treatment is always represented by scaling and root planning (SRP), that is a causal, non-surgical therapy that recognizes as primary aims the control of bacterial infection and the reduction of periodontal plaque-associated inflammation. Yet, another innovative causal therapy is represented by the irradiation of periodontal pockets with laser. To evaluate the effect of a 940-nm diode laser as an adjunct to SRP in patients affected by periodontitis. Sixty-eight adult patients with moderate-to-severe periodontitis were sequentially enrolled and undergone to periodontal examination (V1) in order to detect gingival index (GI), plaque index (PI) and probing depth (PD). The patients were randomly divided into two groups: the first (n=34) received SRP treatment alone, the control group (n=34) received SRP and 940-nm diode laser therapy. Data were analyzed by Student's t-test, with two tails; for all clinical parameters, both groups reported statistically significant differences compared to basal values (p<0.0001). Both procedures were effective in improving GI, PI and PD, but the use of diode laser was associated with more evident results. Considered the better clinical outcomes, diode laser can be routinely associated with SRP in the treatment of periodontal pockets of patients with moderate-to-severe periodontitis.

The short-term effects of non-surgical periodontal therapy on the circulating levels of interleukin-6 and C-reactive protein in patients with chronic periodontitis.

PubMed

George, Annie Kitty; Janam, Prasanthila

2013-01-01

Recent epidemiological studies have shown that periodontal infection is a risk factor for a number of systemic diseases and conditions. In addition to the conventional risk factors, chronic infection and the subsequent generation of a systemic inflammatory response may be associated with this increased risk. This study was conducted to determine whether the presence of chronic periodontitis and subsequent non-surgical periodontal therapy could influence the serum levels of interleukin-6 and C-reactive protein (CRP) in patients with severe chronic generalized periodontitis. Participants were selected from subjects who attended the Department of Periodontics and Oral Implantololgy, Government Dental College, Thiruvananthapuram. Sera were obtained from 25 patients with periodontitis for baseline examination and reassessment after completion of treatment. As a control, sera were also obtained from 20 subjects without periodontitis. Interleukin-6 was determined by sensitive enzyme-linked immunosorbent assay, and high-sensitivity CRP (hsCRP) was measured using latex turbidometric immunoassay. Data were analyzed using computer software, Statistical Package for Social Sciences (SPSS) version 10. The level of interleukin-6 and hsCRP in the sera of periodontitis patients was seen to be higher than those of healthy controls. Interleukin-6 level tended to decrease with improvement of the periodontal condition following treatment and approached that of control subjects, and this decline was statistically significant. The hsCRP levels also showed a decreasing trend following periodontal treatment. In this study, we were able to show that periodontal disease significantly affects the serum levels of systemic inflammatory markers and that non-surgical periodontal therapy could bring about a decrease in the levels of these inflammatory markers.

The short-term effects of non-surgical periodontal therapy on the circulating levels of interleukin-6 and C-reactive protein in patients with chronic periodontitis

PubMed Central

George, Annie Kitty; Janam, Prasanthila

2013-01-01

Background: Recent epidemiological studies have shown that periodontal infection is a risk factor for a number of systemic diseases and conditions. In addition to the conventional risk factors, chronic infection and the subsequent generation of a systemic inflammatory response may be associated with this increased risk. Aims: This study was conducted to determine whether the presence of chronic periodontitis and subsequent non-surgical periodontal therapy could influence the serum levels of interleukin-6 and C-reactive protein (CRP) in patients with severe chronic generalized periodontitis. Settings and Design: Participants were selected from subjects who attended the Department of Periodontics and Oral Implantololgy, Government Dental College, Thiruvananthapuram. Materials and Methods: Sera were obtained from 25 patients with periodontitis for baseline examination and reassessment after completion of treatment. As a control, sera were also obtained from 20 subjects without periodontitis. Interleukin-6 was determined by sensitive enzyme-linked immunosorbent assay, and high-sensitivity CRP (hsCRP) was measured using latex turbidometric immunoassay. Statistical Analysis: Data were analyzed using computer software, Statistical Package for Social Sciences (SPSS) version 10. Results: The level of interleukin-6 and hsCRP in the sera of periodontitis patients was seen to be higher than those of healthy controls. Interleukin-6 level tended to decrease with improvement of the periodontal condition following treatment and approached that of control subjects, and this decline was statistically significant. The hsCRP levels also showed a decreasing trend following periodontal treatment. Conclusions: In this study, we were able to show that periodontal disease significantly affects the serum levels of systemic inflammatory markers and that non-surgical periodontal therapy could bring about a decrease in the levels of these inflammatory markers. PMID:23633770

Gingival crevicular fluid tissue/blood vessel-type plasminogen activator and plasminogen activator inhibitor-2 levels in patients with rheumatoid arthritis: effects of nonsurgical periodontal therapy.

PubMed

Kurgan, Ş; Önder, C; Balcı, N; Fentoğlu, Ö; Eser, F; Balseven, M; Serdar, M A; Tatakis, D N; Günhan, M

2017-06-01

The aim of this study was to evaluate the effect of nonsurgical periodontal therapy on clinical parameters and gingival crevicular fluid levels of tissue/blood vessel-type plasminogen activator (t-PA) and plasminogen activator inhibitor-2 (PAI-2) in patients with periodontitis, with or without rheumatoid arthritis (RA). Fifteen patients with RA and chronic periodontitis (RA-P), 15 systemically healthy patients with chronic periodontitis (H-P) and 15 periodontally and systemically healthy volunteers (C) were included in the study. Plaque index, gingival index, probing pocket depth, clinical attachment level, bleeding on probing, gingival crevicular fluid t-PA and PAI-2 levels, erythrocyte sedimentation rate, serum C-reactive protein and disease activity score were evaluated at baseline and 3 mo after mechanical nonsurgical periodontal therapy. All periodontal clinical parameters were significantly higher in the RA-P and H-P groups compared with the C group (p < 0.001) and decreased significantly after treatment (p < 0.001). Pretreatment t-PA levels were highest in the RA-P group and significantly decreased post-treatment (p = 0.047). Pre- and post-treatment PAI-2 levels were significantly lower in controls compared with both periodontitis groups (p < 0.05). Gingival crevicular fluid volume and the levels of t-PA and PAI-2 were significantly correlated. In patients with periodontitis and RA, nonsurgical periodontal therapy reduced the pretreatment gingival crevicular fluid t-PA levels, which were significantly correlated with gingival crevicular fluid PAI-2 levels. The significantly higher t-PA and PAI-2 gingival crevicular fluid levels in periodontal patients, regardless of systemic status, suggest that the plasminogen activating system plays a role in the disease process of periodontitis. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Clinical response to non-surgical periodontal treatment in patients with interleukin-6 and interleukin-10 polymorphisms

PubMed Central

Doufexi, Aikaterini-Ellisavet; Kouvatsi, Anastasia

2017-01-01

Background Genetic polymorphisms are commonly associated with altered transcriptional activity and possibly make individuals more susceptible to periodontal disease development, increased disease severity and poor treatment outcome. The study aimed to determine the effect of Interleukin-6 (IL-6) -572 G/C (rs1800796) and IL-10 -592 C/A (rs1800872) polymorphisms on the outcomes of non-surgical periodontal therapy in a Caucasian population. Material and Methods Sixty-eight patients with chronic periodontal disease were grouped according to their genotype: IL-6, IL-10, IL-6 and IL-10 susceptible (SCP) and non-susceptible (NSCP). All individuals were clinically evaluated at the first visit, and blood sample were collected from patients after checking the inclusion and exclusion criteria of the study. All patients received non-surgical periodontal therapy from a single-blinded periodontist. Clinical periodontal measurements were repeated 45 days after therapy. Results This population mean aged 47.63 years included 52.2% females and 58.2% non-smokers. Following DNA separation and genotyping, 65.7% of patients were homozygous carriers of the IL-6 - 572G; 49.3% were carriers of the IL-10 -592A- allele (AA and CA genotypes); and 35.8% carried SCP genotypes for both polymorphisms. The clinical parameters after therapy were not associated with the genotype status. The multiple logistic regression analysis did not show any statistically significant association between the genotypes and the variables tested. Conclusions Within the limitations of this longitudinal study, it can be suggested that IL-6 -572 G/C and IL-10 -592 C/A polymorphisms as well as their combination do not influence the outcome of nonsurgical periodontal therapy in Caucasian patients diagnosed with chronic periodontal disease. Key words:Gene polymorphism, genetics, interleukins, periodontal disease, treatment outcome. PMID:28624837

Spontaneous correction of pathologic tooth migration and reduced infrabony pockets following nonsurgical periodontal therapy: a case report.

PubMed

Sato, Shuichi; Ujiie, Hisashi; Ito, Koichi

2004-10-01

This case report describes the spontaneous correction of pathologic tooth migration and reduced infrabony pockets after nonsurgical periodontal therapy. A 3-mm diastema between the maxillary incisors was closed completely, and the mandibular teeth, which had migrated pathologically, returned to the optimal position. Clinical evaluation showed a significant reduction in probing depth, with increased clinical attachment and bone deposition demonstrated radiologically.

Prevalence of periodontopathogens and Candida spp. in smokers after nonsurgical periodontal therapy - a pilot study.

PubMed

Camargo, Gabriela Alessandra da Cruz Galhardo; Abreu, Mariana Gouvêa Latini; Cordeiro, Renata Dos Santos; Wenderoscky, Letícia de Farias; Duque, Cristiane

2016-08-22

This pilot study aimed to evaluate the influence of smoking on clinical and microbiological parameters after nonsurgical periodontal therapy. Forty-eight subjects were grouped into smokers (SM, n = 24) and nonsmokers (NS, n = 24) and paired according to gender, age, ethnicity, and periodontal status. Both groups received oral hygiene education and scaling and root planing. Clinical evaluation was performed using plaque index (PI), bleeding on probing (BOP), pocket probing depth (PPD), gingival recession (GR), and clinical attachment level (CAL) before instrumentation (baseline) and at 3 and 6 months. The prevalence of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Candida albicans, Candida glabrata, Candida tropicalis, and Candida dubliniensis in subgingival biofilm was determined by polymerase chain reaction. The data were statistically analyzed considering p < 0.05. Clinical conditions improved between baseline and 3 months after periodontal treatment. However, NS had a better clinical response, presenting greater PPD reduction and CAL increase in comparison to SM. Periodontal treatment reduced the levels of P. gingivalis, A. actinomycetemcomitans, and T. forsythia individually after 3 months for the NS group and after 6 months for both groups. The prevalence of Candida species was markedly higher in SM than in NS at all time points evaluated. Periodontopathogens associated or not with C. albicans or C. dubliniensis were more prevalent in SM than in NS at baseline and after 3 months. It was concluded that smoking impairs clinical and microbiological responses to periodontal therapy. Periodontopathogens combined or not with some Candida species are resistant to short-term periodontal therapy in SM.

Effect of nonsurgical periodontal treatment in patients with periodontitis and rheumatoid arthritis: A systematic review

PubMed Central

Silvestre-Rangil, Javier; Bagan, Leticia; Bagan, Jose V.

2016-01-01

Background Periodontitis has been regarded as a potential risk factor for rheumatoid arthritis (RA). A systematic review is made to determine whether nonsurgical periodontal treatment in patients with RA offers benefits in terms of the clinical activity and inflammatory markers of the disease. Material and Methods A search was made of the Medline-PubMed, Cochrane, Embase and Scopus databases to identify studies on the relationship between the two disease processes, and especially on the effects of nonsurgical treatment in patients of this kind. The search was based on the following keywords: rheumatoid arthritis AND periodontitis (MeSH), rheumatoid arthritis AND periodontal treatment. Results Eight articles on the nonsurgical treatment of patients with periodontitis and RA were finally included in the study. All of them evaluated clinical (DAS28) and laboratory test activity (ESR, CRP, IL-6, TNFα) before and after treatment. A clear decrease in DAS28 score and ESR was recorded, while other parameters such as CRP, IL-6 and TNFα showed a non significant tendency to decrease as a result of treatment. Conclusions Nonsurgical treatment improved the periodontal condition of patients with periodontitis and RA, with beneficial effects upon the clinical and laboratory test parameters (DAS28 and ESR), while other inflammatory markers showed a marked tendency to decrease. However, all the studies included in the review involved small samples sizes and follow-up periods of no more than 6 months. Larger and particularly longitudinal studies are therefore needed to more firmly establish possible significant relations between the two disease processes. Key words:Periodontitis, rheumatoid arthritis, periodontal treatment. PMID:26946202

Correlative analysis of plasma and urine neopterin levels in the pre- and post-menopausal women with periodontitis, following nonsurgical periodontal therapy.

PubMed

Prasanna, Jammula Surya; Sumadhura, Chinta; Karunakar, Parupalli; Rekharani, Koduganti; Himabindu, Gireddy; Manasa, Ambati

2017-01-01

Periodontitis is an inflammatory condition which is distinguished by the devastation of the supported tooth structures. In such inflammatory conditions, some biomarkers such as neopterin will be secreted and elevated in the body fluids, which can be used as a diagnostic marker for the present and future disease activity. Assessment of the neopterin as a biomarker in inflammatory conditions such as menopause and periodontitis. A cross-sectional interventional study. Sixty female individuals with a mean age of 40-60 years with chronic periodontitis were included in this study. All were categorized into two groups of thirty each, depending on their menstrual history: Group I - thirty premenopausal women and Group II - thirty postmenopausal women. Urine and plasma were collected from both groups to estimate neopterin levels. ELISA kit was used to assess the neopterin levels at baseline and after 3 months of nonsurgical periodontal therapy (NSPT). IBM SPSS version 21 software. A significant depreciation in the mean values of all the parameters from baseline to 3 months ( P < 0.001), in the intragroup analysis, was observed. Plasma (0.006) and urine (0.004) reduction was seen. In both the groups, in 3 months after NSPT, decreased neopterin levels were found, suggesting that the NSPT is the definitive therapy. Further, suggesting that, neopterin levels in the plasma and urine can be used as an index to identify the periodontal inflammation and destruction.

Effects of Nonsurgical Periodontal Therapy on Clinical Response, Microbiological Profile, and Glycemic Control in Malaysian Subjects with Type 1 Diabetes

PubMed Central

Buzinin, Samira Mukhtar; Alabsi, Aied Mohammed; Tan, Alexander Tong Boon

2014-01-01

The association between diabetes mellitus and chronic periodontal disease has long been established. Most of the researches linking these two very common chronic diseases were based on type 2 diabetes mellitus and chronic periodontal disease. However, this study was conducted to investigate the association between type 1 diabetes and chronic periodontal disease in Malaysian subjects. Forty-one Malaysian subjects, of which 20 subjects were type 1 diabetics and with chronic periodontal disease (test group) and 21 subjects with only chronic periodontal disease (control group), were included in the study. Periodontal parameters and plaque samples for microbiological evaluation were done at baseline, 2 and 3 months after nonsurgical periodontal therapy. Blood samples were taken from only the test group and evaluated for HbA1c at baseline and 3 months after periodontal therapy. There were no statistically significant difference in periodontal parameters between groups (P>0.05) and no significant improvement in the level of HbA1c in the test group. Microbiological studies indicated that there were significant reductions in the levels of the tested pathogens in both groups. The results of our study were similar to the findings of several other studies that had been done previously. PMID:25147841

Effect of periodontal therapy on pregnancy outcome in women affected by periodontitis.

PubMed

Tarannum, Fouzia; Faizuddin, Mohamed

2007-11-01

There is convincing evidence to suggest that infections affecting the mother during pregnancy may produce alterations in the normal cytokine- and hormone-regulated gestation, which could result in preterm labor, premature rupture of membranes, and preterm birth (PTB). Studies in the late 1990s associated periodontitis with preterm low birth weight (PLBW) deliveries, and this may have similar pathogenic mechanisms as other maternal infections. This study determined the effect of non-surgical periodontal therapy on pregnancy outcome. A total of 200 pregnant women with periodontitis were randomly assigned to treatment and control groups. Detailed data about previous and current pregnancies were obtained. All women received a full-mouth periodontal examination, including oral hygiene index-simplified, bleeding index, and clinical attachment level. The women in the treatment group received non-surgical periodontal therapy during the gestational period, and those in the control group received periodontal treatment after delivery. Periodontal therapy included plaque control instructions and scaling and root planing performed under local anesthesia. The outcome measures assessed were gestational age and birth weight of the infant. PTB was recorded when delivery occurred at <37 weeks of gestation, and low birth weight (LBW) was recorded when the infant weighed<2,500 g. There were 53 PTBs in the treatment group and 68 PTBs in the control group. Twenty-six LBW infants were recorded in the treatment group, and 48 LBW infants were noted in the control group. The mean gestational ages were 33.8+/-2.8 weeks and 32.7+/-2.8 weeks in the treatment and control groups, respectively. The difference was statistically significant at P<0.006. The mean birth weight was 2,565.3+/-331.2 g in the treatment group and 2,459.6+/-380.7 g in the control group, with the difference being statistically significant at P<0.044. A multiple regression model showed a significant effect of periodontal

Does smoking affect gingival crevicular fluid LL-37 levels following non-surgical periodontal treatment in chronic periodontitis?

PubMed

Türkoğlu, Oya; Eren, Gülnihal; Emingil, Gülnur; Azarsız, Elif; Kutukculer, Necil; Atilla, Gül

2016-01-01

LL-37 contributes to maintaining the balance between health and disease. Smoking is a risk factor for periodontitis that impairs neutrophil functions. The aim of the present study was to comparatively evaluate gingival crevicular fluid (GCF) LL-37 levels in smoker and non-smoker chronic periodontitis (CP) patients and controls, as well as the effect of non-surgical periodontal treatment on GCF LL-37 levels. Thirty-one CP patients (16 smokers, 15 non-smokers) and thirty-one controls (16 smokers, 15 non-smokers) were included in the study. CP patients received non-surgical treatment. GCF LL-37 levels and periodontal parameters were assessed at baseline, 1 and 3 months after completion of non-surgical periodontal treatment. GCF LL-37 levels were analyzed by ELISA. No significant difference was observed in GCF LL-37 levels between smoker and non-smoker controls (p>0.05). Smoker CP group had significantly lower GCF LL-37 level than non-smoker CP group at baseline (p<0.05). GCF LL-37 levels significantly decreased in non-smoker CP group at first week, 1 and 3 months after completion of non-surgical periodontal treatment (p<0.05) although no significant decrease in GCF LL-37 levels was observed in smoker CP group (p>0.05). Periodontal parameters were correlated with GCF LL-37 levels in non-smoker CP group (p<0.05), but not in smoker CP group (p>0.05). GCF LL-37 levels do not seem to be affected from smoking in periodontal health. However, smoking might have a suppressive effect on GCF LL-37 levels in CP. Non-surgical treatment is effective in decreasing GCF LL-37 levels in non-smoker CP patients but not in smokers with CP. Copyright © 2015. Published by Elsevier Ltd.

[Non-surgical periodontal treatment in uncontrolled type 2 diabetes mellitus patients].

PubMed

Garzón-Sanabria, Verónica; Olmos-Bringas, Marisol; Mota-Sanhu, Vanessa; Enríquez-Bárcenas, Luis Fernando; García-Ruiz, Erika; Rivas-Ayala, Lourdes; Rojas-Jiménez, José Alberto

2013-01-01

To evaluate the effect of non-surgical periodontal treatment on the metabolic control, measured by HbA1c in uncontrolled type 2 diabetes mellitus patients with periodontal disease treated with the ADA-EASD algorithm. The study group consisted of 38 patients diagnosed with type 2 diabetes mellitus and periodontal disease, attending a benefit clinic. HbA1c measures were obtained before and after 3 months of the non-surgical periodontal treatment. T student test for dependent samples was applied with a p value less than 0.05 for statistical significance. From the total sample, 79% was female, and mean age was of 51 +/- 9.8 years old. Mean HbA1c at baseline was of 8.6 and 8% at exit. The mean reduction was statistically significant (p = 0.026). After non-surgical periodontal treatment, the prevalence of periodontal disease was of 8%. The mean of personal plaque control before and after the treatment decreased from 82.6% to 35.5% (p < 0.000). Consistent with similar previous studies, in this study we demonstrate progress in glycemic control, remission of periodontal disease and improved personal plaque control.

Effect of nonsurgical periodontal treatment on C-reactive protein levels in maintenance hemodialysis patients.

PubMed

Yazdi, Farin Kiany; Karimi, Noozhan; Rasouli, Manoochehr; Roozbeh, Jamshid

2013-01-01

C-reactive protein (CRP) has been implicated as a possible mediator of the association between periodontitis and several systemic diseases. This study evaluated the impact of nonsurgical periodontal treatment on the serum levels of CRP in chronic kidney disease (CKD) patients on hemodialysis. A total of 77 CKD patients on hemodialysis were included in this study. At baseline, periodontal examination was assessed for all the patients, and chronic periodontitis was defined through clinical attachment level and probing pocket depth, according to the American Association of Periodontology. Nonsurgical periodontal treatment was performed and serum levels of CRP were evaluated at baseline and 8 weeks after periodontal treatment. Periodontal treatment resulted in significant reductions in CRP levels (p < 0.001). The difference between pre- and posttreatment CRP concentrations did not show any significant relationship with the severity of periodontitis. Periodontitis is an important source of systemic inflammation in CKD patients. Nonsurgical periodontal treatment can effectively reduce the serum level of CRP in these patients.

Clinical improvement following therapy for periodontitis: Association with a decrease in IL-1 and IL-6

PubMed Central

REIS, CÁTIA; DA COSTA, ALEXANDRA VIANA; GUIMARÃES, JOÃO TIAGO; TUNA, DIANA; BRAGA, ANA CRISTINA; PACHECO, JOSÉ JULIO; AROSA, FERNANDO A.; SALAZAR, FILOMENA; CARDOSO, ELSA MARIA

2014-01-01

Although a number of inflammatory cytokines have been shown to be associated with periodontal pathogenesis, it is important to investigate further whether these biomarkers are associated with the degree of success in nonsurgical treatment of chronic periodontitis. The aim of the present study was to quantify the total levels of interleukin (IL)-1α, -1β, -6, -10 and tumour necrosis factor (TNF)-α in gingival crevicular fluid (GCF) of chronic periodontitis patients prior to and following nonsurgical periodontal therapy. In total, 52 GCF samples from disease sites of patients with chronic periodontitis, prior to and following periodontal therapy, and ten non-disease sites from non-periodontitis subjects, were collected and cytokine concentrations were determined using a multiplex method. Periodontal parameters, including bleeding on probing, probing pocket depth and the clinical attachment level, in all the sites were recorded. Untreated disease sites exhibited higher cytokine levels in the GCF when compared with the non-disease sites. Nonsurgical periodontal therapy resulted in a statistically significant decrease in the total levels of IL-1α, -1β and -6 in the GCF, but not in IL-10 or TNF-α. The results support the hypothesis that proinflammatory cytokines, including IL-1α, IL-1β and IL-6, are likely to be involved in the pathogenesis of periodontitis and are good markers to evaluate the success of nonsurgical therapy in disease sites of patients with periodontitis. PMID:24944641

Clinical improvement following therapy for periodontitis: Association with a decrease in IL-1 and IL-6.

PubMed

Reis, Cátia; DA Costa, Alexandra Viana; Guimarães, João Tiago; Tuna, Diana; Braga, Ana Cristina; Pacheco, José Julio; Arosa, Fernando A; Salazar, Filomena; Cardoso, Elsa Maria

2014-07-01

Although a number of inflammatory cytokines have been shown to be associated with periodontal pathogenesis, it is important to investigate further whether these biomarkers are associated with the degree of success in nonsurgical treatment of chronic periodontitis. The aim of the present study was to quantify the total levels of interleukin (IL)-1α, -1β, -6, -10 and tumour necrosis factor (TNF)-α in gingival crevicular fluid (GCF) of chronic periodontitis patients prior to and following nonsurgical periodontal therapy. In total, 52 GCF samples from disease sites of patients with chronic periodontitis, prior to and following periodontal therapy, and ten non-disease sites from non-periodontitis subjects, were collected and cytokine concentrations were determined using a multiplex method. Periodontal parameters, including bleeding on probing, probing pocket depth and the clinical attachment level, in all the sites were recorded. Untreated disease sites exhibited higher cytokine levels in the GCF when compared with the non-disease sites. Nonsurgical periodontal therapy resulted in a statistically significant decrease in the total levels of IL-1α, -1β and -6 in the GCF, but not in IL-10 or TNF-α. The results support the hypothesis that proinflammatory cytokines, including IL-1α, IL-1β and IL-6, are likely to be involved in the pathogenesis of periodontitis and are good markers to evaluate the success of nonsurgical therapy in disease sites of patients with periodontitis.

Photodynamic therapy as an adjunct to non-surgical periodontal treatment: a randomized, controlled clinical trial.

PubMed

Christodoulides, Nicos; Nikolidakis, Dimitris; Chondros, Panagiotis; Becker, Jürgen; Schwarz, Frank; Rössler, Ralf; Sculean, Anton

2008-09-01

Recent preclinical and clinical data have suggested a potential benefit of photodynamic therapy (PDT) in the treatment of periodontitis. However, there are very limited data from controlled clinical trials evaluating the effect of PDT in the treatment of periodontitis. The aim of this study was to evaluate the clinical and microbiologic effects of the adjunctive use of PDT to non-surgical periodontal treatment. Twenty-four subjects with chronic periodontitis were randomly treated with scaling and root planing followed by a single episode of PDT (test) or scaling and root planing alone (control). Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depth (PD), gingival recession, and clinical attachment level (CAL) were measured at baseline and 3 and 6 months after therapy. Primary outcome variables were changes in PD and CAL. Microbiologic evaluation of Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia (previously T. forsythensis), Treponema denticola, Parvimonas micra (previously Peptostreptococcus micros or Micromonas micros), Fusobacterium nucleatum, Campylobacter rectus, Eubacterium nodatum, Eikenella corrodens, and Capnocytophaga spp. was performed at baseline and 3 and 6 months following therapy by using a commercially available polymerase chain reaction test. At 3 and 6 months after treatment, there were no statistically significant differences between the groups with regard to CAL, PD, FMPS, or microbiologic changes. At 3 and 6 months, a statistically significantly greater improvement in FMBS was found in the test group. The additional application of a single episode of PDT to scaling and root planing failed to result in an additional improvement in terms of PD reduction and CAL gain, but it resulted in a significantly higher reduction in bleeding scores compared to scaling and root planing alone.

Adjunctive use of antibiotics in periodontal therapy

PubMed Central

Barca, Ece; Cifcibasi, Emine; Cintan, Serdar

2015-01-01

Periodontal diseases are infectious diseases with a mixed microbial aetiology and marked inflammatory response leading to destruction of underlying tissue. Periodontal therapy aims to eliminate pathogens associated with the disease and attain periodontal health. Periodontitis is generally treated by nonsurgical mechanical debridement and regular periodontal maintenance care. Periodontal surgery may be indicated for some patients to improve access to the root surface; however, mechanical debridement alone may not be helpful in all cases. In such cases, adjunctive systemic antibiotic therapy remains the treatment of choice. It can reach microorganisms at the base of the deep periodontal pockets and furcation areas via serum, and also affects organisms residing within gingival epithelium and connective tissue. This review aims to provide an update on clinical issues regarding when and how to prescribe systemic antibiotics in periodontal therapy. The points discussed are the mode of antibiotic action, susceptible periodontal pathogens, antibiotic dosage, antibiotic use in treatment of periodontal disease, and mechanism of bacterial resistance to each antibiotic. PMID:28955547

Effect of photodynamic therapy as an adjuvant to non-surgical periodontal therapy: periodontal and metabolic evaluation in patients with type 2 diabetes mellitus.

PubMed

Barbosa, Flávia Isabela; Araújo, Patrícia Valente; Machado, Lucas José Campos; Magalhães, Cláudia Silami; Guimarães, Milena Maria Moreira; Moreira, Allyson Nogueira

2018-04-27

This pilot study aimed to evaluate the effect of antimicrobial photodynamic therapy (aPDT) as an adjuvant to non-surgical periodontal therapy (NSPT) on periodontal status and glycemic control in patients with type 2 diabetes mellitus and generalized chronic periodontitis. Twelve patients were evaluated at five time points: during the preparation of the patient (T0), during the treatment phase (T1) and after 30 (T2), 90 (T3) and 180 (T4) days. The patients had a mean age of 52.2 years and a 9.58-year history of diabetes, on average, and were divided into two randomized treatment groups: 6 patients received NSPT combined with aPDT (G1) and 6 patients received only NSPT (G2). The aPDT was applied associating the photosensitizing agent methylene blue (10 mg/ ml) with a red laser (660 nm- 40 mW). The total time of exposure was 2 min per tooth. Whitin the limitation of this study, the results showed that the plaque index reduced significantly only in the control group (p = 0.02) at T2 (30 days). For bleeding on probing, both groups showed a significant reduction between T1 and T2, with no difference between groups G1 and G2. Regarding the probing depth, there were no differences between groups, but the parameters decreased over time when compared to T1. The glycated haemoglobin and fructosamine levels did not significantly differ between or within the groups at any time point. When NSPT was combined with aPDT, no additional benefits were observed for the periodontal and metabolic clinical parameters. Copyright © 2018. Published by Elsevier B.V.

Non-surgical periodontal therapy decreases serum elastase levels in aggressive but not in chronic periodontitis.

PubMed

Eickholz, Peter; Siegelin, Yasemin; Scharf, Susanne; Schacher, Beate; Oremek, Gerhard M; Sauer-Eppel, Hildegund; Schubert, Ralf; Wohlfeil, Martin

2013-04-01

Assessment of the effect of non-surgical periodontal therapy (SRP) on serum inflammatory parameters in patients with untreated aggressive (AgP) and chronic (ChP) periodontitis. Overall, 31 ChP and 29 AgP were examined clinically prior to and 12 weeks after SRP (subgingival scaling of all pockets within 2 days) with systemic antibiotics for patients positive for Aggregatibacter actinomycetemcomitans (14 AgP, 9 ChP). Blood was sampled prior to, one day, 6, and 12 weeks after the first SRP visit. Serum elastase, C-reactive protein (CRP), lipopolysaccharide-binding protein (LBP), interleukin (IL) 6, 8, and leukocyte counts were assessed. At baseline, serum elastase, CRP, and LBP were significantly (p < 0.01) higher in AgP than ChP. Serum elastase, CRP, LBP, and IL-6 were significantly (p < 0.001) elevated one day after scaling in both groups. Both groups showed significant clinical improvement (p < 0.001). A significant difference was observed regarding change of serum elastase 12 weeks after SRP between AgP and ChP (p = 0.015). Multiple regression analysis revealed AgP, African origin, and bleeding on probing to be associated with more pronounced elastase reduction. CRP reduction was associated with African origin, systemic antibiotics, and baseline probing pocket depth. SRP results in serum elastase reduction in AgP but not in ChP. © 2013 John Wiley & Sons A/S.

Short-term effects of non-surgical periodontal therapy on clinical measures of impaired glucose tolerance in people with prediabetes and chronic periodontitis.

PubMed

Giblin, Lori J; Boyd, Linda D; Rainchuso, Lori; Chadbourne, Dianne

2014-01-01

Diabetes and periodontal disease are conditions considered to be biologically linked. Prediabetes is a condition in which individuals have blood glucose levels, impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) or glycated hemoglobin (A1C) levels higher than normal but not high enough to be classified as diabetes. Few human studies address the relationship between periodontitis and prediabetes or clarify an association between periodontitis and prediabetes. The purpose of this pilot study was to examine the impact of non-surgical periodontal therapy (NSPT) on clinical measures of glycemic control in prediabetes. Prediabetes measures of IFG, IGT, A1C and periodontal measures of pocket depth (PD), clinical attachment level (CAL), plaque index (PI) and gingival index (GI) were taken at baseline and 3 months in 12 subjects with prediabetes and chronic slight to moderate periodontitis. Blood samples were taken from each subject following an 8 hour fast. This study controlled for changes in medications, body-mass index, physical activity and diet. Comparison of mean prediabetes and periodontal measures from baseline and post-treatment at 3 months demonstrated clinical improvement for both periodontal and prediabetes measures. A mean reduction in PD of 0.27 (p=0.003), CAL of 0.32 (p=0.050) and A1C of 0.19 (p=0.015) reached statistical significance. This pilot study suggests NSPT improves A1C and periodontal measures at 3 months. The robustness of measures is limited due to the small sample size and lack of a control group. Further larger scale studies using a randomized control design would be informative. Copyright © 2014 The American Dental Hygienists’ Association.

Efficacy of Local and Systemic Antimicrobials in the Non-Surgical Treatment of Smokers With Chronic Periodontitis: A Systematic Review.

PubMed

Chambrone, Leandro; Vargas, Miguel; Arboleda, Silie; Serna, Maritza; Guerrero, Marcela; de Sousa, Jose; Lafaurie, Gloria Inés

2016-11-01

The aim of this systematic review is to evaluate whether use of local or systemic antimicrobials would improve clinical results of non-surgical periodontal therapy for smokers with chronic periodontitis (CP). Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, and The Cochrane Central Register of Controlled Trials were searched up to and including March 2016. Randomized clinical trials of duration of at least 6 months were included if they reported on treatment of smokers (≥10 cigarettes per day for minimum 12 months) with CP with non-surgical periodontal therapy either alone or associated with local or systemic antimicrobials. Random-effects meta-analyses were undertaken to evaluate mean differences in probing depth (PD) and clinical attachment level (CAL). Of 108 potentially eligible articles, seven were included. Most individual studies (75%) testing locally delivered antibiotics reported that smokers benefited from this treatment approach. Pooled estimates found additional PD reduction of 0.81 mm (P = 0.01) and CAL gain of 0.91 mm (P = 0.01) at sites with baseline PD ≥5 mm. Conversely, meta-analysis on systemic use of antimicrobials failed to detect significant differences in mean changes from baseline, and only one trial supported their use. In smokers with CP, adjunctive use of local antimicrobials improved efficacy of non-surgical periodontal therapy in reducing PD and improving CAL at sites presenting PD ≥5 mm before treatment. Current evidence does not demonstrate similar gains when scaling and root planing plus systemic antimicrobial/antibiotics were associated with therapy.

Effect of non-surgical periodontal treatment on transferrin serum levels in patients with chronic periodontitis

PubMed Central

Shirmohamadi, Adileh; Chitsazi, Mohamad Taghi; Faramarzi, Masoumeh; Salari, Ashkan; Naser Alavi, Fereshteh; Pashazadeh, Nazila

2016-01-01

Background. Transferrin is a negative acute phase protein, which decreases during inflammation and infection. The aim of the present investigation was to evaluate changes in the transferrin serum levels subsequent to non-surgical treatment of chronic periodontal disease. Methods. Twenty patients with chronic periodontitis and 20 systemically healthy subjects without periodontal disease, who had referred to Tabriz Faculty of Dentistry, were selected. Transferrin serum levels and clinical periodontal parameters (pocket depth, clinical attachment level, gingival index, bleeding index and plaque index) were measured at baseline and 3 months after non-surgical periodontal treatment. Data were analyzed with descriptive statistical methods (means ± standard deviations). Independent samples t-test was used to compare transferrin serum levels and clinical variables between the test and control groups. Paired samples t-test was used in the test group for comparisons before and after treatment. Statistical significance was set at P < 0.05. Results. The mean transferrin serum level in patients with chronic periodontitis (213.1 ± 9.2 mg/dL) was significantly less than that in periodontally healthy subjects (307.8 ± 11.7 mg/dL). Three months after periodontal treatment, the transferrin serum level increased significantly (298.3 ± 7.6 mg/dL) and approached the levels in periodontally healthy subjects (P < 0.05). Conclusion. The decrease and increase in transferrin serum levels with periodontal disease and periodontal treatment, respectively, indicated an inverse relationship between transferrin serum levels and chronic periodontitis. PMID:27651883

Effect of non-surgical periodontal therapy on insulin resistance in patients with type II diabetes mellitus and chronic periodontitis, as assessed by C-peptide and the Homeostasis Assessment Index.

PubMed

Mammen, Jerry; Vadakkekuttical, Rosamma Joseph; George, Joseraj Manaloor; Kaziyarakath, Jaishid Ahadal; Radhakrishnan, Chandni

2017-08-01

A bidirectional relationship exists between diabetes and periodontitis. In the present clinical trial, we evaluated the effects of non-surgical periodontal therapy (NSPT) on insulin resistance in patients with type II diabetes mellitus (DM) and chronic periodontitis. Forty chronic periodontitis patients with type II DM were selected and equally allocated to case and control groups. All patients were assessed for periodontal parameters and systemic parameters. The case group received NSPT, and both groups were re-evaluated after 3 months. All periodontal parameters were found to be significantly improved in the case group compared to the control group 3 months after NSPT. The mean differences in systemic parameters, such as fasting serum C-peptide, Homeostasis Assessment (HOMA) Index-insulin resistance, and HOMA-insulin sensitivity, from baseline to 3 months for the case group were 0.544 ± 0.73, 0.54 ± 0.63, and -25.44 ± 36.81, respectively; for the control group, they were significant at -1.66 ± 1.89, -1.48 ± 1.86, and 31.42 ± 38.82 respectively (P < 0.05). There was a significant decrease in fasting blood glucose and glycosylated hemoglobin A1c from baseline to 3 months in the case group (P < 0.05). The present study showed that periodontal inflammation could affect glycemic control and insulin resistance. Effective periodontal therapy reduced insulin resistance and improved periodontal health status and insulin sensitivity in patients with type II DM and chronic periodontitis. © 2016 John Wiley & Sons Australia, Ltd.

Effect of Nd:YAG laser-assisted non-surgical periodontal therapy on clinical periodontal and serum biomarkers in patients with and without coronary artery disease: A short-term pilot study.

PubMed

Javed, Fawad; Kellesarian, Sergio V; Al-Kheraif, Abdulaziz A; Ranna, Vinisha; Qadri, Talat; Yunker, Michael; Malmstrom, Hans; Romanos, Georgios E

2016-12-01

We hypothesized that nonsurgical-periodontal-therapy (NSPT) with adjunct Nd:YAG laser therapy is more effective in reducing periodontal inflammatory parameters (plaque index [PI], bleeding-on-probing [BOP], and probing-pocket-depth [PPD]) and serum interleukin-1beta (IL-1β) and matrix metalloproteinase-9 (MMP-9) levels in patients with and without coronary artery disease (CAD) than NSPT alone. The aim of this short-term pilot study was to assess the effect of NSPT + Nd:YAG laser therapy on periodontal parameters and serum IL-1β and MMP-9 levels in patients with and without CAD. A prospective randomized clinical study was conducted on 87 patients who were divided into two groups: Group-1: 44 patients with CAD and periodontal disease (PD) and Group-2: 43 patients with PD alone. Treatment-wise, these individuals were randomly divided into two subgroups: (i) NSPT alone and (ii) NSPT + Nd:YAG laser therapy. Demographic information was collected using a self-completed questionnaire. Periodontal parameters (PI, BOP, and PPD) and serum IL-1β and MMP-9 levels were measured at baseline and after 3 months of treatment. P-values <0.05 were considered statistically significant. At 3 months follow-up, PI (P < 0.01), BOP (P < 0.01), PPD ≥ 4 mm (P < 0.01), and serum IL-1β (P < 0.01) and MMP-9 (P < 0.01) levels were significantly higher in patients treated with NSPT alone than those treated with NSPT + Nd:YAG laser therapy. Among patients that underwent NSPT + laser therapy in both groups, periodontal parameters and serum IL-1β, and MMP-9 levels were comparable at 3-months follow-up. NSPT + Nd:YAG laser therapy may be more effective in reducing periodontal inflammation and serum IL-1β and MMP-9 levels in patients with and without CAD than NSPT alone. Lasers Surg. Med. 48:929-935, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Nonsurgical root canal therapy of large cyst-like inflammatory periapical lesions and inflammatory apical cysts.

PubMed

Lin, Louis M; Ricucci, Domenico; Lin, Jarshen; Rosenberg, Paul A

2009-05-01

It is a general belief that large cyst-like periapical lesions and apical true cysts caused by root canal infection are less likely to heal after nonsurgical root canal therapy. Nevertheless, there is no direct evidence to support this assumption. A large cyst-like periapical lesion or an apical true cyst is formed within an area of apical periodontitis and cannot form by itself. Therefore, both large cyst-like periapical lesions and apical true cysts are of inflammatory and not of neoplastic origin. Apical periodontitis lesions, regardless of whether they are granulomas, abscesses, or cysts, fail to heal after nonsurgical root canal therapy for the same reason, intraradicular and/or extraradicular infection. If the microbial etiology of large cyst-like periapical lesions and inflammatory apical true cysts in the root canal is removed by nonsurgical root canal therapy, the lesions might regress by the mechanism of apoptosis in a manner similar to the resolution of inflammatory apical pocket cysts. To achieve satisfactory periapical wound healing, surgical removal of an apical true cyst must include elimination of root canal infection.

Little evidence for the use of diode lasers as an adjunct to non-surgical periodontal therapy.

PubMed

Dederich, Douglas N

2015-03-01

Medline, PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL) and Embase databases. Randomised controlled trials (RCTs) using thermal diode lasers as an adjunct to non-surgical conventional periodontal initial therapy conducted in patients ≥18 years old written in English or Dutch were considered. Study assessment data extraction and quality assessment was carried out independently by two reviewers. The main outcome variables were probing pocket depth (PPD) and clinical attachment loss (CAL), but plaque scores (PS), bleeding scores (BS) and the Gingival Index (GI) were also considered. Meta-analysis was carried out using a random effects model. Nine studies involving 247 patients were included. Seven studies were of split mouth design and two were parallel group studies. The study designs showed considerable heterogeneity and follow up ranged from six weeks to six months. Meta-analysis found no significant effect on PPD, CAL and PS. There was however a significant effect for GI and BS favouring adjunctive use of the diode laser. The collective evidence regarding adjunctive use of the diode laser with SRP indicates that the combined treatment provides an effect comparable to that of SRP alone. With respect to BS the results showed a small but significant effect favouring the diode laser, however, the clinical relevance of this difference remains uncertainStandard . This systematic review questions the adjunctive use of diode laser with traditional mechanical modalities of periodontal therapy in patients with periodontitis. The strength of the recommendation for the adjunctive use of the diode laser is considered to be 'moderate' for changes in PPD and CAL.

Impact of nonsurgical periodontal therapy on total antioxidant capacity in chronic periodontitis patients

PubMed Central

Bansal, Neha; Gupta, Narender Dev; Bey, Afshan; Sharma, Vivek Kumar; Gupta, Namita; Trivedi, Himanshu

2017-01-01

Aim: The aim of this study was to determine the utility of plasma total antioxidant capacity (TAC) as marker of periodontal disease by estimating TAC of periodontally healthy and chronic periodontitis patients and the impact of scaling and root planning on total antioxidant status of periodontitis patients. Materials and Methods: Blood plasma samples were collected from randomly selected eighty individuals (40 periodontally healthy controls and 40 chronic periodontitis patients), with an age range of 20–45 years and were analyzed for TAC by ferric reducing antioxidant power assay. Scaling and root planing was performed in periodontitis patients, and TAC level was measured again after 3 weeks. Data were analyzed with t-test, using SPSS software (PSAW, Windows version 18.0). Results: The mean plasma TAC was significantly lower (792.33 ± 124.33 μmol/L, P < 0.001) in chronic periodontitis patients compared to healthy control (1076.08 ± 193.82 μmol/L). Plasma TAC level increased significantly (989.75 ± 96.80, P < 0.001) after scaling and root planing. Conclusions: An inverse relationship exists between plasma TAC and severity of chronic periodontitis suggesting disturbed oxidant-antioxidant balance in chronic periodontitis. Scaling and root planing resulted in the restoration of TAC to normal levels. These results are important from the perspective of including antioxidants in periodontal therapy regime to boost up body's antioxidant defense system and to reduce oxidative stress-mediated periodontal tissue damage. We concluded that TAC can be used as a biomarker to evaluate the health of periodontium. PMID:29456303

The Kidney and Periodontal Disease (KAPD) study: A pilot randomized controlled trial testing the effect of non-surgical periodontal therapy on chronic kidney disease.

PubMed

Grubbs, Vanessa; Garcia, Faviola; Jue, Bonnie L; Vittinghoff, Eric; Ryder, Mark; Lovett, David; Carrillo, Jacqueline; Offenbacher, Steven; Ganz, Peter; Bibbins-Domingo, Kirsten; Powe, Neil R

2017-02-01

Chronic kidney disease (CKD) remains a prevalent public health problem that disproportionately affects minorities and the poor, despite intense efforts targeting traditional risk factors. Periodontal diseases are common bacterial plaque-induced inflammatory conditions that can respond to treatment and have been implicated as a CKD risk factor. However there is limited evidence that treatment of periodontal disease slows the progression of CKD. We describe the protocol of the Kidney and Periodontal Disease (KAPD) study, a 12-month un-blinded, randomized, controlled pilot trial with two intent-to-treat treatment arms: 1. immediate intensive non-surgical periodontal treatment or 2. rescue treatment with delayed intensive treatment. The goals of this pilot study are to test the feasibility of conducting a larger trial in an ethnically and racially diverse, underserved population (mostly poor and/or low literacy) with both CKD and significant periodontal disease to determine the effect of intensive periodontal treatment on renal and inflammatory biomarkers over a 12-month period. To date, KAPD has identified 634 potentially eligible patients who were invited to in-person screening. Of the 83 (13.1%) of potentially eligible patients who attended in-person screening, 51 (61.4%) were eligible for participation and 46 enrolled in the study. The mean age of participants is 59.2years (range 34 to 73). Twenty of the participants (43.5%) are Black and 22 (47.8%) are Hispanic. Results from the KAPD study will provide needed preliminary evidence of the effectiveness of non-surgical periodontal treatment to slow CKD progression and inform the design future clinical research trials. Copyright © 2016. Published by Elsevier Inc.

Periodontal Therapy Reduces the Severity of Active Rheumatoid Arthritis in Patients Treated With or Without Tumor Necrosis Factor Inhibitors

PubMed Central

Ortiz, P; Bissada, NF; Palomo, L; Han, YW; Al-Zahrani, MS; Panneerselvam, A; Askari, A

2010-01-01

Background Rheumatoid arthritis (RA) and periodontitis (PD) are common chronic inflammatory conditions. Recent studies have shown a beneficial effect of periodontal treatment on reducing the severity of active RA. This study was undertaken to further examine the effect of non-surgical periodontal treatment on signs and symptoms of RA in patients treated with or without anti-Tumor Necrosis Factor (TNF)-α medications. The effect of anti-TNF-α therapy on periodontitis also was assessed. Methods Forty participants diagnosed with moderate/severe RA (under treatment for RA) and severe periodontitis were randomly assigned to receive initial non-surgical periodontal therapy with scaling/root planing and oral hygiene instructions (n=20) or no periodontal therapy (n=20). To control RA, all participants had been using disease-modifying anti-rheumatic drugs (DMARDs), and 20 had been using anti-TNF-α in addition to DMARDs before randomization. Periodontal probing depth (PD), clinical attachment loss (CAL), bleeding on probing (BOP), gingival (GI) and plaque (PI) indices, RA disease activity score (DAS-28) and erythrocyte sedimentation rate (ESR) were measured at baseline and six weeks afterwards. Linear mixed models were used to identify significant differences between subjects receiving periodontal treatment and those who did not. Results Patients receiving periodontal treatment showed a significant decrease in the mean DAS28, ESR (p < 0.001) and serum TNF-α (p < 0.05). There was no statistically significant decrease in these parameters in those patients not receiving periodontal treatment. Anti- TNF-α therapy resulted in a significant improvement in CAL, PD, BOP and GI. Conclusions Non-surgical periodontal therapy had a beneficial effect on signs and symptoms of RA regardless of the medications used to treat this condition. Anti-TNF-α therapy without periodontal treatment has no significant effect on the periodontal condition. PMID:19335072

Glutathione levels in plasma, saliva and gingival crevicular fluid after periodontal therapy in obese and normal weight individuals.

PubMed

Öngöz Dede, F; Bozkurt Doğan, Ş; Balli, U; Avci, B; Durmuşlar, M C; Baratzade, T

2016-12-01

The purpose of this study was to investigate the effects of obesity on reduced and oxidized glutathione (GSH and GSSG) levels in the gingival crevicular fluid, plasma and saliva of patients with chronic periodontitis and to evaluate the changes after nonsurgical periodontal therapy. The study included 60 patients: 30 patients with chronic periodontitis (15 obese patients and 15 normal weight patients) and 30 healthy control subjects (15 obese patients and 15 normal weight patients). Gingival crevicular fluid, plasma and saliva samples were collected, and clinical periodontal measurements were recorded at baseline and at the first month after periodontal therapy from patients with chronic periodontitis. GSH and GSSG levels were analyzed with spectrophotometry. The GSH levels in the plasma, saliva and gingival crevicular fluid in obese individuals with chronic periodontitis were lower than in normal weight individuals at baseline (p < 0.01). There was a significant difference in the GSH/GSSG ratio in plasma and gingival crevicular fluid between the obese and normal weight groups at baseline (p < 0.01). The GSH levels in plasma, gingival crevicular fluid and saliva were significantly increased in both chronic periodontitis groups after nonsurgical periodontal therapy (p < 0.01). A significant positive correlation was found between GSH levels in saliva, plasma and gingival crevicular fluid in all groups (p < 0.001). The study revealed that obesity in patients with chronic periodontitis is associated with decreased GSH levels and the GSH/GSSG ratio. Moreover, nonsurgical periodontal therapy may be helpful for improvement in glutathione values in obese and normal weight individuals with chronic periodontitis. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Systematic review of the adjunctive use of diode and Nd:YAG lasers for nonsurgical periodontal instrumentation.

PubMed

Roncati, Marisa; Gariffo, Annalisa

2014-04-01

The aims of this study were (1) to conduct a literature search and systematically evaluate the additional therapeutic effects of pulsed Nd:YAG or diode laser use in patients with periodontitis, (2) to assess evidence supporting the additional benefit of laser-mediated periodontal treatment in conjunction with scaling and root planning (SRP) (not as monotherapy), and (3) to interpret the evidence presented in retrieved publications. Opinions about the additional use of diode lasers in the nonsurgical treatment of plaque-induced periodontal lesions are conflicting. The April 2011 American Academy of Periodontology's "Statement on the Efficacy of Lasers in the Non-Surgical Treatment of Inflammatory Periodontal Disease" asserted that the use of a laser as monotherapy or in addition to nonsurgical periodontal instrumentation conveyed no advantage. After initial screening, 23/77 potentially relevant articles and abstracts identified through electronic and manual searches of the MEDLINE(®)/PubMed database and the Cochrane Central Register of Controlled Trials (1990-2012) were included in this review. A meta-analysis could be performed. The results indicate that Nd:YAG or diode laser, used in an adjunctive capacity to SRP, may provide some additional benefit, in 6 month studies, compared with mechanical debridement. The results show the adjunctive benefits that diode laser treatment can provide when it is used as an adjunct to nonsurgical periodontal treatment in adults with chronic periodontitis. Further long-term, well-designed, parallel randomized clinical trials are needed to assess the effectiveness of the adjunctive use of the diode laser, as well as the appropriate dosimetry and laser settings.

Host modulation therapeutics in periodontics: role as an adjunctive periodontal therapy.

PubMed

Shinwari, Muhammad Saad; Tanwir, Farzeen; Hyder, Pakiza Raza; Bin Saeed, Muhammad Humza

2014-09-01

Host Modulation Therapy (HMT) is a treatment concept that reduces tissue destruction and stabilizes or even regenerates inflammatory tissue by modifying host response factors. It has been used for treating osteoporosis and arthritis for several decades. However, its use in dentistry has only been recently reported. The objective of this article is to present a review of the various literatures available on HMT and also its role as adjunct therapy in periodontics. For identifying studies for this review, a PUBMED search was carried out in 2013 for all articles published till December 2012. The search was restricted to English language publications only. Longitudinal prospective and retrospective studies were included in the search. The key words used were: Host Modulation Therapy; Sub antimicrobial dose doxycycline and Non-Surgical Periodontal Therapy. The main outcomes sought were host modulation therapeutics in periodontics. Exclusion criteria included cross sectional studies, short case series as well as studies with short follow-up periods. There is a paucity of literature on HMT in periodontics although the only drug approved by United States Food and Drug Administration (FDA) is a subantimicrobial dose of doxycycline (SDD) with highly predictable results as a host modulating agent in periodontal diseases and also an effective adjunctive therapy in various diseases of periodontium. However, more randomized controlled trials are needed to obtain clinical guidelines on the usage of other host modulating agents as adjunct as well as definite therapy for periodontal diseases. SDD is an effective adjunct therapy when used in dosage of 20mg twice daily for minimum 3 months duration in various periodontal diseases with predictable clinical outcomes. It is also recommended that future clinical research on anti cytokine drugs, chemically modified tetracycline and other HMT agents should be conducted so that new drugs are available with highly predictable results.

Effect of non-surgical periodontal therapy on C-reactive protein, oxidative stress, and matrix metalloproteinase (MMP)-9 and MMP-2 levels in patients with type 2 diabetes: a randomized controlled study.

PubMed

Koromantzos, Panagiotis A; Makrilakis, Konstantinos; Dereka, Xanthippi; Offenbacher, Steven; Katsilambros, Nicholas; Vrotsos, Ioannis A; Madianos, Phoebus N

2012-01-01

It is well accepted that glycemic control in patients with diabetes mellitus (DM) is affected by systemic inflammation and oxidative stress. The effect of periodontal therapy on these systemic factors may be related to improvement on glycemic status. The aim of the present study is to assess over a period of 6 months the effect of non-surgical periodontal therapy on serum levels of high-sensitivity C-reactive protein (hsCRP), d-8-iso prostaglandin F2a (d-8-iso) as a marker of oxidative stress, and matrix metalloproteinase (MMP)-2 and MMP-9 on patients with type 2 DM. Sixty participants with type 2 DM and moderate to severe periodontal disease were randomized into intervention (IG) and control (CG) groups. IG received scaling and root planing, whereas CG received supragingival cleaning at baseline and scaling and root planing at 6 months. Participants of both groups were evaluated at baseline and 1, 3, and 6 months. Periodontal data recorded at each visit included probing depth, clinical attachment loss, bleeding on probing, and gingival index. Blood was collected at each visit for the assay of serum glycated hemoglobin A1c (A1c), hsCRP, d-8-iso, MMP-2, and MMP-9. Although there was a trend to a reduction in hsCRP, d-8-iso and MMP-9 it did not reach statistical significance. MMP-2 levels remained unchanged after periodontal treatment. Effective non-surgical periodontal treatment of participants with type 2 DM and moderate to severe periodontal disease improved significantly A1c levels but did not result in a statistically significant improvement in hsCRP, d-8-iso, MMP-2, and MMP-9 levels.

Circulating interleukin-6 and high-sensitivity C-reactive protein decrease after periodontal therapy in otherwise healthy subjects.

PubMed

Marcaccini, Andrea M; Meschiari, César A; Sorgi, Carlos A; Saraiva, Maria C P; de Souza, Ana M; Faccioli, Lúcia H; Tanus-Santos, José E; Novaes, Arthur B; Gerlach, Raquel F

2009-04-01

Periodontal disease has been associated with many chronic inflammatory systemic diseases, and a common chronic inflammation pathway has been suggested for these conditions. However, few studies have evaluated whether periodontal disease, in the absence of other known inflammatory conditions and smoking, affects circulating markers of chronic inflammation. This study compared chronic inflammation markers in control individuals and patients with periodontal disease and observed whether non-surgical periodontal therapy affected inflammatory disease markers after 3 months. Plasma and serum of 20 controls and 25 patients with periodontal disease were obtained prior to and 3 months after non-surgical periodontal therapy. All patients were non-smokers, they did not use any medication, and they had no history or detectable signs and symptoms of systemic diseases. Periodontal and systemic parameters included probing depth, bleeding on probing, clinical attachment level, hematologic parameters, as well as the following inflammatory markers: interleukin (IL)-6, high-sensitivity C-reactive protein (hs-CRP), CD40 ligand, monocyte chemoattractant protein (MCP)-1, soluble P-selectin (sP-selectin), soluble vascular adhesion molecule (sVCAM)-1, and soluble intercellular adhesion molecule (sICAM)-1. There were no differences in the hematologic parameters of the patients in the control and periodontal disease groups. Among the tested inflammatory markers, IL-6 concentrations were higher in the periodontal disease group at baseline compared to the controls (P = 0.006). Therapy was highly effective (P <0.001 for all the analyzed clinical parameters), and a decrease in circulating IL-6 and hs-CRP concentrations was observed 3 months after therapy (P = 0.001 and P = 0.006, respectively). Our results also suggest that the CD40 ligand marker may have been different in the control and periodontal disease groups prior to the therapy (P = 0.009). In apparently otherwise healthy patients

Management of cannabis-induced periodontitis via resective surgical therapy: A clinical report.

PubMed

Momen-Heravi, Fatemeh; Kang, Philip

2017-03-01

There is a lack of clinical research on the potential effect of cannabis use on the periodontium as well as its effect on treatment outcomes. The aim of this case report is to illustrate the clinical presentation of periodontal disease in a young woman who was a chronic cannabis user, as well as successful treatment involving motivating the patient to quit cannabis use and undergo nonsurgical and surgical therapy. A 23-year-old woman sought care at the dental clinic for periodontal treatment. During a review of her medical history, the patient reported using cannabis frequently during a 3-year period, which coincided with the occurrence of gingival inflammation. She used cannabis in the form of cigarettes that were placed at the mandibular anterior region of her mouth for prolonged periods. Localized prominent papillary and marginal gingival enlargement of the anterior mandible were present. The mandibular anterior teeth showed localized severe chronic periodontitis. The clinicians informed the patient about the potentially detrimental consequences of continued cannabis use; she was encouraged to quit, which she did. The clinicians performed nonsurgical therapy (scaling and root planing) and osseous surgery. The treatment outcome was evaluated over 6 months; improved radiographic and clinical results were observed throughout the follow-up period. Substantial availability and usage of cannabis, specifically among young adults, requires dentists to be vigilant about clinical indications of cannabis use and to provide appropriate treatments. Behavioral modification, nonsurgical therapy, and surgical therapy offer the potential for successful management of cannabis-related periodontitis. Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.

Effect of 1% sodium alendronate in the non-surgical treatment of periodontal intraosseous defects: a 6-month clinical trial

PubMed Central

DUTRA, Bernardo Carvalho; OLIVEIRA, Alcione Maria Soares Dutra; OLIVEIRA, Peterson Antônio Dutra; MANZI, Flavio Ricardo; CORTELLI, Sheila Cavalca; COTA, Luís Otávio de Miranda; COSTA, Fernando Oliveira

2017-01-01

Abstract Background and objectives Few studies have evaluated the effect of the topical application of sodium alendronate (ALN) on the treatment of intrabuccal bone defects, especially those caused by periodontitis. This 6-month randomized placebo controlled clinical trial aimed at evaluating the effect of non-surgical periodontal treatment associated with the use of 1% ALN, through clinical evaluations and cone-beam computed tomography (CBCT). Material and Methods Twenty individuals with chronic periodontitis underwent periodontal examination at the baseline as well as 3 and 6 months after periodontal treatment, registering clinical attachment level (CAL), periodontal probing depth (PPD), and bleeding on probing (BOP) as the clinical outcomes. After manual scaling and root planing, 40 bilateral sites with interproximal vertical bone defects were randomly treated with either 1% ALN gel or a placebo. Bone defects were evaluated through CBCT at the baseline and 6 months post-treatment. The clinical and CBCT parameters were compared using the Wilcoxon and Friedman tests (p<0.05). Results Although ALN produced a greater CAL gain when compared to the placebo at 6 months post-treatment (p=0.021), both treatments produced similar effects on the PPD, BOP, and bone height. Significant differences in bone fill were observed only in patients of the ALN group (4.5 to 3.8 mm; p=0.003) at 6 months post-treatment. Conclusions Topical application of 1% ALN might be a beneficial adjuvant to non-surgical periodontal therapy. PMID:28678950

The effects of photodynamic laser therapy in the treatment of marginal chronic periodontitis

NASA Astrophysics Data System (ADS)

Chifor, Radu; Badea, Iulia; Avram, Ramona; Chifor, Ioana; Badea, Mîndra Eugenia

2016-03-01

The aim of this study was to assess the effects of the antimicrobial photodynamic laser therapy performed during the treatment of deep periodontal disease by using 40 MHz high frequency ultrasonography. The periodontal data recorded during the clinical examination before each treatment session were compared with volumetric changes of the gingiva measured on periodontal ultrasound images. The results show a significant decrease of gingival tissue inflammation proved both by a significant decrease of bleeding on probing as well as by a decrease of the gingival tissues volume on sites where the laser therapy was performed. Periodontal tissues that benefit of laser therapy besides classical non-surgical treatment showed a significant clinical improvement of periodontal status. Based on these findings we were able to conclude that the antimicrobial photodynamic laser therapy applied on marginal periodontium has important anti-inflamatory effect. The periodontal ultrasonography is a method which can provide useful data for assessing the volume changes of gingival tissues, allowing a precise monitoring of marginal periodontitis.

Intraosseous anesthesia using a computer-controlled system during non-surgical periodontal therapy (root planing): Two case reports.

PubMed

Han, Keumah; Kim, Jongbin

2018-02-01

Local anesthesia is administered to control pain, but it may induce fear and anxiety. Root planing is a non-surgical periodontal therapy; however, when it is performed in an extensive manner, some tissue removal is inevitable. Notably, this removal may be so painful that local anesthesia is required to be administered to the area scheduled for the treatment. Although patients tend to accept root planing easily, they frequently express a fear of local anesthesia. Intraosseous anesthesia (IA) is an intraosseous injection technique, whereby local anesthetic is injected into the cancellous bone supporting the teeth. A computer-controlled IA system (CIAS) exhibits multiple benefits, such as less painful anesthesia, reduced soft tissue numbness, and the provision of palatal or lingual, as well as buccal, anesthesia via single needle penetration. In this report, we present two cases of root planing that were performed under local anesthesia, using a CIAS.

Intraosseous anesthesia using a computer-controlled system during non-surgical periodontal therapy (root planing): Two case reports

PubMed Central

2018-01-01

Local anesthesia is administered to control pain, but it may induce fear and anxiety. Root planing is a non-surgical periodontal therapy; however, when it is performed in an extensive manner, some tissue removal is inevitable. Notably, this removal may be so painful that local anesthesia is required to be administered to the area scheduled for the treatment. Although patients tend to accept root planing easily, they frequently express a fear of local anesthesia. Intraosseous anesthesia (IA) is an intraosseous injection technique, whereby local anesthetic is injected into the cancellous bone supporting the teeth. A computer-controlled IA system (CIAS) exhibits multiple benefits, such as less painful anesthesia, reduced soft tissue numbness, and the provision of palatal or lingual, as well as buccal, anesthesia via single needle penetration. In this report, we present two cases of root planing that were performed under local anesthesia, using a CIAS. PMID:29556561

Impact of non-surgical periodontal therapy on OHRQoL in an obese population, a randomised control trial.

PubMed

Basher, Samara S; Saub, R; Vaithilingam, R D; Safii, S H; Daher, Aqil M; Al-Bayaty, F H; Baharuddin, N A

2017-11-21

Oral Health Related Quality of Life (OHRQoL) is an important measure of disease and intervention outcomes. Chronic periodontitis (CP) is an inflammatory condition that is associated with obesity and adversely affects OHRQoL. Obese patients with CP incur a double burden of disease. In this article we aimed to explore the effect of Non-Surgical Periodontal Therapy (NSPT) on OHRQoL among obese participants with chronic periodontitis. This was a randomised control clinical trial at the Faculty of Dentistry, University of Malaya. A total of 66 obese patients with chronic periodontitis were randomly allocated into the treatment group (n=33) who received NSPT, while the control group (n=33) received no treatment. Four participants (2 from each group) were non-contactable 12 weeks post intervention. Therefore, their data were removed from the final analysis. The protocol involved questionnaires (characteristics and OHRQoL (Oral Health Impact Profile-14; OHIP-14)) and a clinical examination. The OHIP prevalence of impact (PI), overall mean OHIP severity score (SS) and mean OHIP Extent of Impact (EI) at baseline and at the 12-week follow up were almost similar between the two groups and statistically not significant at (p=0.618), (p=0.573), and (p=0.915), respectively. However, in a within-group comparison, OHIP PI, OHIP SS, and OHIP EI showed a significant improvement for both treatment and control groups and the p values were ((0.002), (0.008) for PI), ((0.006) and (0.004) for SS) and ((0.006) and (0.002) for EI) in-treatment and control groups, respectively. NSPT did not significantly affect the OHRQoL among those obese with CP. Regardless, NSPT, functional limitation and psychological discomfort domains had significantly improved. ( NCT02508415 ). Retrospectively registered on 2 nd of April 2015.

Is obesity associated with healing after non-surgical periodontal therapy? A local vs. systemic evaluation.

PubMed

Duzagac, E; Cifcibasi, E; Erdem, M G; Karabey, V; Kasali, K; Badur, S; Cintan, S

2016-10-01

We aimed to detect the role of obesity on the healing response to periodontal therapy in terms of serum lipids, C-reactive protein (CRP) and both serum and gingival crevicular fluid adipocytokines. Thirty patients with periodontitis with (CPO) (n = 15) and without (n = 15) obesity and 15 healthy controls were included. Serum high-density lipoprotein, low-density lipoprotein, triglyceride, CRP levels and levels of adiponectin, interleukin (IL)-6, tumor necrosis factor (TNF)-α and IL-10 were evaluated before and 3 mo after initial periodontal therapy. Clinical periodontal measurements were also recorded at baseline and 3 mo. Periodontal parameters improved significantly in both periodontitis groups with or without obesity (p < 0.05) with no significant difference in terms of gain clinical attachment level (p > 0.05) and change in numbers of sites with probing depth ≥ 4 mm. High-density lipoprotein significantly increased in both groups (p > 0.05). CRP decreased significantly solely in the normal weight group. IL-6, IL-10 and TNF-α levels in gingival crevicular fluid improved significantly based on therapy in both groups (p < 0.05). Only TNF-α decreased significantly in the CPO, while adiponectin and IL-10 in addition to TNF-α improved significantly in the group of patients with periodontitis without obesity. Patients with CPO respond to periodontal therapy as well as the non-obese controls. This similar response is accompanied with consistent adipokine levels in gingival crevicular fluid. However, obesity affects the CRP and serum adipocytokine levels in response to therapy. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Non-surgical approach to advanced chronic periodontitis: a 17.5-year case report.

PubMed

Kawamura, M; Sadamori, S; Okada, M; Sasahara, H; Hamada, T

2004-03-01

This 17.5-year longitudinal case report details the treatment of advanced chronic periodontitis in a female patient commencing at 34 years of age. The woman was provided with periodontal care comprising of temporary fixation, scaling and root planing, intra-pocket irrigation using a root canal syringe and regular supervised maintenance. The patient presented with a 10-year history of bleeding gums. Therapy conducted in general practice had included simple curettage and irrigation. However, these treatments proved unsuccessful and the patient often changed dentists seeking better treatment. She presented to the University Dental Hospital, for diagnosis and treatment of her periodontal conditions after her mandibular lateral incisor had exfoliated. On presentation a purulent exudate could be expressed from all of the pockets. All anterior teeth, excluding the maxillary canines, demonstrated +2 to +3 mobility. The patient did not want any surgical treatment or her teeth extracted. It was decided to treat the patient conservatively without surgery. By postponing extraction, the authors were in a better position to determine the prognosis of the remaining teeth after the infection was under control. Although six teeth were extracted during the 17.5 years, this case report suggests that a non-surgical approach is a viable option while maintaining regular visits for periodontal care.

Outcomes After 25 Years of Periodontal Treatment and Maintenance of a Patient Affected by Generalized Severe Aggressive Periodontitis.

PubMed

Clementini, Marco; Vignoletti, Fabio; de Sanctis, Massimo

This report describes the long-term outcomes of nonsurgical periodontal therapy and supportive periodontal treatment (SPT) of a 21-year-old patient affected by generalized aggressive periodontitis at multiple teeth with a compromised prognosis. After 25 years of SPT, no teeth had been extracted and no periodontal pockets associated with bleeding on probing were present. Radiographic analysis showed an improvement in infrabony defects, demonstrating long-term improvement is possible with nonsurgical periodontal treatment provided that smoking is not present and the patient is included in a strict SPT.

Adjunctive Non-Surgical Therapy of Inflamed Periodontal Pockets During Maintenance Therapy Using Diode Laser: A Randomized Clinical Trial.

PubMed

Nguyen, Naomi-Trang; Byarlay, Matthew R; Reinhardt, Richard A; Marx, David B; Meinberg, Trudy A; Kaldahl, Wayne B

2015-10-01

Numerous studies have documented the clinical outcomes of laser therapy for untreated periodontitis, but very few have reported on lasers treating inflamed pockets during maintenance therapy. The aim of this study is to compare the effectiveness of scaling and root planing (SRP) plus the adjunctive use of diode laser therapy to SRP alone on changes in the clinical parameters of disease and on the gingival crevicular fluid (GCF) inflammatory mediator interleukin-1β (IL-1β) in patients receiving regular periodontal maintenance therapy. This single-masked and randomized, controlled, prospective study includes 22 patients receiving regular periodontal maintenance therapy who had one or more periodontal sites with a probing depth (PD) ≥ 5 mm with bleeding on probing (BOP). Fifty-six sites were treated with SRP and adjunctive laser therapy (SRP + L). Fifty-eight sites were treated with SRP alone. Clinical parameters, including PD, clinical attachment level (CAL), and BOP, and GCF IL-1β levels were measured immediately before treatment (baseline) and 3 months after treatment. Sites treated with SRP + L and SRP alone resulted in statistically significant reductions in PD and BOP and gains in CAL. These changes were not significantly different between the two therapies. Similarly, differences in GCF IL-1β levels between SRP + L and SRP alone were not statistically significant. In periodontal maintenance patients, SRP + L did not enhance clinical outcomes compared to SRP alone in the treatment of inflamed sites with ≥ 5 mm PD.

Effects of periodontal therapy on C-reactive protein and HDL in serum of subjects with periodontitis.

PubMed

Leite, Anne Carolina Eleutério; Carneiro, Valéria Martins de Araújo; Guimarães, Maria do Carmo Machado

2014-01-01

To investigate the effects of nonsurgical periodontal therapy on levels of high-sensitivity C-reactive protein in the sera and its association with body mass index and high density lipoprotein in subjects with severe periodontitis. Sera from 28 subjects (mean age: 34.36±6.24; 32% men) with severe periodontitis and 27 healthy controls (mean age: 33.18±6.42; 33% men) were collected prior to periodontal therapy. Blood samples were obtained from 23 subjects who completed therapy (9-12 months). Oral and systemic parameters such as the number of blood cells, glucose examination, lipid profile, and high-sensitivity C-reactive protein levels accessed by high-sensitivity immunonephelometry assay, were included. Before therapy, in the periodontitis group, the ratio of subjects with high-sensitivity C-reactive protein <0.3 mg/dL was statistically lower than in the control group (P<0.0216). After therapy, the ratio of subjects with high-sensitivity C-reactive protein <0.3 mg/dL was significantly higher (65.22%) (P<0.0339). The mean value for body mass index was statistically lower in subjects with high-sensitivity C-reactive protein <0.3 mg/dL (24.63±4.19), compared with those with high-sensitivity C-reactive protein >0.3 mg/dL (28.91±6.03) (P<0.0411). High density lipoprotein presented a mean value statistically higher after therapy (P<0.0027). In systemically healthy subjects with periodontitis, periodontal therapy was associated with decreased levels of circulating high-sensitivity C-reactive protein and increase of high density lipoprotein in serum. The clinical trial was registered at http://www.clinicaltrials.gov.br/, No. RBR-24T799.

Periodontal therapy reduces plasma levels of interleukin-6, C-reactive protein, and fibrinogen in patients with severe periodontitis and refractory arterial hypertension.

PubMed

Vidal, Fábio; Figueredo, Carlos Marcelo S; Cordovil, Ivan; Fischer, Ricardo G

2009-05-01

Recent epidemiologic studies suggest that inflammation is the link between periodontal diseases and cardiovascular complications. This study aimed to evaluate the effects of non-surgical periodontal treatment on plasma levels of inflammatory markers (interleukin [IL]-6, C-reactive protein [CRP], and fibrinogen) in patients with severe periodontitis and refractory arterial hypertension. Twenty-two patients were examined and randomly divided into two groups. The test group was composed of 11 patients (mean age, 48.9 +/- 3.9 years) who received periodontal treatment, whereas the control group had 11 patients (mean age, 49.7 +/- 6.0 years) whose treatment was delayed for 3 months. Demographic and clinical periodontal data were collected, and blood tests were performed to measure the levels of IL-6, CRP, and fibrinogen at baseline and 3 months later. The clinical results showed that the mean percentages of sites with bleeding on probing, probing depth (PD) 4 to 5 mm, PD > or =6 mm, clinical attachment loss (CAL) 4 to 5 mm, and CAL > or =6 mm were significantly reduced in the test group 3 months after periodontal treatment. There were no significant differences between the data at baseline and 3 months in the control group. Periodontal treatment significantly reduced the blood levels of fibrinogen, CRP, and IL-6 in the test group. Non-surgical periodontal therapy was effective in improving periodontal clinical data and in reducing the plasma levels of IL-6, CRP, and fibrinogen in hypertensive patients with severe periodontitis.

Effect of Periodontal Therapy on Crevicular Fluid Interleukin-18 Level in Periodontal Health and Disease in Central Maharashtra (India) Population.

PubMed

Mahajani, Monica J; Jadhao, Varsha A; Wankhade, Pooja S; Samson, Emmanuel; Acharya, Vishwas D; Tekale, Pawankumar D

2017-11-01

The incidence and progression of the periodontal disease depend on periodontal microflora and the multifaceted response of the host, and these interactions are mediated by cytokines and chemokines. Interleukin-18 (IL-18) is a proinflammatory cytokine of the IL-1 superfamily. The aim of the present study was the assessment of the periodontal therapy in IL-18 level in periodontal disease and health. Based on clinical attachment loss (CAL), probing pocket depth (PPD), gingival index (GI), and plaque index (PI) patients were divided into three groups: Group I with healthy patients, group II with chronic periodontitis, and group III with posttreatment patients having periodontitis. Mean PI, PPD, CAL, and gingival crevicular fluid (GCF) volume were significantly higher in groups II and III compared with group I. However, there were no significant differences between GI in groups I, II, and III. The total amount of IL-18 in GCF was significantly higher in group II when compared with groups I and III (p < 0.05). The present study confirmed that the IL-18 level in GCF was lower in healthy patients, higher in periodontally involved patients, and reduced at baseline, 3 and 6 weeks after nonsurgical periodontal therapy. The IL-18 might be hypothetically beneficial in distinguishing health from disease and monitoring periodontal disease activity.

Evaluation of efficacy of photodynamic therapy as an adjunct to nonsurgical periodontal therapy in treatment of chronic periodontitis patients: A clinico-microbiological study.

PubMed

Raj, K Ravi; Musalaiah, Svvs; Nagasri, M; Kumar, P Aravind; Reddy, P Indeevar; Greeshma, M

2016-01-01

Photodynamic therapy (PDT) is a local noninvasive treatment modality without side effects caused by antibiotics. The aim of this study was to evaluate the efficacy of adjunctive use of PDT with scaling and root planing as compared with SRP alone in the treatment of chronic periodontitis. Twenty participants with chronic periodontitis having probing pocket depths (PDs) of ≥5 mm were selected for the study. Patients were randomly divided into control group and test group with ten patients in each group. Full-mouth SRP was performed in both the groups, followed by PDT in test group. Assessment of plaque index (PI), gingival index (GI), PD, and clinical attachment level (CAL) was done at baseline and after 3 months. Microbiological assessment of Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola was done by polymerase chain reaction (PCR) at baseline and 3 months after the therapy. There was a significant reduction in PI, GI, PD, CAL, and microbiologic parameters in test group, following SRP and PDT, when compared with SRP alone in control group. PDT in conjunction with SRP has shown additional improvement in periodontal parameters when compared to SRP alone and has a beneficial effect in chronic periodontitis patients.

The effect of periodontal therapy on intra-oral halitosis: a case series.

PubMed

Erovic Ademovski, Seida; Mårtensson, Carina; Persson, G Rutger; Renvert, Stefan

2016-05-01

The aim of this study was to evaluate the effects of non-surgical periodontal therapy on intra-oral halitosis 3 months after therapy. Sixty-eight adults with intra-oral halitosis were included in a case series. Intra-oral halitosis was evaluated at baseline, and at 3 months after treatment using the organoleptic scores (OLS), Halimeter ® , and a gas chromatograph. Significant reductions for OLS (p < 0.01), total sum of volatile sulphur compounds (T-VSC) (p < 0.01) and methyl mercaptan (MM) (p < 0.05) values were found after treatment. Hydrogen sulphide (H 2 S) levels were not significantly reduced. The numbers of probing pockets 4 mm, 5 mm and 6 mm were significantly reduced as a result of therapy (p < 0.001). Bleeding on probing (BOP) and plaque indices were also significantly reduced (p < 0.001). For the 34 individuals with successful periodontal treatment (BOP<20% and a ≥50% reduction of total pocket depth) reductions in OLS (p < 0.01) and T-VSC scores (p < 0.01) were found. Eleven individuals were considered effectively treated for intra-oral halitosis presenting with a T-VSC value <160 ppb, a H 2 S value <112 ppb and a MM value <26 ppb. Non-surgical periodontal therapy resulted in reduction of OLS, MM and T-VSC values 3 months after therapy. Few individuals were considered as effectively treated for intra-oral halitosis. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Periodontal and peri-implant wound healing following laser therapy.

PubMed

Aoki, Akira; Mizutani, Koji; Schwarz, Frank; Sculean, Anton; Yukna, Raymond A; Takasaki, Aristeo A; Romanos, Georgios E; Taniguchi, Yoichi; Sasaki, Katia M; Zeredo, Jorge L; Koshy, Geena; Coluzzi, Donald J; White, Joel M; Abiko, Yoshimitsu; Ishikawa, Isao; Izumi, Yuichi

2015-06-01

Laser irradiation has numerous favorable characteristics, such as ablation or vaporization, hemostasis, biostimulation (photobiomodulation) and microbial inhibition and destruction, which induce various beneficial therapeutic effects and biological responses. Therefore, the use of lasers is considered effective and suitable for treating a variety of inflammatory and infectious oral conditions. The CO2 , neodymium-doped yttrium-aluminium-garnet (Nd:YAG) and diode lasers have mainly been used for periodontal soft-tissue management. With development of the erbium-doped yttrium-aluminium-garnet (Er:YAG) and erbium, chromium-doped yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers, which can be applied not only on soft tissues but also on dental hard tissues, the application of lasers dramatically expanded from periodontal soft-tissue management to hard-tissue treatment. Currently, various periodontal tissues (such as gingiva, tooth roots and bone tissue), as well as titanium implant surfaces, can be treated with lasers, and a variety of dental laser systems are being employed for the management of periodontal and peri-implant diseases. In periodontics, mechanical therapy has conventionally been the mainstream of treatment; however, complete bacterial eradication and/or optimal wound healing may not be necessarily achieved with conventional mechanical therapy alone. Consequently, in addition to chemotherapy consisting of antibiotics and anti-inflammatory agents, phototherapy using lasers and light-emitting diodes has been gradually integrated with mechanical therapy to enhance subsequent wound healing by achieving thorough debridement, decontamination and tissue stimulation. With increasing evidence of benefits, therapies with low- and high-level lasers play an important role in wound healing/tissue regeneration in the treatment of periodontal and peri-implant diseases. This article discusses the outcomes of laser therapy in soft-tissue management, periodontal

Clinical and microbiological evaluation of high intensity diode laser adjutant to non-surgical periodontal treatment: a 6-month clinical trial.

PubMed

Euzebio Alves, Vanessa Tubero; de Andrade, Ana Karina Pinto; Toaliar, Janaita Maria; Conde, Marina Clemente; Zezell, Denise Maria; Cai, Silvana; Pannuti, Claudio Mendes; De Micheli, Giorgio

2013-01-01

This randomized split-mouth clinical trial was designed to evaluate the efficacy of scaling and root planing associated to the high-intensity diode laser on periodontal therapy by means of clinical parameters and microbial reduction. A total of 36 chronic periodontitis subjects, of both genders, were selected. One pair of contralateral single-rooted teeth with pocket depth >5 mm was chosen from each subject. All patients received non-surgical periodontal treatment, after which the experimental teeth were designated to either test or control groups. Both teeth received scaling, root planing and coronal polishing (SRP) and teeth assigned to the test group (SRP + DL) were irradiated with the 808 ± 5 nm diode laser, for 20 s, in two isolated appointments, 1 week apart. The laser was used in the continuous mode, with 1.5 W and power density of 1,193.7 W/cm(2). Clinical and microbiological data were collected at baseline, 6 weeks and 6 months after therapy. There was a significant improvement of all the clinical parameters-clinical attachment level (CAL), probing depth (PD), plaque index (PI) and Bleeding on Probing (BOP)-for both groups (P < 0.001), with no statistical difference between them at the 6 weeks and the 6 months examinations. As for microbiological analysis, a significant reduction after 6 weeks (P > 0.05) was observed as far as colony forming units (CFU) is concerned, for both groups. As for black-pigmented bacteria, a significant reduction was observed in both groups after 6 months. However, the difference between test and control groups was not significant. There was no association between group and presence of Porphyromonas gingivalis, Prevotella intermedia and Aggregatibacter actinomycetemcomitans at any time of the study. After 6 months of evaluation, the high-intensity diode laser has not shown any additional benefits to the conventional periodontal treatment. The high intensity diode laser did not provide additional benefits

Local drug delivery agents as adjuncts to endodontic and periodontal therapy

PubMed Central

Puri, K; Puri, N

2013-01-01

Abstract In the treatment of intracanal and periodontal infections, the local application of antibiotics and other therapeutic agents in the root canal or in periodontal pockets may be a promising approach to achieve sustained/controlled drug release, high antimicrobial activity and low systemic side effects. The conventional method for the elimination of subgingival microbial infection includes mechanical debridement, irrigation with antimicrobial agents or surgical access. But, the effectiveness of conventional nonsurgical treatment is limited by lack of accessibility to bacteria in deeper periodontal pockets, and/or does not completely eliminate intracanal microorganisms. Surgical intervention may be beneficial but cannot be done in all cases, medically compromised cases and also in patients not willing to be subjected to surgical therapy. Development of local drug delivery systems provides an answer to all such difficulties. This comprehensive review tries to cover the detailed information about the latest advances in the various local drug delivery systems, their indications, contraindications and their advantages over systemic drug therapy. PMID:24868252

Effect of Non-Surgical Periodontal Therapy Along With Myo-Inositol on High-Sensitivity C-Reactive Protein and Insulin Resistance in Women With Polycystic Ovary Syndrome and Chronic Periodontitis: A Randomized Controlled Trial.

PubMed

Deepti; Tewari, Shikha; Narula, Satish Chander; Singhal, Savita Rani; Sharma, Rajinder Kumar

2017-10-01

The purpose of this study is to evaluate the effect of non-surgical periodontal therapy and medical treatment on the level of a serologic marker of inflammation (high-sensitivity C-reactive protein [hsCRP]) and insulin resistance (homeostatic model assessment [HOMA]) in women with polycystic ovary syndrome (PCOS) and chronic periodontitis (CP). Women with PCOS and CP (n = 60) were randomly divided into two groups. The test group was treated with scaling and root planing (SRP) and myo-inositol (MI). The control group was treated with MI and given oral hygiene instructions. Anthropometric, metabolic, and periodontal parameters were assessed at baseline and re-evaluated at 3 and 6 months. All parameters of both groups at 6 months were compared with 25 systemically and periodontally healthy females (group A). Periodontal parameters were significantly improved in the test group compared with the control group at 3- and 6-month follow-up (P <0.001). A statistically significant reduction was observed in hsCRP and HOMA in both groups at 3- and 6-month follow-up (P <0.05). However, significantly more improvement in hsCRP (P <0.05) and a statistically comparable reduction in HOMA (P >0.05) was observed in the test group compared with the control group at 3 and 6 months. Both the test and control group showed significant consistent improvement in metabolic parameters at 3- and 6-month follow-up, which was further comparable to group A. SRP together with medical treatment results in a greater reduction of systemic inflammatory burden compared with medical treatment alone in management of women with PCOS and CP.

An evaluation of recruitment methods utilized for a clinical trial with periodontal and diabetes enrollment criteria: the Diabetes and Periodontal Therapy Trial

PubMed Central

Schoenfeld, Elinor R; Hyman, Leslie; Simpson, Leslie Long; Michalowicz, Bryan; Reddy, Michael; Gelato, Marie; Hou, Wei; Engebretson, Steven P; Hytner, Catherine; Lenton, Pat

2014-01-01

Background Diabetes and its complications are a major United States public health concern. Methods The Diabetes and Periodontal Therapy Trial (DPTT) evaluated whether non-surgical treatment of periodontal disease influenced diabetes management among persons with Type 2 diabetes and periodontitis. The aim of this study was to evaluate DPTT’s many recruitment strategies in terms of enrollment success. Results/Conclusion Targeted recruitment strategies were more effective in identifying individuals who met periodontal and diabetes eligibility criteria. Individuals eligible for a baseline visit/enrollment were more often male, had a younger age at diabetes diagnosis, a longer diabetes duration, more often Hispanic and less often African–American. Tracking and evaluating recruitment sources during study enrollment optimized recruitment methods to enroll a diverse participant population based upon gender, race and ethnicity. PMID:25574373

A randomized-controlled trial of low-dose doxycycline for periodontitis in smokers

PubMed Central

Needleman, Ian; Suvan, Jean; Gilthorpe, Mark S.; Tucker, Richard; St George, Geoff; Giannobile, William; Tonetti, Maurizio; Jarvis, Martin

2008-01-01

Background/Aim Tobacco use reduces the effect of non-surgical periodontal therapy. Host-modulation with low-dose doxycycline (LDD) might favour repair and promote an improved treatment response. The aim of this study was to investigate the effect of LDD in smokers on non-surgical periodontal therapy. Material and Methods This was a parallel arm, randomized, identical placebo-controlled trial with masking of examiner, care-giver, participant and statistician and 6 months of follow-up. Patients received non-surgical therapy and 3 months of test or control drug. Statistical analysis used both conventional methods and multilevel modelling. Results Eighteen control and 16 test patients completed the study. The velocity of change was statistically greater for the test group for clinical attachment level −0.19 mm/month (95% CI= −0.34, 0.04; p=0.012) and probing depth 0.30 mm/month (95% CI= −0.42, −0.17; p < 0.001). However, no differences were observed for absolute change in clinical or biochemical markers at 6 months. Conclusions This study does not provide evidence of a benefit of using LDD as an adjunct to non-surgical periodontal therapy in smokers. PMID:17324155

[The supportive outcome of periodontal non-surgical therapy to severe chronic periodontitis accompanied with malformed lingual groove in lateral incisor for 6 years: a case report].

PubMed

Li, Zheng; Kang, Jun

2011-06-01

To track the initiating and developing process of one case diagnosed as chronic periodontitis accompanied with malformed lingual groove in maxillary lateral incisor and report the long-term prognosis to the periodontal conservative and supportive therapy. The patient was diagnosed with mild chronic periodontitis 6 years ago and accepted routine periodontal scaling and root planning (SRP) plus supportive periodontal therapy (SPT) one time. Two years later the periodontal condition deteriorated by deep pockets in molars and severe bone destruction around the maxillary lateral incisor with malformed lingual groove. After SRP in sites which pocket depth more than 4mm plus root canal therapy and lingual groove plasty of maxillary right lateral incisor, the SPT regularly proceeded at 3rd, 6th and 12th month. At present the whole periodontal tissue was healthy, the bone lesion around maxillary lateral incisor recovered well, the tooth had no mobile, the cosmetic effect andtooth function was in good state, and the patient was very satisfied.

Surgical or non-surgical periodontal treatment: factors affecting patient decision making.

PubMed

Patel, Amit M; Richards, Philip S; Wang, Hom-Lay; Inglehart, Marita R

2006-04-01

This study explored which factors affected patients' decisions to pursue either surgical or non-surgical periodontal treatment. Data were collected from 74 patients at a regularly scheduled periodontal appointment, at which each patient was told that periodontal treatment was needed, and 2 weeks following the actual treatment. The surveys assessed the patients' decisions and potential determinants of these decisions. The dental anxiety scale-revised, the state-trait anxiety inventory, and the Iowa dental control index were used to measure psychosocial factors. Patients who decided to have surgery did not differ from patients who decided against surgery in sociodemographic variables such as gender, age, education, and socioeconomic status, nor in their desire for control over the treatment decision. However, they had less dental fear and less general anxiety than the non-surgery patients. Although the two patient groups did not differ in their responses concerning how well the dentists had informed them about the procedure, they differed in the degree of trust and rapport with their dentists. The less dentally fearful and anxious patients were in general and the more they trusted their provider and felt they had good rapport, the more likely they were to accept surgical periodontal treatment. These results stress the importance of good patient-provider communication.

Laser technology to manage periodontal disease: a valid concept?

PubMed

Low, Samuel B; Mott, Angie

2014-06-01

Present day dental lasers can create oral environments conducive for periodontal repair. With the bacterial etiology of periodontitis and the resulting host inflammatory reaction, clinicians continue to search for therapeutic modalities to assist in the non-surgical management of periodontal disease. Traditional chairside therapies consist of mechanical debridement with manual and/or ultrasonic instrumentation with the objective of removing calculus, biofilm, and endotoxin from tooth root surfaces. Decreasing the microbial stimuli and associated end products decreases the inflammatory reaction and allows the host an opportunity to regenerate tissue through wound healing. The purpose of this article is to examine whether dental lasers, which have been in use for the past 3 decades, may augment traditional non-surgical periodontal therapy. Review of research publications related to lasers and non-surgical periodontics with attention focused on systematic studies. Studies utilizing laser technology may demonstrate positive effects on 1) selectively decreasing the biofilm environment, 2) removing calculus deposits and neutralizing endotoxin, 3) removing sulcular epithelium to assist in reattachment and decreased pocket depth, and 4) biostimulation for enhanced wound healing. Comparisons of studies to determine the difference between lasers and their respective effects on the periodontium are difficult to assess due to a wide variation of laser protocols. Copyright © 2014 Elsevier Inc. All rights reserved.

Lack of adjunctive benefit of Er:YAG laser in non-surgical periodontal treatment: a randomized split-mouth clinical trial.

PubMed

Rotundo, Roberto; Nieri, Michele; Cairo, Francesco; Franceschi, Debora; Mervelt, Jana; Bonaccini, Daniele; Esposito, Marco; Pini-Prato, Giovanpaolo

2010-06-01

This split-mouth, randomized, clinical trial aimed to evaluate the efficacy of erbium-doped:yttrium-aluminium-garnet (Er:YAG) laser application in non-surgical periodontal treatment. A total of 27 patients underwent four modalities of non-surgical therapy: supragingival debridement; scaling and root planing (SRP)+Er:YAG laser; Er:YAG laser; and SRP. Each strategy was randomly assigned and performed in one of the four quadrants. Clinical outcomes were evaluated at 3 and 6 months. Subjective benefits of patients have been evaluated by means of questionnaires. Six months after therapy, Er:YAG laser showed no statistical difference in clinical attachment gain with respect to supragingival scaling [0.15 mm (95% CI -0.16; 0.46)], while SRP showed a greater attachment gain than the supragingival scaling [0.37 mm (95% CI 0.05; 0.68)]. No difference resulted between Er:YAG laser+SRP and SRP alone [0.05 mm (95% CI -0.25; 0.36)]. The adjunctive use of Er:YAG laser to conventional SRP did not reveal a more effective result than SRP alone. Furthermore, the sites treated with Er:YAG laser showed similar results of the sites treated with supragingival scaling.

Differential benefits of amoxicillin-metronidazole in different phases of periodontal therapy in a randomized controlled crossover clinical trial.

PubMed

Mombelli, Andrea; Almaghlouth, Adnan; Cionca, Norbert; Courvoisier, Delphine S; Giannopoulou, Catherine

2015-03-01

The specific advantage of administering systemic antibiotics during initial, non-surgical therapy or in the context of periodontal surgery is unclear. This study assesses the differential outcomes of periodontal therapy supplemented with amoxicillin-metronidazole during either the non-surgical or the surgical treatment phase. This is a single-center, randomized placebo-controlled crossover clinical trial with a 1-year follow-up. Eighty participants with Aggregatibacter actinomycetemcomitans-associated moderate to advanced periodontitis were randomized into two treatment groups: group A, antibiotics (500 mg metronidazole plus 375 mg amoxicillin three times per day for 7 days) during the first, non-surgical phase of periodontal therapy (T1) and placebo during the second, surgical phase (T2); and group B, placebo during T1 and antibiotics during T2. The number of sites with probing depth (PD) >4 mm and bleeding on probing (BOP) per patient was the primary outcome. A total of 11,212 sites were clinically monitored on 1,870 teeth. T1 with antibiotics decreased the number of sites with PD >4 mm and BOP per patient significantly more than without (group A: from 34.5 to 5.7, 84%; group B: from 28.7 to 8.7, 70%; P <0.01). Twenty patients treated with antibiotics, but only eight treated with placebo, achieved a 10-fold reduction of diseased sites (P = 0.007). Consequently, fewer patients of group A needed additional therapy, the mean number of surgical interventions was lower, and treatment time in T2 was shorter. Six months after T2, the mean number of residual pockets (group A: 2.8 ± 5.2; group B: 2.2 ± 5.0) was not significantly different and was sustained over 12 months in both groups. Giving the antibiotics during T1 or T2 yielded similar long-term outcomes, but antibiotics in T1 resolved the disease quicker and thus reduced the need for additional surgical intervention.

Local and systemic antimicrobial therapy in periodontics.

PubMed

Herrera, David; Matesanz, Paula; Bascones-Martínez, Antonio; Sanz, Mariano

2012-09-01

This review aimed to update the current evidence on the efficacy of the adjunctive use of local and systemic antimicrobials in the treatment of periodontitis and to assess whether it might improve the clinical limitations and shortcomings of standard nonsurgical treatment in the management of periodontitis. Relevant randomized clinical trials (RCT) with more than 3 months of follow-up, published from 2010 to 2012 for systemic antimicrobials and from 2008 to 2012 for local antimicrobials, were searched in Medline and critically analyzed. Scientific evidence evaluated in different systematic reviews and reviews presented at European and World Workshops were also included. Only adjunctive therapies were considered in the present review: articles comparing debridement alone or plus placebo, versus debridement plus systemic or local antimicrobials were included. Adjunctive systemic antimicrobials have been evaluated both in aggressive and chronic periodontitis: in aggressive periodontitis, amoxicillin and metronidazole have been extensively studied, reporting clinical and microbiological benefits; in chronic periodontitis, different products are under scrutiny, such as azithromycin. The clinical efficacy of local antimicrobials, although extensively demonstrated, is still surrounded by a constant debate on the cost-effectiveness evaluation and on its adequate indications. Despite the clinical efficacy of the adjunctive use of local and systemic antimicrobials, demonstrated in RCTs and in systematic reviews, there is a lack of evidence to support well-defined clinical protocols, including products and dosages. Copyright © 2012 Elsevier Inc. All rights reserved.

Effect of Nonsurgical Periodontal Treatment Combined With Diode Laser or Photodynamic Therapy on Chronic Periodontitis: A Randomized Controlled Split-Mouth Clinical Trial

PubMed Central

Birang, Reza; Shahaboui, Mohammad; Kiani, Sima; Shadmehr, Elham; Naghsh, Narges

2015-01-01

Introduction: The optimum removal of bacteria and their toxins from periodontal pockets is not always obtained by conventional mechanical debridement. Adjunctive therapies may improve tissue healing through detoxification and bactericidal effects. The purpose of the present study was to evaluate the impact of adjunctive laser therapy (LT) and photodynamic therapy (PDT) on patients with chronic periodontitis. Methods: Twenty patients with at least three quadrants involved and each of them presenting pockets 4-8 mm deep were included in the study. Periodontal treatment comprising scaling and root planning (SRP) was accomplished for the whole mouth. Applying a split-mouth design, each quadrant was randomly treated with SRP alone (group A), SRP with LT (group B), and SRP with PDT (group C). The clinical indices were measured at baseline 6 weeks and 3 months after treatment. Microbiological samples were taken and evaluated at baseline and 3-month follow-up. Results: All groups showed statistically significant improvements in terms of clinical attachment level (CAL) gain, periodontal pocket depth (PPD) reduction, papilla bleeding index and microbial count compared to baseline (P < .05). The results showed more significant improvement in the 6-week evaluation in terms of CAL in groups B and C than in group A (P < .05). Group B also revealed a greater reduction in PPD than the other treatment modalities (P < .05). Conclusion: The obtained data suggested that adjunctive LT and PDT have significant short-term benefits in the treatment of chronic periodontitis. Furthermore, LT showed minimal additional advantages compared to PDT. PMID:26464778

Microbiological and clinical effects of probiotics and antibiotics on nonsurgical treatment of chronic periodontitis: a randomized placebo- controlled trial with 9-month follow-up

PubMed Central

Morales, Alicia; Gandolfo, Alessandro; Bravo, Joel; Carvajal, Paola; Silva, Nora; Godoy, Claudia; Garcia-Sesnich, Jocelyn; Hoare, Anilei; Diaz, Patricia; Gamonal, Jorge

2018-01-01

ABSTRACT Objective The aim of this double-blind, placebo-controlled and parallel- arm randomized clinical trial was to evaluate the effects of Lactobacillus rhamnosus SP1-containing probiotic sachet and azithromycin tablets as an adjunct to nonsurgical therapy in clinical parameters and in presence and levels of Tannerella forsythia, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. Material and Methods Forty-seven systemically healthy volunteers with chronic periodontitis were recruited and monitored clinically and microbiologically at baseline for 3, 6 and 9 months after therapy. Subgingival plaque samples were collected from four periodontal sites with clinical attachment level ≥1 mm, probing pocket depth ≥4 mm and bleeding on probing, one site in each quadrant. Samples were cultivated and processed using the PCR technique. Patients received nonsurgical therapy including scaling and root planing (SRP) and were randomly assigned to a probiotic (n=16), antibiotic (n = 16) or placebo (n = 15) group. L. rhamnosus SP1 was taken once a day for 3 months. Azithromycin 500mg was taken once a day for 5 days. Results All groups showed improvements in clinical and microbiological parameters at all time points evaluated. Probiotic and antibiotic groups showed greater reductions in cultivable microbiota compared with baseline. The placebo group showed greater reduction in number of subjects with P. gingivalis compared with baseline. However, there were no significant differences between groups. Conclusions The adjunctive use of L. rhamnosus SP1 sachets and azithromycin during initial therapy resulted in similar clinical and microbiological improvements compared with the placebo group. PMID:29364340

Improvement of an anterior infrabone defect using combined periodontal and orthodontic therapy: A 6-year follow-up case report.

PubMed

de Molon, Rafael Scaf; Kim, Yeon Jung; Dos Santos-Pinto, Ary; Cirelli, Joni Augusto

2014-07-01

Extensive intraosseous lesions represent a clinical challenge for the periodontist. Sites with bone defects have been shown to be at higher risk of periodontitis progression in patients who had not received periodontal therapy. Thus, the aim of this case report was to describe a novel approach for the treatment of 1-walled intraosseous defect by combining nonsurgical periodontal therapy and orthodontic movement toward the bone defect, avoiding regenerative and surgical procedures. A 47-year-old woman underwent the proposed procedures for the treatment of her left central incisor with 9 mm probing depth and 1-walled intraosseous defect in its mesial aspect. Initially, basic periodontal therapy with scaling and root planning was accomplished. Two months later, an orthodontic treatment was planned to eliminate the intraosseous lesion and to improve the interproximal papillary area. Orthodontic root movement toward the osseous defect was performed for 13 months with light forces. After 6 years postoperative it was concluded that combined basic periodontal therapy and orthodontic movement was capable of eliminating the intraosseous defect and improve the esthetics in the interproximal papillary area between the central incisors.

Periodontal diseases of children and adolescents.

PubMed

Children and adolescents are subject to several periodontal diseases. Although there is a much lower prevalence of destructive periodontal diseases in children than in adults, children can develop severe forms of periodontitis. In some cases, this destructive disease is a manifestation of a known underlying systemic disease. In other young patients, the underlying cause for increased susceptibility and early onset of disease is unknown. These diseases are often familial, suggesting a genetic predisposition for aggressive disease. Current modalities for managing periodontal diseases of children and adolescents may include antibiotic therapy in combination with non-surgical and/or surgical therapy. Since early diagnosis ensures the greatest chance for successful treatment, it is important that children receive a periodontal examination as part of their routine dental visits.

Economics of periodontal care: market trends, competitive forces and incentives.

PubMed

Flemmig, Thomas F; Beikler, Thomas

2013-06-01

The adoption of new technologies for the treatment of periodontitis and the replacement of teeth has changed the delivery of periodontal care. The objective of this review was to conduct an economic analysis of a mature periodontal service market with a well-developed workforce, including general dentists, dental hygienists and periodontists. Publicly available information about the delivery of periodontal care in the USA was used. A strong trend toward increased utilization of nonsurgical therapy and decreased utilization of surgical periodontal therapy was observed. Although periodontal surgery remained the domain of periodontists, general dentists had taken over most of the nonsurgical periodontal care. The decline in surgical periodontal therapy was associated with an increased utilization of implant-supported prosthesis. Approximately equal numbers of implants were surgically placed by periodontists, oral and maxillofacial surgeons, and general dentists. Porter's framework of the forces driving industry competition was used to analyze the role of patients, dental insurances, general dentists, competitors, entrants, substitutes and suppliers in the periodontal service market. Estimates of out-of-pocket payments of self-pay and insured patients, reimbursement by dental insurances and providers' earnings for various periodontal procedures and alternative treatments were calculated. Economic incentives for providers may explain some of the observed shifts in the periodontal service market. Given the inherent uncertainty about treatment outcomes in dentistry, which makes clinical judgment critical, providers may yield to economic incentives without jeopardizing their ethical standards and professional norms. Although the economic analysis pertains to the USA, some considerations may also apply to other periodontal service markets. © 2013 John Wiley & Sons A/S.

Pattern of periodontal treatments performed at the periodontology clinic of the Lagos University Teaching Hospital: 22 months review.

PubMed

Umeizudike, K A; Ayanbadejo, P O; Savage, K O; Taiwo, O A

2012-01-01

A critical evaluation of the pattern of periodontal procedures performed is important in providing useful data to the administrator for proper planning and budgeting for dental health service. To assess the pattern of periodontal treatments performed over a given period of time at the Periodontology clinic of the Lagos University Teaching Hospital, Lagos, Nigeria. This was a twenty two months retrospective study of all periodontal procedures performed on patients seen at the periodontology clinic of the Lagos University Teaching Hospital between January 2006 and October 2007. The periodontology treatment record was used to retrieve information which included the patient's age, gender, diagnosis and periodontal procedures given. The procedures were further categorized into surgical and nonsurgical groups. The information obtained was then analyzed using Epi Info 2007 statistical software. A total of 1,938 patients were seen during this period. Females were 1009 (52.1%) and males were 929 (47.9%). (F/M, 1.1:1). A total of 2,110 periodontal treatments were performed. Majority of the patients received non-surgical periodontal therapy which constituted the bulk (96.3%) of the therapies. Scaling and polishing was the most frequently performed non-surgical procedure accounting for 1261 (62.1%) with slightly more males receiving the treatment. Of the surgical treatment modalities, operculectomy accounted for 65.4% and was carried out on more females than males. Regenerative procedures were the least performed surgical treatments. This study highlighted that non-surgical periodontal therapy, particularly scaling and polishing was the most frequently utilized periodontal procedure. Operculectomy was the predominant surgical procedure performed. The low percentage of regenerative surgical procedures was however below the desired expectation.

Periodontal therapy.

PubMed

Niemiec, Brook A

2008-05-01

Periodontal disease is the most common disease in small animal patients. It not only creates severe localized infection, but it has been linked to numerous severe systemic maladies. Proper therapy of this disease process results in a significant increase in the overall health of the patient. The treatment of periodontal disease is currently evolving due to the acceptance of the specific plaque hypothesis of periodontal disease. These findings have led to the development of the "one-stage full-mouth disinfection" treatment as well as a vaccine against these organisms. However, the cornerstone of therapy is still meticulous plaque control. This control is achieved via a combination of regular dental prophylaxis and home care. With progressive disease, advanced periodontal surgery or extraction becomes necessary.

Effect of Supragingival Irrigation with Aerosolized 0.5% Hydrogen Peroxide on Clinical Periodontal Parameters, Markers of Systemic Inflammation, and Morphology of Gingival Tissues in Patients with Periodontitis

PubMed Central

Žekonis, Gediminas; Žekonis, Jonas; Gleiznys, Alvydas; Noreikienė, Viktorija; Balnytė, Ingrida; Šadzevičienė, Renata; Narbutaitė, Julija

2016-01-01

Background Various studies have shown that non-surgical periodontal treatment is correlated with reduction in clinical parameters and plasma levels of inflammatory markers. The aim of this study was to evaluate the effect of long-term weekly supragingival irrigations with aerosolized 0.5% hydrogen peroxide as maintenance therapy followed by non-surgical periodontal treatment on clinical parameters, plasma levels of inflammatory markers, and morphological changes in gingival tissues of patients with periodontitis. Material/Methods In total, 43 patients with chronic periodontitis were randomly allocated to long-term maintenance therapy. The patients’ periodontal status was assessed using clinical parameters of approximal plaque index, modified gingival index, bleeding index, pocket probing depth, and plasma levels of inflammatory markers (high-sensitivity C-reactive protein and white blood cell count) at baseline and after 1, 2, and 3 years. The morphological status of gingival tissues (immediately after supragingival irrigation) was assessed microscopically. Results Complete data were obtained on 34 patients. A highly statistically significant and consistent reduction was observed in all long-term clinical parameters and plasma levels of inflammatory markers. Morphological data showed abundant spherical bubbles in gingival tissues. Conclusions 1. The present study showed that non-surgical periodontal treatment with long-term weekly supragingival irrigations with aerosolized 0.5% hydrogen peroxide improved clinical periodontal status and plasma levels of inflammatory markers and may be a promising method in periodontology. 2. We found that supragingival irrigation with aerosolized 0.5% hydrogen peroxide created large numbers of spherical bubbles in gingival tissues. PMID:27743448

Scaling and Root Planning is Recommended in the Nonsurgical Treatment of Chronic Periodontitis.

PubMed

Herrera, David

2016-03-01

Systematic review and meta-analysis on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. Smiley CJ, Tracy SL, Abt E, Michalowicz BS, John MT, Gunsolley J, Cobb CM, Rossmann J, Harrel SK, Forrest JL, Hujoel PP, Noraian KW, Greenwell H, Frantsve-Hawley J, Estrich C, Hanson N. J Am Dent Assoc 2015;146(7):508-524.e5. The study was funded by the American Dental Association Systematic review with meta-analysis. Copyright © 2016 Elsevier Inc. All rights reserved.

Successful Nonsurgical Management of Periapical Lesions of Endodontic Origin: A Conservative Orthograde Approach

PubMed Central

Karunakaran, J. V.; Abraham, Chris Susan; Karthik, A. Kaneesh; Jayaprakash, N.

2017-01-01

Periapical lesions of endodontic origin are common pathological conditions affecting periradicular tissues. Microbial infection of pulpal tissues is primarily responsible for initiation and progression of apical periodontitis. The primary objective of endodontic therapy should be to restore involved teeth to a state of normalcy nonsurgically. Different nonsurgical management techniques, namely, conservative root canal therapy, decompression technique, method using calcium hydroxide, aspiration-irrigation technique, lesion sterilization and tissue repair therapy, active nonsurgical decompression technique, and the apexum procedure have been advocated. New techniques which use drug-loaded injectable scaffolds, simvastatin, and epigallocatechin-3-gallate have been tried. Surgical option should be considered when intra- or extra-radicular infections are persistent. Incidence of nonendodontic periapical lesions has also been reported. An accurate diagnosis of the periapical lesion whether it is of endodontic or nonendodontic origin has to be made. Surgical methods have many disadvantages, and hence should be considered as an option only in the case of failure of nonsurgical techniques. Assessment of healing of periapical lesions has to be done periodically which necessitates a long-term follow-up. Even large periapical lesions and retreatment cases where the lesion is of endodontic origin have been successfully managed nonsurgically with orthograde endodontic therapy. PMID:29284973

Position paper: periodontal diseases of children and adolescents.

PubMed

Califano, Joseph V

2003-11-01

Children and adolescents are subject to several periodontal diseases. Although there is a much lower prevalence of destructive periodontal diseases in children than in adults, children can develop severe forms of periodontitis. In some cases, this destructive disease is a manifestation of a known underlying systemic disease. In other young patients, the underlying cause for increased susceptibility and early onset of disease is unknown. These diseases are often familial, suggesting a genetic predisposition for aggressive disease. Current modalities for managing periodontal diseases of children and adolescents may include antibiotic therapy in combination with non-surgical and/or surgical therapy. Since early diagnosis ensures the greatest chance for successful treatment, it is important that children receive a periodontal examination as part of their routine dental visits.

A Biofilm Pocket Model to Evaluate Different Non-Surgical Periodontal Treatment Modalities in Terms of Biofilm Removal and Reformation, Surface Alterations and Attachment of Periodontal Ligament Fibroblasts

PubMed Central

Hägi, Tobias T.; Klemensberger, Sabrina; Bereiter, Riccarda; Nietzsche, Sandor; Cosgarea, Raluca; Flury, Simon; Lussi, Adrian; Sculean, Anton; Eick, Sigrun

2015-01-01

Background and Aim There is a lack of suitable in vitro models to evaluate various treatment modalities intending to remove subgingival bacterial biofilm. Consequently, the aims of this in vitro-study were: a) to establish a pocket model enabling mechanical removal of biofilm and b) to evaluate repeated non-surgical periodontal treatment with respect to biofilm removal and reformation, surface alterations, tooth hard-substance-loss, and attachment of periodontal ligament (PDL) fibroblasts. Material and Methods Standardized human dentin specimens were colonized by multi-species biofilms for 3.5 days and subsequently placed into artificially created pockets. Non-surgical periodontal treatment was performed as follows: a) hand-instrumentation with curettes (CUR), b) ultrasonication (US), c) subgingival air-polishing using erythritol (EAP) and d) subgingival air-polishing using erythritol combined with chlorhexidine digluconate (EAP-CHX). The reduction and recolonization of bacterial counts, surface roughness (Ra and Rz), the caused tooth substance-loss (thickness) as well as the attachment of PDL fibroblasts were evaluated and statistically analyzed by means of ANOVA with Post-Hoc LSD. Results After 5 treatments, bacterial reduction in biofilms was highest when applying EAP-CHX (4 log10). The lowest reduction was found after CUR (2 log10). Additionally, substance-loss was the highest when using CUR (128±40 µm) in comparison with US (14±12 µm), EAP (6±7 µm) and EAP-CHX (11±10) µm). Surface was roughened when using CUR and US. Surfaces exposed to US and to EAP attracted the highest numbers of PDL fibroblasts. Conclusion The established biofilm model simulating a periodontal pocket combined with interchangeable placements of test specimens with multi-species biofilms enables the evaluation of different non-surgical treatment modalities on biofilm removal and surface alterations. Compared to hand instrumentation the application of ultrasonication and of air

A Biofilm Pocket Model to Evaluate Different Non-Surgical Periodontal Treatment Modalities in Terms of Biofilm Removal and Reformation, Surface Alterations and Attachment of Periodontal Ligament Fibroblasts.

PubMed

Hägi, Tobias T; Klemensberger, Sabrina; Bereiter, Riccarda; Nietzsche, Sandor; Cosgarea, Raluca; Flury, Simon; Lussi, Adrian; Sculean, Anton; Eick, Sigrun

2015-01-01

There is a lack of suitable in vitro models to evaluate various treatment modalities intending to remove subgingival bacterial biofilm. Consequently, the aims of this in vitro-study were: a) to establish a pocket model enabling mechanical removal of biofilm and b) to evaluate repeated non-surgical periodontal treatment with respect to biofilm removal and reformation, surface alterations, tooth hard-substance-loss, and attachment of periodontal ligament (PDL) fibroblasts. Standardized human dentin specimens were colonized by multi-species biofilms for 3.5 days and subsequently placed into artificially created pockets. Non-surgical periodontal treatment was performed as follows: a) hand-instrumentation with curettes (CUR), b) ultrasonication (US), c) subgingival air-polishing using erythritol (EAP) and d) subgingival air-polishing using erythritol combined with chlorhexidine digluconate (EAP-CHX). The reduction and recolonization of bacterial counts, surface roughness (Ra and Rz), the caused tooth substance-loss (thickness) as well as the attachment of PDL fibroblasts were evaluated and statistically analyzed by means of ANOVA with Post-Hoc LSD. After 5 treatments, bacterial reduction in biofilms was highest when applying EAP-CHX (4 log10). The lowest reduction was found after CUR (2 log10). Additionally, substance-loss was the highest when using CUR (128±40 µm) in comparison with US (14±12 µm), EAP (6±7 µm) and EAP-CHX (11±10) µm). Surface was roughened when using CUR and US. Surfaces exposed to US and to EAP attracted the highest numbers of PDL fibroblasts. The established biofilm model simulating a periodontal pocket combined with interchangeable placements of test specimens with multi-species biofilms enables the evaluation of different non-surgical treatment modalities on biofilm removal and surface alterations. Compared to hand instrumentation the application of ultrasonication and of air-polishing with erythritol prevents from substance-loss and

Risk factors of chronic periodontitis on healing response: a multilevel modelling analysis.

PubMed

Song, J; Zhao, H; Pan, C; Li, C; Liu, J; Pan, Y

2017-09-15

Chronic periodontitis is a multifactorial polygenetic disease with an increasing number of associated factors that have been identified over recent decades. Longitudinal epidemiologic studies have demonstrated that the risk factors were related to the progression of the disease. A traditional multivariate regression model was used to find risk factors associated with chronic periodontitis. However, the approach requirement of standard statistical procedures demands individual independence. Multilevel modelling (MLM) data analysis has widely been used in recent years, regarding thorough hierarchical structuring of the data, decomposing the error terms into different levels, and providing a new analytic method and framework for solving this problem. The purpose of our study is to investigate the relationship of clinical periodontal index and the risk factors in chronic periodontitis through MLM analysis and to identify high-risk individuals in the clinical setting. Fifty-four patients with moderate to severe periodontitis were included. They were treated by means of non-surgical periodontal therapy, and then made follow-up visits regularly at 3, 6, and 12 months after therapy. Each patient answered a questionnaire survey and underwent measurement of clinical periodontal parameters. Compared with baseline, probing depth (PD) and clinical attachment loss (CAL) improved significantly after non-surgical periodontal therapy with regular follow-up visits at 3, 6, and 12 months after therapy. The null model and variance component models with no independent variables included were initially obtained to investigate the variance of the PD and CAL reductions across all three levels, and they showed a statistically significant difference (P < 0.001), thus establishing that MLM data analysis was necessary. Site-level had effects on PD and CAL reduction; those variables could explain 77-78% of PD reduction and 70-80% of CAL reduction at 3, 6, and 12 months. Other levels only

The effect of periodontal therapy on cardiovascular risk markers: a 6-month randomized clinical trial.

PubMed

Caúla, André Luis; Lira-Junior, Ronaldo; Tinoco, Eduardo Muniz Barretto; Fischer, Ricardo Guimarães

2014-09-01

To determine the influence of non-surgical mechanical periodontal treatment on inflammatory markers related to risk for cardiovascular disease. A total of 64 patients with severe chronic periodontitis was randomly subjected to immediately periodontal treatment (test group, n = 32) or delayed periodontal treatment, without treatment during the study period (control group, n = 32). Clinical periodontal and laboratory examinations were performed at baseline (T0), 2 months (T2), and 6 months (T6) after the initial examinations (Control group) or completion of periodontal treatment (Test group). After 2 months of periodontal treatment there was a significant reduction of erythrocyte sedimentation rate (ESR) and triglycerides (p = 0.002, p = 0.004, respectively) in the test group. Median values of C-reactive protein, ESR, total cholesterol, and triglycerides were reduced after 6 month of periodontal treatment in the test group (p < 0.001, p < 0.001, p < 0.001, and p = 0.015, respectively). The non-surgical periodontal treatment was effective in reducing the levels of systemic inflammation markers and improved the lipid profile in subjects with severe chronic periodontitis. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Generalized aggressive periodontitis: microbiological composition and clinical parameters in non-surgical therapy.

PubMed

Usin, María M; Tabares, Sandra M; Menso, Julieta; de Albera, Estela R; Sembaj, Adela

2016-12-01

The aim of this study was to determine the variations in periodontal parameters and microbiological composition in periodontal pockets at the baseline and 3 and 6 months post treatmentin patients with Generalized Aggressive Periodontitis(GAP) undergoing non surgical periodontal treatment combined with chlorhexidine and systemic antibiotics. Medical and dental history was taken from 10 subjects, average age 30.6±2.7 years, diagnosed with GAP. A non surgical periodontal treatment combined with 0.12% chlorhexidine, 875 mg amoxicillin and 500 mg metronidazole every 12 hours for ten days was conducted. At each visit, the following measurements wererecorded: bacterial plaque (BP), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), hypermobility, and furcation lesions, and a sample of subgingivalplaque was taken from the site of the deepest probing depth of each sextant to identify Porphyromonas gingivalis, Treponemadenticola, Tannerella forsythia, Prevotella intermedia and Aggregatibacter actinomycetemcomitans using molecular biology techniques. After 6 months, the Wilcoxon test showed an increase of 0.97 mm in CAL (p=0.0047) and 2.54 mm in PD(p=0.009). A healthy site was defined as having a PD <5 mm, negative BOP and no pathogenic bacteria detected at 6 months, indicating significant improvement (p=0.008), with OR (95%CI) =4.7 (1.102220.11).With the treatment protocol used in this study, 6 months after treatment, patients had an approximately 4- fold higher possibility of presenting PD <5 mm and periodontal pockets without periodontal pathogenic bacteria. Sociedad Argentina de Investigación Odontológica.

Periodontal therapy for severe chronic periodontitis with periodontal regeneration and different types of prosthesis.

PubMed

Kinumatsu, Takashi; Umehara, Kazuhiro; Nagano, Kyosuke; Saito, Atsushi

2014-01-01

We report a patient with severe chronic periodontitis requiring regenerative periodontal surgery and different types of prosthesis in the maxillary and mandibular regions. The patient was a 57-year-old woman who presented with the chief complaint of occlusal pain. An initial clinical examination revealed that 73% of sites had a probing depth of ≥4 mm, and 60% of sites exhibiting bleeding on probing. Radiographic examination revealed vertical bone defects in the molar region and widening of the periodontal ligament space around teeth #17 and 24. Initial periodontal therapy was implemented based on a clinical diagnosis of severe chronic periodontitis. Surgical periodontal therapy was subsequently performed at selected sites. Periodontal regenerative therapy using enamel matrix derivative was performed on #14, 15, and 35-37. Tunnel preparation was performed on #46 as it had a 2-wall vertical bony defect and Degree 3 furcation involvement. Other sites with residual periodontal pockets were treated by modified Widman flap surgery. After a re-evaluation, functional rehabilitation was implemented with a removable maxillary partial denture and a fixed mandibular bridge. No further deterioration was observed in the periodontal condition of most of the teeth during a 2-year period of supportive periodontal therapy (SPT). The patient is currently still undergoing SPT and some minor problems remain. However, the results suggest that treatment and subsequent maintenance for severe periodontitis with traumatic occlusion can be successful as long as the appropriate periodontal and prosthodontic treatment is planned and careful SPT carried out.

Low-cost periodontal therapy.

PubMed

Slots, Jørgen

2012-10-01

Periodontitis is a complex infectious disease that affects low-income individuals disproportionately. Periodontitis is associated with specific bacterial species and herpesviruses, and successful prevention and treatment of the disease is contingent upon effective control of these pathogens. This article presents an efficacious, highly safe, minimally invasive, practical and low-cost periodontal therapy that involves professional and patient-administered mechanical therapy and antimicrobial agents. The major components are scaling for calculus removal, periodontal pocket irrigation with potent antiseptics, and treatment with systemic antibiotics for advanced disease. Povidone-iodine and sodium hypochlorite have all the characteristics for becoming the first-choice antiseptics in the management of periodontal diseases. Both agents show excellent antibacterial and antiviral properties, are readily available throughout the world, have been safely used in periodontal therapy for decades, offer significant benefits for individuals with very limited financial resources, and are well accepted by most dental professionals and patients. Four per cent chlorhexidine applied with a toothbrush to the most posterior part to the tongue dorsum can markedly reduce or eliminate halitosis in most individuals. Systemic antibiotics are used to treat periodontopathic bacteria that are not readily reached by topical therapy, such as pathogens within gingival tissue, within furcation defects, at the base of periodontal pockets, and on the tongue, tonsils and buccal mucosae. Valuable antibiotic therapies are amoxicillin-metronidazole (250 mg of amoxicillin and 250 mg of metronidazole, three times daily for 8 days) for young and middle-aged patients, and ciprofloxacin-metronidazole (500 mg of each, twice daily for 8 days) for elderly patients and for patients in developing countries who frequently harbor enteric rods subgingivally. Scaling to remove dental calculus and the prudent

Use of minocycline as systemic antimicrobial therapy in refractory periodontitis with chronic gingival enlargement.

PubMed

Khatri, Parag M; Kumar, Rajesh

2012-01-01

Periodontal disease is a multifactorial disease having various risk factors, but a dynamic interaction between bacterial products and host response in association with genetic and environmental factors is considered as the primary cause for periodontal tissue destruction in periodontitis. This bacterial-host interaction which is ever-so-present in periodontitis directs us toward utilizing antimicrobial agents along with the routine mechanical debridement. This case report present a case of a female patient with recurrent periodontal infections with gingival enlargement treated with systemic Minocycline in conjunction with the conventional non-surgical approach.

Design Features of the Diabetes and Periodontal Therapy Trial (DPTT): A Multicenter Randomized Single-Masked Clinical Trial Testing the Effect of Non-surgical Periodontal Therapy on Glycosylated Hemoglobin (HbA1c) Levels in Subjects with Type 2 Diabetes and Chronic Periodontitis

PubMed Central

2013-01-01

Background Evidence suggests that periodontitis is associated with prevalent and incident type 2 diabetes mellitus (T2DM), raising the question of whether periodontitis treatment may improve glycemic control in patients with T2DM. Meta-analyses of mostly small clinical trials suggest that periodontitis treatment results in a modest reduction in glycosylated hemoglobin (Hb) A1c. Purpose The purpose of the Diabetes and Periodontal Therapy Trial (DPTT) was to determine if periodontal treatment reduces HbA1c in patients with T2DM and periodontitis. Methods DPTT was a phase-III, single-masked, multi-center, randomized trial with a planned enrollment of 600 participants. Participants were randomly assigned to receive periodontal treatment immediately (Treatment Group) or after 6 months (Control Group). HbA1c values and clinical periodontal measures were determined at baseline and 3 and 6 months following randomization. Medication usage and dosing were assessed at each visit. Periodontal treatment consisted of scaling and root planing for a minimum of two 90-minute sessions, plus the use of an antibacterial mouth rinse for at least 32 days afterwards. The primary outcome was change in HbA1c from baseline to 6 months and the trial was powered to detect a between-group difference of 0.6%. Secondary outcomes included changes in periodontal clinical measures, fasting plasma glucose, the Homeostasis Model Assessment (HOMA2) and the need for rescue diabetes or periodontal therapy. Conclusion Dental and medical researchers collaborated to recruit, treat and monitor participants with two chronic diseases to determine if treatment of one condition affects the status of the other. PMID:24080100

The Effect of Photodynamic Therapy in the Treatment of Chronic Periodontitis: A Review of Literature.

PubMed

Meimandi, Mansour; Talebi Ardakani, Mohammad Reza; Esmaeil Nejad, Azadeh; Yousefnejad, Parisa; Saebi, Khosro; Tayeed, Mohammad Hossein

2017-01-01

Introduction: Chronic periodontitis is the most common periodontal disease which is related to the chronic accumulation of bacterial plaque. Since mechanical methods are not sufficient in the treatment of this disease, administration of local/systemic antibiotic is recommended following mechanical debridement. However, side effects of antibiotics such as microbial resistance and patient allergy led to development of alternative methods. One of these suggested methods is the antimicrobial photodynamic therapy (aPDT). PDT is a local noninvasive treatment modality without the side effects caused by antibiotics. The aim of this study was to review the articles related to the application of PDT with laser in the treatment of chronic periodontitis. Review of literature: In the present review of literature, the authors used key words such as chronic periodontitis, laser and photodynamic therapy, and conducted a literature search via Google Scholar and PubMed for the period of 1990 to 2015. A total of 47 articles in English were found. The articles that were not associated with the topic of research and review articles were deleted and only clinical trials were evaluated. After reviewing 23 articles' abstracts, the full texts of 16 articles were analyzed. Conclusion: Considering the safety, the lack of side effects and general advantages like more patient compliance, the PDT treatment with scaling and root planing (SRP) is recommended as an efficient adjunctive modality for the treatment of localized chronic periodontitis especially during the maintenance phase in non-surgical treatment.

Effect of Non-Surgical Periodontal Treatment on Clinical and Biochemical Risk Markers of Cardiovascular Disease: A Randomized Trial.

PubMed

Hada, Divya Singh; Garg, Subhash; Ramteke, Girish B; Ratre, Madhu Singh

2015-11-01

Various studies have shown periodontal disease is one of the risk factors for coronary heart disease (CHD), and periodontal treatment of patients with CHD has also been correlated with reduction in systemic markers of CHD. The aim of this study is to evaluate the effect of non-surgical periodontal treatment (NSPT) on the cardiovascular clinical and biochemical status of patients with CHD. Seventy known patients with CHD were allocated randomly to either a control group (C; no periodontal therapy) (n = 35) or an experimental group (E; NSPT in the form of scaling and root planing [SRP]) (n = 35). Cardiovascular status was assessed using clinical parameters such as pulse, respiratory rate, blood pressure (BP), and biochemical parameters, such as high-sensitivity C-reactive protein (hsCRP), lipid profile, and white blood cell (WBC) count, at baseline and 1, 3, and 6 months. Intergroup and intragroup comparisons were performed using Student t test, and P <0.05 was considered statistically significant. The complete data at the end of the study were provided by only 55 patients (group C, n = 25; group E, n = 30). Highly statistically significant reduction was observed in systolic BP (7.1 mm Hg) and very-low-density lipoproteins (VLDLs; 5.16 mg/dL) in group E. Changes were also observed in other cardiovascular biochemical and clinical parameters but were not statistically significant. NSPT (in the form of SRP) positively affects limited cardiovascular (clinical and biochemical) status of patients with CHD. Reduction in triglyceride, VLDL, total WBC, lymphocyte, and neutrophil counts and increase in hsCRP, total cholesterol, high-density lipoprotein, and low-density lipoprotein levels were observed. Highly significant reduction in VLDL cholesterol levels and systolic BP was observed among the various parameters measured.

Effect of nonsurgical periodontal therapy verses oral hygiene instructions on type 2 diabetes subjects with chronic periodontitis: a randomised clinical trial.

PubMed

Raman, Renukanth Patabi Cheta; Taiyeb-Ali, Tara Bai; Chan, Siew Pheng; Chinna, Karuthan; Vaithilingam, Rathna Devi

2014-06-25

40 subjects with type 2 diabetes and moderate to severe CP were randomly distributed to groups receiving either NSPT or OHI. Periodontal parameters, glycosylated haemoglobin (HbA1c) and high-sensitivity C-reactive protein (hs-CRP) were evaluated at baseline, 2- and 3-months intervals. 40 subjects with type 2 diabetes and moderate to severe CP were randomly distributed to groups receiving either NSPT or OHI. Periodontal parameters, glycosylated haemoglobin (HbA1c) and high-sensitivity C-reactive protein (hs-CRP) were evaluated at baseline, 2- and 3-months intervals. 15 subjects from NSPT group and 17 from OHI group completed the study. The difference in plaque index (PI) between NSPT and OHI groups were significant at 2 months recall (p = 0.013). There was no significant difference between NSPT and OHI group for all other clinical periodontal parameters, HbA1c and CRP levels. At 3 months post-therapy, periodontal parameters improved significantly in both groups with sites with probing pocket depth (PPD) < 4 mm reported as 98 ± 1.8% in NSPT group and 92 ± 14.9% in OHI group. Mean PPD and mean probing attachment loss (PAL) within the NSPT group reduced significantly from baseline (2.56 ± 0.57 mm, 3.35 ± 0.83 mm) to final visit (1.94 ± 0.26 mm, 2.92 ± 0.72 mm) (p = 0.003, p < 0.001). For OHI group, improvements in mean PPD and mean PAL were also seen from baseline (2.29 ± 0.69 mm, 2.79 ± 0.96 mm) to final visit (2.09 ± 0.72 mm, 2.62 ± 0.97 mm) (p < 0.001 for both). Similarly, HbA1c levels decreased in both groups with NSPT group recording statistically significant reduction (p = 0.038). Participants who demonstrated ≥ 50% reduction in PPD showed significant reductions of HbA1c and hs-CRP levels (p = 0.004 and p = 0.012). NSPT significantly reduced PI at 2 months post-therapy as compared to OHI. Both NSPT and OHI demonstrated improvements in other clinical parameters as well as HbA1c and CRP levels. ClinicalTrials.gov: NCT01951547.

Combined endodontic-periodontic treatment of a palatal groove: a case report.

PubMed

Schwartz, Scott A; Koch, Michael A; Deas, David E; Powell, Charles A

2006-06-01

The palatal groove is a developmental anomaly that predisposes the tooth involved to a severe periodontal defect. When further complicated by pulp necrosis, these grooves often present a diagnostic and treatment planning challenge that requires an interdisciplinary treatment approach. This case report describes the successful collaborative management of a maxillary lateral incisor with an extensive palatal groove using a combination of nonsurgical endodontic therapy, odontoplasty, and periodontal regenerative techniques.

Gene therapy and its implications in Periodontics

PubMed Central

Mahale, Swapna; Dani, Nitin; Ansari, Shumaila S.; Kale, Triveni

2009-01-01

Gene therapy is a field of Biomedicine. With the advent of gene therapy in dentistry, significant progress has been made in the control of periodontal diseases and reconstruction of dento-alveolar apparatus. Implementation in periodontics include: -As a mode of tissue engineering with three approaches: cell, protein-based and gene delivery approach. -Genetic approach to Biofilm Antibiotic Resistance. Future strategies of gene therapy in preventing periodontal diseases: -Enhances host defense mechanism against infection by transfecting host cells with an antimicrobial peptide protein-encoding gene. -Periodontal vaccination. Gene therapy is one of the recent entrants and its applications in the field of periodontics are reviewed in general here. PMID:20376232

[Chronic periodontitis with Takayasu arteritis: a case report].

PubMed

Gao, Wei; Luan, Qing-xian

2015-10-18

This case report concerns a 23-year-old woman with chronic periodontitis who had been previously diagnosed with Takayasu arteritis (TA). Her erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level were decreased before and 3 months after non-surgical periodontal therapy with no change in her prescribed medications (ESR from 31.00 mm/h to 23.0 mm/h, CRP from 21.40 mg/L to 18.46 mm/h). Through the occasional findings, we raised a hypothetical analysis about the potential relationship between periodontitis and TA with respect to inflammatory factors, bacteria and medication. Further studies of large samples are needed to verify the findings.

Infrared lasers for the treatment of moderate to severe periodontitis: An american academy of periodontology best evidence review.

PubMed

Chambrone, Leandro; Ramos, Umberto D; Reynolds, Mark A

2018-04-22

This systematic review assesses the efficacy of infrared laser therapy used alone or as an adjunct to nonsurgical or surgical periodontal therapy, on clinical and patient-centered outcomes in patients with periodontitis. Randomized clinical trials (RCTs) with a follow-up duration ≥ 3 months that evaluated root surface debridement (i.e., scaling and root debridement with or without surgical access) to laser therapy alone or laser therapy plus root surface debridement for the treatment of adult patients (≥18 years old) with moderate to severe aggressive or chronic periodontitis were considered eligible for inclusion. The MEDLINE, EMBASE and CENTRAL databases were searched for articles published up to and including March 2016. Random effects meta-analyses were used throughout the review using continuous data (i.e., mean changes from baseline), and pooled estimates were expressed as weighted mean differences (MDs) with their associated 95% confidence intervals (CIs). Additionally, summaries are presented of the included RCTs, critical remarks of the literature and evidence quality rating/strength of recommendation of laser procedures. Of the 475 potentially eligible articles, 28 were included in the review. Individual study outcomes and seven sets of meta-analysis (1 for the nonsurgical treatment of AgP and 9 for nonsurgical and surgical treatment of CP) showed a benefit of laser therapy in improving clinical attachment level (CAL) and probing depth (PD). However, the comparative differences in clinical outcomes were modest (< 1 mm) and the level of certainty for different therapies was considered low-to-moderate (i.e., more information would be necessary to allow for a reliable and definitive estimation of effect/magnitude of therapies on health outcomes). Overall, most of the Strength of Clinical Recommendations of laser therapies were considered weak or based on expert opinion. In patients with moderate to severe periodontitis, the nonsurgical treatment of Ag

EMG monitoring during functional non-surgical therapy of Achilles tendon rupture.

PubMed

Hüfner, Tobias; Wohifarth, Kai; Fink, Matthias; Thermann, H; Rollnik, Jens D

2002-07-01

After surgical therapy of Achilles tendon rupture, neuromuscular changes may persist, even one year after surgery. We were interested whether these changes are also evident following a non-surgical functional therapy (Variostabil therapy boot/Adidas). Twenty-one patients with complete Achilles tendon rupture were enrolled in the study (mean age 38.5 years, range 24 to 60; 18 men, three women) and followed-up clinically and with surface EMG of the gastrocnemius muscles after four, eight, 12 weeks, and one year after rupture. EMG differences between the affected and non-affected side could only be observed at baseline and after four weeks following Achilles tendon rupture. The results from our study show that EMG changes are not found following non-surgical functional therapy.

Perception regarding factors related to periodontal therapy among general dental practitioners of Belgaum city - a questionnaire survey.

PubMed

Halemani, Shweta; Sanikop, Sheetal; Patil, Suvarna; Jalli, Vishwanath

2014-01-01

To assess the perception regarding periodontists and periodontal therapy among general dental practitioners (GDPs) of Belgaum city. A questionnaire study was conducted among 120 GDPs of Belgaum city comprising 13 closed-ended questions. The questions addressed the following variables: demographics of the dentist, service as GDP, periodontal services provided by the GDP and periodontal services referred to the periodontists. One hundred GDPs responded to the survey. 83% had specialists visit their practice and 78% felt the need for having a consultant periodontist attached to their practice. The procedures performed by the general dental practitioners were as follows: scaling (100%), scaling and root planing (78%), splinting (61%), gingivectomy (47%), ap surgery (24%), frenectomy (33%), crown lengthening (23%), root coverage procedures (12%), bone grafts (8%) and implants (8%). The procedures for which GDPs preferred the service of periodontists include bone grafts (87%), ap surgery (80%), root coverage procedures (77%), crown lengthening (63%) and others. 90% agreed that expertise is required for performing surgical periodontal procedures. 86% agreed that periodontists are competent to treat periodontal diseases. 38% to 55% noticed failures in periodontal procedures even after making use of a periodontist's service. 72% did not provide implant care in their clinic. 84% felt the role of periodontists was limited to post placement maintenance. A variety of periodontal services were offered by GDPs. The most common services were non-surgical in nature.

Effect of periodontal therapy on arterial structure and function among aboriginal australians: a randomized, controlled trial.

PubMed

Kapellas, Kostas; Maple-Brown, Louise J; Jamieson, Lisa M; Do, Loc G; O'Dea, Kerin; Brown, Alex; Cai, Tommy Y; Anstey, Nicholas M; Sullivan, David R; Wang, Hao; Celermajer, David S; Slade, Gary D; Skilton, Michael R

2014-10-01

Observational studies and nonrandomized trials support an association between periodontal disease and atherosclerotic vascular disease. Both diseases occur frequently in Aboriginal Australians. We hypothesized that nonsurgical periodontal therapy would improve measures of arterial function and structure that are subclinical indicators of atherosclerotic vascular disease. This parallel-group, randomized, open label clinical trial enrolled 273 Aboriginal Australians aged ≥18 years with periodontitis. Intervention participants received full-mouth periodontal scaling during a single visit, whereas controls received no treatment. Prespecified primary end points measured 12-month change in carotid intima-media thickness, an indicator of arterial structure, and 3- and 12-month change in pulse wave velocity, an indicator of arterial function. ANCOVA used complete case data to evaluate treatment group differences. End points could be calculated for 169 participants with follow-up data at 3 months and 168 participants at 12 months. Intima-media thickness decreased significantly after 12 months in the intervention group (mean reduction=-0.023 [95% confidence interval {CI}, -0.038 to -0.008] mm) but not in the control group (mean increase=0.002 [95% CI, -0.017 to 0.022] mm). The difference in intima-media thickness change between treatment groups was statistically significant (-0.026 [95% CI, -0.048 to -0.003] mm; P=0.03). In contrast, there were no significant differences between treatment groups in pulse wave velocity at 3 months (mean difference, 0.06 [95% CI, -0.17 to 0.29] m/s; P=0.594) or 12 months (mean difference, 0.21 [95% CI, -0.01 to 0.43] m/s; P=0.062). Periodontal therapy reduced subclinical arterial thickness but not function in Aboriginal Australians with periodontal disease, suggesting periodontal disease and atherosclerosis are significantly associated. © 2014 American Heart Association, Inc.

Adjunct Antimicrobial Therapy and Periodontal Surgery to Treat Generalized Aggressive Periodontitis: A Case Report.

PubMed

Irokawa, Daisuke; Makino-Oi, Asako; Fujita, Takahisa; Yamamoto, Shigeki; Tomita, Sachiyo; Saito, Atsushi

2016-01-01

Here we report a case of generalized aggressive periodontitis treated with periodontal therapy including adjunct antimicrobial therapy and periodontal surgery. The patient was a 22-year-old woman who presented with the chief complaint of gingival recession. Baseline examination revealed generalized plaque deposition and gingival inflammation. Thirty-nine percent of the sites had a probing depth (PD) of 4-6 mm and 2% a PD of ≥7 mm; 63% exhibited bleeding on probing (BOP). Radiographic examination revealed vertical bone loss in the molars and horizontal bone loss in other teeth. Microbiological examination of subgingival plaque revealed the presence of Aggregatibacter actinomycetemcomitans and Tannerella forsythia. Oral health-related quality of life was assessed as a measure of patient-reported outcome. Based on a clinical diagnosis of generalized aggressive periodontitis, initial periodontal therapy and adjunct antimicrobial therapy were implemented. After reducing inflammation and subgingival bacteria, open flap debridement was performed for teeth with a PD of ≥4 mm. Reevaluation showed no sites with a PD of ≥5 mm, a minimal level of BOP, and a marked reduction in the level of the targeted periodontal pathogens. The patient's oral health-related quality of life was slightly worsened during supportive periodontal therapy (SPT). Implementation of adjunct antimicrobial therapy targeting periodontal pathogens and subsequent periodontal surgery resulted in improvement in periodontal and microbiological parameters. This improvement has been adequately maintained over a 2-year period. However, additional care is necessary to further improve the patient's oral health-related quality of life during SPT.

Clinical and histologic evaluation of non-surgical periodontal therapy with enamel matrix derivative: a report of four cases.

PubMed

Mellonig, James T; Valderrama, Pilar; Gregory, Holly J; Cochran, David L

2009-09-01

Enamel matrix derivative (EMD) is a composite of proteins that was demonstrated histologically to work as an adjunct to periodontal regenerative surgical therapy. The purpose of this study was to evaluate the clinical and histologic effects of EMD as an adjunct to scaling and root planing. Four patients with severe chronic periodontitis and scheduled to receive complete dentures were accrued. Probing depth and clinical attachment levels were obtained. Unlimited time was allowed for hand and ultrasonic instrumentation. A notch was placed in the root >or=1 to 2 mm from the apical extent of root planing. EMD was inserted into the pocket, and a periodontal dressing was placed. Patients were seen every 2 weeks for plaque control. At 6 months post-treatment, soft tissue measurements were repeated, and the teeth were removed en bloc and prepared for histomorphologic analysis. Probing depth reduction and clinical attachment level gain were obtained in three-fourths of the specimens. Three of the four specimens analyzed histologically demonstrated new cementum, bone, periodontal ligament, and connective tissue attachment coronal to the notch. In one specimen, the gingival margin had receded below the notch. The results were unexpected and may represent an aberration. However, the substantial reduction in deep probing depths and clinical attachment level gain in three of four specimens, in addition to the histologic findings of new cementum, new bone, a new periodontal ligament, and a new connective tissue attachment, suggest that EMD may be useful as an adjunct to scaling and root planing in single-rooted teeth.

Effect of adjunctive low level laser therapy (LLLT) on nonsurgical treatment of chronic periodontitis.

PubMed

Makhlouf, Mona; Dahaba, Mushira M; Tunér, Jan; Eissa, Sohair A; Harhash, Tarek A-H

2012-03-01

The aim of this split-mouth, double blinded, short-term, controlled clinical trial was to study the effect of low-level laser therapy (LLLT) as an adjunct to scaling and root planing (SRP) for treatment of chronic periodontitis. LLLT is reported to improve the outcome of traditional SRP, but the evidence is still weak. Sixteen patients with a probing pocket depth (PPD) of 4-6 mm involving at least three teeth in each quadrant were recruited for the study. Afterwards, SRP quadrants were randomly assigned for 10 sessions of LLLT. Results showed that when compared to sites treated with SRP alone, those treated with SRP+LLLT (10 sessions, 830 nm, 100 mW, 3 J per point, 3 J/cm(2)) exhibited greater reductions in PPD at 5 weeks and 3 months but not at 6 months. Further, SRP+LLLT-treated sites had a statistically significant increase in mean radiographic bone density when comparing 6- and 12-month data and overall from baseline to 12 months. There was a trend to reduce interleukin (IL)-1β but the difference between control and laser sites was not statistically significant. SRP combined with LLLT improved radiographic bone density and short-term PPD reduction in patients with chronic periodontitis, but did not significantly affect either the gingival crevicular fluid of IL-1β or the gingival or plaque index.

Potential for Stem Cell-Based Periodontal Therapy

PubMed Central

Bassir, Seyed Hossein; Wisitrasameewong, Wichaya; Raanan, Justin; Ghaffarigarakani, Sasan; Chung, Jamie; Freire, Marcelo; Andrada, Luciano C.; Intini, Giuseppe

2015-01-01

Periodontal diseases are highly prevalent and are linked to several systemic diseases. The goal of periodontal treatment is to halt the progression of the disease and regenerate the damaged tissue. However, achieving complete and functional periodontal regeneration is challenging because the periodontium is a complex apparatus composed of different tissues, including bone, cementum, and periodontal ligament. Stem cell-based regenerative therapy may represent an effective therapeutic tool for periodontal regeneration due to their plasticity and ability to differentiate into different cell lineages. This review presents and critically analyzes the available information on stem cell-based therapy for the regeneration of periodontal tissues and suggests new avenues for the development of more effective therapeutic protocols. PMID:26058394

Treatment modalities and evaluation models for periodontitis

PubMed Central

Tariq, Mohammad; Iqbal, Zeenat; Ali, Javed; Baboota, Sanjula; Talegaonkar, Sushama; Ahmad, Zulfiqar; Sahni, Jasjeet K

2012-01-01

Periodontitis is the most common localized dental inflammatory disease related with several pathological conditions like inflammation of gums (gingivitis), degeneration of periodontal ligament, dental cementum and alveolar bone loss. In this perspective, the various preventive and treatment modalities, including oral hygiene, gingival irrigations, mechanical instrumentation, full mouth disinfection, host modulation and antimicrobial therapy, which are used either as adjunctive treatments or as stand-alone therapies in the non-surgical management of periodontal infections, have been discussed. Intra-pocket, sustained release systems have emerged as a novel paradigm for the future research. In this article, special consideration is given to different locally delivered anti-microbial and anti inflammatory medications which are either commercially available or are currently under consideration for Food and Drug Administration (FDA) approval. The various in vitro dissolution models and microbiological strain investigated to impersonate the infected and inflamed periodontal cavity and to predict the in vivo performance of treatment modalities have also been thrashed out. Animal models that have been employed to explore the pathology at the different stages of periodontitis and to evaluate its treatment modalities are enlightened in this proposed review. PMID:23373002

Scope of photodynamic therapy in periodontics.

PubMed

Kumar, Vivek; Sinha, Jolly; Verma, Neelu; Nayan, Kamal; Saimbi, C S; Tripathi, Amitandra K

2015-01-01

Periodontal disease results from inflammation of the supporting structure of the teeth and in response to chronic infection caused by various periodontopathic bacteria. The mechanical removal of this biofilm and adjunctive use of antibacterial disinfectants and antibiotics have been the conventional methods of periodontal therapy. However, the removal of plaque and the reduction in the number of infectious organisms can be impaired in sites with difficult access. Photodynamic therapy (PDT) is a powerful laser-initiated photochemical reaction, involving the use of a photoactive dye (photosensitizer) activated by light of a specific wavelength in the presence of oxygen. Application of PDT in periodontics such as pocket debridement, gingivitis, and aggressive periodontitis continue to evolve into a mature clinical treatment modality and is considered as a promising novel approach for eradicating pathogenic bacteria in periodontitis.

A brief motivational interviewing as an adjunct to periodontal therapy-A potential tool to reduce relapse in oral hygiene behaviours. A three-year study.

PubMed

Stenman, J; Wennström, J L; Abrahamsson, K H

2018-05-01

To evaluate (ii) whether inclusion of a single motivational interviewing (MI) session, as an adjunct to periodontal therapy, might be beneficial for preventing relapse in oral hygiene behaviours among patients treated for chronic periodontitis and (ii) whether individual and clinical characteristics can be of predictive value for retention of sufficient oral hygiene behaviours. This 3-year follow-up of a previously reported randomized controlled trial (RCT) study of 6-month duration included 26 patients. Patients in the test group had received one MI session by a clinical psychologist before initiation of the periodontal treatment. Otherwise, all patients followed the same treatment protocol for conventional educational intervention and non-surgical periodontal therapy. Efficacy variables assessed for evaluation of the standard of self-performed periodontal infection control were marginal bleeding index (MBI; primary efficacy variable) and plaque score (PI). The patterns of change in MBI and PI scores were similar for test and control groups over the observation period. At 3 years, both groups showed a desirable mean full-mouth MBI of 15%, a figure that was comparable to that at the short-term evaluation after active periodontal treatment. The post-treatment MBI was the only variable identified as a predictor of retained adequate oral hygiene behaviours. A single MI session as an adjunct to conventional periodontal therapy could not be proven to be of long-term beneficial additive effect with regard to prevention of relapse in oral hygiene behaviour. Desirable standard of self-performed infection control after active periodontal treatment predicted the retention of sufficient oral hygiene behaviour over time. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The effect of periodontal therapy on glycaemic control in a Hispanic population with type 2 diabetes: a randomized controlled trial.

PubMed

Gay, Isabel C; Tran, Duong T; Cavender, Adriana C; Weltman, Robin; Chang, Jennifer; Luckenbach, Estelle; Tribble, Gena D

2014-07-01

In the Mexican-American population, the prevalence of Type 2 diabetes mellitus (T2DM) is as high as 50% of the population. This randomized controlled clinical trial was designed to elucidate how treatment of periodontal disease affects HbA1c values in this population. One hundred and fifty-four T2DM patients with periodontal disease were enrolled in the study. The test group was treated with scaling and root planing (SRP); the control group received oral hygiene instructions. At baseline and 4-6 weeks after therapy, a complete periodontal examination was performed. Blood was collected at baseline and 4 months later for HbA1c levels. One hundred and twenty-six individuals completed the study. Baseline mean ± SD HbA1c for the test and control groups were 9.0 ± 2.3% and 8.4 ± 2.0% respectively. Non-significant difference in HbA1c reductions (0.6 ± 2.1% and 0.3 ± 1.7%) was found between test and control groups at 4 months. Comparisons of the periodontal clinical parameters between the test and control groups found significant differences with improved results in the test subjects. No statistically significant differences were found in the changes of HbA1c levels between test and control groups. Non-surgical periodontal therapy improved the magnitude of change in periodontal parameters as compared to the control subjects. ClinicalTrials.gov Identifier: NCT01128374. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Systemic antimicrobial therapy (minocycline) as an adjunct to non-surgical approach to recurrent chronic generalized gingival hyperplasia.

PubMed

Khatri, Parag M; Bacha, Shraddanand

2014-03-01

Systemic antibiotic treatment has emerged as a powerful adjunct to conventional mechanical debridement for therapeutic management of the periodontal diseases. The conceptual basis for treating periodontal diseases as infections is particularly attractive in part because of substantial data indicating that these diseases may be associated with specific putative pathogens. Further, discrete groups of patients respond well to systemic antibiotics and exhibit improvement of clinical parameters, including attachment level and inflammation. This bacterial-host interaction, which is ever-so-present in periodontitis, directs us toward utilizing antimicrobial agents along with the routine mechanical debridement. This case report presents a case of a female patient with recurrence of the chronic generalized periodontitis with gingival enlargement, which is treated thrice by referral dentist. A through clinical examination was carried out pre-operatively and treatment was planned with systemic minocycline in conjunction with the conventional non-surgical approach. There was a significant reduction of pocket depth, gain in attachment with dramatic improvement clinically.

Relationship between the formation of volatile sulfur compounds (VSC) and the severity of the periodontal disease: a pilot study.

PubMed

Nogueira-Filho, G R; Peruzzo, D; Sallum, A W

2008-03-01

This aim of this study was to evaluate the relationship between the formation of volatile sulfur compounds (VSC) and the severity of different kinds of periodontal disease. Twenty patients suffering from biofilm-related periodontal diseases and a control group of ten healthy individuals were selected. The patients were divided according to their periodontal diagnoses: marginal gingivitis (MG/n = 10) and chronic periodontitis (CP/n = 10). The patients received non-surgical therapy that consisted of motivation, scaling and root planing. Two experimental periods were used: T1 = baseline and T2 = final evaluation after three months. The data analysis showed that CP group had a significant reduction (p < 0.05) in probing depth (PD) and clinical attachment level (CAL), and group MG presented a reduction in GI (p < 0.05). There was a significant reduction (p < 0.05) in the aspartate aminotransferase (AST), N-a-benzoyl-DL-arginine-p-nitroanilide (BAPNA) and VSC levels in both MG and CP groups, although the deeper residual pockets led to higher AST and VSC levels in the CP group. Within the limits of the present pilot study, it can be concluded that the non-surgical therapy may influence VSC formation in a manner dependent on periodontal disease severity.

Comparative evaluation of serum antioxidant levels in periodontally diseased patients: An interventional study

PubMed Central

Thomas, Biju; Madani, Shabeer Mohamed; Prasad, B. Rajendra; Kumari, Suchetha

2014-01-01

Background: Periodontal disease is an immune-inflammatory disease characterized by connective tissue breakdown, loss of attachment and alveolar bone resorption. In normal physiology, there is a dynamic equilibrium between reactive oxygen species activity and antioxidant defense capacity and when that equilibrium shifts in favor of reactive oxygen species, oxidative stress results. Oxidative stress is thought to play a causative role in the pathogenesis of periodontal diseases. Catalase (CAT) protects cells from hydrogen peroxide generated within them. Even though, CAT is not essential for some cell types under normal conditions, it plays an important role countering the effects of oxidative stress on the cell. Aim: This study was designed to estimate and compare the CAT and total antioxidant capacity (TAOC) levels in the serum of periodontitis, gingivitis, and healthy individuals before and after nonsurgical periodontal therapy. Materials and Methods: This study was conducted in the Department of Periodontics, A. B. Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore. The study was designed as a single blinded interventional study comprising of 75 subjects, inclusive of both sexes and divided into three groups of 25 patients each. Patients were categorized into chronic periodontitis, gingivitis and healthy. The severity of inflammation was assessed by using gingival index and pocket probing depth. Biochemical analysis was done to estimate the TAOC and CAT levels before and after nonsurgical periodontal therapy. Results obtained were then statistically analyzed using ANOVA test and paired t-test. Results: The results showed a higher level of serum TAOC and CAT in the healthy group compared with the other groups. The difference was found to be statistically significant (P < 0.0001). The posttreatment levels of TAOC were statistically higher than the pretreatment levels in periodontitis group. PMID:25191070

Short-term effect of Keyes' approach to periodontal therapy compared with modified Widman flap surgery.

PubMed

Whitehead, S P; Watts, T L

1987-11-01

Keyes' method of non-surgical therapy was compared with modified Widman flap surgery in 9 patients with symmetrical periodontal disease. Following an initial oral hygiene programme, baseline measurements were recorded and paired contralateral areas were subjected randomly to the 2 techniques. 42 teeth receiving surgery were compared with 40 treated by Keyes' method. 6 sites per tooth were scored immediately prior to therapy and 3 months later, using a constant force probe with onlays. Consistent data were recorded for the 6 separate sites, which showed no baseline difference between treatments, slightly greater recession with surgery at 3 months, but no difference between treatments in probing depth and attachment levels. Mean data for individual patients showed similar consistency. Probing depth in deep sites was reduced slightly more with surgery, and there were no differences in bleeding on probing at 3 months. Both techniques gave marked improvements in health. Surprisingly, only 2 subjects preferred Keyes' technique of mechanical therapy, 6 preferred surgery, and 1 had no preference.

Periodontal Regenerative Therapy in Patient with Chronic Periodontitis and Type 2 Diabetes Mellitus: A Case Report.

PubMed

Seshima, Fumi; Nishina, Makiko; Namba, Takashi; Saito, Atsushi

2016-01-01

We report a case of generalized chronic periodontitis and type 2 diabetes mellitus requiring periodontal treatment including regenerative therapy. The patient was a 66-year-old man who presented with the chief complaint of gingival inflammation and mobile teeth in the molar region. He had been being treated for type 2 diabetes mellitus since 1999. His glycated hemoglobin (HbA1c) level was 7.8%. An initial examination revealed sites with a probing depth of ≥7 mm in the molar region, and radiography revealed angular bone defects in this area. Based on a clinical diagnosis of generalized chronic periodontitis, the patient underwent initial periodontal therapy. An improvement was observed in periodontal conditions on reevaluation, and his HbA1c level showed a reduction to 6.9%. Periodontal regenerative therapy with enamel matrix derivative was then performed on #16, 26, and 27. Following another reevaluation, a removable partial denture was fabricated for #47 and the patient placed on supportive periodontal therapy (SPT). To date, periodontal conditions have remained stable and the patient's HbA1c level has increased to 7.5% during SPT. The results show the importance of collaboration between dentist and physician in managing periodontal and diabetic conditions in such patients.

Cigarette smoking and the periodontal patient.

PubMed

Johnson, Georgia K; Hill, Margaret

2004-02-01

Evidence from cross-sectional and case-control studies in various populations demonstrates that adult smokers are approximately three times as likely as non-smokers to have periodontitis. The association between smoking and attachment loss is even stronger when the definition of periodontitis is restricted to the most severely affected subjects. Smokers have a diminished response to periodontal therapy and show approximately half as much improvement in probing depths and clinical attachment levels following non-surgical and various surgical modalities of therapy. Implant failures in smokers are twice those of non-smokers, with a higher failure rate in the maxillary arch accounting for the majority of the difference. Tobacco-induced alterations in microbial and host factors contribute to these deleterious effects of smoking on the periodontium. In longitudinal studies, the rate of periodontal disease progression is increased in smokers, but decreases to that of a non-smoker following tobacco cessation. Likewise, recent non-smokers respond to periodontal therapy in a manner similar to patients who have never smoked. Data regarding the impact of smoking on periodontal status included in this review will be helpful to dental health professionals as they counsel their patients regarding tobacco use. The role of dental health professionals in tobacco cessation is discussed, including the use of the five A's: ask--identify tobacco users; advise--advise them to quit; assess--evaluate the patient's readiness to quit; assist--offer assistance in cessation; and arrange--follow up on the patient's cessation efforts. The addition of pharmacotherapy to behavioral therapy, including nicotine replacement therapy and bupropion, can increase cessation rates. The most popular form of nicotine replacement therapy is the patch, and its use has been shown to double cessation rates compared to behavioral therapy alone. Use of bupropion in combination with nicotine replacement therapy may

The Impact of Resveratrol Supplementation on Blood Glucose, Insulin, Insulin Resistance, Triglyceride, and Periodontal Markers in Type 2 Diabetic Patients with Chronic Periodontitis.

PubMed

Zare Javid, Ahmad; Hormoznejad, Razie; Yousefimanesh, Hojat Allah; Zakerkish, Mehrnoosh; Haghighi-Zadeh, Mohammad Hosein; Dehghan, Parvin; Ravanbakhsh, Maryam

2017-01-01

The aim of this study was to investigate the impact of resveratrol supplementation along with non-surgical periodontal treatment on blood glucose, insulin, insulin resistance, triglyceride (TG), and periodontal markers in patients with type 2 diabetes with periodontal disease. In this double-blind clinical trial study, 43 patients with diabetes with chronic periodontitis were participated. Subjects were randomly allocated to intervention and control groups. The intervention and control groups received either 480 mg/day of resveratrol or placebo capsules (two pills) for 4 weeks. Fasting blood glucose, insulin, insulin resistance (homeostasis model assessment of insulin resistance), TGs, and pocket depth were measured in all subjects' pre-intervention and post-intervention. The mean serum levels of fasting insulin and insulin resistance (homeostasis model assessment of insulin resistance) were significantly lower in the intervention group compared with control group (10.42 ± 0.28 and 10.92 ± 0.9; 3.66 ± 0.97 and 4.49 ± 1.56, respectively). There was a significant difference in the mean pocket depth between intervention and control groups (2.35 ± 0.6 and 3.38 ± 0.5, respectively) following intervention. No significant differences were observed in the mean levels of fasting blood glucose and TGs between two groups' post-intervention. It is recommended that resveratrol supplementation may be beneficial as adjuvant therapy along with non-surgical periodontal treatment in insulin resistance and improving periodontal status among patients with diabetes with periodontal disease. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

[Impact of volatile sulphur compounds in periodontal pockets on initial periodontal therapy].

PubMed

Li, Xiao-Jun; Dong, Ling-Ling; Kong, Jing-Jia

2008-07-01

To investigate the relationship of volatile sulphur compounds((VSC)levels in periodontal pockets with severity of periodontitis, and the impact of VSC on the result of initial periodontal therapy. Twenty-five patients with chronic periodontitis(CP)(13 males and 12 females with average age of 35) were included in this study. Clinical periodontal parameters, plaque index, probing depth(PD), attachment loss(AL), and bleeding on probing(BOP) were recorded before and 3 months after the initial therapy. VSC levels were measured with a portable monitor in a digital score ranging from 0.0 to 5.0. All of 5 054 sites for 840 teeth were included in this study. Before treatment the percentage of VSC-positive sites was 17.1%, 52.3% and 86.0% for shallow (PD<3 mm), moderate(PD 4-6 mm) and deep (PD>7 mm) pocket, respectively (P<0.001). In most VSC-positive sites the VSC levels were<1.0. Percentage of sites with a high VSC levels was significantly different among three groups (P<0.01). All clinical parameters in VSC-negative sites were reduced significantly following the initial therapy. The reduction of PD and AL in VSC-positive sites by treatment was less marked than that in VSC-negative sites. VSC in periodontal pockets may be a potential indicator for detecting severity of CP and a useful predictor for therapeutic success.

Laser therapy for periodontitis

NASA Astrophysics Data System (ADS)

Efanov, O. I.

2001-04-01

An investigation was made of applying pulsed (lambda) equals 0.89 micrometers laser radiation in the treatment for early diagnosed periodontitis. The investigation was made on 65 patients (47 patients constituted the experimental group and 18 patients constituted a control group) affected by periodontitis. Clinical and functional tests revealed that laser therapy produced a string effect on the course of the illness. It reduced bleeding, inflammation, and pruritus. However, it did not produce an affect on electroexcitation. Biomicroscopic examinations and periodontium rheography revealed that the gingival blood flow became normal after the course of laser therapy. The capillary permeability and venous congestion decreased, which was confirmed by the increased time of vacuum tests, raised gingival temperature, reduced tissue clearance, and increased oxygen tension. Apart from that, laser therapy subsided fibrinolysis, proteolytic tissue activity, and decreased the exudative inflammation of periodontium.

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

PubMed

Jentsch, Holger F R; Buchmann, Andreas; Friedrich, Abel; Eick, Sigrun

2016-09-01

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

Evaluation of IL-1β, IL-1ra, and IL-10 levels and outcome of periodontal therapy in chronic periodontitis with familial Mediterranean fever.

PubMed

Bostanci, Vildan; Toker, Hulya; Senel, Soner; Poyraz, Omer; Akpinar, Aysun; Görgün, Emine Pirim; Bakar, Olcay

2017-01-01

This study aimed to examine the IL-1β, IL-1ra, and IL-10 cytokine levels in gingival crevicular fluid (GCF) and serum of familial Mediterranean fever (FMF) and chronic periodontitis (CP) patients, and their response to nonsurgical periodontal therapy. A total of 50 patients, 15 FMF patients with generalized chronic periodontitis (FMF-CP), 15 systemically healthy patients with generalized chronic periodontitis (CP), ten systemically and periodontal healthy controls (HC), and ten periodontally healthy FMF patients (FMF-HC) were enrolled in the study. The cytokine levels in GCF and serum were determined by ELISA. Probing depth, clinical attachment level, and gingival and plaque indices in each participant were also measured. The GCF and clinical parameters at baseline and 6 weeks were recorded. The study indicated statistically significant healing of the clinical parameters in both FMF-CP and CP groups after periodontal treatment. GCF IL-1β levels at 6 weeks in FMF-CP group were significantly lower than the CP group (p < 0.05), and GCF IL-1ra levels were significantly decreased at 6 week in the FMF-CP group (p < 0.05). GCF IL-10 levels were significantly higher in the FMF-CP group than in the other groups at baseline and 6 weeks (p < 0.05). There were no significant differences in serum-IL-1β, IL-1ra, and IL-10 levels either FMF-CP or CP groups at baseline or 6 weeks (p > 0.05). The results of our study suggested that there was a positive correlation between gingival inflammation and serum cytokine levels in FMF patients and also colchicine treatment showed protective effects on GCF cytokine levels in FMF-CP group. Following treatment, GCF IL-1β and GCF IL-1ra levels were decreased in FMF-CP group. GCF IL-10 levels were increased in FMF-CP group compared to other groups. Also, the serum cytokine levels associated with periodontal inflammation in FMF patients.

HETEROGENEITY OF SYSTEMIC INFLAMMATORY RESPONSES TO PERIODONTAL THERAPY

PubMed Central

Behle, Jan H.; Sedaghatfar, Michael H.; Demmer, Ryan T.; Wolf, Dana L.; Celenti, Romanita; Kebschull, Moritz; Belusko, Paul B.; Herrera-Abreu, Miriam; Lalla, Evanthia; Papapanou, Panos N.

2009-01-01

Aims We investigated the effect of comprehensive periodontal therapy on the levels of multiple systemic inflammatory biomarkers. Methods Thirty patients with severe periodontitis received comprehensive periodontal therapy within a 6-week period. Blood samples were obtained at: one week pre- therapy (T1), therapy initiation (T2), treatment completion (T3), and 4 weeks thereafter (T4). We assessed plasma concentrations of 19 biomarkers using multiplex assays, and serum IgG antibodies to periodontal bacteria using checkerboard immunoblotting. At T2 and T4, dental plaque samples were analyzed using checkerboard hybridizations. Results At T3, PAI-1, sE-selectin, sVCAM-1, MMP-9, myeloperoxidase, and a composite Summary Inflammatory Score (SIS) were significantly reduced. However, only sE-selectin, sICAM, and serum amyloid P sustained a reduction at T4. Responses were highly variable: analyses of SIS slopes between baseline and T4 showed that approximately 1/3 and 1/4 of the patients experienced marked reduction and pronounced increase in systemic inflammation, respectively, while the remainder were seemingly unchanged. Changes in inflammatory markers correlated poorly with clinical, microbiological and serological markers of periodontitis. Conclusions Periodontal therapy resulted in an overall reduction of systemic inflammation, but the responses were inconsistent across subjects and largely not sustainable. The determinants of this substantial heterogeneity need to be explored further. PMID:19426174

Azithromycin buccal patch in treatment of chronic periodontitis.

PubMed

Latif, Sajith Abdul; Vandana, K L; Thimmashetty, J; Dalvi, Priyanka Jairaj

2016-01-01

This study aims to explore the clinical, microbiological, and biochemical impact of azithromycin (AZM) buccal patch in chronic generalized patients as a monotherapy as well as an adjunct to nonsurgical therapy. A parallel design was used forty periodontitis patients were randomly allocated into five groups, namely Group 1 scaling root planing (SRP) alone, Group 2 (SRP + AZM patch group), Group 3 (SRP + AZM tablet group), Group 4 (AZM patch monotherapy), and Group 5 (AZM tablet as monotherapy). Plaque index, gingival bleeding index, modified gingival index, probing pocket depth (PPD), and clinical attachment level (CAL) were assessed at baseline and 21 and 90 days. Subgingival pooled plaque sample was collected to assess periodontopathogens like Porphyromonas gingivalis and Prevotella intermedia (Pi) by anaerobic culture method. Tumor necrosis factor alpha (TNF-α) was also evaluated at baseline and 21 days. Periodontal maintenance was performed in Group 1 until 90(th) day, and clinical parameter was assessed at the end of 90(th) day. SRP + AZM tablets showed greater reduction in clinical parameters (P < 0.05) AZM as monotherapy did not offer clinical benefits over SRP. Baseline data were compared at the end, i.e., 90(th) day a significant reduction in plaque scores, gingival bleeding, and PPD was observed however no significant gain in the clinical attachment was observed. The monotherapy resulted in no improvement of periodontal parameters, microbial parameters, and TNF-α level. It is safe to use AZM + SRP as a mode of nonsurgical treatment in periodontitis patients.

Evaluation of the effect of one stage versus two stage full mouth disinfection on C-reactive protein and leucocyte count in patients with chronic periodontitis.

PubMed

Pabolu, Chandra Mohan; Mutthineni, Ramesh Babu; Chintala, Srikanth; Naheeda; Mutthineni, Navya

2013-07-01

Conventional non-surgical periodontal therapy is carried out in quadrant basis with 1-2 week interval. This time lag may result in re-infection of instrumented pocket and may impair healing. Therefore, a new approach to full-mouth non-surgical therapy to be completed within two consecutive days with full-mouth disinfection has been suggested. In periodontitis, leukocyte counts and levels of C-reactive protein (CRP) are likely to be slightly elevated, indicating the presence of infection or inflammation. The aim of this study is to compare the efficacy of one stage and two stage non-surgical therapy on clinical parameters along with CRP levels and total white blood cell (TWBC) count. A total of 20 patients were selected and were divided into two groups. Group 1 received one stage full mouth dis-infection and Group 2 received two stages FMD. Plaque index, sulcus bleeding index, probing depth, clinical attachment loss, serum CRP and TWBC count were evaluated for both the groups at baseline and at 1 month post-treatment. The results were analyzed using the Student t-test. Both treatment modalities lead to a significant improvement of the clinical and hematological parameters; however comparison between the two groups showed no significant difference after 1 month. The therapeutic intervention may have a systemic effect on blood count in periodontitis patients. Though one stage FMD had limited benefits over two stages FMD, the therapy can be accomplished in a shorter duration.

Prediction of loss to follow-up in long-term supportive periodontal therapy in patients with chronic periodontitis

PubMed Central

Yang, Hai Jing

2018-01-01

Aim This study examined the predictors of loss to follow-up in long-term supportive periodontal therapy in patients with chronic periodontitis. Methods A total of 280 patients with moderate to severe chronic periodontitis in a tertiary care hospital in China were investigated and followed over the course of study. Questionnaires on clinical and demographic characteristics, self-efficacy for oral self-care and dental fear at baseline were completed. Participants were followed to determine whether they could adhere to long-term supportive periodontal therapy. Binary logistic regression analysis was used to examine the association between clinical and demographic characteristics, self-efficacy for oral self-care, dental fear and loss to follow-up in long-term supportive periodontal therapy. Results The loss to follow-up in long-term supportive periodontal therapy was significantly associated with age [adjusted OR = 1.042, 95% confidence interval (CI): 1.012–1.074, p = 0.006], severe periodontitis [adjusted OR = 4.892, 95%CI: 2.280–10.499, p<0.001], periodontal surgery [adjusted OR = 11.334, 95% CI: 2.235–57.472, p = 0.003], and middle and low-scoring of self-efficacy scale for self-care groups. The adjusted ORs of loss to follow-up for the middle- (54–59) and low-scoring groups (15–53) were 71.899 (95%CI: 23.926–216.062, p<0.001) and 4.800 (95% CI: 2.263–10.182, p<0.001), respectively, compared with the high-scoring SESS group (60–75). Conclusion Age, severity of periodontitis, periodontal surgery and the level of self-efficacy for self-care may be effective predictors of loss to follow-up in long-term supportive periodontal therapy in patients with chronic periodontitis. PMID:29420586

Periodontal abscess during supportive periodontal therapy: a review of the literature.

PubMed

Silva, Geraldo L M; Soares, Rodrigo V; Zenóbio, Elton G

2008-09-01

The aim of this review is to present the current status of the occurrence and management of a periodontal abscess during supportive periodontal therapy (SPT). A periodontal abscess depicts typical features and has been described in patients under SPT in clinical trials. Common periodontal pathogens have been observed in this lesion and some etiologic factors may be responsible for its recurrence. This condition can be isolated or associated with factors that can change the prognosis of affected teeth. Although it has been frequently noticed in untreated periodontitis, the periodontal abscess can also occur in patients under SPT and has been regarded as one of the possible complications of SPT. Patients with a high susceptibility to periodontal disease lost more teeth than those with a healthy periodontium. Early diagnosis and appropriate intervention for periodontal abscesses in patients under SPT are extremely important for the management of the periodontal abscess since this condition can lead to loss of the involved tooth. A single case of a tooth diagnosed with periodontal abscess that responds favorably to adequate treatment does not seem to affect its longevity. An accurate diagnosis and adequate treatment can preserve the longevity of affected teeth.

Photodynamic therapy in non-surgical treatment of chronic periodontitis: short term randomized clinical trial study

NASA Astrophysics Data System (ADS)

Russo, C.; Palaia, G.; Loskutova, E.; Libotte, F.; Kornblit, R.; Gaimari, G.; Tenore, G.; Romeo, U.

2016-03-01

Introduction: Periodontitis is a chronic inflammatory disease due to exposition to plaque and tartar. Conventional treatments consist of scaling and root planing (SRP) and antibiotics administration. Among them encouraging results have been obtained using alternative protocols, like the antimicrobial photodynamic therapy (PDT). Aim of the Study: Evaluation of PDT effects added to conventional methods. Materials and Methods: 11 patients (4M/7F, 37-67 years aged, non-smoking) affected by untreated chronic periodontal disease, with >3mm pockets in at least 4 teeth were divided in two groups, test and control group. Each patient had to made full-intraoral before and after the treatment. The test group received SRP+PDT, while the control group was subjected to SRP. The PDT was performed through the HELBO®TheraLite (Bredent Medical), diode laser battery powered 670nm with an output of 75mW/cm2. The Helbo Blue photosensitizer, containing methylene blue, was used. The exposure time to the laser effect was of 10'' for each site, for a total of 60'' at 3J/cm2. Results: Both groups had a significant improvement in the reduction of pocket depth (PD), above all in the test group. Statistical analysis was performed through the T-test, evaluating PD between the two groups p=0.96 (p> 0.05), resulting not statistically significant. Conclusion: PDT is a promising support to SRP, achieving a significant reduction in the pocket depth, but more cases are needed to confirm the validity of the used protocol.

Hyaluronic Acid: A Boon in Periodontal Therapy

PubMed Central

Dahiya, Parveen; Kamal, Reet

2013-01-01

Hyaluronic acid is a naturally occurring linear polysaccharide of the extracellular matrix of connective tissue, synovial fluid, and other tissues. Its use in the treatment of the inflammatory process is established in medical areas such as orthopedics, dermatology, and ophthalmology. The Pubmed/Medline database was searched for keywords “Hyaluronic acid and periodontal disease” and “Hyaluronic acid and gingivitis” which resulted in 89 and 22 articles respectively. Only highly relevant articles from electronic and manual search in English literature were selected for the present review article. In the field of dentistry, hyaluronic acid has shown anti-inflammatory and anti-bacterial effects in the treatment of periodontal diseases. Due to its tissue healing properties, it could be used as an adjunct to mechanical therapy in the treatment of periodontitis. Further studies are required to determine the clinical efficacy of hyaluronic acid in healing of periodontal lesion. The aim of the present review, article is to discuss the role of hyaluronic acid in periodontal therapy. PMID:23814761

Longitudinal supportive periodontal therapy for severe chronic periodontitis with furcation involvement: a 12-year follow-up report.

PubMed

Komiya-Ito, Akiyo; Tomita, Sachiyo; Kinumatsu, Takashi; Fujimoto, Yoshihiro; Tsunoda, Masatake; Saito, Atsushi

2013-01-01

We report a case involving a 12-year follow-up after treatment for chronic periodontitis with furcation involvement. A 54-year-old woman presented with the chief complaint of hypersensitivity. Clinical examination at the first visit revealed 15% of sites with a probing depth ≥4 mm and 35% of sites with bleeding on probing. Initial periodontal therapy was implemented based on a clinical diagnosis of severe chronic periodontitis. Surgical periodontal therapy was subsequently performed at selected sites. For #44, regenerative periodontal therapy using enamel matrix derivative (Emdogain(®)) was selected. For #16, which exhibited a 2- to 3-wall vertical bony defect and class III (mesio-distal) furcation involvement, bone graft was scheduled. Other sites with residual periodontal pockets were treated by open flap debridement. For #37, with a gutter-shaped root, odontoplasty was performed. After reevaluation, the patient was placed on supportive periodontal therapy (SPT). During 12 years of SPT, the periodontal condition remained uneventful in most of the teeth. However, bone resorption was observed in the distal aspect of #37, making the prognosis poor. This indicates the need to continuously monitor risk factors, including inflammation and traumatic occlusion, during SPT. Although some problems still remain, severe periodontitis with furcation involvement was successfully maintained longitudinally with an adequate level of patient compliance and careful SPT.

Tooth loss due to periodontal abscess: a retrospective study.

PubMed

McLeod, D E; Lainson, P A; Spivey, J D

1997-10-01

This retrospective study focused on the frequency of tooth loss due to periodontal abscess among 42 patients who were treated by a single clinician over a 5- to 29-year period. A total of 114 patients were selected from the active periodontal recall schedule of a single periodontist at The University of Iowa College of Dentistry. The criteria for inclusion in the study included having a history of moderate to advanced periodontitis, being on 3 to 6 month recall periodontal maintenance care, and completion of active periodontal therapy prior to October 1987. Other parameters evaluated were age; gender; number of teeth present and missing at the initial, reevaluation, and last periodontal recall visit; initial periodontal prognosis; furcation involvement; non-surgical and surgical periodontal therapy; and reasons for tooth loss. Patients were grouped according to the number of teeth lost following active periodontal treatment into well-maintained (0 to 3), downhill (4 to 9), and extreme downhill (10 to 23) groups. Forty-two of the 114 patients were identified as having one or more periodontal abscesses. A total of 109 teeth were affected by periodontal abscess of which 49 (45%) teeth were lost and 60 (55%) were successfully maintained over an average of 12.5 years (5 to 29 years). More furcated teeth were lost than nonfurcated teeth and teeth given a hopeless prognosis were lost more consistently than those given a questionable prognosis in all groups. The frequency of periodontal abscess and tooth loss per patient was greater in the downhill and extreme downhill response groups than the well-maintained group. This suggests that teeth with a history of periodontal abscess can be treated and maintained for several years.

Efect of periodontal disease and non surgical periodontal treatment on C-reactive protein. Evaluation of type 1 diabetic patients

PubMed Central

Llambés, Fernando; Hernández-Mijares, Antonio; Guiha, Rami; Bautista, Daniel; Caffesse, Raúl

2012-01-01

Objectives: The purpose of this study was to analyze how anti-infectious periodontal treatment affects C reactive protein (CRP) values in patients with type 1 diabetes, and correlate baseline CRP levels with periodontal disease severity. Study Design: A cohort of fifty three subjects with type 1 diabetes and moderate to severe periodontitis were recruited. Periodontal parameters were measured, and blood samples were obtained to evaluate high-sensitivity C-reactive protein (hs-CRP). Group 1 was treated with scaling, root planning, and systemic administration of doxycycline. Group 2 received only scaling and root planning. Results: Hs-CRP was reduced after periodontal treatment in group 1 (-0.22 mg/l) and 2 (-0.21 mg/l ) but this reduction was not statistically significant, even in the patients with the best response to periodontal treatment. However, significant correlation appeared between hs-CRP and mean probing pocket depth (PPD) (p=0, 01) and mean clinical attachment level (CAL) (p=0,03). Conclusions: Non-surgical periodontal treatment couldn’t reduce hs-CRP values, however, it was found an association between advanced periodontitis and elevated blood hs-CRP levels in patients with type 1 diabetes. It can be speculated that periodontal disease increases production of pro-inflammatory mediators in patients with type 1 diabetes, but other producing sources of these pro-inflammatory substances may exist. Key words:Periodontal disease, periodontitis, diabetes mellitus type 1, periodontal therapy, C reactive protein. PMID:22322513

[Magnetic therapy for complex treatment of chronic periodontal disease].

PubMed

P'yanzina, A V

The aim of the study was to elaborate the methodology of magnetic therapy for complex treatment of chronic periodontal disease (CPD). The study included 60 patients aged 35 to 65 years with moderate CPD divided in 2 groups. Patients in group 1 (controls) received impulse carbonate irrigation for 12 min №10, group 2 additionally received magnetic therapy for 5 min №10 in maxillary and mandibular areas. periodontal and rheological indices proved magnetic therapy to be useful tool for eradication of inflammation, periodontal tissue functional recovery and stabilization.

Azithromycin buccal patch in treatment of chronic periodontitis

PubMed Central

Latif, Sajith Abdul; Vandana, K. L.; Thimmashetty, J.; Dalvi, Priyanka Jairaj

2016-01-01

Aim: This study aims to explore the clinical, microbiological, and biochemical impact of azithromycin (AZM) buccal patch in chronic generalized patients as a monotherapy as well as an adjunct to nonsurgical therapy. Materials and Methods: A parallel design was used forty periodontitis patients were randomly allocated into five groups, namely Group 1 scaling root planing (SRP) alone, Group 2 (SRP + AZM patch group), Group 3 (SRP + AZM tablet group), Group 4 (AZM patch monotherapy), and Group 5 (AZM tablet as monotherapy). Plaque index, gingival bleeding index, modified gingival index, probing pocket depth (PPD), and clinical attachment level (CAL) were assessed at baseline and 21 and 90 days. Subgingival pooled plaque sample was collected to assess periodontopathogens like Porphyromonas gingivalis and Prevotella intermedia (Pi) by anaerobic culture method. Tumor necrosis factor alpha (TNF-α) was also evaluated at baseline and 21 days. Periodontal maintenance was performed in Group 1 until 90th day, and clinical parameter was assessed at the end of 90th day. Results: SRP + AZM tablets showed greater reduction in clinical parameters (P < 0.05) AZM as monotherapy did not offer clinical benefits over SRP. Baseline data were compared at the end, i.e., 90th day a significant reduction in plaque scores, gingival bleeding, and PPD was observed however no significant gain in the clinical attachment was observed. Conclusion: The monotherapy resulted in no improvement of periodontal parameters, microbial parameters, and TNF-α level. It is safe to use AZM + SRP as a mode of nonsurgical treatment in periodontitis patients. PMID:27127325

Clinical effectiveness of diode laser therapy as an adjunct to non-surgical periodontal treatment: a randomized clinical study.

PubMed

Dukić, Walter; Bago, Ivona; Aurer, Andrej; Roguljić, Marija

2013-08-01

The aim of this randomized clinical study is to evaluate the effect of a 980-nm diode laser as an adjunct to scaling and root planing (SRP) treatment. Thirty-five patients with chronic periodontitis were selected for the split-mouth clinical study. SRP was performed using a sonic device and hand instruments. Quadrants were equally divided between the right and left sides. Teeth were treated with SRP in two control quadrants (control groups [CG]), and the diode laser was used adjunctively with SRP in contralateral quadrants (laser groups [LG]). Diode laser therapy was applied to periodontal pockets on days 1, 3, and 7 after SRP. Baseline data, including approximal plaque index (API), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL), were recorded before the treatment and 6 and 18 weeks after treatment. Changes in PD and CAL were analyzed separately for initially moderate (4 to 6 mm) and deep (7 to 10 mm) pockets. The results were similar for both groups in terms of API, BOP, PD in deep pockets, and CAL. The laser group showed only significant PD gain in moderate pockets during the baseline to 18-week (P <0.05) and 6- to 18- week (P <0.05) periods, whereas no difference was found between LG and CG in the remaining clinical parameters (P >0.05). The present study indicates that, compared to SRP alone, multiple adjunctive applications of a 980-nm diode laser with SRP showed PD improvements only in moderate periodontal pockets (4 to 6 mm).

Effectiveness of Mechanical Debridement Combined With Adjunctive Therapies for Nonsurgical Treatment of Periimplantitis: A Systematic Review.

PubMed

de Almeida, Juliano Milanezi; Matheus, Henrique Rinaldi; Rodrigues Gusman, David Jonathan; Faleiros, Paula Lazilha; Januário de Araújo, Nathália; Noronha Novaes, Vivian Cristina

2017-02-01

This study aimed to perform a systematic review of the effectiveness of nonsurgical treatment associated with different adjuvant therapies on periimplantitis. Different individuals, following a research process, performed a network research of controlled and randomized controlled clinical trials on PubMed, Embase/MEDLINE, with 20 years' time constraint and the last search in January 2016. From 108 articles found by the first search, they analyzed 10 full texts, and in none did they find a standard control group. When compared, mechanical therapies combined with adjuvant therapy decreased prevalence of periimplant ratios; however, some groups showed unsatisfactory results, mainly related to the probing depth and bleeding index. When comparing debridement with other nonsurgical therapies (Er:YAG, Vector, air abrasive with amino acid glycine powder), increased periimplant levels were noticed in the test and control groups, although in different periods. Despite the improvement in the periimplant indices, there is no sufficient evidence to score the best results or even to choose the best association for nonsurgical treatment of periimplantitis; hence, more trials are necessary to answer this question.

Evaluation of the effect of one stage versus two stage full mouth disinfection on C-reactive protein and leucocyte count in patients with chronic periodontitis

PubMed Central

Pabolu, Chandra Mohan; Mutthineni, Ramesh Babu; Chintala, Srikanth; Naheeda; Mutthineni, Navya

2013-01-01

Background: Conventional non-surgical periodontal therapy is carried out in quadrant basis with 1-2 week interval. This time lag may result in re-infection of instrumented pocket and may impair healing. Therefore, a new approach to full-mouth non-surgical therapy to be completed within two consecutive days with full-mouth disinfection has been suggested. In periodontitis, leukocyte counts and levels of C-reactive protein (CRP) are likely to be slightly elevated, indicating the presence of infection or inflammation. The aim of this study is to compare the efficacy of one stage and two stage non-surgical therapy on clinical parameters along with CRP levels and total white blood cell (TWBC) count. Materials and Methods: A total of 20 patients were selected and were divided into two groups. Group 1 received one stage full mouth dis-infection and Group 2 received two stages FMD. Plaque index, sulcus bleeding index, probing depth, clinical attachment loss, serum CRP and TWBC count were evaluated for both the groups at baseline and at 1 month post-treatment. Results: The results were analyzed using the Student t-test. Both treatment modalities lead to a significant improvement of the clinical and hematological parameters; however comparison between the two groups showed no significant difference after 1 month. Conclusion: The therapeutic intervention may have a systemic effect on blood count in periodontitis patients. Though one stage FMD had limited benefits over two stages FMD, the therapy can be accomplished in a shorter duration. PMID:24174726

Treatment of periodontitis in smokers with multiple sessions of antimicrobial photodynamic therapy or systemic antibiotics: A randomized clinical trial.

PubMed

Theodoro, Letícia Helena; Assem, Naida Zanini; Longo, Mariéllen; Alves, Márcio Luiz Ferro; Duque, Cristiane; Stipp, Rafael Nobrega; Vizoto, Natália Leal; Garcia, Valdir Gouveia

2018-06-01

The aim of this study was to evaluate the effects of non-surgical periodontal therapies on smokers with chronic periodontitis, involving multiple adjunctive applications of antimicrobial photodynamic therapy (aPDT), and systemic metronidazole (MTZ) with amoxicillin (AMX). All participants were treated with scaling and root planing (SRP). Seventeen patients received 400 mg of MTZ and 500 mg of AMX three times per day for 7 days (MTZ + AMX). Additionally, 17 patients received a placebo, and 17 patients were treated with three applications of aPDT (immediately, 48 h and 96 h after SRP). Clinical and microbiological examinations were performed at baseline and at 90 and 180 days post-therapy. Subgingival samples were analyzed using real-time polymerase chain reaction. After 180 days, the patients in groups MTZ + AMX and aPDT had significantly lower mean probing depths, more clinical attachment level gains and less bleeding on probing. At 180 days, in the moderate pocket there was a reduction in the levels of Porphyromonas gingivalis and Prevotella nigrescens in the MTZ + AMX group, while group aPDT showed a reduction in Prevotella nigrescens. Furthermore, at 180 days, in the deep pocket a reduction in Porphyromonas gingivalis, Prevotella intermedia and Prevotella nigrescens was observed in group MTZ + AMX, as well as a reduction in the levels of Prevotella intermedia and Prevotella nigrescens in group aPDT. In smokers with periodontitis, the MTZ + AMX and aPDT treatments significantly improved the effects of SRP. Copyright © 2018 Elsevier B.V. All rights reserved.

Local oxygen therapy for treating acute necrotizing periodontal disease in smokers.

PubMed

Gaggl, Alexander J; Rainer, Heribert; Grund, Eveline; Chiari, Friedrich M

2006-01-01

The main aim of treatment for acute necrotizing periodontal disease is fast and effective reduction of anaerobic destructive microorganisms to avoid periodontal damage. The effect of adjunctive local oxygen therapy in the treatment of necrotizing periodontal disease was examined in this study. Thirty patients with acute necrotizing periodontal disease were treated with the systemic antibiotics amoxicillin, clavulanic acid, and metronidazole. In 15 out of 30 patients, adjunctive local oxygen therapy was administered. The patients were followed from the first to 10th day of treatment with clinical and bacteriological examinations. The clinical examination registered gingival bleeding, periodontal probing depth, and attachment loss; to follow up microbiological colonization of the periodontal sulcus, five representative bacteria were registered by a semiquantitative DNA polymerase chain reaction test. In both groups of patients, colonization with Prevotella intermedia, Tannerella forsythensis, and Treponema denticola was initially positive. None of these three microorganisms were completely eradicated in any of the patients in the group without oxygen therapy within the first 10 days of treatment. In the group with adjunctive oxygen therapy, all patients either showed a reduction in or complete eradication of the microorganisms, resulting in more rapid clinical restitution with less periodontal destruction. Adjunctive oxygen therapy results in early eradication of pathogenic anaerobic microorganisms in cases of acute necrotizing periodontal disease. The damage to periodontal tissue is reduced.

Gene therapy in periodontics

PubMed Central

Chatterjee, Anirban; Singh, Nidhi; Saluja, Mini

2013-01-01

GENES are made of DNA - the code of life. They are made up of two types of base pair from different number of hydrogen bonds AT, GC which can be turned into instruction. Everyone inherits genes from their parents and passes them on in turn to their children. Every person's genes are different, and the changes in sequence determine the inherited differences between each of us. Some changes, usually in a single gene, may cause serious diseases. Gene therapy is ‘the use of genes as medicine’. It involves the transfer of a therapeutic or working gene copy into specific cells of an individual in order to repair a faulty gene copy. Thus it may be used to replace a faulty gene, or to introduce a new gene whose function is to cure or to favorably modify the clinical course of a condition. It has a promising era in the field of periodontics. Gene therapy has been used as a mode of tissue engineering in periodontics. The tissue engineering approach reconstructs the natural target tissue by combining four elements namely: Scaffold, signaling molecules, cells and blood supply and thus can help in the reconstruction of damaged periodontium including cementum, gingival, periodontal ligament and bone. PMID:23869119

Gene therapy in periodontics.

PubMed

Chatterjee, Anirban; Singh, Nidhi; Saluja, Mini

2013-03-01

GENES are made of DNA - the code of life. They are made up of two types of base pair from different number of hydrogen bonds AT, GC which can be turned into instruction. Everyone inherits genes from their parents and passes them on in turn to their children. Every person's genes are different, and the changes in sequence determine the inherited differences between each of us. Some changes, usually in a single gene, may cause serious diseases. Gene therapy is 'the use of genes as medicine'. It involves the transfer of a therapeutic or working gene copy into specific cells of an individual in order to repair a faulty gene copy. Thus it may be used to replace a faulty gene, or to introduce a new gene whose function is to cure or to favorably modify the clinical course of a condition. It has a promising era in the field of periodontics. Gene therapy has been used as a mode of tissue engineering in periodontics. The tissue engineering approach reconstructs the natural target tissue by combining four elements namely: Scaffold, signaling molecules, cells and blood supply and thus can help in the reconstruction of damaged periodontium including cementum, gingival, periodontal ligament and bone.

Effect of periodontal therapy on serum C-reactive protein levels in patients with gingivitis and chronic periodontitis: a clinicobiochemical study.

PubMed

Patil, Veena A; Desai, Manthan H

2013-03-01

The aim of the present study was to evaluate the effect of periodontal therapy on serum C-reactive protein (CRP) levels in patients with gingivitis and chronic periodontitis. A total of 60 subjects (30 males and 30 females) were included in the study with 20 subjects in each of the groups classified based on community periodontal index (CPI) scores: I: Healthy, II: Gingivitis, III: Mild periodontitis. Periodontal therapy was performed on groups II and III patients. Venous blood was collected from each subject at baseline and 3 months after periodontal therapy. The collected sample was subjected to biochemical analysis to detect CRP levels by using immunoturbidimetric method. The present study demonstrated that the periodontitis group had a higher mean CRP levels (2.49 ± 0.47 ng/ml) as compared to the gingivitis group (1.40 ± 0.32 ng/ml) and healthy group (0.56 ± 0.20 ng/ml). The mean CRP values after periodontal therapy were found to be reduced to 0.44 ± 0.23 ng/ml in group II and 1.30 ± 0.36 ng/ml in group III patients. Within the limitations of this study, it can be concluded that CRP level progressively increases from periodontal health to disease. A decrease in CRP levels with periodontal treatment was also observed. Due to its opsonizing abilities CRP plays an important role in the innate host defence. It can be hypothesized that CRP is a potential biomarker of periodontal disease. A number of studies have reported elevated serum CRP levels in periodontitis subjects. Long standing periodontal disease and raised CRP levels enhance the risk of cardiovascular disease, cerebrovascular accidents and preterm low birth weight infants. There is also evidence that effective periodontal therapy can lower serum CRP levels. However, the data of interventional studies on CRP in gingivitis and periodontitis is scarce.

Periodontal therapy alters gene expression of peripheral blood monocytes

PubMed Central

Papapanou, Panos N.; Sedaghatfar, Michael H.; Demmer, Ryan T.; Wolf, Dana L.; Yang, Jun; Roth, Georg A.; Celenti, Romanita; Belusko, Paul B.; Lalla, Evanthia; Pavlidis, Paul

2009-01-01

Aims We investigated the effects of periodontal therapy on gene expression of peripheral blood monocytes. Methods Fifteen patients with periodontitis gave blood samples at four time points: 1 week before periodontal treatment (#1), at treatment initiation (baseline, #2), 6-week (#3) and 10-week post-baseline (#4). At baseline and 10 weeks, periodontal status was recorded and subgingival plaque samples were obtained. Periodontal therapy (periodontal surgery and extractions without adjunctive antibiotics) was completed within 6 weeks. At each time point, serum concentrations of 19 biomarkers were determined. Peripheral blood monocytes were purified, RNA was extracted, reverse-transcribed, labelled and hybridized with AffymetrixU133Plus2.0 chips. Expression profiles were analysed using linear random-effects models. Further analysis of gene ontology terms summarized the expression patterns into biologically relevant categories. Differential expression of selected genes was confirmed by real-time reverse transcriptase-polymerase chain reaction in a subset of patients. Results Treatment resulted in a substantial improvement in clinical periodontal status and reduction in the levels of several periodontal pathogens. Expression profiling over time revealed more than 11,000 probe sets differentially expressed at a false discovery rate of <0.05. Approximately 1/3 of the patients showed substantial changes in expression in genes relevant to innate immunity, apoptosis and cell signalling. Conclusions The data suggest that periodontal therapy may alter monocytic gene expression in a manner consistent with a systemic anti-inflammatory effect. PMID:17716309

Unilateral severe chronic periodontitis associated with ipsilateral surgical resection of cranial nerves V, VI, and VII.

PubMed

Zavarella, Matthew M; Leblebicioglu, Binnaz; Claman, Lewis J; Tatakis, Dimitris N

2006-01-01

The central and peripheral nervous systems participate in several local physiological and pathological processes. There is experimental evidence that the inflammatory, local immune, and wound healing responses of a tissue can be modulated by its innervation. The aim of this clinical report is to present a case of unilateral severe periodontitis associated with ipsilateral surgical resection of the fifth, sixth, and seventh cranial nerves and to discuss the possible contribution of the nervous system to periodontal pathogenesis. A 39-year-old female patient with a history of a cerebrovascular accident caused by a right pontine arteriovenous malformation and destruction of the right fifth, sixth, and seventh cranial nerves was diagnosed with severe chronic periodontitis affecting only the right maxillary and mandibular quadrants. The patient's oral hygiene was similar for right and left sides of the mouth. Percentages of tooth surfaces carrying dental plaque were 41% and 36% for right and left sides, respectively. Non-surgical and surgical periodontal therapy was performed, and the patient was placed on a regular periodontal maintenance schedule. Healing following initial periodontal therapy and osseous periodontal surgery occurred without complications. Follow-up clinical findings at 1 year revealed stable periodontal health. This case report suggests that periodontal innervation may contribute to the regulation of local processes involved in periodontitis pathogenesis. It also suggests that periodontal therapy can be performed successfully at sites and in patients affected by paralysis.

Periodontal therapy for the management of cardiovascular disease in patients with chronic periodontitis.

PubMed

Li, Chunjie; Lv, Zongkai; Shi, Zongdao; Zhu, Ye; Wu, Yafei; Li, Longjiang; Iheozor-Ejiofor, Zipporah

2014-08-15

There is an association between chronic periodontitis and cardiovascular disease (CVD). However, it is not known whether periodontal therapy could prevent or manage CVD in patients with chronic periodontitis. The objective of this systematic review was to investigate the effects of periodontal therapy in preventing the occurrence of, and management or recurrence of, CVD in patients with chronic periodontitis. The electronic databases that were searched were the Cochrane Oral Health Group's Trials Register (to 7 April 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 3), MEDLINE via OVID (1946 to 7 April 2014), EMBASE via OVID (1980 to 7 April 2014), CINAHL via EBSCO (1937 to 7 April 2014), OpenGrey (to 7 April 2014), the Chinese BioMedical Literature Database (1978 to April 2014), the China National Knowledge Infrastructure (1994 to April 2014) and the VIP database (1989 to April 2014). We searched the US National Institutes of Health Trials Register, the World Health Organization (WHO) Clinical Trials Registry Platform and Sciencepaper Online for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. Randomised controlled trials (RCTs) and quasi-RCTs were considered eligible. Studies were selected if they included patients with a diagnosis of chronic periodontitis and previous CVD (secondary prevention studies) or no CVD (primary prevention studies); patients in the intervention group received active periodontal therapy compared to maintenance therapy, no periodontal treatment or another kind of periodontal treatment in the control group. Two review authors carried out the study identification, data extraction and risk of bias assessment independently and in duplicate. Any discrepancies between the two authors were resolved by discussion or with a third review author. A formal pilot-tested data extraction form was adopted for the data extraction

Influence of Periodontal Therapy on Systemic Lipopolysaccharides in Children with Localized Aggressive Periodontitis.

PubMed

Kalash, D; Vovk, A; Huang, H; Aukhil, I; Wallet, S M; Shaddox, L M

2015-01-01

A previous study has shown that children with localized aggressive periodontitis (LAP) demonstrate a lipopolysaccharide (LPS) hyper-responsiveness in addition to elevated levels of systemic LPS when compared to periodontally healthy children. The purpose of this study was to evaluate whether periodontal therapy modulates systemic lipopolysaccharide levels and whether these levels may influence clinical outcomes. Peripheral blood samples and clinical parameters (probing depth [PD], clinical attachment levels [CAL], percent sites greater than four mm, bleeding on probing [BoP], and visible plaque [P]) were collected from 29 LAP patients prior to and at three, six, and 12 months following scaling and root planning and systemic antibiotics. Serum LPS levels were quantified using a chromogenic assay. Twenty-five patients were compliant with the prescribed antibiotic treatment and demonstrated a significant reduction in LPS as well as overall PD, CAL, and plaque at all time points post-therapy. Additionally LPS reductions correlated with reductions in PD, CAL, and plaque. Localized aggressive periodontitis therapy with antibiotics plays an important role in reducing systemic lipopolysaccharide levels. Since LPS is a key mediator of the LAP hyperinflammatory response, its systemic reduction is especially important for the successful management of these children.

Antibiotics/antimicrobials: systemic and local administration in the therapy of mild to moderately advanced periodontitis.

PubMed

Jepsen, Karin; Jepsen, Søren

2016-06-01

This review gives an update of the current scientific evidence on the efficacy of the adjunctive use of systemic and local antibiotics/antimicrobials in the treatment of periodontitis. In particular, it addresses whether their use can improve the results of nonsurgical mechanical therapy in mild-to-moderate forms of the disease. Large numbers of randomized clinical trials and systematic reviews with meta-analyses have clearly established that adjunctive systemic antibiotics, combined with mechanical debridement, offer clinical improvements additional to those obtained with scaling and root planing alone. These effects are more pronounced in aggressive periodontitis and in initially deep pockets, whereas more limited additional improvements, of 0.3 mm for additional pocket reduction and 0.2 mm for additional clinical attachment gain, have been documented for moderately deep sites (4-6 mm) in patients with chronic periodontitis. The marginal clinical benefit in patients with moderate disease has to be balanced against possible side effects. Notably, it has to be realized that an increasing number of warnings have been articulated against the unrestricted use of antibiotics in treating periodontal diseases because of the emerging global public health issue of bacterial resistance. The effects of the adjunctive local administration of antimicrobials have also been very well documented in several systematic reviews. Overall, in persistent or recurrent localized deep sites, the application of antimicrobials by sustained-delivery devices may offer a benefit of an additional 0.4 mm in pocket depth reduction and 0.3 mm in clinical attachment level gain. In conclusion, the slight additional benefits of adjunctive antimicrobials, which were shown for moderate forms of periodontitis, have to be balanced against their side effects and therefore their prescription should be limited as much as possible. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

12 years' preservation of maxillary permanent incisors with cervical root fractures adjacent to aggressive periodontitis: Report of a case.

PubMed

Tobiska, Sandra; Krastl, Gabriel

2018-05-17

This case report presents long-term results following horizontal root fracture of both maxillary central incisors in a 19-year-old woman with aggressive periodontitis. Due to extensive marginal bone loss and the close proximity of the fracture lines to the bottoms of the periodontal pockets, the prognosis of both teeth was uncertain at the time of the accident. Nevertheless, a conservative treatment strategy consisting of splinting and nonsurgical periodontal therapy was initiated. Follow-up at 12 years after the start of treatment revealed a stable situation from clinical and radiologic perspectives. Permanent fixation to the adjacent teeth and regular supportive periodontal care were the basis for a favorable long-term prognosis.

Effect of intensive oral hygiene regimen during pregnancy on periodontal health, cytokine levels, and pregnancy outcomes: a pilot study.

PubMed

Kaur, Maninder; Geisinger, Maria L; Geurs, Nicolaas C; Griffin, Russell; Vassilopoulos, Philip J; Vermeulen, Lisa; Haigh, Sandra; Reddy, Michael S

2014-12-01

Data are limited on the potential effect of intensive oral hygiene regimens and periodontal therapy during pregnancy on periodontal health, gingival crevicular fluid (GCF) and serum cytokines, and pregnancy outcomes. A clinical trial was conducted on 120 community-dwelling, 16- to 35-year-old pregnant women at 16 to 24 weeks of gestation. Each participant presented with clinical evidence of generalized, moderate-to-severe gingivitis. Oral hygiene products were provided, together with instructions for an intensive daily regimen of hygiene practices. Non-surgical therapy was provided at baseline. Oral examinations were completed at baseline and again at 4 and 8 weeks. In addition, samples of blood and GCF were collected at baseline and week 8. Mean changes in clinical variables and GCF and serum cytokine levels (interleukin [IL]-1β, IL-6, tumor necrosis factor [TNF]-α) between baseline and week 8 were calculated using paired t test. Pregnancy outcomes were recorded at parturition. RESULTS indicated a statistically significant reduction in all clinical variables (P <0.0001) and decreased levels of TNF-α (P = 0.0076) and IL-1β (P = 0.0098) in GCF during the study period. The rate of preterm births (<37 weeks of gestation) was 6.7% (P = 0.113) and low birth weight (<2,500 g) was 10.2% (P = 1.00). Among the population studied, intensive instructions and non-surgical periodontal therapy provided during 8 weeks at early pregnancy resulted in decreased gingival inflammation and a generalized improvement in periodontal health. Large-scale, randomized, controlled studies are needed to substantiate these findings.

Oxidative Stress and Antioxidants in the Diagnosis and Therapy of Periodontitis

PubMed Central

Tóthová, L'ubomíra; Celec, Peter

2017-01-01

Oxidative stress has been implicated in the pathogenesis of numerous diseases. However, large interventional studies with antioxidants failed to show benefits in the prevention or treatment of cardiovascular diseases, cancer, or diabetes mellitus. Numerous clinical studies have confirmed the association of oxidative stress markers and periodontitis. Technical and biological variability is high for most of the analyzed markers and none of them seems to be optimal for routine clinical use. In a research setting, analysis of a palette of oxidative stress markers is needed to cover lipid peroxidation, protein oxidation, and the antioxidant status. The source of reactive oxygen species and their role in the pathogenesis of periodontitis remains unclear. Interventional experiments indicate that oxidative stress might be more than just a simple consequence of the inflammation. Small studies have confirmed that some antioxidants could have therapeutic value at least as an addition to the standard non-surgical treatment of periodontitis. A clear evidence for the efficiency of antioxidant treatment in large patient cohorts is lacking. Potentially, because lowering of oxidative stress markers might be a secondary effect of anti-inflammatory or antibacterial agents. As the field of research of oxidative stress in periodontitis gains attraction and the number of relevant published papers is increasing a systematic overview of the conducted observational and interventional studies is needed. This review summarizes the currently available literature linking oxidative stress and periodontitis and points toward the potential of adjuvant antioxidant treatment, especially in cases where standard treatment fails to improve the periodontal status. PMID:29311982

Non-surgical periodontal treatment of peri-implant diseases with the adjunctive use of diode laser: preliminary clinical study.

PubMed

Lerario, Francesco; Roncati, Marisa; Gariffo, Annalisa; Attorresi, Enrica; Lucchese, Alessandra; Galanakis, Alexandros; Palaia, Gaspare; Romeo, Umberto

2016-01-01

Peri-implant diseases present in two forms: peri-implant mucositis and peri-implantitis. The prevalence of peri-implant complications is significantly rising. The aim of this study was to compare conventional treatment of inflamed peri-implant tissues with conventional treatment together with diode laser application. Twenty-seven patients (age 36 to 67, 15 women and 12 men, 12 smokers and 15 non-smokers) requiring treatment for mucositis or peri-implantitis were taken into account for this preliminary study. Plaque index (PI), pocket depth (PD), and bleeding on probing (BoP) were recorded at baseline evaluation. Patients in control group (CG) received conventional non-surgical periodontal treatment. Patients in test group received conventional non-surgical periodontal treatment together with diode laser application (810 nm, 30 s, 1 W, 50 Hz, t on = 100 ms, t off = 100 ms, energy density = 24.87 J/cm(2)). Paired t test was used to evaluate the difference in repeated measurements of considered indexes at T 0 and T 1 (1 year) in both groups. A total of 606 sites were taken into account in the test group (TG) and 144 in the CG. PD mean variation in the TG was 2.66 mm ± 1.07, while mean PD variation in the CG was 0.94 ± 1.13 mm. Paired t testing of the variation in PD in CG and TG revealed a statistically significant difference between the two groups (p < 0.0001). A reduction of pathological sites from 89 % (T 0) to 14.35 % (T 1) was achieved in the TG, while reduction obtained in the CG was from 75.69 % (T 0) to 50 % (T 1); BoP scores at time T 1 had fallen below 5 % in the TG and decreased to 59.7 %, in the CG. Within the limitations of this study, diode laser seems to be an additional valuable tool for peri-implant disease treatment.

Zinc plus octenidine: a new formulation for treating periodontal pathogens. A single blind study.

PubMed

Lauritano, D; Candotto, V; Bignozzi, C A; Pazzi, D; Carinci, F; Cura, F; Tagliabue, A; Tettamanti, L

2018-01-01

Periodontal treatment has the aim to reduce oral infection, and prevent the progression of the disease. The potential benefits of new chemical devices for periodontal therapy, include improved patient compliance, an easier access to periodontal pocket and a lower dosage of antimicrobial agent. The objective of this study was to explore the efficacy of a chemical device containing zinc and octenidine in the treatment of chronic periodontitis in adult patients. Ten patients with a diagnosis of chronic periodontitis (20 localized chronic periodontitis sites) in the age group of 35 to 55 were selected. None of these patients received any surgical or non-surgical periodontal therapy and demonstrated radiographic evidence of moderate bone loss. The chemical device zinc plus octenedine was used by each patient after daily oral hygiene. Microbial analysis were analyzed at baseline and on the 15th day. After the treatment, a remarkable decrease in bacteria amount, both for some species and for the total count was observed in the study group. Specifically T. Forsythia and T. Denticola were eradicated whereas Total Bacteria Loading and Fusobacterium Nucleatum showed a reduction of 38% and 55%, respectively. Our study demonstrated the efficacy of the new chemical device containing zinc and octenidine in a sustained release drug delivery system in the management of moderate to severe chronic periodontitis.

Periodontal ligament injection versus routine local infiltration for nonsurgical single posterior maxillary permanent tooth extraction: comparative double-blinded randomized clinical study.

PubMed

Al-Shayyab, Mohammad H

2017-01-01

The aim of this study was to evaluate the efficacy of, and patients' subjective responses to, periodontal ligament (PDL) anesthetic injection compared to traditional local-anesthetic infiltration injection for the nonsurgical extraction of one posterior maxillary permanent tooth. All patients scheduled for nonsurgical symmetrical maxillary posterior permanent tooth extraction in the Department of Oral and Maxillofacial Surgery at the University of Jordan Hospital, Amman, Jordan over a 7-month period were invited to participate in this prospective randomized double-blinded split-mouth study. Every patient received the recommended volume of 2% lidocaine with 1:100,000 epinephrine for PDL injection on the experimental side and for local infiltration on the control side. A visual analog scale (VAS) and verbal rating scale (VRS) were used to describe pain felt during injection and extraction, respectively. Statistical significance was based on probability values <0.05 and measured using χ 2 and Student t -tests and nonparametric Mann-Whitney and Kruskal-Wallis tests. Of the 73 patients eligible for this study, 55 met the inclusion criteria: 32 males and 23 females, with a mean age of 34.87±14.93 years. Differences in VAS scores and VRS data between the two techniques were statistically significant ( P <0.001) and in favor of the infiltration injection. The PDL injection may not be the alternative anesthetic technique of choice to routine local infiltration for the nonsurgical extraction of one posterior maxillary permanent tooth.

Periodontal ligament injection versus routine local infiltration for nonsurgical single posterior maxillary permanent tooth extraction: comparative double-blinded randomized clinical study

PubMed Central

Al-Shayyab, Mohammad H

2017-01-01

Aim The aim of this study was to evaluate the efficacy of, and patients’ subjective responses to, periodontal ligament (PDL) anesthetic injection compared to traditional local-anesthetic infiltration injection for the nonsurgical extraction of one posterior maxillary permanent tooth. Materials and methods All patients scheduled for nonsurgical symmetrical maxillary posterior permanent tooth extraction in the Department of Oral and Maxillofacial Surgery at the University of Jordan Hospital, Amman, Jordan over a 7-month period were invited to participate in this prospective randomized double-blinded split-mouth study. Every patient received the recommended volume of 2% lidocaine with 1:100,000 epinephrine for PDL injection on the experimental side and for local infiltration on the control side. A visual analog scale (VAS) and verbal rating scale (VRS) were used to describe pain felt during injection and extraction, respectively. Statistical significance was based on probability values <0.05 and measured using χ2 and Student t-tests and nonparametric Mann–Whitney and Kruskal–Wallis tests. Results Of the 73 patients eligible for this study, 55 met the inclusion criteria: 32 males and 23 females, with a mean age of 34.87±14.93 years. Differences in VAS scores and VRS data between the two techniques were statistically significant (P<0.001) and in favor of the infiltration injection. Conclusion The PDL injection may not be the alternative anesthetic technique of choice to routine local infiltration for the nonsurgical extraction of one posterior maxillary permanent tooth. PMID:29070950

[Complex treatment of chronic periodontitis with balneopeloid therapy].

PubMed

Leonova, L E; Smelova, L Z; Pavlova, G A; Chernyshova, L E

2013-01-01

Complex investigation and treatment has been realized on 127 patients aged from 27 to 45 years with chronic generalized periodontitis. Patients were divided into two groups. In the fist group (68 patients) complex treatment included course of balneopeloid therapy with irrigation of high mineralized natural water (sanatorium "Tumentransgas" chink №1-95, Ugorsk) followed by application of sapropel mud (the Pake lake). The second group (59 patients) received only conventional periodontal treatment. Positive effect of balneopeloid therapy was identified, which was reflected in stabilizations of pathological process in the periodontal tissues in 78% of patients, as well as changes in physical and chemical properties of the oral gluid. Also the number of periodontopahogenic germs of gingival pockets was decreased.

Neutrophil hyper-responsiveness in periodontitis.

PubMed

Matthews, J B; Wright, H J; Roberts, A; Ling-Mountford, N; Cooper, P R; Chapple, I L C

2007-08-01

Peripheral neutrophil hyper-responsiveness in chronic periodontitis leads to excessive reactive oxygen species (ROS) production. We aimed to determine whether neutrophil hyper-responsiveness was constitutive or reactive, and to discover the effect of non-surgical therapy. Peripheral blood neutrophils from patients (n = 19), before and 3 months after therapy, and matched control individuals were Fc gamma-receptor-stimulated with/without priming with P. gingivalis and F. nucleatum. Total and extracellular ROS were determined by luminol/isoluminol chemiluminescence. The high total ROS generation of patients' neutrophils compared with that of control individuals (P = 0.016) continued at a reduced level post-therapy (P = 0.059). Reduced activity post-therapy was also seen with priming. Unstimulated total ROS levels did not differ between patients and control individuals before or after therapy. However, the high unstimulated, extracellular ROS production by patients' neutrophils compared with control individuals (P < 0.05) continued post-therapy and was unaffected by priming. Therapy reduced Fc gamma-receptor-stimulated total ROS production, but not unstimulated extracellular radical release, suggesting that constitutive and reactive mechanisms underlie neutrophil hyper-responsiveness.

Supportive periodontal therapy and periodontal biotype as prognostic factors in implants placed in patients with a history of periodontitis.

PubMed

Aguirre-Zorzano, Luis-Antonio; Vallejo-Aisa, Francisco-Javier; Estefanía-Fresco, Ruth

2013-09-01

To evaluate bone loss around implants placed in patients with a history of treated chronic periodontitis and who did or did not attend supportive periodontal therapy, after one year in function. Furthermore, the influence of periodontal biotype and level of plaque was also evaluated. Forty-nine patients participated voluntarily in the study. All subjects had a history of chronic periodontitis, which had been previously treated. After the active treatment, 27 patients attended supportive periodontal therapy (SPT) and the rest did not (No SPT). The O'Leary plaque index and periodontal biotype were recorded for each subject and 246 Astra Tech® OsseospeedTM implants were radiographically analysed (123 placed in SPT patients and 123 in No SPT patients) at the time of loading and one year later, measuring marginal bone loss with the program Dental Studio NX 6.0®. The statistical analysis was performed with Windows SPSS, applying Pearson's correlation index and the Kruskal-Wallis and U-Mann Whitney non-parametric tests. Six patients were found to have periimplantitis and sixteen mucositis. The survival rate was 99.59% (100% SPT and 99.18% No SPT). Mean bone loss was 0.39 mm (range [-0.71 - 8.05]). Among SPT patients, 95% of the implants had losses less than or equal to the mean (mean bone loss of 0.16 mm) compared to 53.7% for the No SPT group (mean bone loss of 0.62 mm). A statistically significant relationship was demonstrated between bone loss around the implant and the patient's periodontal biotype and plaque index. The marginal bone loss around implants in patients with treated chronic periodontitis is minimal if they are in a controlled SPT programme and there is individual control of plaque index. Moreover, the presence of a thin periodontal biotype represents a risk factor for additional bone loss.

Effect of Intensive Oral Hygiene Regimen During Pregnancy on Periodontal Health, Cytokine Levels, and Pregnancy Outcomes: A Pilot Study

PubMed Central

Kaur, Maninder; Geisinger, Maria L.; Geurs, Nicolaas C.; Griffin, Russell; Vassilopoulos, Philip J.; Vermeulen, Lisa; Haigh, Sandra; Reddy, Michael S.

2015-01-01

Background Data are limited on the potential effect of intensive oral hygiene regimens and periodontal therapy during pregnancy on periodontal health, gingival crevicular fluid (GCF) and serum cytokines, and pregnancy outcomes. Methods A clinical trial was conducted on 120 community-dwelling, 16- to 35-year-old pregnant women at 16 to 24 weeks of gestation. Each participant presented with clinical evidence of generalized, moderate-to-severe gingivitis. Oral hygiene products were provided, together with instructions for an intensive daily regimen of hygiene practices. Non-surgical therapy was provided at baseline. Oral examinations were completed at baseline and again at 4 and 8 weeks. In addition, samples of blood and GCF were collected at baseline and week 8. Mean changes in clinical variables and GCF and serum cytokine levels (interleukin [IL]-1β, IL-6, tumor necrosis factor [TNF]-α) between baseline and week 8 were calculated using paired t test. Pregnancy outcomes were recorded at parturition. Results Results indicated a statistically significant reduction in all clinical variables (P <0.0001) and decreased levels of TNF-α (P = 0.0076) and IL-1β (P = 0.0098) in GCF during the study period. The rate of preterm births (<37 weeks of gestation) was 6.7% (P = 0.113) and low birth weight (<2,500 g) was 10.2% (P = 1.00). Conclusions Among the population studied, intensive instructions and non-surgical periodontal therapy provided during 8 weeks at early pregnancy resulted in decreased gingival inflammation and a generalized improvement in periodontal health. Large-scale, randomized, controlled studies are needed to substantiate these findings. PMID:25079400

The effect of the duration of intravenous zolendronate medication on the success of non-surgical endodontic therapy: a retrospective study.

PubMed

Dereci, Ömür; Orhan, Ekim Onur; Irmak, Özgür; Ay, Sinan

2016-02-01

Aim of this study is to compare the clinical and radiographic success of non-surgical endodontic therapy in patients receiving intravenous zolendronate less than 1 year and more than 1 year. The clinical and radiographic follow-up data of 24 patients who were receiving IV zolendronate with 37 teeth were retrieved from the archives to evaluate clinical and radiographic healing at the end of 12 months after non-surgical endodontic therapy. The clinical and radiographic scores of teeth treated with non-surgical endodontic therapy were analyzed. The amount of non-healed and incomplete healed teeth in patients receiving zolendronate more than 1 year were more than the amount of teeth of non-healed and incomplete healed in patients receiving bisphosphonates less than 1 year (p <0.05). There was a strong relationship between the duration of the bisphosphonate medication and endodontic success.

Effect of surgical periodontal treatment associated to antimicrobial photodynamic therapy on chronic periodontitis: A randomized controlled clinical trial.

PubMed

Martins, Sérgio H L; Novaes, Arthur B; Taba, Mario; Palioto, Daniela B; Messora, Michel R; Reino, Danilo M; Souza, Sérgio L S

2017-07-01

This randomized controlled clinical trial evaluated the effects of an adjunctive single application of antimicrobial photodynamic therapy (aPDT) in Surgical Periodontal Treatment (ST) in patients with severe chronic periodontitis (SCP). In a split-mouth design, 20 patients with SCP were treated with aPDT+ST (Test Group, TG) or ST only (Control Group, CG). aPDT was applied in a single episode, using a diode laser and a phenothiazine photosensitizer. All patients were monitored until 90 days after surgical therapy. Levels of 40 subgingival species were measured by checkerboard DNA-DNA hybridization at baseline, 60 and 150 days. Clinical and microbiological parameters were evaluated. In deep periodontal pockets depth (PPD ≥5 mm), Test Group presented a significantly higher decrease in PPD than Control Group at 90 days after surgical therapy (p < .05). Test Group also demonstrated significantly less periodontal pathogens of red complex (Treponema denticola) (p < .05). A single episode of aPDT used in adjunct to open flap debridement of the root surface in the surgical treatment of SCP: i) significantly improved clinical periodontal parameters; ii) eliminates periodontal pathogens of the red complex more effectively (NCT02734784). © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Gene therapy with growth factors for periodontal tissue engineering–A review

PubMed Central

Gupta, Shipra; Mahendra, Aneet

2012-01-01

The treatment of oral and periodontal diseases and associated anomalies accounts for a significant proportion of the healthcare burden, with the manifestations of these conditions being functionally and psychologically debilitating. A challenge faced by periodontal therapy is the predictable regeneration of periodontal tissues lost as a consequence of disease. Growth factors are critical to the development, maturation, maintenance and repair of oral tissues as they establish an extra-cellular environment that is conducive to cell and tissue growth. Tissue engineering principles aim to exploit these properties in the development of biomimetic materials that can provide an appropriate microenvironment for tissue development. The aim of this paper is to review emerging periodontal therapies in the areas of materials science, growth factor biology and cell/gene therapy. Various such materials have been formulated into devices that can be used as vehicles for delivery of cells, growth factors and DNA. Different mechanisms of drug delivery are addressed in the context of novel approaches to reconstruct and engineer oral and tooth supporting structure. Key words: Periodontal disease, gene therapy, regeneration, tissue repair, growth factors, tissue engineering. PMID:22143705

Lemongrass essential oil gel as a local drug delivery agent for the treatment of periodontitis

PubMed Central

Warad, Shivaraj B.; Kolar, Sahana S.; Kalburgi, Veena; Kalburgi, Nagaraj B.

2013-01-01

Background: It has been long recognized that periodontal diseases are infections of the periodontium, comprising the bacterial etiology, an immune response, and tissue destruction. Treatment strategies aiming primarily at suppressing or eliminating specific periodontal pathogens include adjunct use of local and systemic antibiotics as part of nonsurgical periodontal therapy. Unwanted side effects and resistance of microorganisms toward antibiotics due to their widespread use have modified the general perception about their efficacy. Research in phytosciences has revealed various medicinal plants offering a new choice of optional antimicrobial therapy. Cymbopogon citratus, Stapf. (lemongrass) is a popular medicinal plant. At a concentration ≤2%, lemongrass essential oil inhibits the growth of several kinds of microorganisms including periodontal pathogens, especially the reference strains Actinomyces naeslundii and Porphyromonas gingivalis, which were resistant to tetracycline hydrochloride. Aims: To evaluate the efficacy of locally delivered 2% lemongrass essential oil in gel form as an adjunct to scaling and root planing, as compared to scaling and root planing alone for the treatment of chronic periodontitis. Materials and Methods: 2% Lemongrass essential oil gel was prepared and placed in moderate to deep periodontal pockets after scaling and root planing. Results: Statistically significant reduction in probing depth and gingival index and gain in relative attachment level were noted in the experimental group as compared to the control group at 1 and 3 months. Conclusion: Locally delivered 2% lemongrass essential oil gel offers a new choice of safe and effective adjunct to scaling and root planing in periodontal therapy. PMID:24991068

Commentary: Is There Clinical Benefit From Using a Diode or Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Periodontitis?

PubMed

Cobb, Charles M

2016-10-01

Despite a quarter of a century of laser research, there is a persistent debate regarding the efficacy of dental lasers in the treatment of periodontitis or periodontal maintenance therapy. There are many claims and much hyperbole surrounding the use of lasers, either as a monotherapy or adjunctive to scaling and root planing, to treat periodontitis. There is little evidence that using a diode or neodymium:yttrium-aluminum-garnet laser adds clinical value over and above conventional non-surgical or surgical periodontal treatment. There is a significant need for better designed human clinical trials. Data from such trials should be analyzed according to initial probing depth and characteristics of the treated sites, such as non-molar, molar flat surfaces, and molar furcations, and evaluated for long-term post-treatment results.

Natural History of Periodontitis and a Review of Technologies to Prevent and Treat It.

ERIC Educational Resources Information Center

Antczak-Bouckoms, Alexia

1994-01-01

The classification scheme for periodontal diseases developed in 1989 is discussed, and technologies, both surgical and nonsurgical, for prevention, control, and regeneration of periodontal tissues are described and compared. Research needs are discussed. (MSE)

Effect of periodontal therapy on C-reactive protein levels in gingival crevicular fluid of patients with gingivitis and chronic periodontitis: A clinical and biochemical study.

PubMed

Jayaprakash, Deepika; Aghanashini, Suchetha; Vijayendra, Ranganatha Rao; Chatterjee, Anirban; Rosh, Radhika Mohan; Bharwani, Ashit

2014-07-01

C-reactive protein (CRP) is a type I acute phase reactant. A number of studies have reported elevated serum CRP levels in periodontitis subjects, which decrease following periodontal therapy. However, the data of interventional studies on gingival crevicular fluid (GCF) levels of CRP is very scarce. The aim of the present study was to evaluate the effect of periodontal therapy on GCF CRP levels in patients with gingivitis and chronic periodontitis. A total of 60 subjects were included in the study with 20 subjects each in following groups: I-Healthy, II-Gingivitis, III-Mild periodontitis based on community periodontal index scores. Periodontal therapy was performed on Group II and Group III patients. GCF was collected from each subject at baseline and 3 months after periodontal therapy. The collected sample was subjected to biochemical analysis to detect CRP levels by using commercially available chemiluminescence immunoassay kit. The present study demonstrated that the periodontitis group had a higher mean CRP level (2.49 ± 0.47 ng/ml) when compared with the Gingivitis group (1.40 ± 0.32 ng/ml) and Healthy group (0.56 ± 0.20 ng/ml). The mean CRP values after periodontal therapy were found to be reduced to 0.44 ± 0.23 ng/ml in Group II and 1.30 ± 0.36 ng/ml in Group III patients. Within the limitations of this study, it can be concluded that GCF CRP level progressively increases from periodontal health to disease. It can also be stated that there is a decrease in GCF CRP levels with periodontal treatment.

Determining the relationship between atherosclerosis and periodontopathogenic microorganisms in chronic periodontitis patients.

PubMed

Bozoglan, Alihan; Ertugrul, Abdullah Seckin; Taspınar, Mehmet; Yuzbasioglu, Betul

2017-05-01

The aim of this study is to determine the relationship between atherosclerosis and periodontopathogenic microorganisms in chronic periodontitis patients following periodontal treatment. A total of 40 patients were included in the study. 20 of these patients diagnosed with atherosclerosis and chronic periodontitis formed the test group. The remaining 20 patients were systemically healthy patients diagnosed with chronic periodontitis and formed the control group. All patients had nonsurgical periodontal treatment. The periodontopathogenic microorganism levels were determined at baseline and at 6 months in microbial dental plaque samples and WBC, LDL, HDL, PLT, fibrinogen, creatinine and hs-CRP levels were determined by blood samples. Statistically significant reduction has been achieved in clinical periodontal parameters following non-surgical periodontal treatment in test and control groups. Following periodontal treatment, WBC, LDL, PLT, fibrinogen, creatinine and hs-CRP levels significantly decreased and HDL levels significantly increased in both test and control groups. Similarly, the periodontopathogenic microorganism levels significantly decreased following periodontal treatment in the test and control groups. A statistically significant positive correlation has been determined between the periodontopathogenic microorganism levels and WBC, LDL, PLT, fibrinogen, creatinine, and hs-CRP levels in the test group. The association between hs-CRP, WBC, LDL, PLT, fibrinogen, creatinine, and the amount of periodontopathogenic microorganisms indicates the possibility that periodontal treatment could decrease the risk atherosclerosis. More studies must be conducted in order for these results to be supported.

PDT in non-surgical treatment of periodontitis in kidney transplanted patients: a split-mouth, randomized clinical trial

NASA Astrophysics Data System (ADS)

Marinho, Kelly C. T.; Giovani, Elcio M.

2016-03-01

This study was to evaluate clinical and microbiological effectiveness of photodynamic therapy (PDT) in the treatment of periodontal disease in kidney-transplanted patients. Eight kidney transplanted patients treated at Paulista University were arranged in two groups: SRP performed scaling and root planning by ultrasound; SRP+PDT- in the same patient, which was held to PDT in the opposite quadrant, with 0.01% methylene blue and red laser gallium aluminum arsenide, wavelength 660 nm, power 100 mW. There was reduction in probing pocket depth after 45 days and 3 months regardless the group examined; plaque and bleeding index showed improvement over time, regardless the technique used, and bleeding index in the SRP+PDT group was lower when compared with the baseline the other times. There was no difference in the frequency of pathogens. Photodynamic therapy may be an option for treatment of periodontal disease in renal-transplanted patients and its effectiveness is similar to conventional therapy.

The effect of periodontal treatment on C-reactive protein: A clinical study.

PubMed

Kumar, Santosh; Shah, Samir; Budhiraja, Shilpa; Desai, Khushboo; Shah, Chirag; Mehta, Dhaval

2013-07-01

Chronic periodontitis in amultifactorial inflammatory disease which is caused by various microorganisms. Many studies have found close association between chronic periodontitis and C-reactive protein (CRP). CRPis an inflammatory marker which increases in all inflammatory condition. The present clinical study was designed to show the effect of periodontal treatment on the CRP levels of gingival crevicular fluid and to determine the effect of nonsurgical therapy in minimizing the CRP levels in chronic generalized periodontitis. Gingival crevicular fluid was collected using a micro capillary pipette that was hand calibrated at every 1 mm till 10 mm, from selected sites in the subjects on the 1st, 14th and 45th days. Decreased CRP levels of gingival crevicular fluid were observed at the end of the study. There was a 37% reduction in probing pocket depth and 45% gain in clinical attachment level and a reduction of about 57% after 14 days and 90% reduction of CRP levels in gingival crevicular fluid after 45 days. Thus, the results show that the presence of CRP level is more significant in gingival crevicular fluid and confirms the underlying inflammatory component of the disease activity in chronic periodontitis.

Influence of periodontal treatment on rheumatoid arthritis: a systematic review and meta-analysis.

PubMed

Calderaro, Débora Cerqueira; Corrêa, Jôice Dias; Ferreira, Gilda Aparecida; Barbosa, Izabela Guimarães; Martins, Carolina Castro; Silva, Tarcília Aparecida; Teixeira, Antônio Lúcio

To evaluate the influence of periodontal treatment on rheumatoid arthritis activity. MEDLINE/PUBMED, The Cochrane Library, Clinical Trials, SciELO and LILACS were searched for studies published until December 2014. Included articles were: prospective studies; including patients older than 18 years, diagnosed with periodontitis and rheumatoid arthritis submitted to non-surgical periodontal treatment; with a control group receiving no periodontal treatment; with outcomes including at least one marker of rheumatoid arthritis activity. Methodological quality of the studies was assessed using PEDro scale. Quantitative data were pooled in statistical meta-analysis using Review Manager 5. Four articles were included. Non-surgical periodontal treatment was associated with a significant reduction of DAS28 (OR: -1.18; 95% CI: -1.43, -0.93; p<0.00001). Erythrocyte sedimentation rate, C-reactive protein, patient's assessment of rheumatoid activity using visual analogical scale, tender and swollen joint counts showed a trend toward reduction (not statistically significant). The reduction of DAS 28 in patients with rheumatoid arthritis after periodontal treatment suggests that the improvement of periodontal condition is beneficial to these patients. Further randomized controlled clinical trials are necessary to confirm this finding. Copyright © 2016. Published by Elsevier Editora Ltda.

Influence of periodontal treatment on rheumatoid arthritis: a systematic review and meta-analysis.

PubMed

Calderaro, Débora Cerqueira; Corrêa, Jôice Dias; Ferreira, Gilda Aparecida; Barbosa, Izabela Guimarães; Martins, Carolina Castro; Silva, Tarcília Aparecida; Teixeira, Antônio Lúcio

2016-11-26

To evaluate the influence of periodontal treatment on rheumatoid arthritis activity. MEDLINE/PUBMED, The Cochrane Library, Clinical Trials, SciELO and LILACS were searched for studies published until December 2014. Included articles were: prospective studies; including patients older than 18 years, diagnosed with periodontitis and rheumatoid arthritis submitted to non-surgical periodontal treatment; with a control group receiving no periodontal treatment; with outcomes including at least one marker of rheumatoid arthritis activity. Methodological quality of the studies was assessed using PEDro scale. Quantitative data were pooled in statistical meta-analysis using Review Manager 5. Four articles were included. Non-surgical periodontal treatment was associated with a significant reduction of DAS28 (OR: -1.18; 95% CI: -1.43, -0.93; p <0.00001). Erythrocyte sedimentation rate, C-reactive protein, patient's assessment of rheumatoid activity using visual analogical scale, tender and swollen joint counts showed a trend towards reduction (not statistically significant). The reduction of DAS 28 in patients with rheumatoid arthritis after periodontal treatment suggests that the improvement of periodontal condition is beneficial to these patients. Further randomized controlled clinical trials are necessary to confirm this finding. Copyright © 2016. Published by Elsevier Editora Ltda.

Effect of periodontal therapy on C-reactive protein levels in gingival crevicular fluid of patients with gingivitis and chronic periodontitis: A clinical and biochemical study

PubMed Central

Jayaprakash, Deepika; Aghanashini, Suchetha; Vijayendra, Ranganatha Rao; Chatterjee, Anirban; Rosh, Radhika Mohan; Bharwani, Ashit

2014-01-01

Background and Objectives: C-reactive protein (CRP) is a type I acute phase reactant. A number of studies have reported elevated serum CRP levels in periodontitis subjects, which decrease following periodontal therapy. However, the data of interventional studies on gingival crevicular fluid (GCF) levels of CRP is very scarce. The aim of the present study was to evaluate the effect of periodontal therapy on GCF CRP levels in patients with gingivitis and chronic periodontitis. Materials and Methods: A total of 60 subjects were included in the study with 20 subjects each in following groups: I-Healthy, II-Gingivitis, III-Mild periodontitis based on community periodontal index scores. Periodontal therapy was performed on Group II and Group III patients. GCF was collected from each subject at baseline and 3 months after periodontal therapy. The collected sample was subjected to biochemical analysis to detect CRP levels by using commercially available chemiluminescence immunoassay kit. Results: The present study demonstrated that the periodontitis group had a higher mean CRP level (2.49 ± 0.47 ng/ml) when compared with the Gingivitis group (1.40 ± 0.32 ng/ml) and Healthy group (0.56 ± 0.20 ng/ml). The mean CRP values after periodontal therapy were found to be reduced to 0.44 ± 0.23 ng/ml in Group II and 1.30 ± 0.36 ng/ml in Group III patients. Interpretation and Conclusion: Within the limitations of this study, it can be concluded that GCF CRP level progressively increases from periodontal health to disease. It can also be stated that there is a decrease in GCF CRP levels with periodontal treatment. PMID:25210259

The Effect of Periodontitis on Expression of Interleukin-21: A Systematic Review

PubMed Central

Mootha, Archana; Malaiappan, Sankari; Jayakumar, N. D.; Varghese, Sheeja S.; Toby Thomas, Julie

2016-01-01

Purpose. Inflammation and tissue breakdown are led by an array of inflammatory destructive mediators associated with initiation and progression of inflammatory diseases like periodontitis. Current evidence shows that these inflammatory mediators have a definitive role in the pathogenesis of various systemic diseases with an inflammatory component. Interleukin-21 (IL-21) has been associated with systemic diseases like rheumatoid arthritis and Crohn's disease that follow a chronic inflammatory cascade. Similarly recent studies have associated Interleukin-21 levels with periodontitis. This systematic review was aimed to assess the levels of IL-21 in subjects with periodontitis. Methods. A complete literature search was done in PubMed, Medline, Science Direct, and Cochrane databases and Google Scholar based on the inclusion/exclusion criteria. Six relevant articles were procured. Full text was read individually by two reviewers and data extraction was done based on STROBE statement. Results. After data extraction five observational and one interventional study were obtained. All the studies showed an increased expression of IL-21 in periodontitis and the interventional study showed reduction in IL-21 levels after nonsurgical periodontal therapy (NSP). Conclusion. Interleukin-21 levels are higher in periodontitis than controls. With this limited evidence further longitudinal studies are required to consider this as a definitive inflammatory marker. PMID:26998377

Repair of experimental plaque-induced periodontal disease in dogs.

PubMed

Shoukry, M; Ben Ali, L; Abdel Naby, M; Soliman, A

2007-09-01

Forty mongrel dogs were used in this study for induction of periodontal disease by placing subgingival silk ligatures affecting maxillary and mandibular premolar teeth during a 12-month period. Experimental premolar teeth received monthly clinical, radiographic, and histometric/pathologic assessments. The results demonstrated significant increases in scores and values of periodontal disease parameters associated with variable degrees of alveolar bone loss. The experimental maxillary premolar teeth exhibited more severe and rapid rates of periodontal disease compared with mandibular premolar teeth. Histometric analysis showed significant reduction in free and attached gingiva of the experimental teeth. Histopathological examination of buccolingual sections from experimental premolar teeth showed the presence of rete pegs within the sulcular epithelium with acanthosis and erosive changes, widening of the periodontal ligament, and alveolar bone resorption. Various methods for periodontal repair were studied in 194 experimental premolar teeth exhibiting different degrees of periodontal disease. The treatment plan comprised non-surgical (teeth scaling, root planing, and oral hygiene) and surgical methods (closed gingival curettage, modified Widman flap, and reconstructive surgery using autogenous bone marrow graft and canine amniotic membrane). The initial non-surgical treatment resulted in a periodontal recovery rate of 37.6% and was found effective for treatment of early periodontal disease based on resolution of gingivitis and reduction of periodontal probing depths. Surgical treatment by closed gingival curettage to eliminate the diseased pocket lining resulted in a recovery rate of 48.8% and proved effective in substantially reducing deep periodontal pockets. Open root planing following flap elevation resulted in a recovery rate of 85.4% and was effective for deep and refractory periodontal pockets. Autogenous bone graft implantation combined with canine amniotic

Reactive correction of a maxillary incisor in single-tooth crossbite following periodontal therapy.

PubMed

Huang, Chih-Hao; Brunsvold, Michael A

2005-05-01

The reactive correction of a single tooth anterior crossbite following periodontal therapy is described. This case report provides new information regarding correction of a crossbite relationship and con- firms existing reports of tooth movement following periodontal therapy. A 39-year-old woman in good general health presented with a history of recurrent periodontal abscesses of a maxillary incisor. Probing depths of the abscessed tooth ranged from 5 to 12 mm, and class 1 mobility was noted. Radiographs revealed that the tooth had previously been treated endodontically. The patient's periodontal diagnosis was generalized chronic moderate to severe periodontitis. Treatment considerations were complicated by a single-tooth crossbite relationship of the involved incisor and clinical evidence that the periodontal abscess communicated with an apical infection. Treatment of the abscess consisted of cause-related therapy, bone grafting, and occlusal adjustment. Five months after surgical treatment, an edge-to-edge incisal relationship was observed, the first indicator of tooth movement. Further correction to a normal incisal relationship resulted 1 year after modification of the proximal contact. At this time, there was normal probing depth with only slight recession and mobility. Bone fill was radiographically noted. It appears that some cases of maxillary incisor crossbite that are complicated by periodontal disease may be corrected, without orthodontic appliances, following periodontal treatment.

Low-Level Lasers as an Adjunct in Periodontal Therapy in Patients with Diabetes Mellitus

PubMed Central

Kesić, Ljiljana; Mihailović, Dragan; Jovanović, Goran; Antić, Slobodan; Brkić, Zlata

2012-01-01

Abstract Background Diabetes mellitus (DM) increases the risk of periodontitis, and severe periodontitis often coexists with severe DM. The proposed dual pathway of tissue destruction suggests that control of chronic periodontal infection and gingival inflammation is essential for achieving long-term control of DM. The purpose this study is to evaluate the effects of low-level laser therapy (LLLT) by exfoliative cytology in patients with DM and gingival inflammation. Subjects and Methods Three hundred patients were divided in three equal groups: Group 1 consisted of patients with periodontitis and type 1 DM, Group 2 of patients with periodontitis and type 2 DM, and Group 3 of patients with periodontitis (control group). After oral examination, smears were taken from gingival tissue, and afterward all of the patients received oral hygiene instructions, removal of dental plaque, and full-mouth scaling and root planing. A split-mouth design was applied; on the right side of jaws GaAlAs LLLT (670 nm, 5 mW, 14 min/day) (model Mils 94; Optica Laser, Sofia, Bulgaria) was applied for five consecutive days. After the therapy was completed, smears from both sides of jaws were taken. The morphometric analysis was done using the National Institutes of Health Image software program and a model NU2 microscope (Carl Zeiss, Jena, Germany). Results Investigated parameters were significantly lower after therapy compared with values before therapy. After therapy on the side subjected to LLLT, there was no significantly difference between patients with DM and the control group. Conclusions It can be concluded that LLLT as an adjunct in periodontal therapy reduces gingival inflammation in patients with DM and periodontitis. PMID:22928615

Treatment of plaque-induced gingivitis, chronic periodontitis, and other clinical conditions.

PubMed

2001-12-01

The inflammatory components of plaque induced gingivitis and chronic periodontitis can be managed effectively for the majority of patients with a plaque control program and non-surgical and/or surgical root debridement coupled with continued periodontal maintenance procedures. Some patients may need additional therapeutic procedures. All of the therapeutic modalities reviewed in this position paper may be utilized by the clinician at various times over the long-term management of the patient's periodontal condition.

Treatment of plaque-induced gingivitis, chronic periodontitis, and other clinical conditions.

PubMed

The inflammatory components of plaque induced gingivitis and chronic periodontitis can be managed effectively for the majority of patients with a plaque control program and nonsurgical and/or surgical root debridement coupled with continued periodontal maintenance procedures. Some patients may need additional therapeutic procedures. All of the therapeutic modalities reviewed in this position paper may be utilized by the clinician at various times over the long-term management of the patient's periodontal condition.

Patient compliance and supportive periodontal therapy: Study among young adults of Namakkal district

PubMed Central

Gokulanathan, Subramanium; Balan, Natarajan; Aravind, Ramaraj Jayabalan; Thangavelu, Kavin

2014-01-01

Aims: The aim of this study is to assess the patient compliance to supportive and maintenance periodontal therapy and to determine the reason for noncompliance among young adult patients of Namakkal district, India. Materials and Methods: This was a cross-sectional study conducted on 400 patients who underwent periodontal therapy and subsequently recalled for supportive and maintenance periodontal treatment in the Department of Periodontics, Vivekanandha Dental College for Women, Namakkal. Patients age group 25-35 years and of both gender were equally selected and grouped by occupation and socioeconomic status. According to their compliance with appointments, they are categorized as complete compliance, partially compliance and insufficient or noncompliance. Noncompliance and partially compliance patients were contacted and asked to rate their experience and reason for noncompliance. Results: In this study, 80% of patients showed complete compliance and were regular for supportive periodontal therapy appointments. Women were more regular in maintaining recall appointments than men. Salaried employers showed 84.3% complete compliance, while self-employed personals showed 77% complete compliance and 75% of nonworking personals were regular to the appointment schedule. Noncompliance person has quoted lack of time and forgetting the appointment date as a major reason for missed appointments. Conclusions: This study recommends the need for improvement in communication skills of practitioners and weekend appointment for patient undergoing periodontal maintenance therapy. PMID:25210365

Periodontal therapy for pregnant women and cases of low birthweight: an intervention study.

PubMed

Cruz, Simone S; Costa, Maria da Conceição N; Gomes-Filho, Isaac S; Barreto, Maurício L; dos Santos, Carlos Antônio S T; Martins, Angela Guimarães; Passos, Johelle de S; de Freitas, Camila Oliveira T; Sampaio, Fábio P; Cerqueira, Eneida de M M

2010-02-01

Over the past decade, strong evidence for an association between maternal periodontitis and low birthweight has started to appear. However, few intervention studies have been proposed for investigating this hypothesis. The aim of this study was to evaluate whether periodontal therapy among pregnant women would reduce the incidence of low birthweight. A nonrandomized intervention study was performed, with two control groups. The sample comprised 339 pregnant women: 141 in the experimental group (treated for periodontitis), 145 in control group 1 (without periodontitis) and 53 in control group 2 (with untreated periodontitis). The experimental group received periodontal treatment throughout pregnancy, whereas control group 1 was only monitored over the same period. After delivery, birthweight information on the newborns was obtained. The analysis procedures consisted of stratified analysis followed by logistic regression. The frequency of low birthweight among the women with treated periodontitis was 9.22%, while it was 13.10% in the group without periodontal disease. However, the difference was not statistically significant (RR 0.72; 95% CI 0.36-1.45). The occurrence of this outcome in the group with untreated periodontitis (24.53%) was greater than in the other two groups. This suggests that periodontal therapy is a protective factor for birthweight.

Nonsurgical and surgical treatment of periodontitis: how many options for one disease?

PubMed

Graziani, Filippo; Karapetsa, Dimitra; Alonso, Bettina; Herrera, David

2017-10-01

Treatment of periodontitis aims at preventing further disease progression with the intentions to reduce the risk of tooth loss, minimize symptoms and perception of the disease, possibly restore lost periodontal tissue and provide information on maintaining a healthy periodontium. Therapeutic intervention includes introduction of techniques to change behavior, such as: individually tailored oral-hygiene instructions; a smoking-cessation program; dietary adjustment; subgingival instrumentation to remove plaque and calculus; local and systemic pharmacotherapy; and various types of surgery. No single treatment option has shown superiority, and virtually all types of mechanical periodontal treatment benefit from adjunctive antimicrobial chemotherapy. Periodontal treatment, because of the chronic nature of periodontitis, is a lifelong commitment to intricate oral-hygiene techniques, which, when properly implemented, will minimize the risk of disease initiation and progression. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Impact of a sodium carbonate spray combined with professional oral hygiene procedures in patients with Sjögren's syndrome: an explorative study.

PubMed

Gambino, Alessio; Broccoletti, Roberto; Cafaro, Adriana; Cabras, Marco; Carcieri, Paola; Arduino, Paolo G

2017-06-01

The aim of this study was to make an initial estimation on the effects of a sodium bicarbonate and xylitol spray (Cariex ® ), associated with non-surgical periodontal therapy, in participants with primary Sjögren's syndrome. Sjögren's syndrome (SS) is a multisystem autoimmune disease that predominantly involves salivary and lachrymal glands, with the clinical effect of dry eyes and mouth. A prospective cohort of 22 women and two men has been evaluated. They were randomized into three groups (eight patients each): Group A) those treated once with non-surgical periodontal therapy, education and motivation to oral hygiene, associated with the use of Cariex ® ; Group B) treated only with Cariex ® ; Group C) treated only with non-surgical periodontal therapy, education and motivation to oral hygiene. Clinical variables described after treatment were unstimulated whole salivary flow, stimulated whole salivary flow, salivary pH, reported pain (using Visual Analogue Scale) and the Periodontal Screening and Recording index. Salivary flow rate improved in all groups, but the difference was statistically significant only in those treated with Cariex ® , alone or in combination with periodontal therapy. Gingival status improved in participants who underwent periodontal non-surgical therapy while remained unchanged in those only treated with Cariex ® . Reported pain decreased in all groups, showing the best result in participants treated with periodontal therapy together with Cariex ® . We propose a practical approach for improving gingival conditions and alleviating oral symptoms in patients with SS. Future randomized and controlled trials are however required to confirm these results as well as larger population, and also assessing other parameters due to oral dryness, possible oral infections and more comprehensive periodontal indices. © 2016 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Effect of Periodontal Therapy With Amoxicillin-Metronidazole on Pharyngeal Carriage of Penicillin- and Erythromycin-Resistant Viridans Streptococci.

PubMed

Mombelli, Andrea; Cionca, Norbert; Almaghlouth, Adnan; Cherkaoui, Abdessalam; Schrenzel, Jacques; Giannopoulou, Catherine

2016-05-01

Previous studies have focused on antibiotic resistance of Gram-negative bacteria before and after periodontal therapy. The purpose of this analysis is to assess changes in resistance patterns of the commensal Gram-positive microbiota. The viridans group streptococci (VGS) have been suggested to serve as reservoirs of resistance genes for more pathogenic streptococci and may be implicated in some non-oral infections. In this randomized clinical trial, 80 patients with periodontitis are distributed randomly into two groups. In group A, patients received 375 mg amoxicillin and 500 mg metronidazole three times per day for 7 days during the non-surgical treatment phase (T1). In group B, the antibiotics were administered during the surgical phase (T2). Resistance of VGS to penicillin and erythromycin was determined by the epsilometer test. At baseline, VGS from 12.5% (group A) and 11.8% (group B) of patients had a minimum inhibitory concentration (MIC) >2 μg/mL to penicillin. Three months after T1, VGS from 15.6% and 16.7% of patients had an MIC >2 μg/mL, respectively. Six months after T2 VGS from 5.9% and 5.9% and 12 months after T2 VGS from 6.1% and 6.3% patients had an MIC >2 μg/mL. There was no effect of therapy with antibiotics, administered either in T1 or T2, on the carriage of penicillin-resistant VGS. Erythromycin resistance was high at baseline and remained unchanged throughout the study. MICs for penicillin and erythromycin were correlated (P <0.05). Amoxicillin plus metronidazole did not significantly affect the resistance pattern of the VGS to penicillin or erythromycin.

In vivo osteoprotegerin gene therapy preventing bone loss induced by periodontitis.

PubMed

Tang, H; Mattheos, N; Yao, Y; Jia, Y; Ma, L; Gong, P

2015-08-01

The objective of this study was to investigate the effects of osteoprotegerin (OPG) gene therapy on alveolar bone resorption caused by experimental periodontitis in rats, thus forming a foundation for potential clinical applications of OPG gene therapy in the treatment of periodontitis and peri-implantitis. To study the effects of OPG on alveolar bone protection, an experimental periodontitis model was used by placing a bacterial plaque retentive silk ligature in the gingival sulcus around the maxillary second molar tooth, injection of Porphyromonas gingivalis and high carbohydrate diet. A total of 30 Sprague-Dawley rats were randomly divided into three groups, with 10 rats in each group: group I (control) was treated with 10 μL normal saline injection; group II with 10 μL mock vector; and group III with 10 μL local OPG gene transfer by transfection with in vitro constructed pcDNA3.1-human OPG (pcDNA3.1-hOPG). A subperiosteal injection was done adjacent to the second molars on days 0, 7, 14 and 21. Four weeks later, all animals were killed and radiographic, histological and immunohistochemical examinations were performed. Statistical analysis included ANOVA and LSD-Bonferroni test. Group III (OPG gene therapy) had significantly enhanced (p < 0.05) integrated optical density of OPG, had significantly decreased alveolar bone resorption volume and active osteoclast number (p < 0.05) through descriptive histological examination when compared with the other two groups at week 4. Local recombinant OPG plasmid-mediated gene therapy suppresses osteoclastogenesis in vivo and inhibits alveolar bone height reduction caused by experimental periodontitis in rats. OPG gene therapy may be beneficial in preventing progressive periodontal bone loss. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

[Nonsurgical therapy of abdominal and retroperitoneal abscesses].

PubMed

Reuss, J A; Seitz, K

1987-06-01

From 1976 to March 1987 intraabdominal or retroperitoneal abscesses were confirmed by ultrasound in 40 patients. 13 patients had surgical drainage with zero-mortality. 3 of 27 patients were treated with antibiotics (only systemically). 24 patients were treated by percutaneous catheter drainage or needle aspiration. Elective cholecystectomy was performed later in 3 patients. Nonsurgical treatment was successful in 22/27 cases. 3 patients died despite percutaneous drainage. Failure of percutaneous drainage required surgical intervention in 3 patients. The considerably poorer primary condition of the patients receiving nonsurgical treatment allows no comparison with the surgical group. Advantages of percutaneous drainage and needle aspiration are a high success rate and low mortality. These techniques can be used even in critically ill persons.

Lasers in periodontics: a review of the literature.

PubMed

Cobb, Charles M

2006-04-01

therapy. Current evidence does suggest that use of the Nd:YAG or Er:YAG wavelengths for treatment of chronic periodontitis may be equivalent to scaling and root planing (SRP) with respect to reduction in probing depth and subgingival bacterial populations. However, if gain in clinical attachment level is considered the gold standard for non-surgical periodontal therapy, then the evidence supporting laser-mediated periodontal treatment over traditional therapy is minimal at best. Lastly, there is limited evidence suggesting that lasers used in an adjunctive capacity to SRP may provide some additional benefit.

Effect of Surgical Periodontal Therapy on Serum C-reactive Protein Levels Using ELISA in Both Chronic and Aggressive Periodontitis Patient

PubMed Central

Gupta, Bharat; Patil, Neha; Yadav, Manoj; Tripathi, Shashank; Sinha, Saurabh; Sharma, Saurabh; Gupta, Saurabh

2015-01-01

Background Periodontitis can be defined as a local inflammatory process which mediates destruction of periodontal tissues & is triggered by bacterial insult. In periodontal infections, the levels of C reactive proteins are elevated as compared to the levels in a periodontally healthy individual. The study was done to determine the relative levels of serum CRP in aggressive, chronic and periodontally healthy subjects and to evaluate the effect of surgical periodontal therapy on serum C-reactive protein levels. Materials and Methods Serum samples were collected from 150 participants (50 healthy control patients (non-periodontitis), 50 patients with chronic periodontitis and aggressive periodontitis. Serum C- reactive protein levels were assessed by means of immunoturbidimetric assay at baseline for subjects in all the 3 groups and 3 months after completion of surgical therapy. Results The mean baseline C-reactive protein (CRP) concentrations in the Groups I, II and III were 1.65±0.57 mg/L, 3.03±2.14 mg/L and 3.09±2.27 mg/L respectively. After treatment, the mean C-reactive protein (CRP) levels in Groups II and III reduced from 3.03±1.67 mg/L to 1.46±1.67 mg/L and from 3.09±1.21 to 1.43±1.21 mg/L respectively. Similar results were found for probing depth and all indexes in Group II and III after treatment. Also, the mean attachment loss in Groups II and III reduced, so the results were highly significant. Conclusion Successful periodontal treatment results in significant decrease in serum C-reactive protein (CRP) levels in otherwise healthy subjects. PMID:26557605

Clinical effect of azithromycin as an adjunct to non-surgical treatment of chronic periodontitis: a meta-analysis of randomized controlled clinical trials.

PubMed

Zhang, Z; Zheng, Y; Bian, X

2016-06-01

evidence that azithromycin used as an adjunct to SRP significantly improves the efficacy of non-surgical periodontal therapy on reducing probing depth, BOP and improving AL, particularly at the initially deep probing depth sites. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis.

PubMed

Manresa, Carolina; Sanz-Miralles, Elena C; Twigg, Joshua; Bravo, Manuel

2018-01-01

Periodontitis is a bacterially-induced, chronic inflammatory disease that destroys the connective tissues and bone that support teeth. Active periodontal treatment aims to reduce the inflammatory response, primarily through eradication of bacterial deposits. Following completion of treatment and arrest of inflammation, supportive periodontal therapy (SPT) is employed to reduce the probability of re-infection and progression of the disease; to maintain teeth without pain, excessive mobility or persistent infection in the long term, and to prevent related oral diseases.According to the American Academy of Periodontology, SPT should include all components of a typical dental recall examination, and importantly should also include periodontal re-evaluation and risk assessment, supragingival and subgingival removal of bacterial plaque and calculus, and re-treatment of any sites showing recurrent or persistent disease. While the first four points might be expected to form part of the routine examination appointment for periodontally healthy patients, the inclusion of thorough periodontal evaluation, risk assessment and subsequent treatment - normally including mechanical debridement of any plaque or calculus deposits - differentiates SPT from routine care.Success of SPT has been reported in a number of long-term, retrospective studies. This review aimed to assess the evidence available from randomised controlled trials (RCTs). To determine the effects of supportive periodontal therapy (SPT) in the maintenance of the dentition of adults treated for periodontitis. Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 May 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 5), MEDLINE Ovid (1946 to 8 May 2017), and Embase Ovid (1980 to 8 May 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization

Management of Chronic Periodontitis Using Chlorhexidine Chip and Diode Laser-A Clinical Study.

PubMed

Jose, Kachapilly Arun; Ambooken, Majo; Mathew, Jayan Jacob; Issac, Annie Valayil; Kunju, Ajithkumar Parachalil; Parameshwaran, Renjith Athirkandathil

2016-04-01

The use of adjuncts like chlorhexidine local delivery and diode laser decontamination have been found to improve the clinical outcomes of scaling and root planing in non-surgical periodontal therapy in patients with chronic periodontitis. To evaluate the effects of diode laser and chlorhexidine chip as adjuncts to scaling and root planing in the management of chronic periodontitis. The objective is to evaluate the outcome of chlorhexidine chip and diode laser as adjuncts to scaling and root planing on clinical parameters like Plaque Index, Gingival Index, probing pocket depth and clinical attachment level. Department of Periodontics. Randomized clinical trial with split mouth design. Fifteen chronic periodontitis patients having a probing pocket depth of 5mm-7mm on at least one interproximal site in each quadrant of the mouth were included in the study. After initial treatment, four sites in each patient were randomly subjected to scaling and root planing (control), chlorhexidine chip application (CHX chip group), diode laser (810 nm) decontamination (Diode laser group) or combination of both (Diode laser and chip group). Plaque Index (PI), Gingival Index (GI), probing pocket depth (PPD) and clinical attachment level (CAL) were assessed at baseline, one month and three months. Results were statistically analysed using paired T test, one-way ANOVA, Tukey's HSD test and repeated measure ANOVA. Post-treatment, the test and control sites showed a statistically significant reduction in PI, GI, PPD, and CAL. After three months, a mean PPD reduction of 1.47±0.52 mm in control group, 1.40±0.83 mm in diode laser group, 2.67±0.62 mm in CHX group, and 2.80± 0.77 mm in combination group was seen. The mean gain in CAL were 1.47±0.52 mm in the control group, 1.40±0.83 mm in diode laser group, 2.67± 0.49 mm in CHX group and 2.67± 0.82 mm in combination group respectively. The differences in PPD reduction and CAL gain between control group and CHX chip and combination

Management of Chronic Periodontitis Using Chlorhexidine Chip and Diode Laser-A Clinical Study

PubMed Central

Ambooken, Majo; Mathew, Jayan Jacob; Issac, Annie Valayil; Kunju, Ajithkumar Parachalil; Parameshwaran, Renjith Athirkandathil

2016-01-01

Introduction The use of adjuncts like chlorhexidine local delivery and diode laser decontamination have been found to improve the clinical outcomes of scaling and root planing in non-surgical periodontal therapy in patients with chronic periodontitis. Aim To evaluate the effects of diode laser and chlorhexidine chip as adjuncts to scaling and root planing in the management of chronic periodontitis. The objective is to evaluate the outcome of chlorhexidine chip and diode laser as adjuncts to scaling and root planing on clinical parameters like Plaque Index, Gingival Index, probing pocket depth and clinical attachment level. Study and Design Department of Periodontics. Randomized clinical trial with split mouth design. Materials and Methods Fifteen chronic periodontitis patients having a probing pocket depth of 5mm-7mm on at least one interproximal site in each quadrant of the mouth were included in the study. After initial treatment, four sites in each patient were randomly subjected to scaling and root planing (control), chlorhexidine chip application (CHX chip group), diode laser (810 nm) decontamination (Diode laser group) or combination of both (Diode laser and chip group). Plaque Index (PI), Gingival Index (GI), probing pocket depth (PPD) and clinical attachment level (CAL) were assessed at baseline, one month and three months. Statistical analysis Results were statistically analysed using paired T test, one-way ANOVA, Tukey’s HSD test and repeated measure ANOVA. Results Post-treatment, the test and control sites showed a statistically significant reduction in PI, GI, PPD, and CAL. After three months, a mean PPD reduction of 1.47±0.52 mm in control group, 1.40±0.83 mm in diode laser group, 2.67±0.62 mm in CHX group, and 2.80± 0.77 mm in combination group was seen. The mean gain in CAL were 1.47±0.52 mm in the control group, 1.40±0.83 mm in diode laser group, 2.67± 0.49 mm in CHX group and 2.67± 0.82 mm in combination group respectively. The

Towards microbiome transplant as a therapy for periodontitis: an exploratory study of periodontitis microbial signature contrasted by oral health, caries and edentulism.

PubMed

Pozhitkov, Alex E; Leroux, Brian G; Randolph, Timothy W; Beikler, Thomas; Flemmig, Thomas F; Noble, Peter A

2015-10-14

Conventional periodontal therapy aims at controlling supra- and subgingival biofilms. Although periodontal therapy was shown to improve periodontal health, it does not completely arrest the disease. Almost all subjects compliant with periodontal maintenance continue to experience progressive clinical attachment loss and a fraction of them loses teeth. An oral microbial transplant may be a new alternative for treating periodontitis (inspired by fecal transplant). First, it must be established that microbiomes of oral health and periodontitis are distinct. In that case, the health-associated microbiome could be introduced into the oral cavity of periodontitis patients. This relates to the goals of our study: (i) to assess if microbial communities of the entire oral cavity of subjects with periodontitis were different from or oral health contrasted by microbiotas of caries and edentulism patients; (ii) to test in vitro if safe concentration of sodium hypochlorite could be used for initial eradication of the original oral microbiota followed by a safe neutralization of the hypochlorite prior transplantation. Sixteen systemically healthy white adults with clinical signs of one of the following oral conditions were enrolled: periodontitis, established caries, edentulism, and oral health. Oral biofilm samples were collected from sub- and supra-gingival sites, and oral mucosae. DNA was extracted and 16S rRNA genes were amplified. Amplicons from the same patient were pooled, sequenced and quantified. Volunteer's oral plaque was treated with saline, 16 mM NaOCl and NaOCl neutralized by ascorbate buffer followed by plating on blood agar. Ordination plots of rRNA gene abundances revealed distinct groupings for the oral microbiomes of subjects with periodontitis, edentulism, or oral health. The oral microbiome in subjects with periodontitis showed the greatest diversity harboring 29 bacterial species at significantly higher abundance compared to subjects with the other

Effect of compliance during periodontal maintenance therapy on levels of bacteria associated with periodontitis: A 6-year prospective study.

PubMed

Costa, Fernando Oliveira; Vieira, Thaís Riberal; Cortelli, Sheila Cavalca; Cota, Luís Otávio Miranda; Costa, José Eustáquio; Aguiar, Maria Cássia Ferreira; Cortelli, José Roberto

2018-05-01

It is well established that regular compliance during periodontal maintenance therapy (PMT) maintains the stability of periodontal clinical parameters obtained after active periodontal therapy (APT). However, compliance during PMT has not yet been related to subgingival bacterial levels. Thus, this study followed individuals in PMT over 6 years and longitudinally evaluated the effects of compliance on periodontitis-associated bacterial levels and its relation to periodontal status. From a 6-year prospective cohort study with 212 individuals in PMT, 91 were determined to be eligible. From this total, 28 regular compliers (RC) were randomly selected and matched for age and sex with 28 irregular compliers (IC). Complete periodontal examination and microbiological samples were obtained 5 times: T1 (prior to APT), T2 (after APT), T3 (2 years), T4 (4 years), and T5 (6 years). Total bacteria counts and levels of Actinomyces naeslundii, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were evaluated through quantitative polymerase chain reaction. RC had less tooth loss and better clinical and microbiological conditions over time when compared with IC. IC had higher total bacterial counts and higher levels of T. denticola. Moreover, among IC, total bacterial counts were positively associated with plaque index and bleeding on probing, while levels of A. naeslundii, T. forsythia, and T. denticola were negatively associated with clinical attachment loss (4 to 5 mm) among RC. Compliance positively influenced subgingival microbiota and contributed to stability of periodontal clinical status. Regular visits during PMT sustained microbiological benefits provided by APT over a 6-year period. © 2018 American Academy of Periodontology.

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

PubMed

Fritoli, Aretuza; Gonçalves, Cristiane; Faveri, Marcelo; Figueiredo, Luciene Cristina; Pérez-Chaparro, Paula Juliana; Fermiano, Daiane; Feres, Magda

2015-01-01

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

Compositional stability of a salivary bacterial population against supragingival microbiota shift following periodontal therapy.

PubMed

Yamanaka, Wataru; Takeshita, Toru; Shibata, Yukie; Matsuo, Kazuki; Eshima, Nobuoki; Yokoyama, Takeshi; Yamashita, Yoshihisa

2012-01-01

Supragingival plaque is permanently in contact with saliva. However, the extent to which the microbiota contributes to the salivary bacterial population remains unclear. We compared the compositional shift in the salivary bacterial population with that in supragingival plaque following periodontal therapy. Samples were collected from 19 patients with periodontitis before and after periodontal therapy (mean sample collection interval, 25.8 ± 2.6 months), and their bacterial composition was investigated using barcoded pyrosequencing analysis of the 16S rRNA gene. Phylogenetic community analysis using the UniFrac distance metric revealed that the overall bacterial community composition of saliva is distinct from that of supragingival plaque, both pre- and post-therapy. Temporal variation following therapy in the salivary bacterial population was significantly smaller than in the plaque microbiota, and the post-therapy saliva sample was significantly more similar to that pre-therapy from the same individual than to those from other subjects. Following periodontal therapy, microbial richness and biodiversity were significantly decreased in the plaque microbiota, but not in the salivary bacterial population. The operational taxonomic units whose relative abundances changed significantly after therapy were not common to the two microbiotae. These results reveal the compositional stability of salivary bacterial populations against shifts in the supragingival microbiota, suggesting that the effect of the supragingival plaque microbiota on salivary bacterial population composition is limited.

Ozone therapy in periodontics

PubMed Central

Gupta, G; Mansi, B

2012-01-01

Gingival and Periodontal diseases represent a major concern both in dentistry and medicine. The majority of the contributing factors and causes in the etiology of these diseases are reduced or treated with ozone in all its application forms (gas, water, oil). The beneficial biological effects of ozone, its anti-microbial activity, oxidation of bio-molecules precursors and microbial toxins implicated in periodontal diseases and its healing and tissue regeneration properties, make the use of ozone well indicated in all stages of gingival and periodontal diseases. The primary objective of this article is to provide a general review about the clinical applications of ozone in periodontics. The secondary objective is to summarize the available in vitro and in vivo studies in Periodontics in which ozone has been used. This objective would be of importance to future researchers in terms of what has been tried and what the potentials are for the clinical application of ozone in Periodontics. PMID:22574088

Ozone therapy in periodontics.

PubMed

Gupta, G; Mansi, B

2012-02-22

Gingival and Periodontal diseases represent a major concern both in dentistry and medicine. The majority of the contributing factors and causes in the etiology of these diseases are reduced or treated with ozone in all its application forms (gas, water, oil). The beneficial biological effects of ozone, its anti-microbial activity, oxidation of bio-molecules precursors and microbial toxins implicated in periodontal diseases and its healing and tissue regeneration properties, make the use of ozone well indicated in all stages of gingival and periodontal diseases. The primary objective of this article is to provide a general review about the clinical applications of ozone in periodontics. The secondary objective is to summarize the available in vitro and in vivo studies in Periodontics in which ozone has been used. This objective would be of importance to future researchers in terms of what has been tried and what the potentials are for the clinical application of ozone in Periodontics.

[Effects of periodontal mechanical therapy with local and systemic drugs on carotid artery and serum high-sensitivity C-reactive protein in rats with chronic periodontitis associated with atherosclerosis].

PubMed

Ren, Xiuyun; Chang, Le; Yue, Zijie; Lin, Mu; Shi, Xuexue; Sun, Lili

2013-10-01

The aim of this study is to investigate the effects of serum high-sensitivity C-reactive protein (hsCRP) and the pathological changes in the carotid artery after periodontal mechanical therapy with local and systemic drugs in SD rats with chronic periodontitis (CP) associated with atherosclerosis (As). Thirty-five SD rats were randomly divided into two groups: control group (group A) and CP+As group (group B). Group B was further divided into the natural process group (B1), the periodontal mechanical treatment group (B2), the periodontal mechanical treatment plus local drugs group (B3), and the periodontal mechanical treatment plus local and systemic drugs group (B4). Each group comprised seven rats. Serum hsCRP levels were evaluated at baseline 1 week after the first periodontal therapy and 1, 3, and 5 weeks after the second periodontal therapy by enzyme linked immunosorbent assay (ELISA). The pathological lesion in the carotid artery plaque was stained with hematine and eosin. The levels of serum hsCRP in group B1 increased gradually as time passed and became significantly higher than that of the other groups five weeks after periodontal therapy (P < 0.001). The levels of serum hsCRP in groups B2, B3, and B4 increased gradually and reached the peak 1 week after the second periodontal therapy. After that, the levels of serum hsCRP decreased gradually but were still higher than that of group A (P < 0.05). The levels of serum hsCRP in groups B3 and B4 were significantly lower than that in group B2 3 and 5 weeks after the second periodontal therapy (P < 0.001). Histologic sections revealed increased foam cell infiltration and disordered and destructed elastic fibers in groups B1 and B2. The thickness of the blood vessels in groups B3 and B4 was more uniform than that in groups B1 and B2. The elastic fibers in groups B3 and B4 were lined up in order. Direct periodontal mechanical treatment results in acute, short-term, systemic inflammation and might increase the risk

The Effect of Orthodontic Therapy on Periodontal Health: A Review of the Literature

PubMed Central

Alfuriji, Samah; Alhazmi, Nora; Alhamlan, Nasir; Al-Ehaideb, Ali; Alruwaithi, Moatazbellah; Alkatheeri, Nasser; Geevarghese, Amrita

2014-01-01

Objectives. This review aims to evaluate the effect of orthodontic therapy on periodontal health. Data. Original articles that reported on the effect of orthodontic therapy on periodontal health were included. The reference lists of potentially relevant review articles were also sought. Sources. A literature search was conducted using the databases, Medline, EMBASE, Cochrane Library, Web of Science, Google Scholar, and Scopus databases for relevant studies. The search was carried out by using a combined text and the MeSH search strategies: using the key words in different combinations: “periodontal disease,” “orthodontics” and “root resorption.” This was supplemented by hand-searching in peer-reviewed journals and cross-referenced with the articles accessed. Articles published only in English language were included. Letters to the Editor, historical reviews and unpublished articles were not sought. Conclusions. Within the limitations of the present literature review, it was observed that there is a very close inter-relationship between the periodontal health and the outcome of orthodontic therapy. PMID:24991214

Periodontal management of a patient with severe aplastic anemia: a case report.

PubMed

Agnihotri, Rupali; Bhat, Khandige Mahalinga; Bhat, Giliyar Subraya; Pandurang, Pratibha

2009-01-01

This article describes the periodontal management of a patient with severe aplastic anemia. A 51-year-old female patient was hospitalized with aplastic anemia and was referred for the management of her cyclosporine-induced gingival enlargement and bleeding from her gums. She also complained of pain in the palatal area and the mandibular anterior region. The patient was managed successfully with supra- and subgingival instrumentation, local drug delivery (LDD), electrosurgery, repeated oral hygiene instruction, and constant supervision. The treatment resulted in dramatic improvement in the patient's oral health and quality of life. This report highlights the importance of nonsurgical therapy followed by electrosurgery for the management of residual gingival enlargement.

Chemically modified tetracyclines an emerging host modulator in chronic periodontitis patients: A randomized, double-blind, placebo-controlled, clinical trial.

PubMed

Alyousef, Abdullah A; Divakar, Darshan Devang; Muzaheed

2017-09-01

Although periodontal diseases are caused by some of the specific pathogens, most of the tissue damage is caused by the host reaction to disease and not actually by the infections. Therefore, host modulatory therapy (HMT) has advanced benefit for the treatment of periodontitis, which works basically by reducing tissue destruction and regeneration in periodontium by altering the critical aspects of host response regulation and up regulating defensive regenerative responses. The present study was conducted with the goal to test an innovative therapeutic option using chemically modified tetracycline in patients affected with generalized, moderate and severe chronic periodontitis. We assumed that CMT might have the potential to provoke an assessable clinical result and pharmacologically impede the level inflammatory flow. CMT (incyclinide) treated group had significantly higher CAL (clinical attachment) values than Placebo Control suggesting an improved CAL in CMT treatment. Host modulation therapy width incyclinide can be as an adjunct to conventional nonsurgical therapies without antimicrobial resistance. Progress was noticed in the clinical parameters but not the serum CRP level in our study establishing the role of CMTs in controlling chronic periodontitis. Also CMT treatment indicates its role in anti-inflammatory process as it inhibited IL-12 and TNF alpha but IL-10 level was not affected. However, more randomized placebo-controlled clinical trials with large sample size are required in order to authenticate the usage of CMTs in chronic periodontitis treatment. Based on this understanding, exploration of the novel, low-cost synthetic inhibitors that can be used as potential therapeutic agents, has been tested. Copyright © 2017 Elsevier Ltd. All rights reserved.

Systemic antibiotics in periodontics.

PubMed

Slots, Jørgen

2004-11-01

This position paper addresses the role of systemic antibiotics in the treatment of periodontal disease. Topical antibiotic therapy is not discussed here. The paper was prepared by the Research, Science and Therapy Committee of the American Academy of Periodontology. The document consists of three sections: 1) concept of antibiotic periodontal therapy; 2) efficacy of antibiotic periodontal therapy; and 3) practical aspects of antibiotic periodontal therapy. The conclusions drawn in this paper represent the position of the American Academy of Periodontology and are intended for the information of the dental profession.

Short-term clinical outcomes of laser supported periodontal treatment concept using Er,Cr:YSGG (2780nm) and diode (940 nm): a pilot study

NASA Astrophysics Data System (ADS)

Odor, Alin A.; Violant, Deborah; Badea, Victoria; Gutknecht, Norbert

2016-03-01

Backgrounds: Er,Cr:YSGG (2780nm) and diode (940 nm) lasers can be used adjacent to the conventional periodontal treatment as minimally invasive non-surgical devices. Aim: To describe the short-term clinical outcomes by combining Er,Cr:YSGG (2780nm) and diode 940 nm lasers in non-surgical periodontal treatment. Materials and methods: A total of 10 patients with periodontal disease (mild, moderate, severe) - 233 teeth and 677 periodontal pockets ranging from 4 mm to 12 mm - were treated with Er,Cr:YSGG (2780nm) and diode (940 nm) lasers in adjunct to manual and piezoelectric scaling and root planning (SRP). Periodontal parameters such as mean probing depth (PD), mean clinical attachment level (CAL) and mean bleeding on probing (BOP) were evaluated at baseline and 6 months after the laser treatment using an electronic periodontal chart. Results: At baseline, the mean PD was 4.06 ± 1.06 mm, mean CAL was 4.56 ± 1.43 mm, and mean BOP was 43.8 ± 23.84 %. At 6 months after the laser supported periodontal treatments the mean PD was 2.6 ± 0.58 mm (p <0.001), mean CAL was 3.36 ± 1.24 mm (p <0.001) and mean BOP was 17 ± 9.34 % (p <0.001). Also 3 patients showed radiographic signs of bone regeneration. Conclusion: The combination of two laser wavelengths in adjunct to SRP offers significant improvements of periodontal clinical parameters such as PD, CAL and BOP. Keywords: Laser supported periodontal treatment concept, Er,Cr:YSGG and diode 940nm lasers, Scaling and root planning, Minimally invasive non-surgical device

Combined photoablative and photodynamic diode laser therapy as an adjunct to non-surgical periodontal treatment: a randomized split-mouth clinical trial.

PubMed

Giannelli, Marco; Formigli, Lucia; Lorenzini, Luca; Bani, Daniele

2012-10-01

Comparing the efficacy of photoablative and photodynamic diode laser in adjunct to scaling -root planing (SRP) and SRP alone for the treatment of chronic periodontitis. Twenty-six patients were studied. Maxillary left or right quadrants were randomly assigned to sham-laser treatment + SRP or laser + SRP. This consisted of photoablative intra/extra-pocket de-epithelization with diode laser (λ = 810 nm), followed by single SRP and multiple photodynamic treatments (once weekly, 4-10 applications, mean ± SD: 3.7 ± 2.4) using diode laser (λ = 635 nm) and 0.3% methylene blue as photosensitizer. The patients were monitored at days 0 and 365 by clinical assessment (probing depth, PD; clinical attachment level, CAL; bleeding on probing, BOP) and at days 0, 15, 30, 45, 60, 75, 90, 365 by cytofluorescence analysis of gingival exfoliative samples taken in proximity of the teeth to be treated (polymorphonuclear leukocytes, PMN; red blood cells, RBC; damaged epithelial cells, DEC; bacteria). At day 365, compared with the control quadrants, the laser + SRP therapy yielded a significant (p < 0.001) reduction in PD (-1.9 mm), CAL (-1.7 mm) and BOP (-33.2% bleeding sites), as well as in bacterial contamination - especially spirochetes - and PMN and RBC shedding in the gingival samples (p < 0.001). Diode laser treatment (photoablation followed by multiple photodynamic cycles) adjunctive to conventional SRP improves healing in chronic periodontitis patients. © 2012 John Wiley & Sons A/S.

The effect of periodontal treatment on serum leptin, interleukin-6, and C-reactive protein.

PubMed

Shimada, Yasuko; Komatsu, Yasutaka; Ikezawa-Suzuki, Ikuyo; Tai, Hideaki; Sugita, Noriko; Yoshie, Hiromasa

2010-08-01

Previous studies suggest that periodontitis is closely related to obesity and metabolic syndrome. Leptin, a pleiotrophic hormone produced by adipose tissue, has been reported to be related to periodontitis. This study investigates the effects of periodontal treatment on the serum levels of leptin and other cytokines in patients with chronic periodontitis (CP). Serum samples were taken from 33 CP patients (22 non-smokers, 11 smokers) and 18 healthy subjects. The serum leptin, adiponectin, tumor necrosis factor-alpha, interleukin (IL)-6, and C-reactive protein (CRP) levels were measured before and after non-surgical periodontal treatment. Significant differences between healthy and CP patients were found in serum leptin, IL-6, and CRP levels (P = 0.0018, P = 0.0064, and P = 0.0095, respectively). The serum leptin level was associated with mean probing depth, mean clinical attachment level, mean alveolar bone loss, and body mass index. There were significant associations between serum leptin levels and IL-6 and CRP levels. After non-surgical periodontal treatment, serum leptin, IL-6, and CRP levels were significantly decreased (mean +/- SD before and after, P value, respectively: leptin, 8.02 +/- 5.5, 7.10 +/- 4.4, P = 0.015; IL-6, 1.73 +/- 1.02, 1.36 +/- 0.73, P = 0.048; and CRP, 802.0 +/- 1065, 491.2 +/- 479.3, P = 0.047). Periodontal treatment is effective in reducing serum leptin, IL-6, and CRP levels. The results suggest that leptin, IL-6, and CRP could be mediating factors that connect metabolic syndrome and periodontitis.

Dietary therapy is the best option for refractory nonsurgical epilepsy.

PubMed

Felton, Elizabeth A; Cervenka, Mackenzie C

2015-09-01

Ketogenic diet therapies for epilepsy have been described since the fifth century and published in scientific literature since the early 1900s. Since that time, the diet's popularity has waxed and waned as newer drugs and other treatments have been introduced. However, in recent years, dietary therapy for epilepsy has been increasingly accepted by physicians and desired by patients as an alternative to new drugs and neurostimulation. The introduction of less restrictive versions of the classic ketogenic diet, such as the modified Atkins diet (MAD), have led to increased numbers of adult patients with refractory epilepsy who are initiating dietary treatment. Approximately half of adults and children who start a ketogenic diet have a >50% seizure reduction, which is impressive given that these patients typically have medically refractory epilepsy. We believe that ketogenic dietary treatment is the best option for children and adults with refractory nonsurgical epilepsy due to its efficacy, rapid seizure reduction, synergistic effects with other antiseizure treatments, known and treatable side effects, potential to treat comorbid medical conditions, and worldwide availability. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

Low-Level Laser Therapy (LLLT) for periodontal pockets: a review

NASA Astrophysics Data System (ADS)

Pribac, Valentin; Todea, Carmen; Duma, Virgil-Florin

2016-03-01

The applications of lasers in medicine, both in the field of diagnosis and treatment are gaining momentum. In dentistry in particular, numerous types of lasers with a wide range of characteristics are being utilized in all fields. In consequence, a lot of experience and knowledge has been gained in the last two decades in this domain; this resulted in the development of novel technologies and devices. A brief overview is made in the first part of this article on these topics. The treatment of periodontal disease with laser therapy is pointed out, as well as the photodynamic therapy which is using LLLT for the activation of the sensitizing gel that is introduced in the periodontal pockets. This paper reviews also the application of photodynamic therapy in clinical trials which have different results; a standardization of the protocol utilized for this procedure is concluded to be necessary.

Long-term efficacy of microbiology-driven periodontal laser-assisted therapy.

PubMed

Martelli, F S; Fanti, E; Rosati, C; Martelli, M; Bacci, G; Martelli, M L; Medico, E

2016-03-01

Periodontitis represents a highly prevalent health problem, causing severe functional impairment, reduced quality of life and increased risk of systemic disorders, including respiratory, cardiovascular and osteoarticular diseases, diabetes and fertility problems. It is a typical example of a multifactorial disease, where a polymicrobial infection inducing chronic inflammation of periodontal tissues is favoured by environmental factors, life style and genetic background. Since periodontal pathogens can colonise poorly vascularised niches, antiseptics and antibiotics are typically associated with local treatments to manage the defects, with unstable outcomes especially in early-onset cases. Here, the results of a retrospective study are reported, evaluating the efficacy of a protocol (Periodontal Biological Laser-Assisted Therapy, Perioblast™) by which microbial profiling of periodontal pockets is used to determine the extent and duration of local neodymium-doped yttrium aluminium garnet (Nd:YAG) laser irradiation plus conventional treatment. The protocol was applied multicentrically on 2683 patients, and found to produce a significant and enduring improvement of all clinical and bacteriological parameters, even in aggressive cases. Microbiome sequencing of selected pockets revealed major population shifts after treatment, as well as strains potentially associated with periodontitis in the absence of known pathogens. This study, conducted for the first time on such a large series, clearly demonstrates long-term efficacy of microbiology-driven non-invasive treatment of periodontal disease.

Site-specific treatment outcome in smokers following 12 months of supportive periodontal therapy.

PubMed

Bunaes, Dagmar F; Lie, Stein Atle; Åstrøm, Anne Nordrehaug; Mustafa, Kamal; Leknes, Knut N

2016-12-01

To evaluate the effect of cigarette smoking on periodontal health at patient, tooth, and site levels following supportive therapy. Eighty chronic periodontitis patients, 40 smokers and 40 non-smokers, were recruited to a single-arm clinical trial. Periodontal examinations were performed at baseline (T0), 3 months following active periodontal therapy (T1), and 12 months following supportive periodontal therapy (T2). Smoking status was validated measuring serum cotinine levels. Probing depth (PD) ≥ 5 mm with bleeding on probing (BoP) was defined as the primary outcome. Logistic regression analyses adjusted for clustered observations of patients, teeth, and sites and mixed effects models were employed to analyse the data. All clinical parameters improved from T0 to T2 (p < 0.001), whereas PD, bleeding index (BI), and plaque index (PI) increased from T1 to T2 in smokers and non-smokers (p < 0.001). An overall negative effect of smoking was revealed at T2 (OR = 2.78, CI: 1.49, 5.18, p < 0.001), with the most pronounced effect at maxillary single-rooted teeth (OR = 5.08, CI: 2.01, 12.78, p < 0.001). At the patient level, less variation in treatment outcome was detected within smokers (ICC = 0.137) compared with non-smokers (ICC = 0.051). Smoking has a negative effect on periodontal health following 12 months of supportive therapy, in particular at maxillary single-rooted teeth. © 2016 The Authors. Journal of Clinical Periodontology Published by John Wiley & Sons Ltd.

Analysis of Charges Associated with Definitive Nonsurgical Therapy for Early-Stage Lateralized Tonsil Cancer.

PubMed

Lewis, Carol M; Chronowski, Gregory M; Dong, Wenli; Gunn, G Brandon; Rosenthal, David I; Weber, Randal S

2015-08-01

The cost of treatment as it affects comparative effectiveness is becoming increasingly more important. Because cost data are not readily available, we evaluated the charges associated with definitive nonsurgical therapy for early-stage lateralized tonsil cancers. Patients treated with unilateral radiation therapy (RT) for T1 or T2 tonsil cancer between 1995 and 2007 were retrospectively reviewed. Total and radiation-specific charges, from 3 months before to 4 months after radiation, were adjusted for inflation. All facets of treatment were evaluated for significant associations with total billing. Eighty-four patients were identified. Three-year overall survival, disease-specific survival, and recurrence-free survival were 97 % [95 % confidence interval (CI) 0.88-0.99], 98 % (95 % CI 0.89-1), and 96 % (95 % CI 0.88-0.99), respectively. The median for radiation-specific charges was $60,412 (range $16,811-$84,792). The median for total charges associated with treatment was $109,917 (range $36,680-$231,895). Total billing for treatment was significantly associated with the year of diagnosis (p = 0.008), intensity-modulated radiation therapy versus wedge pair RT (p = 0.005), preradiation direct laryngoscopy (p < 0.0001), chemotherapy (p < 0.0001), gastrostomy tube placement (p = 0.004), and postradiation neck dissection (p = 0.005). Although cost data for treatment are not readily available, historically, the recovery rate is approximately 30 %. The charges associated with definitive nonsurgical therapy for early-stage lateralized tonsil cancer have a wide range likely due to treatment-related procedures, the use of chemotherapy, and evolving RT technologies. These benchmark data are important given renewed interested in primary surgery for tonsil cancer. Cost of care, disease control, and functional outcomes will be critical for comparisons of effectiveness when selecting treatment modalities.

Periodontal diseases.

PubMed

Kinane, Denis F; Stathopoulou, Panagiota G; Papapanou, Panos N

2017-06-22

Periodontal diseases comprise a wide range of inflammatory conditions that affect the supporting structures of the teeth (the gingiva, bone and periodontal ligament), which could lead to tooth loss and contribute to systemic inflammation. Chronic periodontitis predominantly affects adults, but aggressive periodontitis may occasionally occur in children. Periodontal disease initiation and propagation is through a dysbiosis of the commensal oral microbiota (dental plaque), which then interacts with the immune defences of the host, leading to inflammation and disease. This pathophysiological situation persists through bouts of activity and quiescence, until the affected tooth is extracted or the microbial biofilm is therapeutically removed and the inflammation subsides. The severity of the periodontal disease depends on environmental and host risk factors, both modifiable (for example, smoking) and non-modifiable (for example, genetic susceptibility). Prevention is achieved with daily self-performed oral hygiene and professional removal of the microbial biofilm on a quarterly or bi-annual basis. New treatment modalities that are actively explored include antimicrobial therapy, host modulation therapy, laser therapy and tissue engineering for tissue repair and regeneration.

Impact of periodontal therapy on the subgingival microbiota of severe periodontitis: comparison between good responders and individuals with refractory periodontitis using the human oral microbe identification microarray.

PubMed

Colombo, Ana Paula V; Bennet, Susan; Cotton, Sean L; Goodson, J Max; Kent, Ralph; Haffajee, Anne D; Socransky, Sigmund S; Hasturk, Hatice; Van Dyke, Thomas E; Dewhirst, Floyd E; Paster, Bruce J

2012-10-01

This study compares the changes to the subgingival microbiota of individuals with "refractory" periodontitis (RP) or treatable periodontitis (good responders [GR]) before and after periodontal therapy by using the Human Oral Microbe Identification Microarray (HOMIM) analysis. Individuals with chronic periodontitis were classified as RP (n = 17) based on mean attachment loss (AL) and/or >3 sites with AL ≥2.5 mm after scaling and root planing, surgery, and systemically administered amoxicillin and metronidazole or as GR (n = 30) based on mean attachment gain and no sites with AL ≥2.5 mm after treatment. Subgingival plaque samples were taken at baseline and 15 months after treatment and analyzed for the presence of 300 species by HOMIM analysis. Significant differences in taxa before and post-therapy were sought using the Wilcoxon test. The majority of species evaluated decreased in prevalence in both groups after treatment; however, only a small subset of organisms was significantly affected. Species that increased or persisted in high frequency in RP but were significantly reduced in GR included Bacteroidetes sp., Porphyromonas endodontalis, Porphyromonas gingivalis, Prevotella spp., Tannerella forsythia, Dialister spp., Selenomonas spp., Catonella morbi, Eubacterium spp., Filifactor alocis, Parvimonas micra, Peptostreptococcus sp. OT113, Fusobacterium sp. OT203, Pseudoramibacter alactolyticus, Streptococcus intermedius or Streptococcus constellatus, and Shuttlesworthia satelles. In contrast, Capnocytophaga sputigena, Cardiobacterium hominis, Gemella haemolysans, Haemophilus parainfluenzae, Kingella oralis, Lautropia mirabilis, Neisseria elongata, Rothia dentocariosa, Streptococcus australis, and Veillonella spp. were more associated with therapeutic success. Persistence of putative and novel periodontal pathogens, as well as low prevalence of beneficial species was associated with chronic refractory periodontitis.

Effects of Periodontal Therapy on Rate of Preterm Delivery A Randomized Controlled Trial

PubMed Central

Offenbacher, Steven; Beck, James D.; Jared, Heather L.; Mauriello, Sally M.; Mendoza, Luisto C.; Couper, David J.; Stewart, Dawn D.; Murtha, Amy P.; Cochran, David L.; Dudley, Donald J.; Reddy, Michael S.; Geurs, Nicolaas C.; Hauth, John C.

2010-01-01

OBJECTIVE To test the effects of maternal periodontal disease treatment on the incidence of preterm birth (delivery before 37 weeks of gestation). METHODS The Maternal Oral Therapy to Reduce Obstetric Risk Study was a randomized, treatment-masked, controlled clinical trial of pregnant women with periodontal disease who were receiving standard obstetric care. Participants were assigned to either a periodontal treatment arm, consisting of scaling and root planing early in the second trimester, or a delayed treatment arm that provided periodontal care after delivery. Pregnancy and maternal periodontal status were followed to delivery and neonatal outcomes until discharge. The primary outcome (gestational age less than 37 weeks) and the secondary outcome (gestational age less than 35 weeks) were analyzed using a χ2 test of equality of two proportions. RESULTS The study randomized 1,806 patients at three performance sites and completed 1,760 evaluable patients. At baseline, there were no differences comparing the treatment and control arms for any of the periodontal or obstetric measures. The rate of preterm delivery for the treatment group was 13.1% and 11.5% for the control group (P=.316). There were no significant differences when comparing women in the treatment group with those in the control group with regard to the adverse event rate or the major obstetric and neonatal outcomes. CONCLUSION Periodontal therapy did not reduce the incidence of preterm delivery. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT00097656. LEVEL OF EVIDENCE I PMID:19701034

[Combination of periodontal, orthodontic and endodontic therapy in upper anterior teeth with hopeless prognosis and long-time follow-up: a case report].

PubMed

Li, Y; Xu, L; Zhou, Y H; Ouyang, X Y; Cao, T

2017-08-18

It is complicated to decide the treatment plan of hopeless anterior teeth in esthetic zone due to severe periodontitis, periodontal-endodontic combined lesion or teeth trauma. The optional treatment plan for this kind of teeth includes retention after periodontal treatment, extraction and implant treatment, extraction and prosthodontic treatment and so on. To make an appropriate treatment plan, patients' periodontal conditions, periodontal biotype, local anatomy, esthetic demand, economic condition and social psychological status should be comprehensively considered. A combine of periodontal, endodontic and orthodontic therapy may achieve a good treatment effect in hopeless anterior teeth with severe periodontal destruction, tooth extrusion and occlusal trauma. In this case, a 20-year-old female who presented with symptoms of bleeding on brushing and upper incisors loosening for 1 month came to the Department of Periodontology, Peking University School and Hospital of Stomatology. The clinical examinations revealed that the patient's right upper incisor had signs of mobility (III°), intrusion of 1-2 mm, and probing depth (PD) of 9-10 mm. The periapical radiograph showed that the alveolar bone of right upper incisor absorbed horizontally to the apex. And the patients showed Angle II° malocclusion with II° overbite in anterior teeth and maxillary protrusion. A diagnosis of aggressive periodontitis and Angle II° malocclusion was made. The treatment of this patient lasts for 5 years which include periodontal initial therapy, orthodontic therapy, guided tissue regeneration (GTR) of right upper incisor and supportive periodontal therapy and the clinical result is fine. A hopeless upper incisor was successfully retained and the longtime clinical condition was stable. The strategy of retention of hopeless upper anterior teeth, the relationship of periodontal treatment and orthodontic treatment, and the indications of periodontal and orthodontic combined therapy were

Tooth loss in well-maintained patients with chronic periodontitis during long-term supportive therapy in Brazil.

PubMed

Chambrone, Luiz A; Chambrone, Leandro

2006-10-01

The objective of this retrospective study was to assess the reasons for tooth loss in a sample of patients who underwent periodontal therapy and supportive periodontal therapy (SPT) in a Brazilian private periodontal practice. A sample of 120 subjects who had been treated and maintained for 10 years or longer was selected from patients attending a periodontal practice. All patients followed a similar treatment: basic procedures, re-evaluation and periodontal surgery where indicated. Reasons for tooth loss were categorized as periodontal, caries, endodontal, root fractures and extraction of retained or partially erupted third molars. Of the 2927 teeth present at the completion of active periodontal treatment, 53 (1.8%) were lost due to periodontal disease, 16 (0.5%) for root fracture, six (0.2%) to caries, five (0.2%) for endodontic reasons and 31 (1.0%) were lost to extraction of retained or partially erupted third molars. Logistic regression analysis was performed to investigate the association between five independent variables with tooth loss due to periodontitis. Only age (> 60 years) and smoking were statistically significant (p < 0.05). The findings of this survey were consistent with previous studies. Older subjects and smokers were more susceptible to periodontal tooth loss. In addition, patients with generalized chronic periodontitis were treated and maintained for long-term periods with low rates of tooth loss.

The effects of periodontal therapy on intracrevicular prostaglandin E2 concentrations and clinical parameters in pregnancy.

PubMed

Yalcin, Funda; Basegmez, Cansu; Isik, Gulden; Berber, Lacin; Eskinazi, Esti; Soydinc, Mahtaban; Issever, Halim; Onan, Utku

2002-02-01

The increase in circulating levels of progesterone during pregnancy stimulates production of prostaglandins, especially prostaglandin E2, possibly resulting in pregnancy gingivitis. The purpose of this study is to evaluate the influence of prostaglandin E2 concentrations on gingival tissues in pregnancy and to assess its relationship to clinical parameters. This study evaluates the effects of periodontal treatment on clinical indices including plaque index, gingival index, probing depth, and gingival crevicular fluid prostaglandin E2 levels of 22 pregnant women in their first, second, and third trimesters. Initial periodontal therapy consisting of scaling, root planing, and oral hygiene instruction was performed at the beginning of the first trimester and repeated each trimester. Prostaglandin E2 concentrations in gingival crevicular fluid were determined using a commercially available enzyme immunoassay kit. The statistical tests used were paired sample test and correlation analysis. The results of the study show that periodontal therapy has resulted in an improvement in clinical parameters (P<0.05). There is also a statistically significant decrease in levels of prostaglandin E2 at the second and third trimesters following periodontal therapy (P <0.001). The correlation between prostaglandin E2 concentrations and clinical parameters is found to be non-significant (P >0.05). Our data indicate that levels of prostaglandin E2 in gingival crevicular fluid may be used as a marker of gingival inflammation in order to determine the effects of periodontal therapy in pregnancy. Periodontal therapy that is performed throughout the entire pregnancy period may help prevent the threat of pregnancy gingivitis.

Evaluation of commercially available biodegradable tetracycline fiber therapy in chronic periodontitis

PubMed Central

Sachdeva, Surinder; Agarwal, Vipin

2011-01-01

Background: Chronic periodontitis is an inflammatory disorder caused by dental plaque having mixed microbial flora. The different treatment modalities available to treat this disease are aimed at removal of micro-organisms from both hard and soft tissues. Systemic as well as local anti-microbial agents are helpful adjuncts in reducing microbes especially in inaccessible areas along with mechanical debridement therapy. Materials and Methods: The study was conducted in a split mouth design. Thirty-five patients having at least two non-adjacent sites in different quadrants with periodontal pockets ≥5 mm and with bleeding on probing at initial visit were selected. The selected sites were treated with both scaling and root planing plus tetracycline fibers or with scaling and root planing alone. Baseline and follow-up measurements included plaque index, gingival index, probing pocket depth, and clinical attachment level. Result: Both treatment modalities were affective in improving clinical parameters over three months’ observation period. The combined antimicrobial and mechanical debridement therapy has shown better results as compared with scaling and root planing alone. Conclusion: Application of tetracycline in modified collagen matrix following scaling and root planing might be beneficial in treatment of chronic periodontitis and improving periodontal parameters for 3-month duration. PMID:21976836

Current Status and Future Development of Cell Transplantation Therapy for Periodontal Tissue Regeneration

PubMed Central

Yoshida, Toshiyuki; Washio, Kaoru; Iwata, Takanori; Okano, Teruo; Ishikawa, Isao

2012-01-01

It has been shown that stem cell transplantation can regenerate periodontal tissue, and several clinical trials involving transplantation of stem cells into human patients have already begun or are in preparation. However, stem cell transplantation therapy is a new technology, and the events following transplantation are poorly understood. Several studies have reported side effects and potential risks associated with stem cell transplantation therapy. To protect patients from such risks, governments have placed regulations on stem cell transplantation therapies. It is important for the clinicians to understand the relevant risks and governmental regulations. This paper describes the ongoing clinical studies, basic research, risks, and governmental controls related to stem cell transplantation therapy. Then, one clinical study is introduced as an example of a government-approved periodontal cell transplantation therapy. PMID:22315604

Barriers and Facilitators Associated with Non-Surgical Treatment Use for Osteoarthritis Patients in Orthopaedic Practice.

PubMed

Hofstede, Stefanie N; Marang-van de Mheen, Perla J; Vliet Vlieland, Thea P M; van den Ende, Cornelia H M; Nelissen, Rob G H H; van Bodegom-Vos, Leti

2016-01-01

International evidence-based guidelines for the management of patients with hip and knee osteoarthritis (OA) recommend to start with (a combination of) non-surgical treatments, and using surgical intervention only if a patient does not respond sufficiently to non-surgical treatment options. Despite these recommendations, there are strong indications that non-surgical treatments are not optimally used in orthopaedic practice. To improve the adoption of non-surgical treatments, more insight is needed into barriers and facilitators of these treatments. Therefore, this study assessed which barriers and facilitators are associated with the use and prescription of different non-surgical treatments before hip and knee OA in orthopaedic practice among patients and orthopaedic surgeons in the Netherlands. We performed two internet-based surveys among 172 orthopaedic surgeons and 174 OA patients. Univariate association and multivariable regression techniques are used to identify barriers and facilitators associated with the use of non-surgical treatments. Most barriers and facilitators among patients were associated with the use of physical therapy, lifestyle advice and dietary therapy. Among orthopaedic surgeons, most were associated with prescription of acetaminophen, dietary therapy and physical therapy. Examples of barriers and facilitators among patients included "People in my environment had positive experiences with a surgery" (facilitator for education about OA), and "Advice of people in my environment to keep on moving" (facilitator for lifestyle and dietary advice). For orthopaedic surgeons, examples were "Lack of knowledge about guideline" (barrier for lifestyle advice), "Agreements/ deliberations with primary care" and "Easy communication with a dietician" (facilitators for dietary therapy). Also the belief in the efficacy of these treatments was associated with increased prescription. Strategies to improve non-surgical treatment use in orthopaedic practice

Gene Therapy of Bone Morphogenetic Protein for Periodontal Tissue Engineering

PubMed Central

Jin, Q-M.; Anusaksathien, O.; Webb, S.A.; Rutherford, R.B.; Giannobile, W.V.

2009-01-01

Background The reconstruction of lost periodontal support including bone, ligament, and cementum is a major goal of therapy. Bone morphogenetic proteins (BMPs) have shown much potential in the regeneration of the periodontium. Limitations of BMP administration to periodontal lesions include need for high-dose bolus delivery, BMP transient biological activity, and low bioavailability of factors at the wound site. Gene transfer offers promise as an alternative treatment strategy to deliver BMPs to periodontal tissues. Methods This study utilized ex vivo BMP-7 gene transfer to stimulate tissue engineering of alveolar bone wounds. Syngeneic dermal fibroblasts (SDFs) were transduced ex vivo with adenoviruses encoding either green fluorescent protein (Ad-GFP or control virus), BMP-7 (Ad-BMP-7), or an antagonist of BMP bioactivity, noggin (Ad-noggin). Transduced cells were seeded onto gelatin carriers and then transplanted to large mandibular alveolar bone defects in a rat wound repair model. Results Ad-noggin treatment tended to inhibit osteogenesis as compared to the control-treated and Ad-BMP-7-treated specimens. The osseous lesions treated by Ad-BMP-7 gene delivery demonstrated rapid chrondrogenesis, with subsequent osteogenesis, cementogenesis and predictable bridging of the periodontal bone defects. Conclusion These results demonstrate the first successful evidence of periodontal tissue engineering using ex vivo gene transfer of BMPs and offers a new approach for repairing periodontal defects. PMID:12666709

Histological analysis of effects of 24% EDTA gel for nonsurgical treatment of periodontal tissues.

PubMed

de Vasconcellos, Luana Marotta Reis; Ricardo, Lucilene Hernandes; Balducci, Ivan; de Vasconcellos, Luis Gustavo Oliveira; Carvalho, Yasmin Rodarte

2006-12-01

The aim of this study was to investigate, by means of histological and histomorphometric analysis, the effects of 24% ethylenediaminetetraacetic acid (EDTA) gel in periodontal tissue when used in combination with conventional periodontal treatment. Periodontitis was induced in the 2nd upper left permanent molars of 45 male Wistar rats by means of ligature. After 5 weeks, this was removed and debridement was performed. The animals were then randomly divided into 3 groups; group 1: mechanical treatment, group 2: mechanical treatment and EDTA gel application for 2 min, and group 3: mechanical treatment and placebo gel application for 2 min. After the treatment, rinsing was done with 0.9% saline solution for 1 min in all cases, followed by root notching in the deepest part of the pocket. After 4, 10, and 28 days the animals were sacrificed. The averages obtained were evaluated by means of test two-way analysis of variance (ANOVA) and Tukey statistical tests (P < 0.05). The results showed that with respect to the type of treatment employed, there were no statistically significant differences in the vitality of the periodontal tissue. It was concluded that 24% EDTA gel did not interfere with periodontal tissue repair when used in combination with conventional periodontal treatment.

Differential diagnosis and treatment of periodontitis-mimicking actinomycosis.

PubMed

Kim, Nam Ryang; Park, Jun-Beom; Ko, Youngkyung

2012-12-01

Actinomycosis is an uncommon chronic granulomatous disease that presents as a slowly progressive, indolent, indurated infiltration with multiple abscesses, fistulas, and sinuses. The purpose of this article is to report on a case of actinomycosis with clinical findings similar to periodontitis. A 46-year-old female presented with recurrent throbbing pain on the right first and second molar of the mandible three weeks after root planing. Exploratory flap surgery was performed, and the bluish-gray tissue fragment found in the interproximal area between the two molars was sent for histopathology. The diagnosis from the biopsy was actinomycosis. The clinical and radiographic manifestations of this case were clinically indistinguishable from periodontitis. The patient did not report any symptoms, and she is scheduled for a follow-up visit. The present study has identified periodontitis-mimicking actinomycosis. Actinomycosis should be included in the differential diagnosis in cases with periodontal pain and inflammation that do not respond to nonsurgical treatment for periodontitis. More routine submissions of tissue removed from the oral cavity for biopsies may be beneficial for differential diagnosis.

Do we treat our patients or rather periodontal microbes with adjunctive antibiotics in periodontal therapy? A 16S rDNA microbial community analysis.

PubMed

Hagenfeld, Daniel; Koch, Raphael; Jünemann, Sebastian; Prior, Karola; Harks, Inga; Eickholz, Peter; Hoffmann, Thomas; Kim, Ti-Sun; Kocher, Thomas; Meyle, Jörg; Kaner, Doğan; Schlagenhauf, Ulrich; Ehmke, Benjamin; Harmsen, Dag

2018-01-01

Empiric antibiotics are often used in combination with mechanical debridement to treat patients suffering from periodontitis and to eliminate disease-associated pathogens. Until now, only a few next generation sequencing 16S rDNA amplicon based publications with rather small sample sizes studied the effect of those interventions on the subgingival microbiome. Therefore, we studied subgingival samples of 89 patients with chronic periodontitis (solely non-smokers) before and two months after therapy. Forty-seven patients received mechanical periodontal therapy only, whereas 42 patients additionally received oral administered amoxicillin plus metronidazole (500 and 400 mg, respectively; 3x/day for 7 days). Samples were sequenced with Illumina MiSeq 300 base pairs paired end technology (V3 and V4 hypervariable regions of the 16S rDNA). Inter-group differences before and after therapy of clinical variables (percentage of sites with pocket depth ≥ 5mm, percentage of sites with bleeding on probing) and microbiome variables (diversity, richness, evenness, and dissimilarity) were calculated, a principal coordinate analysis (PCoA) was conducted, and differential abundance of agglomerated ribosomal sequence variants (aRSVs) classified on genus level was calculated using a negative binomial regression model. We found statistically noticeable decreased richness, and increased dissimilarity in the antibiotic, but not in the placebo group after therapy. The PCoA revealed a clear compositional separation of microbiomes after therapy in the antibiotic group, which could not be seen in the group receiving mechanical therapy only. This difference was even more pronounced on aRSV level. Here, adjunctive antibiotics were able to induce a microbiome shift by statistically noticeably reducing aRSVs belonging to genera containing disease-associated species, e.g., Porphyromonas, Tannerella, Treponema, and Aggregatibacter, and by noticeably increasing genera containing health

Estimate of CRP and TNF-alpha level before and after periodontal therapy in cardiovascular disease patients

PubMed Central

Koppolu, Pradeep; Durvasula, Satyanarayana; Palaparthy, Rajababu; Rao, Mukhesh; Sagar, Vidya; Reddy, Sunil Kumar; Lingam, Swapna

2013-01-01

Introduction Epidemiological studies show that individuals with periodontitis have a radically amplified threat to develop cardiovascular disease. CRP& TNF-α, are acute phase proteins monitored as a marker of inflammatory status, which have been identified as a major risk factor for atherosclerotic complications. Elevated CRP & TNF-α level in periodontitis patients have been reported by several groups. The present study was performed to determine whether presence of periodontitis and periodontal therapy could influence the serum levels of CRP & TNF-α in cardiovascular disease patients. Methods Forty cardiovascular disease subjects participated in the study. They were classified into two groups. Group A (Control) where no periodontal treatment was given, Group B (Test) where periodontal treatment (scaling & root planing) was performed. Periodontal clinical parameters like OHI-S, probing pocket depth, were evaluated together with serum CRP, TNF-α, at baseline and reassessed after 8 weeks for all the subjects in both the groups. Results The CRP & TNF-α levels in both the groups decreased but the decrease in the Group A was minimal and was not statistically significant (P > 0.05); whereas in Group B where periodontal therapy was performed, there was statistically significant decrease. Conclusion It can be concluded from the study that there can be a possible causal relationship between pathogenesis of periodontal disease and CVD as inferred from the statistical significant outcome in the form of decreased inflammatory biomarkers after the periodontal treatment. PMID:24198887

Two-year clinical outcomes following non-surgical mechanical therapy of peri-implantitis with adjunctive diode laser application.

PubMed

Mettraux, Gérald R; Sculean, Anton; Bürgin, Walter B; Salvi, Giovanni E

2016-07-01

Non-surgical mechanical therapy of peri-implantitis (PI) with/without adjunctive measures yields limited clinical improvements. To evaluate the clinical outcomes following non-surgical mechanical therapy of PI with adjunctive application of a diode laser after an observation period ≥2 years. At baseline (BL), 15 patients with 23 implants with a sandblasted and acid-etched (SLA) surface diagnosed with PI were enrolled and treated. PI was defined as presence of probing pocket depths (PPD) ≥5 mm with bleeding on probing (BoP) and/or suppuration and ≥2 threads with bone loss after delivery of the restoration. Implant sites were treated with carbon fiber and metal curettes followed by repeated application of a diode laser 3x for 30 s (settings: 810 nm, 2.5 W, 50 Hz, 10 ms). This procedure was performed at Day 0 (i.e., baseline), 7 and 14. Adjunctive antiseptics or adjunctive systemic antibiotics were not prescribed. All implants were in function after 2 years. The deepest PPD decreased from 7.5 ± 2.6 mm to 3.6 ± 0.7 mm at buccal (P < 0.0001) and from 7.7 ± 2.1 mm to 3.8 ± 0.9 mm at oral sites (P < 0.0001), respectively. The % of implants with ≥1 site with BoP decreased from 100% at BL to 43% after 2 years (P = 0.0002). The % of implants with suppuration decreased from 87% at BL to 0% after 2 years (P < 0.0001). Non-surgical mechanical therapy of PI with adjunctive repeated application of a diode laser yielded significant clinical improvements after an observation period of at least 2 years. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Saving Single-rooted Teeth with Combined Endodontic-periodontal Lesions.

PubMed

Pico-Blanco, Alexandre; Castelo-Baz, Pablo; Caneiro-Queija, Leticia; Liñares-González, Antonio; Martin-Lancharro, Pablo; Blanco-Carrión, Juan

2016-12-01

Teeth affected by combined endodontic-periodontal lesions are usually considered by all prognosis classifications as hopeless teeth. The development of new biomaterials combined with modern endodontic and periodontal regeneration techniques may improve dental prognosis and maintain the affected teeth. Moreover, 1 of the replacement options for those teeth, dental implants, has shown an increasing number of biological and technical complications. Five patients were included in this case series study. Full periodontal and radiographic examination revealed generalized chronic periodontitis. Moreover, endodontic-periodontal lesions affecting single-rooted teeth were detected in those patients with tissue destruction beyond the apex. After splinting those teeth, conventional endodontic and nonsurgical periodontal treatment was performed. Three months later, periodontal regeneration was applied at those teeth in order to reconstruct supporting tissues and to improve dental prognosis. After a follow-up period ranging from 14 months to 17 years, it was observed that all teeth remain asymptomatic and in normal function. No signs of apical pathosis were observed, and the periodontium was stable. All patients were included in a strict maintenance program to check the periodontal and apical status. This case series shows that it is possible to change the prognosis of teeth affected by combined endodontic-periodontal lesions, even if the periodontal support is destroyed beyond the apex. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Regenerative periodontal therapy in mucogingival surgery for root coverage.

PubMed

Abitbol, T; Santi, E; Urbani, G

1997-02-01

This article illustrates the potential benefits of regenerative periodontal therapy in mucogingival surgery and esthetic dental treatment. Cases are described in which the treatment of soft-tissue recessions and root exposures are treated with surgical procedures where both clinical soft-tissue augmentation and the regeneration of periodontal attachment are obtained. Cases are also presented to illustrate the clinical application of guided tissue regeneration. Resorbable and nonresorbable barriers are placed over the root surface and bone and covered by the overlying flap, which allows the selective repopulation of the lesion by progenitor cells and the inhibition of a long junctional epithelium. Emphasis is placed on regenerative procedures in soft-tissue augmentation, particularly with respect to rationales, techniques, and indications.

Management of Teeth with Persistent Apical Periodontitis after Root Canal Treatment Using Regenerative Endodontic Therapy.

PubMed

Saoud, Tarek Mohamed A; Huang, George T-J; Gibbs, Jennifer L; Sigurdsson, Asgeir; Lin, Louis M

2015-10-01

Regenerative endodontic therapy (RET) is currently used to treat immature teeth with necrotic pulp and/or apical periodontitis. However, recently RET has been used to treat mature teeth with necrotic pulp and/or apical periodontitis and resulted in regression of clinical signs and/or symptoms and resolution of apical periodontitis. The purpose of this case report was to describe the potential of using RET to treat 2 mature teeth with persistent apical periodontitis after root canal therapy using RET. Two male patients, one 26-year old and another 12-year old, presented for retreatment of persistent apical periodontitis after root canal treatment of 2 mature teeth (#9 and #19). The gutta-percha fillings in the canals of teeth #9 and #19 were removed with Carvene gutta-percha solvent (Prevest DenPro, Jammu, India) and ProTaper Universal rotary retreatment files (Dentsply Maillefer, Ballaigues, Switzerland). The canals of both teeth were further chemomechanically debrided with rotary retreatment files and copious amounts of sodium hypochlorite irrigation and dressed with Metapaste (Meta Biomed, Chungbuk, Korea). RET was performed on teeth #9 and #19. Periapical bleeding was provoked into the disinfected root canals. The blood clots were covered with mineral trioxide aggregate plugs, and the access cavities were restored with intermediate restorative material. Teeth #9 and #19 showed regression of clinical signs and/or symptoms and healing of apical periodontitis after 13-month and 14-month follow-ups, respectively. Tooth #9 revealed narrowing of the canal space and apical closure by deposition of hard tissue. RET has the potential to be used to retreat teeth with persistent apical periodontitis after root canal therapy. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Photodynamic therapy for periodontal disease

NASA Astrophysics Data System (ADS)

Weersink, Robert A.

2002-05-01

Periodontal disease is a family of chronic inflammatory conditions caused by bacterial infections.' It is manifested in red, swollen gingiva (gums) and can lead to destruction of the connective tissue and bone that hold teeth in place. Conventional treatments typically require some form of invasive surgery, depending on the disease stage at time of detection. Photodynamic Therapy (PDT) is the use of light-activated drugs (photosensitizers) for treatment of a variety of conditions 2 such as solid tumors, pre-malignancies, macular degeneration and actinic keratitis. There have been a number of studies of PDT as an antibacterial agent. 3'4 Depending on the photosensitizer and strain of bacteria, significant killing (several LOGS) can be achieved.

Laser reduction of specific microorganisms in the periodontal pocket using Er:YAG and Nd:YAG lasers: a randomized controlled clinical study.

PubMed

Grzech-Leśniak, K; Sculean, A; Gašpirc, Boris

2018-05-15

The objective of this study was to evaluate the microbiological and clinical outcomes following nonsurgical treatment by either scaling and root planing, combination of Nd:YAG and Er:YAG lasers, or by Er:YAG laser treatment alone. The study involved 60 patients with generalized chronic periodontitis, randomly assigned into one of three treatment groups of 20 patients. The first group received scaling and root planing by hand instruments (SRP group), the second group received Er:YAG laser treatment alone (Er group), and the third group received combined treatment with Nd:YAG and Er:YAG lasers (NdErNd group). Microbiological samples, taken from the periodontal pockets at baseline and 6 months after treatments, were assessed with PET Plus tests. The combined NdErNd laser (93.0%), followed closely by Er:YAG laser (84.9%), treatment resulted in the highest reduction of all bacteria count after 6 months, whereas SRP (46.2%) failed to reduce Treponema denticola, Peptostreptococcus micros, and Capnocytophaga gingivalis. Full-mouth plaque and bleeding on probing scores dropped after 6 months and were the lowest in both laser groups. The combination of NdErNd resulted in higher probing pocket depth reduction and gain of clinical attachment level (1.99 ± 0.23 mm) compared to SRP (0.86 ± 0.13 mm) or Er:YAG laser alone (0.93 ± 0.20 mm) in 4-6 mm-deep pockets. Within their limits, the present results provide support for the combination of Nd:YAG and Er:YAG lasers to additionally improve the microbiological and clinical outcomes of nonsurgical periodontal therapy in patients with moderate to severe chronic periodontitis.

Effect of periodontal therapy on metabolic control and an inflammatory mediator in type 2 diabetic subjects: a report on 17 consecutive cases.

PubMed

Serrano, Carlos; Pérez, Clara; Sabogal, Diego

2012-04-01

A reciprocal relationship between diabetes mellitus and chronic periodontitis has been described, whereby chronic periodontal infection could affect diabetic metabolic control. Therefore, periodontal therapy could influence metabolic control or systemic inflammation leading to diabetic complications. This case report series presents the effect of therapy on periodontal indices, glycated hemoglobin (HbA1c) and high-sensitivity C-reactive protein (hs-CRP) in a group of type 2 diabetic patients. Seventeen diabetic patients diagnosed with moderate to severe chronic periodontitis received periodontal therapy. All patients received a hygienic phase of treatment and were re-examined 3 months later. At re-examination, subjects judged to need periodontal surgery were treated and re-examined after a further 3 months. A complete clinical examination and measurements of HbA1c and hs-CRP were evaluated. Periodontal treatment led to a significant improvement in periodontal indices; only five patients required periodontal surgery. The percentage of bleeding on probing was reduced by nearly 40%; percentage of pockets > or = 5 mm was less than half baseline values; mean pocket depth reduction was 1.21 mm (0.58) and attachment level gain was 0.74 mm (0.69). Nevertheless, no changes were present for HbA1c; a reduction in hs-CRP of 1.37 mg/L (2.67) was present. Periodontal therapy in this case series group produced a significant improvement in the clinical condition, butdid not affect metabolic control. It led to a decrease in hs-CRP.

Non-surgical retreatment of a failed apicoectomy without retrofilling using white mineral trioxide aggregate as an apical barrier.

PubMed

Stefopoulos, Spyridon; Tzanetakis, Giorgos N; Kontakiotis, Evangelos G

2012-01-01

Root-end resected teeth with persistent apical periodontitis are usually retreated surgically or a combination of non-surgical and surgical retreatment is employed. However, patients are sometimes unwilling to be subjected to a second surgical procedure. The apical barrier technique that is used for apical closure of immature teeth with necrotic pulps may be an alternative to non-surgically retreat a failed apicoectomy. Mineral trioxide aggregate (MTA) has become the material of choice in such cases because of its excellent biocompatibility, sealing ability and osseoinductive properties. This case report describes the non-surgical retreatment of a failed apicoectomy with no attempt at retrofilling of a maxillary central incisor. White MTA was used to induce apical closure of the wide resected apical area. Four-year follow-up examination revealed an asymptomatic, fully functional tooth with a satisfactory healing of the apical lesion. White MTA apical barrier may constitute a reliable and efficient technique to non-surgically retreat teeth with failed root-end resection. The predictability of such a treatment is of great benefit for the patient who is unwilling to be submitted to a second surgical procedure.

[Periodontitis treatment by "vector" system].

PubMed

Vadachkoriia, N R; Mandzhavidze, N A; Gumberidze, N Sh

2008-11-01

Periodontal therapy by means of Vector device directly effects an environment of the tooth. It allows removing sub gingival dental plaque destroying pathogenic microorganisms and their toxins, washing out periodontal pockets carefully and polishing teeth roots. During treatment the hard tissues are not injured and the gum is not injured as well. Efficiency of a new ultrasonic technique in the complex treatment of periodontal diseases was declared. Periodontal therapy with the ultrasonic device leads to clinical improvements. It was found that Vector treatment was effective in the treatment of patients suffering from periodontitis.

Antiviral therapy after non-surgical tumor ablation in patients with hepatocellular carcinoma associated with hepatitis C virus.

PubMed

Hung, Chao-Hung; Lee, Chuan-Mo; Wang, Jing-Houng; Tung, Hung-Da; Chen, Chien-Hung; Lu, Sheng-Nan

2005-10-01

Antiviral therapy for chronic hepatitis C virus (HCV) infection has led to a reduction in the incidence of hepatocellular carcinoma (HCC). The purpose of the present paper was to assess whether antiviral therapy might suppress tumor recurrence and influence overall survival in patients with HCV-related HCC who had complete ablation of nodules by non-surgical treatments. Twenty patients with three or fewer nodules of HCV-related HCC who were treated with percutaneous tumor ablation and/or transcatheter arterial embolization received combined interferon (IFN; 3 or 5 million units of IFN alpha-2b thrice weekly) plus ribavirin (1000-1200 mg per day) therapy for 24-48 weeks after complete ablation of lesions. During the same period, an additional 40 age- and sex-matched control patients with similar characteristics of tumors (sizes, numbers and treatment modalities) and severity of liver disease were recruited from the HCC database. Both recurrence-free survival and actuarial survival were evaluated. Of the 20 patients, 16 completed therapy and 10 showed a sustained response with normalization of alanine aminotransferase and negative HCV-RNA at 6 months after therapy completion. Due to severe side-effects experienced by Child B patients, who mostly discontinued antiviral therapy, clinical outcome was analyzed in the Child A treated (n = 16) and control (n = 33) patients. There was no significant difference in the incidence of local recurrence in sustained responders compared with non-responders or control patients (P = 0.174, 0.1284, respectively); but the second recurrence-free interval in the sustained responders was significantly longer than that of non-responders and the control group (P = 0.0141, 0.0243, respectively). Survival in sustained responders was better than in non-responders and control patients (P = 0.0691, 0.0554, respectively). These results indicate that successful antiviral therapy after non-surgical tumor ablation for HCV-related HCC may lower tumor

Adjunctive daily supplementation with encapsulated fruit, vegetable and berry juice powder concentrates and clinical periodontal outcomes: a double-blind RCT

PubMed Central

Chapple, Iain L C; Milward, Michael R; Ling-Mountford, Nicola; Weston, Paul; Carter, Kevin; Askey, Keeley; Dallal, Gerard E; De Spirt, Silke; Sies, Helmut; Patel, Dina; Matthews, John B

2012-01-01

Aim A double-blind randomized controlled trial to determine whether dietary supplementation with fruit/vegetable/berry juice powder concentrates, simultaneously with non-surgical periodontal therapy, improved 2-month treatment outcomes. Methods Volunteers with chronic periodontitis were randomly assigned to one of three groups: fruit/vegetable (FV), fruit/vegetable/berry (FVB) or placebo. Supplements were taken daily during non-surgical debridement and maintenance and outcomes assessed at 2, 5 and 8 months after completion. Primary outcomes were mean probing pocket depth (PPD), clinical attachment gain, % sites bleeding on probing (% BOP) at 2 months. Adherence and plasma β-carotene were determined. Results Sixty-one nutritionally replete (by serum biochemistry) volunteers enrolled and 60 (n = 20 per arm) completed the 2-month review. Clinical outcomes improved in all groups at 2 months, with additional improvement in PPD versus placebo for FV (p < 0.03). Gingival crevicular fluid volumes diminished more in supplement groups than placebo (FVB; p < 0.05) at 2 months, but not at later times. The % BOP (5 months) and cumulative plaque scores (8 months) were lowered more in the FV group (p < 0.05). Conclusions Adjunctive juice powder concentrates appear to improve initial pocket depth reductions in nutritionally replete patients, where plasma micronutrient bioavailability is attainable. Definitive multicentre studies in untreated and treated patients are required to ascertain the clinical significance of such changes. PMID:22093005

The Effect of Scaling and Root Planing on Glycaemic Control, Periodontal Status and Gingival Crevicular Fluid TNF-α Levels in an Indian Population- To Reveal the Ambivalent Link

PubMed Central

A, Suchetha; P, Lakshmi; N, Sapna; S M, Apoorva; Bhat, Divya; Mundinamane, Darshan B

2014-01-01

Context: Periodontal disease and diabetes mellitus(DM) share a two - way relationship. It can be hypothesized that successful management of periodontal infection in diabetes will lead not only to reduction of local signs and symptoms of the disease, but also to better control of glucose metabolism. Aims: To monitor the effect of Scaling and Root planing (SRP) on glycaemic control in patients with type 2 diabetes mellitus by estimating the HbA1c and GCF TNF-α levels. Settings and Design: This Interventional clinicobiochemical study was carried out over a period of 6 months from December 2010-May 2011 in Bengaluru, Karnataka, India. Materials and Methods: Fifteen well-controlled, 15 moderately controlled and 15 poorly controlled diabetic subjects were enrolled in this study. All participants were subjected to non-surgical periodontal (SRP) therapy. GCF sampling and clinical periodontal parameters assessment were done at baseline and 3 months post-therapy. TNF-α levels in GCF were analyzed by enzyme-linked immunosorbent assay (ELISA) at baseline and 3 months post therapy. The improvement in glycaemic control was assessed using HbA1c levels at 3 months reevaluation. Statistical analysis: The data obtained were statistically analysed using Kruskal-Wallis test, Mann-Whitney test and Wilcoxon Signed Rank test. Results: Following periodontal treatment, all patients demon- strated a significant improvement in periodontal status. A reduction in TNF-α level and the HbA1c values were also observed. Conclusion: The result indicates that SRP is effective in improving metabolic control in Type 2 Diabetes Mellitus patients possibly through the reduction of TNF-α which in turn might improve the insulin resistance. PMID:25584310

MFG-E8 inhibits periodontitis in non-human primates and its gingival crevicular fluid levels can differentiate periodontal health from disease in humans

PubMed Central

Kajikawa, Tetsuhiro; Meshikhes, Fatimah; Maekawa, Tomoki; Hajishengallis, Evlambia; Hosur, Kavita B.; Abe, Toshiharu; Moss, Kevin; Chavakis, Triantafyllos; Hajishengallis, George

2017-01-01

Aim We have previously shown that the secreted glycoprotein MFG-E8 has anti-inflammatory and anti-osteoclastogenic properties. Our objective was to investigate the potential of MFG-E8 as a diagnostic or therapeutic agent in periodontitis. Materials and Methods Periodontitis was induced in non-human primates (NHPs) by placing ligatures around posterior teeth on both halves of the mandible for a split-mouth design: one side was treated with MFG-E8−Fc and the other with Fc control. Disease was assessed by clinical periodontal examinations, radiographic analysis of bone loss, and analysis of cytokine mRNA expression in gingival biopsy samples. Gingival crevicular fluid (GCF) was collected from human healthy volunteers or subjects with gingivitis, chronic moderate periodontitis, or chronic severe periodontitis. Additionally, GCF was collected from a subset of severe periodontitis patients following scaling and root planing (SRP) and after pocket reduction surgery. GCF was analyzed to quantify MFG-E8 and periodontitis-relevant cytokines using multiplex assays. Results In NHPs, sites treated with MFG-E8-Fc exhibited significantly less ligature-induced periodontal inflammation and bone loss than Fc control-treated sites. In humans, the GCF levels of MFG-E8 were significantly higher in health than in periodontitis, whereas the reverse was true for the proinflammatory cytokines tested. Consistently, MFG-E8 was elevated in GCF after both non-surgical (SRP) and surgical periodontal treatment of periodontitis patients. Conclusion MFG-E8 is, in principle, a novel therapeutic agent and biomarker of periodontitis. PMID:28207941

Multidisciplinary therapy for the treatment of malocclusion in a patient with chronic periodontitis with a five-year follow-up: A case report.

PubMed

Zhang, Dongmei; Lin, Li; Tang, Xiaoling; Li, Chen; Liu, Jingbo; Wang, Hongyang; Pan, Yaping

2017-10-01

Multidisciplinary therapy is essential in dental practice to achieve optimized outcomes. The present case report describes the application of periodontal surgery with a five-year follow-up in a patient with malocclusion and chronic periodontitis. In the presence of periodontal inflammation, orthodontic therapy may result in further periodontal breakdown due to plaque accumulation. In order to prevent this progression, scaling and root planning with a periodontal endoscope was applied, and continuous clinical monitoring and risk assessment was performed every 3 months using a Florida Probe. This combined treatment supports the long-term maintenance of periodontal conditions, functional occlusion and harmony of the facial profile.

Effect of periodontal treatment on the clinical parameters of patients with rheumatoid arthritis: study protocol of the randomized, controlled ESPERA trial

PubMed Central

2013-01-01

Background Rheumatoid arthritis (RA) is a chronic inflammatory disorder that leads to joint damage, deformity, and pain. It affects approximately 1% of adults in developed countries. Periodontitis is a chronic oral infection, caused by inflammatory reactions to gram-negative anaerobic bacteria, and affecting about 35 to 50% of adults. If left untreated, periodontitis can lead to tooth loss. A significant association has been shown to exist between periodontitis and RA in observational studies. Some intervention studies have suggested that periodontal treatment can reduce serum inflammatory biomarkers such as C-reactive protein, or erythrocyte sedimentation rate. We hypothesize that periodontitis could be an aggravating factor in patients with RA, and that its treatment would improve RA outcomes. The aim of this clinical trial is to assess the effect of periodontal treatment on the biological and clinical parameters of patients with RA. Methods/design The ESPERA (Experimental Study of Periodontitis and Rheumatoid Arthritis) study is an open-label, randomized, controlled trial. Subjects with both RA and periodontitis will be recruited at two university hospitals in southwestern France. In total, 40 subjects will be randomized into two arms (intervention and control groups), and will be followed up for 3 months. Intervention will consist of full-mouth supra-gingival and sub-gingival non-surgical scaling and root planing, followed by systemic antibiotic therapy, local antiseptics, and oral hygiene instructions. After the 3-month follow-up period, the same intervention will be applied to the subjects randomized to the control group. The primary outcome will be change of in Disease Activity Score in 28 Joints (DAS28) at the end of the follow-up period. Secondary outcomes will be the percentages of subjects with 20%, 50%, and 70% improvement in disease according to the American College of Rheumatology criteria. Health-related quality of life assessments (the Health

Glycemic control and adipokines after periodontal therapy in patients with Type 2 diabetes and chronic periodontitis.

PubMed

Wang, Shunqin; Liu, Jingsong; Zhang, Junfeng; Lin, Jiancheng; Yang, Shuyu; Yao, Jiangwu; Du, Minquan

2017-11-27

The mechanism by which chronic periodontitis (CP) affects type 2 diabetes (T2DM) remains unclear. Therefore, the aim of this study is to evaluate the effects of periodontal therapy (PT) on the glycemic control and adipokines of patients with T2DM and CP with the purpose of elucidating the possible mechanisms by which CP influences T2DM. Forty-four patients with T2DM and CP were randomly divided into two groups according to whether they underwent PT. Periodontal status, blood glucose, and the levels of serum tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), adiponectin (APN), and fibroblast growth factor-21 (FGF-21) were measured at baseline and after 3 months. The results revealed that the probing depth (PD) and attachment loss (AL) were significantly improved, the serum levels of TNF-α and IL-6 were significantly decreased, and APN and FGF-21 exhibited substantial increases in the intervention group after 3 months (p < 0.05), whereas no significant changes were observed in the control group. The glycated hemoglobin (HbA1c) levels in both groups decreased significantly after 3 months compared with baseline (p < 0.05), but the intervention group exhibited a significantly greater change (p < 0.05). In conclusion, PT may relieve periodontal inflammation, which causes a reduction of insulin-antagonizing adipokines and an increase in insulin-sensitizing adipokines, thereby eliciting an improvement in glycemic control.

Current concepts in periodontal bioengineering

PubMed Central

Taba, M.; Jin, Q.; Sugai, J.V.; Giannobile, W.V.

2008-01-01

Repair of tooth supporting alveolar bone defects caused by periodontal and peri-implant tissue destruction is a major goal of reconstructive therapy. Oral and craniofacial tissue engineering has been achieved with limited success by the utilization of a variety of approaches such as cell-occlusive barrier membranes, bone substitutes and autogenous block grafting techniques. Signaling molecules such as growth factors have been used to restore lost tooth support because of damage by periodontal disease or trauma. This paper will review emerging periodontal therapies in the areas of materials science, growth factor biology and cell/gene therapy. Several different polymer delivery systems that aid in the targeting of proteins, genes and cells to periodontal and peri-implant defects will be highlighted. Results from preclinical and clinical trials will be reviewed using the topical application of bone morphogenetic proteins (BMP-2 and BMP-7) and platelet-derived growth factor-BB (PDGF) for periodontal and peri-implant regeneration. The paper concludes with recent research on the use of ex vivo and in vivo gene delivery strategies via gene therapy vectors encoding growth promoting and inhibiting molecules (PDGF, BMP, noggin and others) to regenerate periodontal structures including bone, periodontal ligament and cementum. PMID:16238610

In vitro chlorhexidine release from alginate based microbeads for periodontal therapy

PubMed Central

Reske, Thomas; Böhmer, Femke; Hornung, Anne; Grabow, Niels; Lang, Hermann

2017-01-01

Periodontitis is one of the most common infectious diseases globally that, if untreated, leads to destruction of the tooth supporting tissues and finally results in tooth loss. Evidence shows that standard procedures as mechanical root cleaning could be supported by further treatment options such as locally applied substances. Due to gingival crevicular fluid flow, substances are commonly washed out off the periodontal pockets. The evaluation of administration techniques and the development of local drug releasing devices is thus an important aspect in periodontal research. This study describes the development and examination of a new alginate based, biodegradable and easily applicable drug delivery system for chlorhexidine (CHX). Different micro beads were produced and loaded with CHX and the release profiles were investigated by high performance liquid chromatography (HPLC). The in vitro-demonstrated release of CHX from alginate based beads shows comparable releasing characteristics as clinically approved systems. Yet many characteristics of this new delivery system show to be favourable for periodontal therapy. Easy application by injection, low production costs and multifunctional adaptions to patient related specifics may improve the usage in routine care. PMID:28973028

Periodontics--tissue engineering and the future.

PubMed

Douglass, Gordon L

2005-03-01

Periodontics has a long history of utilizing advances in science to expand and improve periodontal therapies. Recently the American Academy of Periodontology published the findings of the Contemporary Science Workshop, which conducted state-of-the-art evidence-based reviews of current and emerging areas in periodontics. The findings of this workshop provide the basis for an evidence-based approach to periodontal therapy. While the workshop evaluated all areas of periodontics, it is in the area of tissue engineering that the most exciting advances are becoming a reality.

Long-term effect on tooth vitality of regenerative therapy in deep periodontal bony defects: a retrospective study.

PubMed

de Sanctis, Massimo; Goracci, Cecilia; Zucchelli, Giovanni

2013-01-01

Over the last few decades, many authors have investigated the effect of periodontal disease and treatment on pulpal status with controversial results. This study was conducted to verify whether periodontal disease in a deep intrabony defect and complex therapy, including aggressive root planing such as in periodontal regeneration, have an influence on tooth vitality. One hundred thirty-seven patients who fulfilled the requirements were included. The collected data did not support the need for "preventive" root canal treatment in severely compromised teeth that are planned to undergo periodontal regenerative surgery.

Periodontal treatment improves endothelial dysfunction in patients with severe periodontitis.

PubMed

Seinost, Gerald; Wimmer, Gernot; Skerget, Martina; Thaller, Erik; Brodmann, Marianne; Gasser, Robert; Bratschko, Rudolf O; Pilger, Ernst

2005-06-01

Because epidemiological studies provide evidence that periodontal infections are associated with an increased risk of progression of cardiovascular and cerebrovascular disease, we postulated that endothelial dysfunction, a critical element in the pathogenesis of atherosclerosis, would be present in patients with periodontal disease. We tested endothelial function in 30 patients with severe periodontitis and 31 control subjects using flow-mediated dilation (FMD) of the brachial artery. The groups were matched for age, sex, and cardiovascular risk factors. Three months after periodontal treatment, including both mechanical and pharmacological therapy, endothelial function was reassessed by brachial artery FMD. Markers of systemic inflammation were measured at baseline and at follow up. Flow-mediated dilation was significantly lower in patients with periodontitis than in control subjects (6.1% +/- 4.4% vs 8.5% +/- 3.4%, P = .002). Successful periodontal treatment resulted in a significant improvement in FMD (9.8% +/- 5.7%; P = .003 compared to baseline) accompanied by a significant decrease in C-reactive protein concentrations (1.1 +/- 1.9 vs 0.8 +/- 0.8 at baseline, P = .026). Endothelium-independent nitro-induced vasodilation did not differ between the study groups at baseline or after periodontal therapy. These results indicate that treatment of severe periodontitis reverses endothelial dysfunction. Whether improved endothelial function will translate into a beneficial effect on atherogenesis and cardiovascular events needs further investigation.

[Investigation of the prevalence of periodontal diseases among naval personnel during prolonged sailing].

PubMed

Zhao, Zheng; Li, Lu-Jia; Huang, Zheng-Nan; Jia, Bao-Jun; Yang, Hai-Qing

2015-02-01

To investigate the prevalence of periodontal diseases among naval personnel during prolonged sailing. The calculus index-simplified (CI-S), plaque index (PLI), gingival index (GI), community periodontal index (CPI), attachment loss (AL), number of missing tooth (NMT) and prevalence of periodontal disease were recorded among 186 naval personnel who participated in prolonged sailing before and after sailing. The data was analyzed with SPSS 14.0 software package. Each periodontal index after sailing was significantly higher than that of before sailing(P<0.01). Before sailing, the prevalence of periodontal diseases from 186 objects was 59.7%; While after sailing the prevalence increased to 83.3%. Among them, patients who suffered from gingivitis and mid or moderate periodontitis raised greatly, and significant differences were found in the prevalence and degree of periodontal disease (P<0.01) compared between pre-sailing and post-sailing. Prolonged sailing environment, food constraint and poor oral hygiene can influence periodontal state of naval personnel. To enhance propaganda and education on oral hygiene promptly and effectively, to develop the habit of correct toothbrushing, to have balanced and rational diet, and to perform proper periodontal non-surgical treatment and medication are essential to periodontal health of naval personnel during prolonged sailing.

Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline.

PubMed

Chou, Roger; Atlas, Steven J; Stanos, Steven P; Rosenquist, Richard W

2009-05-01

Systematic review. To systematically assess benefits and harms of nonsurgical interventional therapies for low back and radicular pain. Although use of certain interventional therapies is common or increasing, there is also uncertainty or controversy about their efficacy. Electronic database searches on Ovid MEDLINE and the Cochrane databases were conducted through July 2008 to identify randomized controlled trials and systematic reviews of local injections, botulinum toxin injection, prolotherapy, epidural steroid injection, facet joint injection, therapeutic medial branch block, sacroiliac joint injection, intradiscal steroid injection, chemonucleolysis, radiofrequency denervation, intradiscal electrothermal therapy, percutaneous intradiscal radiofrequency thermocoagulation, Coblation nucleoplasty, and spinal cord stimulation. All relevant studies were methodologically assessed by 2 independent reviewers using criteria developed by the Cochrane Back Review Group (for trials) and by Oxman (for systematic reviews). A qualitative synthesis of results was performed using methods adapted from the US Preventive Services Task Force. For sciatica or prolapsed lumbar disc with radiculopathy, we found good evidence that chemonucleolysis is moderately superior to placebo injection but inferior to surgery, and fair evidence that epidural steroid injection is moderately effective for short-term (but not long-term) symptom relief. We found fair evidence that spinal cord stimulation is moderately effective for failed back surgery syndrome with persistent radiculopathy, though device-related complications are common. We found good or fair evidence that prolotherapy, facet joint injection, intradiscal steroid injection, and percutaneous intradiscal radiofrequency thermocoagulation are not effective. Insufficient evidence exists to reliably evaluate other interventional therapies. Few nonsurgical interventional therapies for low back pain have been shown to be effective in

Knowledge of risk factors and the periodontal disease-systemic link in dental students' clinical decisions.

PubMed

Friesen, Lynn Roosa; Walker, Mary P; Kisling, Rebecca E; Liu, Ying; Williams, Karen B

2014-09-01

This study evaluated second-, third-, and fourth-year dental students' ability to identify systemic conditions associated with periodontal disease, risk factors most important for referral, and medications with an effect on the periodontium and their ability to apply this knowledge to make clinical decisions regarding treatment and referral of periodontal patients. A twenty-one question survey was administered at one U.S. dental school in the spring semester of 2012 to elicit the students' knowledge and confidence regarding clinical reasoning. The response rate was 86 percent. Periodontal risk factors were accurately selected by at least 50 percent of students in all three classes; these were poorly controlled diabetes, ≥6 mm pockets posteriorly, and lack of response to previous non-surgical therapy. Confidence in knowledge, knowledge of risk factors, and knowledge of medications with an effect on the periodontium improved with training and were predictive of better referral decision making. The greatest impact of training was seen on the students' ability to make correct decisions about referral and treatment for seven clinical scenarios. Although the study found a large increase in the students' abilities from the second through fourth years, the mean of 4.6 (out of 7) for the fourth-year students shows that, on average, those students missed correct treatment or referral on more than two of seven clinical cases. These results suggest that dental curricula should emphasize more critical decision making with respect to referral and treatment criteria in managing the periodontal patient.

Professional oral hygiene treatment and detailed oral hygiene instructions in patients affected by mucous membrane pemphigoid with specific gingival localization: a pilot study in 12 patients.

PubMed

Arduino, P G; Lopetuso, E; Carcieri, P; Giacometti, S; Carbone, M; Tanteri, C; Broccoletti, R

2012-05-01

The aim of this prospective case series was to assess the clinical efficiency of an oral hygiene protocol in patients affected by mucous membrane pemphigoid (MMP) with specific gingival localization, before starting any medical treatment. Patients received oral hygiene instruction followed by non-surgical periodontal therapy including oral hygiene instructions in a 3-week cohort study. Clinical outcome variables were recorded at baseline and 5 weeks after intervention and included, as periodontal parameters, full mouth plaque (FMPS) and bleeding (FMBS) scores and patient-related outcomes (visual analogue score of pain). A total of 12 patients were recruited. The mean age at presentation was 59.5 ± 14.52 years. Five weeks after finishing the oral hygiene and periodontal therapy protocol, a statistical significant reduction was observed for FMPS (P = 0.001), FMBS (P = 0.022) and reported pain (P = 0.0028). Professional oral hygiene procedures and non-surgical periodontal therapy are connected with improvement of gingival status and decrease in gingival-related pain, in female patients affected by MMP with specific gingival localization. © 2011 John Wiley & Sons A/S.

Evaluation of the effect of non-surgical periodontal treatment on oral health-related quality of life: estimation of minimal important differences 1 year after treatment.

PubMed

Jönsson, Birgitta; Öhrn, Kerstin

2014-03-01

To evaluate an individually tailored oral health educational programme on patient-reported outcome compared with a standard oral health educational programme, assess change over time and determine minimal important differences (MID) in change scores for two different oral health related quality of life (OHRQoL) instrument after non-surgical periodontal treatment (NSPT). In a randomized controlled trial evaluating two educational programmes, patients (n = 87) with chronic periodontitis completed a questionnaire at baseline and after 12 months. OHRQoL was assessed with the General Oral Health Assessment Index (GOHAI) and the UK oral health-related quality-of-life measure (OHQoL-UK). In addition, patients' global rating of oral health and socio-demographic variables were recorded. The MID was estimated with anchor-based and distributions-based methods. There were no differences between the two educational groups. The OHRQoL was significantly improved after treatment. The MID was approximately five for OHQoL-UK with a moderate ES, and three for GOHAI with a Small ES, and 46-50% of the patients showed improvements beyond the MID. Both oral health educational groups reported higher scores in OHRQoL after NSPT resulting in more positive well-being (OHQoL-UK) and less frequent oral problems (GOHAI). OHQoL-UK gave a greater effect size and mean change scores but both instruments were associated with the participants' self-rated change in oral health. The changes were meaningful for the patients supported by the estimated MID. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

PAR-2 expression in the gingival crevicular fluid reflects chronic periodontitis severity.

PubMed

Fukushima, Henrique; Alves, Vanessa Tubero Euzebio; Carvalho, Verônica Franco de; Ambrósio, Lucas Macedo Batitucci; Eichler, Rosangela Aparecida Dos Santos; Carvalho, Maria Helena Catelli de; Saraiva, Luciana; Holzhausen, Marinella

2017-01-26

Recent studies investigating protease-activated receptor type 2 (PAR-2) suggest an association between the receptor and periodontal inflammation. It is known that gingipain, a bacterial protease secreted by the important periodontopathogen Porphyromonas gingivalis can activate PAR-2. Previous studies by our group found that PAR-2 is overexpressed in the gingival crevicular fluid (GCF) of patients with moderate chronic periodontitis (MP). The present study aimed at evaluating whether PAR-2 expression is associated with chronic periodontitis severity. GCF samples and clinical parameters, including plaque and bleeding on probing indices, probing pocket depth and clinical attachment level, were collected from the control group (n = 19) at baseline, and from MP patients (n = 19) and severe chronic periodontitis (SP) (n = 19) patients before and 6 weeks after periodontal non-surgical treatment. PAR-2 and gingipain messenger RNA (mRNA) in the GCF of 4 periodontal sites per patient were evaluated by Reverse Transcription Polymerase Chain Reaction (RT-qPCR). PAR-2 and gingipain expressions were greater in periodontitis patients than in control group patients. In addition, the SP group presented increased PAR-2 and gingipain mRNA levels, compared with the MP group. Furthermore, periodontal treatment significantly reduced (p <0.05) PAR-2 expression in patients with periodontitis. In conclusion, PAR-2 is associated with chronic periodontitis severity and with gingipain levels in the periodontal pocket, thus suggesting that PAR-2 expression in the GCF reflects the severity of destruction during periodontal infection.

Dental practitioners with a special interest in periodontics: the West Sussex experience.

PubMed

Cheshire, P D; Saner, P; Lesley, R; Beckerson, J; Butler, M; Zanjani, B

2011-02-12

The experience of a pilot service involving practitioners with a special interest in periodontics is described. The service functioned as a clinical network between the primary and secondary sector and featured consultant outreach. Between June 2006 and May 2007 it experienced 441 referrals. It improved patient access to periodontal care and was successful in targeting specific disease categories and in meeting key performance indicators. The service was non-surgical and emphasised patient self-efficacy. It produced highly effective clinical outcomes. It was well accepted by both patients and referring practitioners. It did not replace the need for a consultant-led service in the eyes of the referring practitioners. The BPE was used to identify suitable patients; audit indicated that there was a tendency for practitioners to underscore the level of periodontal disease.

Five-year comparative study on conventional and laser-assisted therapy of periimplantitis and periodontitis

NASA Astrophysics Data System (ADS)

Bach, Georg; Neckel, Claus P.

2000-03-01

Numerous groups have recommended the use of the diode laser to decontaminate infected root and implant surfaces. The aim of this study was to show the outcome after laser assisted and conventional therapy of periimplantitis and periodontitis administering approved treatment protocols. Between 1994 and 1999 a total of 50 patients with periimplantitis (20) and periodontitis (30) were treated in two groups each. Clinical, microbiological and radiographic evaluation was performed before and 6, 12, 24, 36, 48 and 60 months after treatment. In addition to the conventional treatment protocol, flap surgery, the tooth or implant surface was decontaminated with a 810 nm diode laser using 1 Watt output for 20 sec (CW mode). All accessible surfaces were decontaminated at the follow up dates. In the periimplantitis group recurrence of the marker bacteria was higher and faster over time for the conventionally operated patients. Also the clinical and radiographic reevaluation showed significantly better results. The laser group of the periodontitis patients also showed significantly better outcome in terms of clinical evaluation, microbiological counts, radiographic evaluation and tooth loss. In comparison to other long term studies our results for the conventional therapy were adequate, the laser assisted therapy brought up significantly better and reproducible results.

Combined periodontic-orthodonticendodontic interdisciplinary approach in the treatment of periodontally compromised tooth

PubMed Central

Deepa, D; Mehta, D. S.; Puri, Viren K.; Shetty, Sadashiva

2010-01-01

Orthodontic treatment in adult patients is one of the most frequently encountered components involving multidisciplinary approaches. In the present report, a 28-year-old male patient was treated for localized chronic periodontitis with pocket formation, mobility, pathologic migration and malalignment of maxillary left lateral incisor tooth #22. The periodontal therapy included motivation, education and oral-hygiene instructions (O.H.I.), scaling and root planing and periodontal flap surgery. Subsequently on resolution of periodontal inflammation, orthodontic therapy was carried out using the orthodontic aligner for a period of 6 months. Post-treatment (3 years) results showed complete resolution of infrabony pocket with significant bone fill, reduced tooth mobility and complete alignment of the affected maxillary left lateral incisor, thus restoring the esthetics and function. PMID:21691554

Combined periodontic-orthodonticendodontic interdisciplinary approach in the treatment of periodontally compromised tooth.

PubMed

Deepa, D; Mehta, D S; Puri, Viren K; Shetty, Sadashiva

2010-04-01

Orthodontic treatment in adult patients is one of the most frequently encountered components involving multidisciplinary approaches. In the present report, a 28-year-old male patient was treated for localized chronic periodontitis with pocket formation, mobility, pathologic migration and malalignment of maxillary left lateral incisor tooth #22. The periodontal therapy included motivation, education and oral-hygiene instructions (O.H.I.), scaling and root planing and periodontal flap surgery. Subsequently on resolution of periodontal inflammation, orthodontic therapy was carried out using the orthodontic aligner for a period of 6 months. Post-treatment (3 years) results showed complete resolution of infrabony pocket with significant bone fill, reduced tooth mobility and complete alignment of the affected maxillary left lateral incisor, thus restoring the esthetics and function.

Prevention and treatment of periodontal diseases in primary care.

PubMed

Matthews, Debora C

2014-09-01

The aim of this guidance is to support the dental team to; manage patients with periodontal diseases in primary care appropriately; improve the quality of decision making for referral to secondary care; improve the overall oral health of the population. It focuses on the prevention and non-surgical treatment of periodontal diseases and implant diseases in primary care. The surgical treatment of periodontal and implant diseases and the management of patients by periodontal specialists or in a secondary care setting are outwith the scope of this guidance and are not discussed in detail. The guidance is based on existing guidelines, including those from the British Society of Periodontology, relevant systematic reviews, research evidence and the opinion of experts and experienced practitioners. The methodological approach is based on the international standards set out by the Appraisal of Guidelines Research and Evaluation (AGREE) Collaboration (www.agreetrust.org). The guiding principle for developing guidance within SDCEP is to first source existing guidelines, policy documents, legislation or other recommendations. Similarly, relevant systematic reviews are also initially identified. These documents are appraised for their quality of development, evidence base and applicability to the remit of the guidance under development. In the absence of these documents or when supplementary information is required, other published literature and unpublished work may be sought.Review and updating. The guidance will be reviewed in three years and updated accordingly. Recommendations are provided for assessment and diagnosis; changing patient behaviour; treatment of gingival conditions; periodontal conditions; long term maintenance; management of patients with dental implants; referral and record keeping. The key recommendations highlighted are: Assess and explain risk factors for periodontal diseases to patients. Screen all patients for periodontal diseases at every routine

Improvement in Oral Health-related Quality of Life by Periodontal Treatment: A Case Report on Elderly Patient with Chronic Periodontitis.

PubMed

Suzuki, Eiichi; Aoki, Hideo; Tomita, Sachiyo; Saito, Atsushi

2016-01-01

We report a case of an elderly patient with chronic periodontitis requiring periodontal surgery. An 86-year-old man presented to Tokyo Dental College Suidobashi Hospital with the chief complaint of tooth fracture in the anterior region and occlusal pain in the posterior region. Clinical examination revealed 47% of sites with a probing depth (PD) of ≥4 mm and 47% of sites with bleeding on probing. Radiographic examination revealed generalized moderate horizontal bone loss with localized vertical defects. A clinical diagnosis of moderate chronic periodontitis was made. The patient's oral health-related quality of life (QoL) was also assessed at the time of each periodontal assessment. Initial periodontal therapy was provided followed by periodontal surgery. Open flap debridement was performed at sites with a PD of ≥5 mm (teeth #15-17). Surgical crown lengthening with an apically positioned flap was performed on #11 and 13 to gain an adequate biological width for the subsequent crown restoration. After confirming the stability of the periodontal tissue, provisional restorations were replaced with final restorations. No further deterioration was observed in the periodontal condition during the subsequent 1-year period of supportive periodontal therapy. Oral health-related QoL was markedly improved by the periodontal therapy. This suggests that periodontal therapy plays an important role in improving and maintaining oral health-related QoL in elderly people.

Epidermolysis bullosa acquisita: clinical manifestations, microscopic findings, and surgical periodontal therapy. A case report.

PubMed

Hakki, S S; Celenligil-Nazliel, H; Karaduman, A; Usubütün, A; Ertoy, D; Ayhan, A; Ruacan, S

2001-04-01

Epidermolysis bullosa acquisita (EBA) is an uncommon, acquired, chronic subepidermal bullous disease. This report describes a case of EBA with gingival involvement. A 43-year-old woman with EBA was referred to our clinic for periodontal therapy because of gingival tenderness and bleeding. She has been on cyclosporin A therapy for the last 2 years. Clinical findings were analyzed. Anterior gingivectomy operations were performed in 2 stages. The samples obtained during the surgery were examined using histopathologic, immunohistologic, and electronmicroscopic methods. Long-term effects of the surgical periodontal treatment on gingiva were evaluated both clinically and microscopically. The dentition displayed minimal enamel hypoplasia. Decayed, missing, and filled surfaces score was found to be elevated. Periodontal examination showed generalized diffuse gingival inflammation and gingival enlargement localized mainly to the anterior region. Nikolsky's sign was positive. However, wound healing was uneventful after the operations. Microscopic findings were similar to those obtained from the skin. Twenty-one months after the operations, Nikolsky's sign was negative and no remarkable gingival inflammation was noted. Microscopic examination revealed that the blisters were fewer in number and smaller in size. These results indicate that gingival tissues may also be involved in EBA. Uneventful wound healing after periodontal surgery in this case suggests that periodontal surgery can be performed in patients with EBA. Moreover, both our clinical and histopathologic findings imply that gingivectomy proves useful in maintaining gingival integrity in these patients. Our data may also suggest that the patients with EBA are highly likely to develop dental caries.

Nonsurgical Management of Adolescent Idiopathic Scoliosis.

PubMed

Gomez, Jaime A; Hresko, M Timothy; Glotzbecker, Michael P

2016-08-01

Pediatric patient visits for spinal deformity are common. Most of these visits are for nonsurgical management of scoliosis, with approximately 600,000 visits for adolescent idiopathic scoliosis (AIS) annually. Appropriate management of scoliotic curves that do not meet surgical indication parameters is essential. Renewed enthusiasm for nonsurgical management of AIS (eg, bracing, physical therapy) exists in part because of the results of the Bracing in Adolescent Idiopathic Scoliosis Trial, which is the only randomized controlled trial available on the use of bracing for AIS. Bracing is appropriate for idiopathic curves between 20° and 40°, with successful control of these curves reported in >70% of patients. Patient adherence to the prescribed duration of wear is essential to maximize the effectiveness of the brace. The choice of brace type must be individualized according to the deformity and the patient's personality as well as the practice setting and brace availability.

Relationship between Acute Phase of Chronic Periodontitis and Meteorological Factors in the Maintenance Phase of Periodontal Treatment: A Pilot Study.

PubMed

Takeuchi, Noriko; Ekuni, Daisuke; Tomofuji, Takaaki; Morita, Manabu

2015-08-05

The acute phase of chronic periodontitis may occur even in patients during supportive periodontal therapy. However, the details are not fully understood. Since the natural environment, including meteorology affects human health, we hypothesized that weather conditions may affect occurrence of acute phase of chronic periodontitis. The aim of this study was to investigate the relationship between weather conditions and acute phase of chronic periodontitis in patients under supportive periodontal therapy. Patients who were diagnosed with acute phase of chronic periodontitis under supportive periodontal therapy during 2011-2013 were selected for this study. We performed oral examinations and collected questionnaires and meteorological data. Of 369 patients who experienced acute phase of chronic periodontitis, 153 had acute phase of chronic periodontitis without direct-triggered episodes. When using the autoregressive integrated moving average model of time-series analysis, the independent covariant of maximum hourly range of barometric pressure, maximum hourly range of temperature, and maximum daily wind speed were significantly associated with occurrence of acute phase of chronic periodontitis (p < 0.05), and 3.1% of the variations in these occurrence over the study period were explained by these factors. Meteorological variables may predict occurrence of acute phase of chronic periodontitis.

[Control of generalized chronic periodontitis combined with calcium-antagonist-related gingival overgrowth by a complex periodontal-endodontic-prosthodontic treatment. Case report].

PubMed

Szánto, Erika; Gera, István

2011-12-01

To day a relatively high percentage of elderly population of the industrialized world suffers with different cardiovascular diseases and are on permanent antihypertensive therapy. One of the most frequently used drugs is the calcium channel blockers prescribed against high blood pressure. The most common oral side effect of these drugs is the gingival enlargement that might develop even on otherwise healthy gingiva. The incidence of chronic periodontitis in this age group is also high and the Ca antagonist medication in those individuals might substantially modify the clinical course of periodontal inflammation leading to gingival enlargement and hypertrophic pocket wall. The case presented here is a 52 years old hypertonic woman with a long history of Ca-antagonist therapy and generalized chronic periodontitis combined with gingival hyperplasia. After the change of medication the 1,5 years comprehensive periodontal endodontic and prosthodontic therapy restored patient's periodontal health and provided complex dental rehabilitation. Nevertheless, only regular periodontal supportive therapy could ensure predictable outcome and guarantee long lasting periodontal health.

Treatment of a Periodontic-Endodontic Lesion in a Patient with Aggressive Periodontitis.

PubMed

Fahmy, Mina D; Luepke, Paul G; Ibrahim, Mohamed S; Guentsch, Arndt

2016-01-01

Case Description. This case report describes the successful management of a left mandibular first molar with a combined periodontic-endodontic lesion in a 35-year-old Caucasian woman with aggressive periodontitis using a concerted approach including endodontic treatment, periodontal therapy, and a periodontal regenerative procedure using an enamel matrix derivate. In spite of anticipated poor prognosis, the tooth lesion healed. This case report also discusses the rationale behind different treatment interventions. Practical Implication. Periodontic-endodontic lesions can be successfully treated if dental professionals follow a concerted treatment protocol that integrates endodontic and periodontic specialties. General dentists can be the gatekeepers in managing these cases.

Treatment of a Periodontic-Endodontic Lesion in a Patient with Aggressive Periodontitis

PubMed Central

2016-01-01

Case Description. This case report describes the successful management of a left mandibular first molar with a combined periodontic-endodontic lesion in a 35-year-old Caucasian woman with aggressive periodontitis using a concerted approach including endodontic treatment, periodontal therapy, and a periodontal regenerative procedure using an enamel matrix derivate. In spite of anticipated poor prognosis, the tooth lesion healed. This case report also discusses the rationale behind different treatment interventions. Practical Implication. Periodontic-endodontic lesions can be successfully treated if dental professionals follow a concerted treatment protocol that integrates endodontic and periodontic specialties. General dentists can be the gatekeepers in managing these cases. PMID:27418983

Systemic medications: clinical significance in periodontics.

PubMed

Ciancio, Sebastian G

2002-05-01

Systemic medications are of value as adjuncts to periodontal therapy. These medications can be divided into two major categories: antibiotics and agents for host modulation. Antibiotics have been shown to be valuable adjuncts in specialized types of periodontal disease, such as localized and generalized aggressive periodontitis, and of possible value in severe chronic periodontitis. Antibiotics have been studied individually, in combination and in sequential therapy. Host modulators include Periostat, non-steroidal anti-inflammatory agents, alendronate (Fosamax), hormone replacement therapy and anti-arthritic medications. These agents produce their beneficial effects by a variety of mechanisms of action, including inhibition of matrix metalloproteinases, inhibition of prostaglandin production, stimulation of osteoblasts, inhibition of osteoclasts, and other anti-inflammatory mechanisms of action.

Conditioned Medium from Periodontal Ligament Stem Cells Enhances Periodontal Regeneration.

PubMed

Nagata, Mizuki; Iwasaki, Kengo; Akazawa, Keiko; Komaki, Motohiro; Yokoyama, Naoki; Izumi, Yuichi; Morita, Ikuo

2017-05-01

Periodontal disease is one of the most common infectious diseases in adults and is characterized by the destruction of tooth-supporting tissues. Mesenchymal stem cells (MSCs) comprise the mesoderm-originating stem cell population, which has been studied and used for cell therapy. However, because of the lower rate of cell survival after MSC transplantation in various disease models, paracrine functions of MSCs have been receiving increased attention as a regenerative mechanism. The aim of this study was to investigate the regenerative potential of transplanted conditioned medium (CM) obtained from cultured periodontal ligament stem cells (PDLSCs), the adult stem cell population in tooth-supporting tissues, using a rat periodontal defect model. Cell-free CM was collected from PDLSCs and fibroblasts, using ultrafiltration and transplanted into surgically created periodontal defects. Protein content of CM was examined by antibody arrays. Formation of new periodontal tissues was analyzed using microcomputed tomography and histological sections. PDLSC-CM transplantation enhanced periodontal tissue regeneration in a concentration-dependent manner, whereas fibroblast-CM did not show any regenerative function. Proteomic analysis revealed that extracellular matrix proteins, enzymes, angiogenic factors, growth factors and cytokines were contained in PDLSC-CM. Furthermore, PDLSC-CM transplantation resulted in the decreased mRNA level of tumor necrosis factor-α (TNF-α) in healing periodontal tissues. In addition, we found that PDLSC-CM suppressed the mRNA level of TNF-α in the monocyte/macrophage cell line, RAW cells, stimulated with IFN-γ. Our findings suggested that PDLSC-CM enhanced periodontal regeneration by suppressing the inflammatory response through TNF-α production, and transplantation of PDLSC-CM could be a novel approach for periodontal regenerative therapy.

Conditioned Medium from Periodontal Ligament Stem Cells Enhances Periodontal Regeneration

PubMed Central

Nagata, Mizuki; Akazawa, Keiko; Komaki, Motohiro; Yokoyama, Naoki; Izumi, Yuichi; Morita, Ikuo

2017-01-01

Periodontal disease is one of the most common infectious diseases in adults and is characterized by the destruction of tooth-supporting tissues. Mesenchymal stem cells (MSCs) comprise the mesoderm-originating stem cell population, which has been studied and used for cell therapy. However, because of the lower rate of cell survival after MSC transplantation in various disease models, paracrine functions of MSCs have been receiving increased attention as a regenerative mechanism. The aim of this study was to investigate the regenerative potential of transplanted conditioned medium (CM) obtained from cultured periodontal ligament stem cells (PDLSCs), the adult stem cell population in tooth-supporting tissues, using a rat periodontal defect model. Cell-free CM was collected from PDLSCs and fibroblasts, using ultrafiltration and transplanted into surgically created periodontal defects. Protein content of CM was examined by antibody arrays. Formation of new periodontal tissues was analyzed using microcomputed tomography and histological sections. PDLSC-CM transplantation enhanced periodontal tissue regeneration in a concentration-dependent manner, whereas fibroblast-CM did not show any regenerative function. Proteomic analysis revealed that extracellular matrix proteins, enzymes, angiogenic factors, growth factors and cytokines were contained in PDLSC-CM. Furthermore, PDLSC-CM transplantation resulted in the decreased mRNA level of tumor necrosis factor-α (TNF-α) in healing periodontal tissues. In addition, we found that PDLSC-CM suppressed the mRNA level of TNF-α in the monocyte/macrophage cell line, RAW cells, stimulated with IFN-γ. Our findings suggested that PDLSC-CM enhanced periodontal regeneration by suppressing the inflammatory response through TNF-α production, and transplantation of PDLSC-CM could be a novel approach for periodontal regenerative therapy. PMID:28027709

Management of failed periodontal surgical intervention for a furcal lesion with a nonsurgical endodontic approach

PubMed Central

Asgary, Saeed

2014-01-01

As long as the prognosis of teeth remains a matter of concern, the endodontic-periodontal relationship will be considered a challenge for the clinician. Many etiologic factors, including bacteria, fungi, and viruses, plus other contributing factors, such as trauma, root resorptions/perforations, and dental malformations, play a role in the co-occurrence of endodontic and periodontal lesions. Whatever the cause, a correct diagnosis on which to base the treatment plan is the key to successful maintenance of the tooth. This article reports the successful endodontic management of a furcation lesion in a mandibular molar that was nonresponsive to a previous periodontal surgical graft. The case had presented a diagnostic challenge for the clinicians, and this article reviews the key points that can lead to a correct diagnosis and treatment planning. PMID:24790924

Failing to meet the goals of periodontal recall programs. What next?

PubMed

McCracken, Giles; Asuni, Abisola; Ritchie, Mark; Vernazza, Christopher; Heasman, Peter

2017-10-01

Supportive periodontal care is a crucial aspect of the management of chronic periodontitis and peri-implantitis and is inevitably a long-term commitment for both the clinician and the patient. The principal goals of supportive care are to achieve a high standard of plaque control, minimize bleeding and maintain pockets at less than 6 mm. Gain of attachment around natural teeth during supportive periodontal care has been reported, although gain of attachment and of bone during supportive care may be a more pragmatic and aspirational aim in the longer term. Furthermore, we occasionally see patients for whom, despite excellent home and professional care (surgical or nonsurgical), including the management of risk factors, supportive periodontal care appears to be failing and therefore for such patients the clinician needs to consider further management options. This review considers, in particular, the options of using local or systemically delivered antimicrobials to eradicate periodontal and peri-implant disease progression and discusses the extent to which culture and sensitivity testing before the prescription of systemically delivered antimicrobials may be a cost-effective alternative to prescribing 'blind'. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Results from the Periodontitis and Vascular Events (PAVE) Study: a pilot multicentered, randomized, controlled trial to study effects of periodontal therapy in a secondary prevention model of cardiovascular disease.

PubMed

Offenbacher, Steven; Beck, James D; Moss, Kevin; Mendoza, Luisito; Paquette, David W; Barrow, David A; Couper, David J; Stewart, Dawn D; Falkner, Karen L; Graham, Susan P; Grossi, Sara; Gunsolley, John C; Madden, Theresa; Maupome, Gerardo; Trevisan, Maurizio; Van Dyke, Thomas E; Genco, Robert J

2009-02-01

In the Periodontitis and Vascular Events (PAVE) pilot study, periodontal therapy was provided as an intervention in a secondary cardiac event prevention model through five coordinated cardiac-dental centers. Subjects were randomized to either community care or protocol provided scaling and root planing to evaluate effects on periodontal status and systemic levels of high-sensitivity C-reactive protein (hs-CRP). After 6 months, there was a significant reduction in mean probing depth and extent of 4- or 5-mm pockets. However, there were no significant differences in attachment levels, bleeding upon probing, or extent of subgingival calculus comparing subjects assigned to protocol therapy (n = 151) to those assigned to community care (n = 152). Using intent-to-treat analyses, there was no significant effect on serum hs-CRP levels at 6 months. However, 48% of the subjects randomized to community care received preventive or periodontal treatments. Secondary analyses demonstrated that consideration of any preventive or periodontal care (i.e., any treatment) compared to no treatment showed a significant reduction in the percentage of people with elevated hs-CRP (values >3 mg/l) at 6 months. However, obesity nullified the periodontal treatment effects on hs-CRP reduction. The adjusted odds ratio for hs-CRP levels >3 mg/l at 6 months for any treatment versus no treatment among non-obese individuals was 0.26 (95% confidence interval: 0.09 to 0.72), adjusting for smoking, marital status, and gender. This pilot study demonstrated the critical role of considering obesity as well as rigorous preventive and periodontal care in trials designed to reduce cardiovascular risk.

Melatonin prevents radiation-induced oxidative stress and periodontal tissue breakdown in irradiated rats with experimental periodontitis.

PubMed

Köse, O; Arabaci, T; Kizildag, A; Erdemci, B; Özkal Eminoğlu, D; Gedikli, S; Özkanlar, S; Zihni, M; Albayrak, M; Kara, A; Kermen, E

2017-06-01

The aim of this study was to analyze the biochemical and histochemical effects of radiation therapy and protective melatonin administration on periodontal tissues in rats with experimental periodontitis. Sixty male Sprague Dawley rats were divided into six groups, as follows: control; experimental periodontitis (Ped); radiotherapy administration (Rt); experimental periodontitis and exposure to irradiation (Ped-Rt); radiotherapy and protective melatonin administration (Rt-Mel); and periodontitis, radiation therapy and protective melatonin administration (Ped-Rt-Mel). The rats were killed at the end of the experimental procedure, and the oxidative stress level and periodontal destruction were compared among the groups. The oxidative stress index and the levels of 8-hydroxy-2'-deoxyguanosine, malondialdehyde and C-terminal telopeptide of type I collagen were found to be significantly higher in the Ped-Rt group compared with the Ped group (p < 0.05), and the levels were lower in the Ped-Rt-Mel group than in the Ped-Rt group (p < 0.05). Alveolar bone destruction and attachment level were also significantly lower in the Ped-Rt-Mel group than in the Ped-Rt group (p < 0.05). It was found that radiotherapy increased oxidative stress, the periodontal attachment level and alveolar bone loss, and protective melatonin administration significantly reduced the oxidative parameters and prevented periodontal damage in irradiated rats with experimental periodontitis. Further research is needed regarding the use of systemic melatonin administration before radiation therapy. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Serum Lp-PLA2: as a novel viewpoint in periodontal treatment of hyperlipidaemics.

PubMed

Fentoğlu, Özlem; Kirzioğlu, Fatma Yeşim; Tözüm Bulut, Memduha; Kurgan, Şivge; Koçak, Havva; Sütcü, Recep; Kale Köroğlu, Banu; Günhan, Meral

2015-01-01

To evaluate the effects of periodontal treatment on serum lipoprotein-associated phospholipase A2 (Lp-PLA2) and C-reactive protein (CRP) levels in hyperlipidaemic patients with periodontitis. The study included 52 hyperlipidaemics and 28 systemically healthy controls (C) with periodontitis. Of the 52 hyperlipidaemics, 29 received a suggested diet (HD), and 23 of them were prescribed statin (HS). Clinical periodontal parameters, serum lipids, Lp-PLA2, and CRP levels were assessed at the baseline and 2 months after the completion of the nonsurgical periodontal treatment (2MPT). Serum parameters were also evaluated 1 week following the periodontal treatment (1WPT). At the baseline, patients in the HS group had a higher percentage of bleeding on probing than those in the C and HD groups. Hyperlipidaemics had higher serum triglyceride levels than the control group at 2MPT compared to the baseline. At 2MPT, the levels of Lp-PLA2 in the HS group were significantly higher compared to the baseline and 1WPT. There were no statistically significant differences in CRP levels between study periods for all groups. The periodontal treatment may affect the inflammatory control of hyperlipidaemic patients with periodontitis via increased Lp-PLA2 levels and severity of the impaired lipid metabolism. These findings may be important regarding the therapeutic strategies for hyperlipidaemics with periodontitis.

Clinical efficacy of subgingivally delivered 0.5% controlled release azithromycin gel in the management of chronic periodontitis.

PubMed

Tyagi, Prashant; Vaish, Shubhra; Dodwad, Vidya

2011-06-01

Recent developments suggest that the local delivery of antimicrobials into periodontal pockets can improve periodontal health. Azithromycin (AZM) has a wide antimicrobial spectrum of action toward anaerobic bacteria as well as Gram-negative bacilli. It is effective against periodontal pathogens such as Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis. Therefore, this study was undertaken to investigate the clinical effectiveness of AZM at 0.5% concentration in an indigenously prepared bioabsorbable controlled release gel as an adjunct to non-surgical mechanical therapy in the treatment of chronic periodontitis. Thirty sites in patients with chronic periodontitis and probing depth (PD) 4-6 mm were categorized randomly into two treatment groups: Scaling and root planing (SRP) plus 0.5% AZM gel (group 1) and SRP only (group 2). Clinical evaluation was undertaken using the Gingival Index (GI) of Loe and Silness and plaque was assessed using the Turesky et al. modification of Quigley Hein Index at baseline and 21 days. Pocket PD and clinical attachment level (CAL) were also measured. Results were expressed as mean±standard deviation and percentages and the data were analyzed using Statistical Package for Social Sciences (SPSS version 16.0, SPSS, Chicago, IL) software. Both therapies resulted in significant improvements. Mean reduction in GI from baseline to 21 days was 1.20±0.41 and 0.73±0.45 in group 1 and group 2, respectively. Plaque Index also improved through the study period in both groups, i.e., 0.86±0.51 in group 1 and 1.6±0.97 in group 2. Mean PD reduced significantly with SRP plus AZM gel application in group 1, i.e., 2.1±0.91 mm as compared to 1.0±1.06 mm achieved with SRP alone. A significant gain in mean CAL gain was observed in the test group (1.8±0.63 mm) as compared to control group (1.0±1.06 mm). Although both treatment strategies seem to benefit patients, the adjunctive use of 0.5% of AZM showed significant results.

Minimally invasive periodontal therapy

PubMed Central

Dannan, Aous

2011-01-01

Minimally invasive dentistry is a concept that preserves dentition and supporting structures. However, minimally invasive procedures in periodontal treatment are supposed to be limited within periodontal surgery, the aim of which is to represent alternative approaches developed to allow less extensive manipulation of surrounding tissues than conventional procedures, while accomplishing the same objectives. In this review, the concept of minimally invasive periodontal surgery (MIPS) is firstly explained. An electronic search for all studies regarding efficacy and effectiveness of MIPS between 2001 and 2009 was conducted. For this purpose, suitable key words from Medical Subject Headings on PubMed were used to extract the required studies. All studies are demonstrated and important results are concluded. Preliminary data from case cohorts and from many studies reveal that the microsurgical access flap, in terms of MIPS, has a high potential to seal the healing wound from the contaminated oral environment by achieving and maintaining primary closure. Soft tissues are mostly preserved and minimal gingival recession is observed, an important feature to meet the demands of the patient and the clinician in the esthetic zone. However, although the potential efficacy of MIPS in the treatment of deep intrabony defects has been proved, larger studies are required to confirm and extend the reported positive preliminary outcomes. PMID:22368356

Professional oral hygiene as a therapeutic option for pediatric patients with plasma cell gingivitis: preliminary results of a prospective case series.

PubMed

Arduino, Paolo G; D'Aiuto, Francesco; Cavallito, Claudio; Carcieri, Paola; Carbone, Mario; Conrotto, Davide; Defabianis, Patrizia; Broccoletti, Roberto

2011-12-01

Plasma cell gingivitis (PCG) is a rare, benign inflammatory condition of unclear etiology with no definitive standard of care ever reported to our knowledge. The aim of this case series is to ascertain the clinical efficacy of professional oral hygiene and periodontal therapy in younger individuals with a histologically confirmed diagnosis of PCG. All patients received non-surgical periodontal therapy, including oral hygiene instructions, and thorough supragingival scaling and polishing with the removal of all deposits and staining combined with the use of antimicrobials in a 9-week cohort study. Clinical outcome variables were recorded at baseline and 4 weeks after the intervention and included, as periodontal parameters, full-mouth plaque scores (FMPS), full-mouth bleeding scores (FMBS), the clinical extension of gingival involvement, and patient-related outcomes (visual analog score of pain). A total of 11 patients (six males and five females; mean age: 11 ± 0.86 years) were recruited. Four weeks after finishing the oral hygiene and periodontal therapy protocol, a statistically significant reduction was observed for FMPS (P = 0.000), FMBS (P = 0.000), reported pain (P = 0.003) and clinical gingival involvement (P = 0.003). Standard, professional oral hygiene procedures and non-surgical periodontal therapy including antimicrobials were associated with a marked improvement of clinical and patient-related outcomes in pediatric cases of PCG.

A histological evaluation of a low-level laser therapy as an adjunct to periodontal therapy in patients with diabetes mellitus.

PubMed

Obradović, Radmila; Kesić, Ljiljana; Mihailović, Dragan; Antić, Slobodan; Jovanović, Goran; Petrović, Aleksandar; Peševska, Snežana

2013-01-01

Diabetes mellitus (DM) and chronic periodontitis are common chronic diseases in adults in the world population. DM has a strong influence on the oral cavity and represents a risk factor for gingivitis and periodontitis. Low-level laser therapy (LLLT) has proven effective in the reduction of inflammation and swelling. The aim of the present study was to evaluate the efficacy of LLLT in diabetic periodontitis through histological analysis. A total of 300 diabetics with chronic periodontal disease and teeth indicated for extraction were assigned into six equal groups. In the groups 1 and 4, indicated teeth were extracted before treatment, and in the rest of the groups upon completion of the entire treatment. All patients received oral hygiene instructions and full-mouth conservative periodontal treatment. In groups 3 and 6, LLLT was applied (670 nm, 5 mW, 2 J/cm(2), 16 min, 5 days). Histologic findings of gingival tissue treated with LLLT showed expressed healing, as is evident by the absence of inflammatory cells. Tissue edema could not be seen, and the number of blood vessels was reduced. In the gingival lamina, propria pronounced collagenization and homogenization were present. It can be concluded that LLLT has shown efficacy in the treatment of periodontitis in diabetics. Because of more pronounced alterations of periodontium in diabetics, the use of LLLT is of particular importance.

Nonsurgical Management of a Periapical Cyst: A Case Report

PubMed Central

Dandotikar, Deepakraj; Peddi, Ravigna; Lakhani, Bharvi; Lata, Kamini; Mathur, Aditi; Chowdary, Uday Kumar

2013-01-01

Large periapical lesions, regardless of whether they are granulomas, abscesses or cysts, are primarily caused by root canal infection. Thus the treatment protocol should be elimination of etiological factors in the root canal system rather than their product, apical true cyst. A 10 year old female patient reported to the Department of Pedodontics and Preventive Dentistry, Dr R Ahmed Dental College & Hospital, Kolkata, with the chief complaint of pain and swelling in relation to upper front fractured teeth. Clinical and radiological findings were suggestive of periapical radicular cyst. Non-surgical endodontic therapy was performed using 1% sodium hypochlorite solution irrigant and Calcium hydroxide intra canal medicament. A 12 months follow-up radiographic examination revealed progressive involution of periapical radiolucency without any clinical symptoms. Periapical cysts respond favorably to non-surgical endodontic treatment and should be considered as primary treatment modality. How to cite this article: Dandotikar D, Peddi R, Lakhani B, Lata K, Mathur A, Chowdary U K. Nonsurgical Management of a Periapical Cyst: A Case Report. J Int Oral Health 2013; 5(3):79-84. PMID:24155607

Nonsurgical management of a periapical cyst: a case report.

PubMed

Dandotikar, Deepakraj; Peddi, Ravigna; Lakhani, Bharvi; Lata, Kamini; Mathur, Aditi; Chowdary, Uday Kumar

2013-06-01

Large periapical lesions, regardless of whether they are granulomas, abscesses or cysts, are primarily caused by root canal infection. Thus the treatment protocol should be elimination of etiological factors in the root canal system rather than their product, apical true cyst. A 10 year old female patient reported to the Department of Pedodontics and Preventive Dentistry, Dr R Ahmed Dental College & Hospital, Kolkata, with the chief complaint of pain and swelling in relation to upper front fractured teeth. Clinical and radiological findings were suggestive of periapical radicular cyst. Non-surgical endodontic therapy was performed using 1% sodium hypochlorite solution irrigant and Calcium hydroxide intra canal medicament. A 12 months follow-up radiographic examination revealed progressive involution of periapical radiolucency without any clinical symptoms. Periapical cysts respond favorably to non-surgical endodontic treatment and should be considered as primary treatment modality. How to cite this article: Dandotikar D, Peddi R, Lakhani B, Lata K, Mathur A, Chowdary U K. Nonsurgical Management of a Periapical Cyst: A Case Report. J Int Oral Health 2013; 5(3):79-84.

Impact of Periodontal Therapy on the Subgingival Microbiota of Severe Periodontitis: Comparison between Good Responders and “Refractory” Subjects by the Human Oral Microbe Identification Microarray (HOMIM)

PubMed Central

Colombo, Ana Paula V.; Bennet, Susan; Cotton, Sean L.; Goodson, J. Max; Kent, Ralph; Haffajee, Anne D.; Socransky, Sigmund S.; Hasturk, Hatice; Van Dyke, Thomas E.; Dewhirst, Floyd E.; Paster, Bruce J.

2014-01-01

Aim This study compared the changes on the subgingival microbiota of subjects with “refractory” periodontitis (RP) or treatable periodontitis (GR) before and after periodontal therapy by using the Human Oral Microbe Identification Microarray (HOMIM). Methods Individuals with chronic periodontitis were classified as RP (n=17) based on mean attachment loss (AL) and/or >3 sites with AL ≥2.5 mm after scaling and root planing, surgery and systemically administered amoxicillin and metronidazole or as GR (n=30) based on mean attachment gain and no sites with AL ≥2.5 mm after treatment. Subgingival plaque samples were taken at baseline and 15 months after treatment and analyzed for the presence of 300 species by HOMIM analysis. Significant differences in taxa before and after therapy were sought using the Wilcoxon test. Results The majority of species evaluated decreased in prevalence in both groups after treatment; however, only a small subset of organisms was significantly affected. Species that increased or persisted in high frequency in RP but were significantly reduced in GR included Bacteroidetes sp., Porphyromonas endodontalis, Porphyromonas gingivalis, Prevotella spp., Tannerella forsythia, Dialister spp., Selenomonas spp., Catonella morbi, Eubacterium spp., Filifactor alocis, Parvimonas micra, Peptostreptococcus sp. OT113, Fusobacterium sp. OT203, Pseudoramibacter alactolyticus, Streptococcus intermedius or Streptococcus constellatus and Shuttlesworthia satelles. In contrast, Capnocytophaga sputigena, Cardiobacterium hominis, Gemella haemolysans, Haemophilus parainfluenzae, Kingella oralis, Lautropia mirabilis, Neisseria elongata, Rothia dentocariosa, Streptococcus australis and Veillonella spp. were more associated with therapeutic success. Conclusion Persistence of putative and novel periodontal pathogens, as well as low prevalence of beneficial species was associated with chronic “refractory” periodontitis. PMID:22324467

Results From the Periodontitis and Vascular Events (PAVE) Study: A Pilot Multicentered, Randomized, Controlled Trial to Study Effects of Periodontal Therapy in a Secondary Prevention Model of Cardiovascular Disease

PubMed Central

Offenbacher, Steven; Beck, James D.; Moss, Kevin; Mendoza, Luisito; Paquette, David W.; Barrow, David A.; Couper, David J.; Stewart, Dawn D.; Falkner, Karen L.; Graham, Susan P.; Grossi, Sara; Gunsolley, John C.; Madden, Theresa; Maupome, Gerardo; Trevisan, Maurizio; Van Dyke, Thomas E.; Genco, Robert J.

2009-01-01

Background In the Periodontitis and Vascular Events (PAVE) pilot study, periodontal therapy was provided as an intervention in a secondary cardiac event prevention model through five coordinated cardiac– dental centers. Methods Subjects were randomized to either community care or protocol provided scaling and root planing to evaluate effects on periodontal status and systemic levels of high-sensitivity C-reactive protein (hs-CRP). Results After 6 months, there was a significant reduction in mean probing depth and extent of 4- or 5-mm pockets. However, there were no significant differences in attachment levels, bleeding upon probing, or extent of subgingival calculus comparing subjects assigned to protocol therapy (n = 151) to those assigned to community care (n = 152). Using intent-to-treat analyses, there was no significant effect on serum hs-CRP levels at 6 months. However, 48% of the subjects randomized to community care received preventive or periodontal treatments. Secondary analyses demonstrated that consideration of any preventive or periodontal care (i.e., any treatment) compared to no treatment showed a significant reduction in the percentage of people with elevated hs-CRP (values >3 mg/l) at 6 months. However, obesity nullified the periodontal treatment effects on hs-CRP reduction. The adjusted odds ratio for hs-CRP levels >3 mg/l at 6 months for any treatment versus no treatment among non-obese individuals was 0.26 (95%confidence interval: 0.09 to 0.72), adjusting for smoking, marital status, and gender. Conclusion This pilot study demonstrated the critical role of considering obesity as well as rigorous preventive and periodontal care in trials designed to reduce cardiovascular risk. PMID:19186958

Resistance of Nonmelanoma Skin Cancer to Nonsurgical Treatments. Part II: Photodynamic Therapy, Vismodegib, Cetuximab, Intralesional Methotrexate, and Radiotherapy.

PubMed

Gracia-Cazaña, T; Salazar, N; Zamarrón, A; Mascaraque, M; Lucena, S R; Juarranz, Á

2016-11-01

A wide range of treatments is now available for nonmelanoma skin cancer, including 5-fluorouracil, ingenol mebutate, imiquimod, diclofenac, photodynamic therapy, methotrexate, cetuximab, vismodegib, and radiotherapy. All are associated with high clinical and histologic response rates. However, some tumors do not respond due to resistance, which may be primary or acquired. Study of the resistance processes is a broad area of research that aims to increase our understanding of the nature of each tumor and the biologic features that make it resistant, as well as to facilitate the design of new therapies directed against these tumors. In this second article, having covered the topical treatments of nonmelanoma skin cancer, we review resistance to other nonsurgical treatments, such as monoclonal antibodies against basal and squamous cell carcinomas, intralesional chemotherapy, photodynamic therapy, and radiotherapy. Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

Periodontal disease.

PubMed

Niemiec, Brook A

2008-05-01

Periodontal disease is the most commonly diagnosed problem in small animal veterinary medicine. In the vast majority of cases, however, there are little to no outward clinical signs of the disease process, and, therefore, therapy often comes very late in the disease course. Consequently, periodontal disease is also the most undertreated animal health problem. In addition, unchecked periodontal disease has numerous dire consequences both locally and systemically. These consequences are detailed in the article and should be utilized to educate clients and encourage compliance of therapeutic recommendations. The local consequences include oronasal fistulas, class II perio-endo lesions, pathologic fractures, ocular problems, osteomyelitis, and an increased incidence of oral cancer. Systemic diseases linked to periodontal disease include: renal, hepatic, pulmonary, and cardiac diseases; osteoporosis, adverse pregnancy effects, and diabetes mellitus. Before the discussion of consequences, this article covers the pathogenesis of periodontal disease, followed by clinical features and diagnostic tests.

Maxillary sinusitis and periapical abscess following periodontal therapy: a case report using three-dimensional evaluation.

PubMed

Huang, Chih-Hao; Brunsvold, Michael A

2006-01-01

Maxillary sinusitis may develop from the extension of periodontal disease. In this case, reconstructed three-dimensional images from multidetector spiral computed tomographs were helpful in evaluating periodontal bony defects and their relationship with the maxillary sinus. A 42-year-old woman in good general health presented with a chronic deep periodontal pocket on the palatal and interproximal aspects of tooth #14. Probing depths of the tooth ranged from 2 to 9 mm, and it exhibited a Class 1 mobility. Radiographs revealed a close relationship between the root apex and the maxillary sinus. The patient's periodontal diagnosis was localized severe chronic periodontitis. Treatment of the tooth consisted of cause-related therapy, surgical exploration, and bone grafting. A very deep circumferential bony defect at the palatal root of tooth #14 was noted during surgery. After the operation, the wound healed without incidence, but 10 days later, a maxillary sinusitis and periapical abscess developed. To control the infection, an evaluation of sinus and alveolus using computed tomographs was performed, systemic antibiotics were prescribed, and endodontic treatment was initiated. Two weeks after surgical treatment, the infection was relieved with the help of antibiotics and endodontic treatment. Bilateral bony communications between the maxillary sinus and periodontal bony defect of maxillary first molars were shown on three-dimensional computed tomographs. The digitally reconstructed images added valuable information for evaluating the periodontal defects. Three-dimensional images from spiral computed tomographs (CT) aided in evaluating and treating the close relationship between maxillary sinus disease and adjacent periodontal defects.

Non-surgical treatments for the management of early osteoarthritis.

PubMed

Filardo, Giuseppe; Kon, Elizaveta; Longo, Umile Giuseppe; Madry, Henning; Marchettini, Paolo; Marmotti, Antonio; Van Assche, Dieter; Zanon, Giacomo; Peretti, Giuseppe M

2016-06-01

Non-surgical treatments are usually the first choice for the management of knee degeneration, especially in the early osteoarthritis (OA) phase when no clear lesions or combined abnormalities need to be addressed surgically. Early OA may be addressed by a wide range of non-surgical approaches, from non-pharmacological modalities to dietary supplements and pharmacological therapies, as well as physical therapies and novel biological minimally invasive procedures involving injections of various substances to obtain a clinical improvement and possibly a disease-modifying effect. Numerous pharmaceutical agents are able to provide clinical benefit, but no one has shown all the characteristic of an ideal treatment, and side effects have been reported at both systemic and local level. Patients and physicians should have realistic outcome goals in pharmacological treatment, which should be considered together with other conservative measures. Among these, exercise is an effective conservative approach, while physical therapies lack literature support. Even though a combination of these therapeutic options might be the most suitable strategy, there is a paucity of studies focusing on combining treatments, which is the most common clinical scenario. Further studies are needed to increase the limited evidence on non-surgical treatments and their combination, to optimize indications, application modalities, and results with particular focus on early OA. In fact, most of the available evidence regards established OA. Increased knowledge about degeneration mechanisms will help to better target the available treatments and develop new biological options, where preliminary results are promising, especially concerning early disease phases. Specific treatments aimed at improving joint homoeostasis, or even counteracting tissue damage by inducing regenerative processes, might be successful in early OA, where tissue loss and anatomical changes are still at very initial stages.

Periodontal disease, periodontal treatment and systemic nitric oxide in dogs.

PubMed

Nemec, A; Verstraete, F J M; Jerin, A; Šentjurc, M; Kass, P H; Petelin, M; Pavlica, Z

2013-06-01

Thirty-two client-owned dogs treated for periodontal disease were divided in group 1 if no periodontitis, group 2 if ≤25%, and group 3 if >25% of the teeth present were affected with periodontitis. Blood was tested before and 2 weeks after periodontal therapy for nitrosyl hemoglobin (HbNO), plasma nitrite/nitrate (NOx) and 3-nitrotyrosine (NT) levels. No HbNO was detected in any of the animals tested. There was no significant difference in the NOx plasma levels within each group or across the groups before and after the treatment, but a noticeable increase in NOx plasma levels was observed in group 3 after the treatment. Plasma NT was detected in only one third of the animals. NO levels varied greatly across individual dogs. The data are suggestive of an overall increase in systemic NO response 2 weeks after periodontal treatment in dogs with advanced periodontal disease, but the response is greatly individually-dependent. Copyright © 2012 Elsevier Ltd. All rights reserved.

Efficacy of periodontal stem cell transplantation in the treatment of advanced periodontitis.

PubMed

Park, Joo-Young; Jeon, Soung Hoo; Choung, Pill-Hoon

2011-01-01

Periodontitis is the most common cause for tooth loss in adults and advanced types affect 10-15% of adults worldwide. The attempts to save tooth and regenerate the periodontal apparatus including cementum, periodontal ligament, and alveolar bone reach to the dental tissue-derived stem cell therapy. Although there have been several periodontitis models suggested, the apical involvement of tooth root is especially challenging to be regenerated and dental stem cell therapy for the state has never been investigated. Three kinds of dental tissue-derived adult stem cells (aDSCs) were obtained from the extracted immature molars of beagle dogs (n = 8), and ex vivo expanded periodontal ligament stem cells (PDLSCs), dental pulp stem cells (DPSCs), and periapical follicular stem cells (PAFSCs) were transplanted into the apical involvement defect. As for the lack of cementum-specific markers, anti-human cementum protein 1 (rhCEMP1) antibody was fabricated and the aDSCs and the regenerated tissues were immunostained with anti-CEMP1 antibody. Autologous PDLSCs showed the best regenerating capacity of periodontal ligament, alveolar bone, and cementum as well as peripheral nerve and blood vessel, which were evaluated by conventional and immune histology, 3D micro-CT, and clinical index. The rhCEMP1 was expressed strongest in PDLSCs and in the regenerated periodontal ligament space. We suggest here the PDLSCs as the most favorable candidate for the clinical application among the three dental stem cells and can be used for treatment of advanced periodontitis where tooth removal was indicated in the clinical cases. © 2011 Cognizant Comm. Corp.

Periodontal regeneration using periodontal ligament stem cell-transferred amnion.

PubMed

Iwasaki, Kengo; Komaki, Motohiro; Yokoyama, Naoki; Tanaka, Yuichi; Taki, Atsuko; Honda, Izumi; Kimura, Yasuyuki; Takeda, Masaki; Akazawa, Keiko; Oda, Shigeru; Izumi, Yuichi; Morita, Ikuo

2014-02-01

Periodontal disease is characterized by the destruction of tooth supporting tissues. Regeneration of periodontal tissues using ex vivo expanded cells has been introduced and studied, although appropriate methodology has not yet been established. We developed a novel cell transplant method for periodontal regeneration using periodontal ligament stem cell (PDLSC)-transferred amniotic membrane (PDLSC-amnion). The aim of this study was to investigate the regenerative potential of PDLSC-amnion in a rat periodontal defect model. Cultured PDLSCs were transferred onto amniotic membranes using a glass substrate treated with polyethylene glycol and photolithography. The properties of PDLSCs were investigated by flow cytometry and in vitro differentiation. PDLSC-amnion was transplanted into surgically created periodontal defects in rat maxillary molars. Periodontal regeneration was evaluated by microcomputed tomography (micro-CT) and histological analysis. PDLSCs showed mesenchymal stem cell-like characteristics such as cell surface marker expression (CD90, CD44, CD73, CD105, CD146, and STRO-1) and trilineage differentiation ability (i.e., into osteoblasts, adipocytes, and chondrocytes). PDLSC-amnion exhibited a single layer of PDLSCs on the amniotic membrane and stability of the sheet even with movement and deformation caused by surgical instruments. We observed that the PDLSC-amnion enhanced periodontal tissue regeneration as determined by micro-CT and histology by 4 weeks after transplantation. These data suggest that PDLSC-amnion has therapeutic potential as a novel cell-based regenerative periodontal therapy.

[Oxidative stress and antioxitant therapy of chronic periodontitis].

PubMed

Shen, Y X; Guo, S J; Wu, Y F

2016-07-01

Chronic periodontitis is a progressive, infectious inflammation disease, caused by the dysbiosis of oral resident flora, leading to the destruction of periodontium. The onset of pathogenic microorganisms is the etiological factor of periodontitis, while the immuno-inflammatory response affects the progression of the disease. Under chronic periodontitis, oxidative stress occurs when excessive reactive oxygen species are produced and exceed the compensative capacity of the organism. Oxidative stress leads to the destruction of periodontium, in a direct way(damaging the biomolecule) or an indirect way(enhancing the produce of inflammatory cytokine and destructive enzymes). Therefore, as the antagonist of the reactive oxygen species, antioxidants may be helpful to treat the chronic periodontitis. This paper reviewed relevant literatures about the destructive role of excessive reactive oxygen species and protective role of antioxidants in chronic periodontitis.

Multidisciplinary approach to non-surgical management of inguinal disruption in a professional hockey player treated with platelet-rich plasma, manual therapy and exercise: a case report

PubMed Central

St-Onge, Eric; MacIntyre, Ian G.; Galea, Anthony M.

2015-01-01

Objective: To present the clinical management of inguinal disruption in a professional hockey player and highlight the importance of a multidisciplinary approach to diagnosis and management. Clinical Features: A professional hockey player with recurrent groin pain presented to the clinic after an acute exacerbation of pain while playing hockey. Intervention: The patient received a clinical diagnosis of inguinal disruption. Imaging revealed a tear in the rectus abdominis. Management included two platelet-rich plasma (PRP) injections to the injured tissue, and subsequent manual therapy and exercise. The patient returned to his prior level of performance in 3.5 weeks. Discussion: This case demonstrated the importance of a multidisciplinary team and the need for advanced imaging in athletes with groin pain. Summary: Research quality concerning the non-surgical management of inguinal disruption remains low. This case adds evidence that PRP, with the addition of manual therapy and exercise may serve as a relatively quick and effective non-surgical management strategy. PMID:26816415

Multidisciplinary approach to non-surgical management of inguinal disruption in a professional hockey player treated with platelet-rich plasma, manual therapy and exercise: a case report.

PubMed

St-Onge, Eric; MacIntyre, Ian G; Galea, Anthony M

2015-12-01

To present the clinical management of inguinal disruption in a professional hockey player and highlight the importance of a multidisciplinary approach to diagnosis and management. A professional hockey player with recurrent groin pain presented to the clinic after an acute exacerbation of pain while playing hockey. The patient received a clinical diagnosis of inguinal disruption. Imaging revealed a tear in the rectus abdominis. Management included two platelet-rich plasma (PRP) injections to the injured tissue, and subsequent manual therapy and exercise. The patient returned to his prior level of performance in 3.5 weeks. This case demonstrated the importance of a multidisciplinary team and the need for advanced imaging in athletes with groin pain. Research quality concerning the non-surgical management of inguinal disruption remains low. This case adds evidence that PRP, with the addition of manual therapy and exercise may serve as a relatively quick and effective non-surgical management strategy.

Polymeric Nanoparticle-Based Photodynamic Therapy for Chronic Periodontitis in Vivo.

PubMed

de Freitas, Laura Marise; Calixto, Giovana Maria Fioramonti; Chorilli, Marlus; Giusti, Juçaíra Stella M; Bagnato, Vanderlei Salvador; Soukos, Nikolaos S; Amiji, Mansoor M; Fontana, Carla Raquel

2016-05-20

Antimicrobial photodynamic therapy (aPDT) is increasingly being explored for treatment of periodontitis. Here, we investigated the effect of aPDT on human dental plaque bacteria in suspensions and biofilms in vitro using methylene blue (MB)-loaded poly(lactic-co-glycolic) (PLGA) nanoparticles (MB-NP) and red light at 660 nm. The effect of MB-NP-based aPDT was also evaluated in a clinical pilot study with 10 adult human subjects with chronic periodontitis. Dental plaque samples from human subjects were exposed to aPDT-in planktonic and biofilm phases-with MB or MB-NP (25 µg/mL) at 20 J/cm² in vitro. Patients were treated either with ultrasonic scaling and scaling and root planing (US + SRP) or ultrasonic scaling + SRP + aPDT with MB-NP (25 µg/mL and 20 J/cm²) in a split-mouth design. In biofilms, MB-NP eliminated approximately 25% more bacteria than free MB. The clinical study demonstrated the safety of aPDT. Both groups showed similar improvements of clinical parameters one month following treatments. However, at three months ultrasonic SRP + aPDT showed a greater effect (28.82%) on gingival bleeding index (GBI) compared to ultrasonic SRP. The utilization of PLGA nanoparticles encapsulated with MB may be a promising adjunct in antimicrobial periodontal treatment.

Orthotics Compared to Conventional Therapy and Other Non-Surgical Treatments for Plantar Fasciitis

PubMed Central

Lewis, Rebecca D.; Wright, Paul; McCarthy, Laine H.

2016-01-01

Clinical Question In adults with acute plantar fasciitis whose symptoms have not been relieved with the conventional regimen of NSAIDS, stretching and lifestyle modification, do the addition of orthotics (prefabricated or custom fitted) reduce pain and improve function compared with other non-surgical treatments (manipulative chiropractic, physical therapy and/or heel steroid injections)? Answer Yes. Studies have shown that orthotics, both prefabricated and custom fitted, reduce pain and improve function in adults with acute plantar fasciitis with few risks or side effects. Used alone or in addition to conventional therapy (NSAIDs, stretching, lifestyle modification), orthotics are effective and well tolerated by patients for short-term pain relief and improved function. Prefabricated orthotics are less costly and provide similar relief to more expensive custom orthotics. Level of Evidence of the Answer A Search Terms Plantar fasciitis, heel pain, treatment, orthotics, Limits Adult, human, English, Review, Randomized-Control Trials, Systematic Reviews, adults age 18 or more, publication dates 2004 to present. Date Search was Conducted January 16, 2014; updated January 20, 2015 Inclusion Criteria Recent published systematic reviews, randomized controlled, meta-analyses; adults with confirmed acute or recent diagnosis of plantar fasciitis. Exclusion Criteria Studies older than 10 years, children, adolescents less than 18 years of age, chronic or recalcitrant plantar fasciitis. PMID:26855444

Orthotics Compared to Conventional Therapy and Other Non-Surgical Treatments for Plantar Fasciitis.

PubMed

Lewis, Rebecca D; Wright, Paul; McCarthy, Laine H

2015-12-01

In adults with acute plantar fasciitis whose symptoms have not been relieved with the conventional regimen of NSAIDS, stretching and lifestyle modification, do the addition of orthotics (prefabricated or custom fitted) reduce pain and improve function compared with other non-surgical treatments (manipulative chiropractic, physical therapy and/or heel steroid injections)? Yes. Studies have shown that orthotics, both prefabricated and custom fitted, reduce pain and improve function in adults with acute plantar fasciitis with few risks or side effects. Used alone or in addition to conventional therapy (NSAIDs, stretching, lifestyle modification), orthotics are effective and well tolerated by patients for short-term pain relief and improved function. Prefabricated orthotics are less costly and provide similar relief to more expensive custom orthotics. Level of Evidence of the Answer: A Search Terms: Plantar fasciitis, heel pain, treatment, orthotics, Limits: Adult, human, English, Review, Randomized-Control Trials, Systematic Reviews, adults age 18 or more, publication dates 2004 to present. Date Search was Conducted: January 16, 2014; updated January 20, 2015 INCLUSION CRITERIA: Recent published systematic reviews, randomized controlled, meta-analyses; adults with confirmed acute or recent diagnosis of plantar fasciitis. Studies older than 10 years, children, adolescents less than 18 years of age, chronic or recalcitrant plantar fasciitis.

Acute periodontal lesions.

PubMed

Herrera, David; Alonso, Bettina; de Arriba, Lorenzo; Santa Cruz, Isabel; Serrano, Cristina; Sanz, Mariano

2014-06-01

This review provides updates on acute conditions affecting the periodontal tissues, including abscesses in the periodontium, necrotizing periodontal diseases and other acute conditions that cause gingival lesions with acute presentation, such as infectious processes not associated with oral bacterial biofilms, mucocutaneous disorders and traumatic and allergic lesions. A periodontal abscess is clinically important because it is a relatively frequent dental emergency, it can compromise the periodontal prognosis of the affected tooth and bacteria within the abscess can spread and cause infections in other body sites. Different types of abscesses have been identified, mainly classified by their etiology, and there are clear differences between those affecting a pre-existing periodontal pocket and those affecting healthy sites. Therapy for this acute condition consists of drainage and tissue debridement, while an evaluation of the need for systemic antimicrobial therapy will be made for each case, based on local and systemic factors. The definitive treatment of the pre-existing condition should be accomplished after the acute phase is controlled. Necrotizing periodontal diseases present three typical clinical features: papilla necrosis, gingival bleeding and pain. Although the prevalence of these diseases is not high, their importance is clear because they represent the most severe conditions associated with the dental biofilm, with very rapid tissue destruction. In addition to bacteria, the etiology of necrotizing periodontal disease includes numerous factors that alter the host response and predispose to these diseases, namely HIV infection, malnutrition, stress or tobacco smoking. The treatment consists of superficial debridement, careful mechanical oral hygiene, rinsing with chlorhexidine and daily re-evaluation. Systemic antimicrobials may be used adjunctively in severe cases or in nonresponding conditions, being the first option metronidazole. Once the acute

Therapy and treatment with a high-energy laser in case of a periodontal disease treatment instead of physiotherapy or low-level laser treatment

NASA Astrophysics Data System (ADS)

Buerger, Friedhelm R.

1996-12-01

Since intensive efforts ofprophylaxis including fluoridisation, better oral hygiene, eating ofless sugar containing foods, reduced the risk ofcaries and the problems ofcaries lesions significantly. But, especially beginning at the age of3O years more than 80 % ofthe population in almost every nation shows signs of periodontal defects. This you can call an epidemic disease. Because people get older and expect a lot concerning their outlook, their esthetic, their phonetic, they have great expectations towards their natural dentition and keep their own teeth. This is a great challenge to periodontal prophylaxis and periodontal therapy. According to the progress ofthe disease different therapies are indicated. Starting with oral hygiene instructions to establish better oral hygiene with all the modem technologies ofmicrobiological investigations, pharmaceutical therapy, physiotherapy, low level laser treatment, periodontal-surgery, like curettage, deepscaling and rootplaning but also more sophisticated teatmentplans with gingivoplasty, gingivectomy, flap-procedures and mucogingival surgeiy including bone fillings, regenerativ technics the whole spectrum oftreatment options has widely expanded during the last years.

Total anti-oxidant capacity of saliva in chronic periodontitis patients before and after periodontal treatment.

PubMed

Shirzaiy, M; Ansari, S M; Dehghan, J H; Ghaeni, S H

2014-01-01

Periodontal disease is among the most common inflammatory conditions which is associated with many different factors. One of the contributing factors to the pathogenesis of this condition may compromise the defensive mechanism of antioxidants. The present study evaluates the antioxidant capacity of saliva in periodontal patients before and after periodontal treatment. In this cross sectional study, 31 patients systemically healthy non smokers with chronic periodontitis were recruited. The antioxidant capacity of saliva was measured before the initial phase of periodontal therapy and after completion of the treatment. Data were analyzed using SPSS 19 software. Paired T-Test, Independent sample T-test and ANOVA tests were used as appropriated. The mean and standard deviation antioxidant capacity of the saliva after the treatment.(0.962± 0.287µM)was significantly higher than before the treatment (0.655 ± 0.281 µM ,p<0.001). The mean difference of antioxidant capacity of the saliva before and after periodontal treatment was higher among men than among women; however, the difference was not significant (P=0.07). The mean difference of salivary antioxidant capacity was not significantly differed among different ages (P=0.772). The antioxidant capacity of saliva was higher after periodontal therapy among patients with periodontal disease, however the change was not varied across the ages and gender. Therefore, the alterations in the defensive mechanism of antioxidants could be the key factors contribute to the pathogenesis of periodontal diseases.

Relative abundance of total subgingival plaque-specific bacteria in salivary microbiota reflects the overall periodontal condition in patients with periodontitis.

PubMed

Kageyama, Shinya; Takeshita, Toru; Asakawa, Mikari; Shibata, Yukie; Takeuchi, Kenji; Yamanaka, Wataru; Yamashita, Yoshihisa

2017-01-01

Increasing attention is being focused on evaluating the salivary microbiota as a promising method for monitoring oral health; however, its bacterial composition greatly differs from that of dental plaque microbiota, which is a dominant etiologic factor of oral diseases. This study evaluated the relative abundance of subgingival plaque-specific bacteria in the salivary microbiota and examined a relationship between the abundance and severity of periodontal condition in patients with periodontitis. Four samples (subgingival and supragingival plaques, saliva, and tongue coating) per each subject were collected from 14 patients with a broad range of severity of periodontitis before periodontal therapy. The bacterial composition was analyzed by 16S rRNA gene amplicon sequencing using Ion PGM. Of the 66 species-level operational taxonomic units (OTUs) representing the mean relative abundance of ≥ 1% in any of the four niches, 12 OTUs corresponding to known periodontal pathogens, including Porphyromonas gingivalis, were characteristically predominant in the subgingival plaque and constituted 37.3 ± 22.9% of the microbiota. The total relative abundance of these OTUs occupied only 1.6 ± 1.2% of the salivary microbiota, but significantly correlated with the percentage of diseased sites (periodontal pocket depth ≥ 4 mm; r = 0.78, P < 0.001), in addition to the abundance of subgingival plaque microbiota (r = 0.61, P = 0.02). After periodontal therapy, the total relative abundance of these 12 OTUs was evaluated as well as before periodontal therapy and reductions of the abundance through periodontal therapy were strongly correlated in saliva and subgingival plaque (r = 0.81, P < 0.001). Based on these results, salivary microbiota might be a promising target for the evaluation of subgingival plaque-derived bacteria representing the present condition of periodontal health.

Relative abundance of total subgingival plaque-specific bacteria in salivary microbiota reflects the overall periodontal condition in patients with periodontitis

PubMed Central

Kageyama, Shinya; Takeshita, Toru; Asakawa, Mikari; Shibata, Yukie; Takeuchi, Kenji; Yamanaka, Wataru

2017-01-01

Increasing attention is being focused on evaluating the salivary microbiota as a promising method for monitoring oral health; however, its bacterial composition greatly differs from that of dental plaque microbiota, which is a dominant etiologic factor of oral diseases. This study evaluated the relative abundance of subgingival plaque-specific bacteria in the salivary microbiota and examined a relationship between the abundance and severity of periodontal condition in patients with periodontitis. Four samples (subgingival and supragingival plaques, saliva, and tongue coating) per each subject were collected from 14 patients with a broad range of severity of periodontitis before periodontal therapy. The bacterial composition was analyzed by 16S rRNA gene amplicon sequencing using Ion PGM. Of the 66 species-level operational taxonomic units (OTUs) representing the mean relative abundance of ≥ 1% in any of the four niches, 12 OTUs corresponding to known periodontal pathogens, including Porphyromonas gingivalis, were characteristically predominant in the subgingival plaque and constituted 37.3 ± 22.9% of the microbiota. The total relative abundance of these OTUs occupied only 1.6 ± 1.2% of the salivary microbiota, but significantly correlated with the percentage of diseased sites (periodontal pocket depth ≥ 4 mm; r = 0.78, P < 0.001), in addition to the abundance of subgingival plaque microbiota (r = 0.61, P = 0.02). After periodontal therapy, the total relative abundance of these 12 OTUs was evaluated as well as before periodontal therapy and reductions of the abundance through periodontal therapy were strongly correlated in saliva and subgingival plaque (r = 0.81, P < 0.001). Based on these results, salivary microbiota might be a promising target for the evaluation of subgingival plaque-derived bacteria representing the present condition of periodontal health. PMID:28369125

Periodontal management of patients with cardiovascular diseases.

PubMed

2002-08-01

Periodontists are often called upon to provide periodontal therapy for patients with a variety of cardiovascular diseases. Safe and effective periodontal treatment requires a general understanding of the underlying cardiovascular diseases, their medical management, and necessary modifications to dental/periodontal therapy that may be required. In this informational paper more common cardiovascular disorders will be discussed and dental management considerations briefly described. This paper is intended for the use of periodontists and members of the dental profession.

Periodontal Regeneration Using Periodontal Ligament Stem Cell-Transferred Amnion

PubMed Central

Iwasaki, Kengo; Yokoyama, Naoki; Tanaka, Yuichi; Taki, Atsuko; Honda, Izumi; Kimura, Yasuyuki; Takeda, Masaki; Akazawa, Keiko; Oda, Shigeru; Izumi, Yuichi; Morita, Ikuo

2014-01-01

Periodontal disease is characterized by the destruction of tooth supporting tissues. Regeneration of periodontal tissues using ex vivo expanded cells has been introduced and studied, although appropriate methodology has not yet been established. We developed a novel cell transplant method for periodontal regeneration using periodontal ligament stem cell (PDLSC)-transferred amniotic membrane (PDLSC-amnion). The aim of this study was to investigate the regenerative potential of PDLSC-amnion in a rat periodontal defect model. Cultured PDLSCs were transferred onto amniotic membranes using a glass substrate treated with polyethylene glycol and photolithography. The properties of PDLSCs were investigated by flow cytometry and in vitro differentiation. PDLSC-amnion was transplanted into surgically created periodontal defects in rat maxillary molars. Periodontal regeneration was evaluated by microcomputed tomography (micro-CT) and histological analysis. PDLSCs showed mesenchymal stem cell-like characteristics such as cell surface marker expression (CD90, CD44, CD73, CD105, CD146, and STRO-1) and trilineage differentiation ability (i.e., into osteoblasts, adipocytes, and chondrocytes). PDLSC-amnion exhibited a single layer of PDLSCs on the amniotic membrane and stability of the sheet even with movement and deformation caused by surgical instruments. We observed that the PDLSC-amnion enhanced periodontal tissue regeneration as determined by micro-CT and histology by 4 weeks after transplantation. These data suggest that PDLSC-amnion has therapeutic potential as a novel cell-based regenerative periodontal therapy. PMID:24032400

Prevention and Periodontal Treatment in Down Syndrome Patients: A Systematic Review

PubMed Central

Greghi, Sebastião Luiz Aguiar; de Resende, Maria Lúcia Rubo; Sant’Ana, Adriana Campos Passanezi; Damante, Carla Andreotti

2016-01-01

The aim of this systematic literature review was to evaluate which type of periodontal preventive and therapeutic approaches presents superior outcomes in patients with Down syndrome (DS). Studies reporting different methods of periodontal care from DS patients were considered eligible. Included clinical studies should indicate at least two periodontal parameters in different periods of assessment. Screening of the articles, data extraction and quality assessment were conducted independently and in duplicate. Electronic search according to the PICO search, with both Key-words and MESH terms were conducted in MEDLINE, EMBASE and CENTRAL databases until March 2016. Manual search was conducted in four journals, namely Journal of Periodontology, Journal of Clinical Periodontology, Journal of Periodontal Research and Special Care in Dentistry and their electronic databases were searched. Electronic and manual search resulted in 763 papers, and of them 744 were excluded after title/abstract assessment. The full text of 19 potentially eligible publications was screened and 9 studies met inclusion criteria. The results demonstrated the importance to introduce youngest DS patients in preventive programs, as well as participation of parents, caregivers or institutional attendants in supervising/performing oral hygiene. In studies with higher frequency of attendance, all age groups presented superior preventive and therapeutic results, irrespective of the therapeutic approach used (surgical/nonsurgical/periodontal care program). The important factors for reducing periodontal parameters were the frequency of the appointments and association with chlorhexidine/plaque disclosing agents as adjuvant treatment. This systematic review demonstrated that early introduction in periodontal care, participation of parents/caregivers/institutional attendants, frequency of attendance and association with chemical adjuvants (independently of the periodontal treatment adopted) seems to

Uterine atony: definition, prevention, nonsurgical management, and uterine tamponade.

PubMed

Breathnach, Fionnuala; Geary, Michael

2009-04-01

Uterine atony, or failure of the uterus to contract following delivery, is the most common cause of postpartum hemorrhage. This review serves to examine the prevention and treatment of uterine atony, including risk-factor recognition and active management of the third stage of labor. A range of uterotonic agents will be compared for efficacy, safety, and ease of administration. Oxytocin and ergot alkaloids represent the cornerstone of uterotonic therapy, while prostaglandin therapy has been studied more recently as an attractive alternative, particularly for resource-poor settings. Newer supplementary medical therapies, such as recombinant factor VII and hemostatic agents, and adjunctive nonsurgical methods aimed at achieving uterine tamponade will be evaluated.

Non-surgical interventions for convergence insufficiency

PubMed Central

Scheiman, Mitchell; Gwiazda, Jane; Li, Tianjing

2014-01-01

Background Convergence insufficiency is a common eye muscle co-ordination problem in which the eyes have a strong tendency to drift outward (exophoria) when reading or doing close work. Symptoms may include eye strain, headaches, double vision, print moving on the page, frequent loss of place when reading, inability to concentrate, and short attention span. Objectives To systematically assess and synthesize evidence from randomized controlled trials (RCTs) on the effectiveness of non-surgical interventions for convergence insufficiency. Search strategy We searched The Cochrane Library, MEDLINE, EMBASE, Science Citation Index, the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov) on 7 October 2010. We manually searched reference lists and optometric journals. Selection criteria We included RCTs examining any form of non-surgical intervention against placebo, no treatment, sham treatment, or each other. Data collection and analysis Two authors independently assessed eligibility, risk of bias, and extracted data. We performed meta-analyses when appropriate. Main results We included six trials (three in children, three in adults) with a total of 475 participants. We graded four trials at low risk of bias. Evidence from one trial (graded at low risk of bias) suggests that base-in prism reading glasses was no more effective than placebo reading glasses in improving clinical signs or symptoms in children. Evidence from one trial (graded at high risk of bias) suggests that base-in prism glasses using a progressive addition lens design was more effective than progressive addition lens alone in decreasing symptoms in adults. At three weeks of therapy, the mean difference in Convergence Insufficiency Symptoms Survey (CISS) score was −10.24 points (95% confidence interval (CI) −15.45 to −5.03). Evidence from two trials (graded at low risk of bias) suggests that outpatient (or office-based as used in the

Periodontist-Dental Hygienist Collaboration in Periodontal Care for Chronic Periodontitis: An 11-year Case Report.

PubMed

Tomita, Sachiyo; Uekusa, Tomomi; Hosono, Meiko; Kigure, Takashi; Sugito, Hiroki; Saito, Atsushi

2016-01-01

We report a case of severe chronic periodontitis treated and longitudinally maintained by a periodontist and dental hygienists. The patient was a 45-year-old woman who presented with the chief complaint of gingival bleeding and tooth mobility. An initial examination revealed generalized gingival inflammation and subgingival calculus in the premolar and molar regions. Premature contact was observed in #14 and 45. Clinical examination revealed 42% of sites with a probing depth (PD) of ≥4 mm and 44% of sites with bleeding on probing. Radiographic examination revealed vertical bone resorption in #35, 36, and 45, and horizontal bone resorption in other regions. Based on a clinical diagnosis of severe chronic periodontitis, initial periodontal therapy consisting of plaque control, scaling and root planing, and removal of an ill-fitting prosthesis was performed. Following suppression of inflammation, occlusal adjustment of premature contact sites was performed. Open flap debridement was performed for teeth with a PD of ≥5 mm. After confirming the stability of the periodontal tissue, final prostheses were placed on #16, 35-37, and 46. Following re-evaluation, the patient was placed on supportive periodontal therapy. It has been 11 years since the patient's first visit, and the periodontal conditions have remained stable. Meticulous periodontal care maintained over a number of years by a periodontist and dental hygienist have yielded a clinically favorable outcome.

Effects of surgical vs. nonsurgical therapy on erectile dysfunction and quality of life in obstructive sleep apnea syndrome: a pilot study.

PubMed

Shin, Hyun-Woo; Park, Ju-Hyun; Park, Jong-Wan; Rhee, Chae-Seo; Lee, Chul Hee; Min, Yang-Gi; Kim, Dong-Young

2013-08-01

Obstructive sleep apnea syndrome (OSAS) is associated with erectile dysfunction (ED). The improvement of ED after medical therapy including continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs) is still controversial. Furthermore, the efficacy of surgical treatment has been little investigated. The aim of this nonrandomized prospective study was to evaluate the effects of surgical (uvulopalatopharyngoplasty [UPPP]) and nonsurgical approaches (CPAP and MAD) on ED and quality of life (QOL) in OSAS. OSAS patients underwent UPPP (N = 30), CPAP (N = 16), or MAD (N = 10) and completed the Korean versions of the International Index of Erectile Function questionnaire (KIIEF-5) and the Calgary Sleep Apnea Quality of Life Index (SAQLI) before and after a median of 7 months of treatment (interquartile range, 4-15 months). All patients underwent a full-night in-laboratory polysomnography at baseline and follow-up. The main outcome measures are the KIIEF-5 and SAQLI scores. CPAP group showed older age, higher body mass index, and more severe OSAS than other groups. Apnea-hypopnea index and lowest oxygen saturation level improved significantly in all groups, but Epworth Sleepiness Scale score decreased significantly in UPPP and MAD groups. Significant increase of KIIEF-5 was observed in patients who underwent UPPP (P = 0.039, paired t-test), but not in nonsurgical treatment group. All groups had the tendency of better QOL after treatment, but statistical significance was found only in MAD group. Neck circumference (r = 0.360, P = 0.006) and KIIEF-5 score (r = -0.484, P < 0.001) at baseline were significantly related to the improvement of KIIEF-5. This study demonstrated that ED in OSAS may improve following UPPP. Better disease-specific QOL was observed after both surgical and nonsurgical therapies in OSAS. These findings suggest that interventions for OSAS can provide the alleviation of ED and increase QOL in OSAS

Association of a common genetic factor, PTGER3, with outcome of periodontal therapy and preterm birth.

PubMed

Jeffcoat, Marjorie K; Jeffcoat, Robert L; Tanna, Nipul; Parry, Samuel H

2014-03-01

Clinical evidence suggests an association between preterm birth and periodontal disease. This study explores whether specific genetic polymorphisms are associated with success of periodontal therapy in pregnant women with periodontal disease and, further, whether any of these same polymorphisms are also associated with spontaneous preterm birth (sPTB). One hundred sixty high-risk pregnant women (6 to 20 weeks of gestation) with periodontal disease (≥ 3 sites with attachment loss ≥ 4 mm) were studied. All women received scaling and root planing plus oral hygiene instruction. Periodontal examinations were performed before treatment and 20 weeks later. Participants were classified according to two study outcomes: 1) success or failure of periodontal treatment; and 2) presence or absence of sPTB. Maternal DNA samples from mucosal swabs were characterized using a 1536-SNP (single-nucleotide polymorphism) custom polymerase chain reaction chip. A probabilistic model of each dichotomous outcome, derived using a stepwise Bayesian procedure, was compared to respective null hypotheses on the basis of Monte Carlo simulations and significance estimates obtained using three measures (z-test, Welch t-test, and probability convolution). The models were further confirmed by logistic regression analyses. The models revealed a significant relation between a specific polymorphism of prostaglandin E receptor 3 (a gene associated with inflammatory response) and both periodontal treatment failure (odds ratio 11.09, P <0.0002) and sPTB (odds ratio 6.89, P < 0.0032). These results demonstrate that the risk of unsuccessful periodontal treatment is associated with tag SNPs in specific genes that regulate the inflammatory response, one of which is also associated with sPTB.

Comparing the efficiency of Er,Cr:YSGG laser and diode laser on human β-defensin-1 and IL-1β levels during the treatment of generalized aggressive periodontitis and chronic periodontitis.

PubMed

Ertugrul, Abdullah Seckin; Tekin, Yasin; Talmac, Ahmet Cemil

2017-11-01

The aim of this study is to determine the suitability of the Er,Cr:YSGG and 940 ± 15-nm diode laser for the treatment of generalized aggressive periodontitis and chronic periodontitis by measuring the levels of human β-defensin-1 and IL-1β. A total of 26 patients were included in this study. The study was designed as a "split-mouth" experiment. We performed scaling and root planing in the right maxillary quadrant, scaling and root planning + Er,Cr:YSGG laser in the left maxillary quadrant, scaling and root planning + 940 ± 15-nm diode laser in the left mandibular quadrant, and only scaling and root planing in the right mandibular quadrant. The presence of human β-defensin-1 and IL-1β was analyzed with an ELISA. When the baseline and post-treatment human β-defensin-1 levels and IL-1β levels of the study groups were evaluated, a decrease in human β-defensin-1 and IL-1β were observed in the quadrant where the Er,Cr:YSGG laser was applied in both the generalized aggressive periodontitis group and the chronic periodontitis group. The use of the Er,Cr:YSGG laser at non-surgical periodontal treatment decreased both IL-1β and human β-defensin-1 levels. It is likely that Er,Cr:YSGG laser is more suitable for the treatment of generalized aggressive periodontitis and chronic periodontitis.

The periodontal – endodontic continuum: A review

PubMed Central

Sunitha V, Raja; Emmadi, Pamela; Namasivayam, Ambalavanan; Thyegarajan, Ramakrishnan; Rajaraman, Vijayalakshmi

2008-01-01

Periodontal therapy deals with many aspects of the supporting structures, including the prevention and repair of lesions of the gingival sulcus. Endodontics deals primarily with disease of the pulp and periapical tissues. The success of both periodontal and endodontic therapy depends on the elimination of both disease processes, whether they exist separately or as a combined lesion. The relationship between periodontal and endodontic disease has been a subject of speculation for many years. This paper aims at presenting a comprehensive review of several aspects of perio-endo lesions. PMID:20142886

Antimicrobial photodynamic therapy with photosensitizer in ethanol improves oxidative status and gingival collagen in a short-term in periodontitis.

PubMed

Pillusky, Fernanda Maia; Barcelos, Raquel Cristine Silva; Vey, Luciana Taschetto; Barin, Luisa Machado; de Mello Palma, Victor; Maciel, Roberto Marinho; Kantorski, Karla Zanini; Bürger, Marilise Escobar; Danesi, Cristiane Cademartori

2017-09-01

This study evaluated the antimicrobial photodynamic therapy (aPDT) effects using the methylene blue (MB) in ethanol 20% on systemic oxidative status and collagen content from gingiva of rats with periodontitis. Rats were divided into five experimental groups: NC (negative control; no periodontitis); PC (positive control; periodontitis without any treatment); SRP (periodontitis and scaling and root planing), aPDT I (periodontitis and SRP+aPDT+MB solubilized in water), and aPDT II (periodontitis and SRP+aPDT+MB solubilized in ethanol 20%). After 7days of removal of the ligature, the periodontal treatments were performed. At 7/15/30days, gingival tissue was removed for morphometric analysis. The erythrocytes were used to evaluate systemic oxidative status. PC group showed higher lipoperoxidation levels at 7/15/30days. aPDT indicated a protective influence in erythrocytes at 15days observed by the elevation in levels of systemic antioxidant defense. aPDT II group was the only one that restored the total collagen area in 15days, and recovered the type I collagen area at the same time point. aPDT as an adjunct to the SRP can induce the systemic protective response against oxidative stress periodontitis-induced and recover the gingival collagen, thus promoting the healing periodontal, particularly when the MB is dissolved in ethanol 20%. Copyright © 2017 Elsevier B.V. All rights reserved.

Treatment of peri-implantitis: clinical outcome of chloramine as an adjunctive to non-surgical therapy, a randomized clinical trial.

PubMed

Roos-Jansåker, Ann-Marie; Almhöjd, Ulrica S; Jansson, Henrik

2017-01-01

To evaluate the adjunctive clinical effects of a chloramine to non-surgical treatment of peri-implantitis. Eighteen individuals diagnosed with peri-implantitis (clinical signs of inflammation and progressive bone loss) on at least two implants were included. Clinical variables; plaque accumulation (Pl), probing depth (PD), clinical attachment level (CAL) and bleeding on probing (BoP), were recorded at baseline and at 3-month follow-up. Primary clinical efficacy variable was the change in the number of sites with BoP. The implants were randomized into two different treatment groups: test and control. Both implants received supra- and submucosal debridement by ultrasonic instrumentation supplemented with hand instruments. The implants assigned to the test group first received local applications of a chloramine gel (Perisolv ™ ; RLS Global AB, Gothenburg, Sweden) followed by mechanical instrumentation. The oral hygiene was checked at 6 weeks. After 3 months, implants of both groups showed statistically significant reduction (P < 0.001) in the number of BoP-positive sites compared with baseline. The reduction of BoP-positive sites in the test group changed from 0.97 (SD ± 0.12) to 0.38 (SD ± 0.46), and in the control group from 0.97 (SD ± 0.12) to 0.31 (SD ± 0.42). Between-group comparisons revealed no statistically significant differences at baseline and after 3 months, for BoP or any of the other variables. In the present randomized clinical trial of peri-implantitis therapy; non-surgical mechanical debridement with adjunctive use of a chloramine is equally effective in the reduction of mucosal inflammation as conventional non-surgical mechanical debridement up to 3 months. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Maintenance of class III trifurcated molars versus implant placement in regenerated extraction sockets: long-term results of 2 cases.

PubMed

Zafiropoulos, Gregory-George K; di Prisco, Manuela Occipite; Deli, Giorgio; Hoffmann, Oliver

2011-03-01

Studies to date have reached differing conclusions regarding the long-term prognosis of teeth with class III furcation involvement. Replacement of such teeth with implants could be an alternative. This report compares the treatment outcomes of 2 cases with similar disease progression: 1 treated by implant therapy and 1 maintained with nonsurgical periodontal treatment. Two patients with advanced chronic periodontitis and class III furcation involvement of all molars were treated. Case 1 received a conservative periodontal and antibiotic treatment, followed by 15 years of maintenance. In case 2, the molars were extracted and replaced with implants, and the implants were observed for 7 years. Clinical attachment level (CAL), probing attachment level (PAL), bleeding on probing, plaque index, and periodontal pathogens were recorded. Despite good compliance of case 1, periodontal pathogens were not eliminated and tissue destruction was not halted. The PAL outcomes of case 2 improved over time; mean PAL loss reached 0.35 mm/y in the first 3 years and then decreased to 0.01 mm/y. While CAL outcomes did not change in case 2, case 1 showed increased CAL loss after 8 years. Based on the limited findings of this case report, extraction of molars with class III furcation involvement and subsequent implant placement may render a better predictability of treatment outcomes than nonsurgical periodontal therapy in the cases of infection with periodontal pathogens.

An abbreviated history of osseous surgery.

PubMed

Rudy, Robert J; Marcuschamer, Eduardo

2011-01-01

Various forms of periodontal therapy, including surgery, have been advocated and documented in the dental literature during the last three centuries. This variety of treatment modalities has been developed to address the anatomical consequences (pocket formation and bone loss) sustained from chronic periodontal disease. The marked differences in techniques have created significant controversies between the greatest leaders in dentistry and their equally influential disciples. Nevertheless, these leaders have always shared a common goal: the preservation of the natural dentition in a harmonious environment of health, comfort, and proper function. This article discusses the history of periodontal osseous surgery, including not only the technical issues, but also the conceptual underpinnings of this form of therapeutic intervention. In the process of examining this subject closely, three main controversies in the field of periodontics are brought into sharper focus: non-surgical versus surgical periodontal therapy; gingivectomy versus osseous resective periodontal therapy; and the nature of clinical decision-making: scientific and evidenced-based versus subjective clinical judgement.

PDT in periodontal disease of HAART resistance patients

NASA Astrophysics Data System (ADS)

Giovani, Elcio M.; Noro-Filho, Gilberto A.; Caputo, Bruno V.; Casarin, Renato; Costa, Claudio; Salgado, Daniela; Santos, Camila C.

2016-03-01

HIV/Aids patients present a change of microbiota associated with host immunodeficiency. Photodynamic therapy (PDT) showed as a promising and viable alternative in reducing microbiota. Present study evaluate effectiveness of photodynamic therapy in periodontal disease of AIDS patients with highly activity antiretroviral therapy (HAART) failure, measuring the clinical periodontal parameters and periodontal microbiota. Twelve patients with HARRT resistance (R group) divided into two groups (control and PDT) and 12 patients with no HAART resistance (NR group) divided into two groups (control and PDT). The results show the difference in baseline of CD4 cells count, NR group 640.0 +/- 176.2 cells/mm3 R group and 333.3 +/- 205.8 cells / mm3 (p<0.05), and in 8.3% detectable viral load in NR group and 75% detectable (p <0.001) in R group. As clinical periodontal parameters (PD and CAL), PDT was more effective than the control group only in the NR group (p <0.05%), moreover, there was no difference in the evaluation of clinical periodontal parameters between the both R groups (p>0.05%). Microbiological evaluation in R group presents a general reduction in the Aa at 3 and 6 months. Furthermore, demonstrated a reduction of Pg in all groups at 6 months and in R group at 3 months. The impact assessment of photodynamic therapy in patients with different levels of immunosuppression determined that the combination of mechanical periodontal treatment with photodynamic therapy in patients with HAART failure did not cause additional benefits. Therefore, PDT in this study could not been indicated in HAART resistance patients.

A randomized controlled trial of pre-conception treatment for periodontal disease to improve periodontal status during pregnancy and birth outcomes.

PubMed

Jiang, Hong; Xiong, Xu; Su, Yi; Zhang, Yiming; Wu, Hongqiao; Jiang, Zhijun; Qian, Xu

2013-12-09

Evidence has suggested that periodontal disease is associated with an increased risk of various adverse pregnancy and birth outcomes. However, several large clinical randomized controlled trials failed to demonstrate periodontal therapy during pregnancy reduced the incidence of adverse pregnancy and birth outcomes. It has been suggested that the pre-conception period may be an optimal period for periodontal disease treatment rather than during pregnancy. To date, no randomized controlled trial (RCT) has examined if treating periodontal disease before pregnancy reduces adverse birth outcomes. This study aims to examine if the pre-conception treatment of periodontal disease will lead to improved periodontal status during late pregnancy and subsequent birth outcomes. A sample of 470 (235 in each arm of the study) pre-conception women who plan to conceive within one year and with periodontal disease will be recruited for the study. All participants will be randomly allocated to the intervention or control group. The intervention group will receive free therapy including dental scaling and root planning (the standard therapy), supragingival prophylaxis, and oral hygiene education. The control group will only receive supragingival prophylaxis and oral hygiene education. Women will be followed throughout their pregnancy and then to childbirth. The main outcomes include periodontal disease status in late pregnancy and birth outcomes measured such as mean birth weight (grams), and mean gestational age (weeks). Periodontal disease will be diagnosed through a dental examination by measuring probing depth, clinical attachment loss and percentage of bleeding on probing (BOP) between gestational age of 32 and 36 weeks. Local and systemic inflammatory mediators are also included as main outcomes. This will be the first RCT to test whether treating periodontal disease among pre-conception women reduces periodontal disease during pregnancy and prevents adverse birth outcomes. If

Periodontitis: facts, fallacies and the future.

PubMed

Slots, Jørgen

2017-10-01

This volume of Periodontology 2000 represents the 25th anniversary of the Journal, and uses the occasion to assess important advancements in periodontology over the past quarter-century as well as the hurdles that remain. Periodontitis is defined by pathologic loss of the periodontal ligament and alveolar bone. The disease involves complex dynamic interactions among active herpesviruses, specific bacterial pathogens and destructive immune responses. Periodontal diagnostics is currently based on clinical rather than etiologic criteria, and provides limited therapeutic guidance. Periodontal causative treatment consists of scaling, antiseptic rinses and occasionally systemic antibiotics, and surgical intervention has been de-emphasized, except perhaps for the most advanced types of periodontitis. Plastic surgical therapy includes soft-tissue grafting to cover exposed root surfaces and bone grafting to provide support for implants. Dental implants are used to replace severely diseased or missing teeth, but implant overuse is of concern. The utility of laser treatment for periodontitis remains unresolved. Host modulation and risk-factor modification therapies may benefit select patient groups. Patient self-care is a critical part of periodontal health care, and twice-weekly oral rinsing with 0.10-0.25% sodium hypochlorite constitutes a valuable adjunct to conventional anti-plaque and anti-gingivitis treatments. A link between periodontal herpesviruses and systemic diseases is a strong biological plausibility. In summary, research during the past 25 years has significantly changed our concepts of periodontitis pathobiology and has produced more-effective and less-costly therapeutic options. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Periodontal Therapy Reduces the Rate of Preterm Low Birth Weight in Women With Pregnancy-Associated Gingivitis.

PubMed

López, Néstor J; Da Silva, Isabel; Ipinza, Joaquín; Gutiérrez, Jorge

2005-11-01

One hypothesis to explain the association between periodontal disease (PD) preterm/low birth weight (PT/LBW) is that PT/LBW may be indirectly mediated through translocation of bacteria or bacterial products in the systemic circulation. Transient bacteremias occur in subjects with marginal periodontitis or with gingivitis, and it is possible that bacteria and their products may reach the placental membranes hematogenously and provide the inflammatory effect to induce preterm labor. The effect of gingivitis as a potential risk factor for PT/LBW has still not been studied. A randomized controlled trial was undertaken to determine the effect of routine plaque control and scaling on the pregnancy outcomes in women with gingivitis. Eight hundred seventy (870) pregnant women with gingivitis, aged 18 to 42, were enrolled while receiving prenatal care in Santiago, Chile. Women were randomly assigned in a two-to-one fashion to either a treatment group (N = 580), receiving periodontal treatment before 28 weeks of gestation or to a control group (N = 290), receiving periodontal treatment after delivery. Periodontal therapy consisted of plaque control, scaling, and daily rinsing with 0.12% clorhexidine. Maintenance therapy was provided every 2 to 3 weeks until delivery, and consisted of oral hygiene instruction and supragingival plaque removal by instrumentation, as needed. The primary outcomes assessed were delivery at less than 37 weeks of gestation or an infant weighing less than 2,500 g. Of the 870 women enrolled, 36 women (27 in the treatment group and nine in the control group) were excluded from the analyses for different reasons. The incidence of PT/LBW in the treatment group was 2.14% (12/560) and in the control group, 6.71% (19/283) (odds ratio [OR] 3.26; 95% confidence interval [CI] 1.56 to 6.83; P = 0.0009). Multivariate logistic regression analysis showed that, after adjusting for several known risk factors for PT/LBW, women with gingivitis were at a higher risk of

Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis.

PubMed

López, Néstor J; Da Silva, Isabel; Ipinza, Joaquín; Gutiérrez, Jorge

2005-11-01

One hypothesis to explain the association between periodontal disease (PD) preterm/low birth weight (PT/LBW) is that PT/LBW may be indirectly mediated through translocation of bacteria or bacterial products in the systemic circulation. Transient bacteremias occur in subjects with marginal periodontitis or with gingivitis, and it is possible that bacteria and their products may reach the placental membranes hematogenously and provide the inflammatory effect to induce preterm labor. The effect of gingivitis as a potential risk factor for PT/LBW has still not been studied. A randomized controlled trial was undertaken to determine the effect of routine plaque control and scaling on the pregnancy outcomes in women with gingivitis. Eight hundred seventy (870) pregnant women with gingivitis, aged 18 to 42, were enrolled while receiving prenatal care in Santiago, Chile. Women were randomly assigned in a two-to-one fashion to either a treatment group (N = 580), receiving periodontal treatment before 28 weeks of gestation or to a control group (N = 290), receiving periodontal treatment after delivery. Periodontal therapy consisted of plaque control, scaling, and daily rinsing with 0.12% clorhexidine. Maintenance therapy was provided every 2 to 3 weeks until delivery, and consisted of oral hygiene instruction and supragingival plaque removal by instrumentation, as needed. The primary outcomes assessed were delivery at less than 37 weeks of gestation or an infant weighing less than 2,500 g. Of the 870 women enrolled, 36 women (27 in the treatment group and nine in the control group) were excluded from the analyses for different reasons. The incidence of PT/LBW in the treatment group was 2.14% (12/560) and in the control group, 6.71% (19/283) (odds ratio [OR] 3.26; 95% confidence interval [CI] 1.56 to 6.83; P = 0.0009). Multivariate logistic regression analysis showed that, after adjusting for several known risk factors for PT/LBW, women with gingivitis were at a higher risk of

Three-year follow-up results for non-surgical root canal therapy of idiopathic external root resorption on a maxillary canine with MTA: a case report

PubMed Central

Huang, Zheng; Chen, Li-Li; Wang, Cong-Yi; Dai, Lin; Cheng, Bo; Sun, Jun; Sun, Jun

2014-01-01

External root resorption (ERR) is an uncommon and intractable disease. Treatment alternatives are case-dependant and aim for the repair of the resorptive lesion and long-term retention of the tooth. A forty-year-old Asian female was diagnosed with idiopathic ERR on tooth #11 (the left maxillary canine) by CBCT. Non-surgical root canal therapy was completed with the aid of an operating microscope. The apical third of the root canal was filled with warm gutta-percha and the resorption defect was filled with mineral trioxide aggregate (MTA). The periapical radiographs were taken immediately after operation, one-month follow-up, six-month follow-up and three-year follow-up, respectively. Clinically, the canine was asymptomatic, and no evidence of any further resorption was found. The six-month follow-up radiograph showed initial healing of the bony lesion, while the three-year follow-up radiograph manifested almost complete healing. MTA can be a superior material to be successfully used in the non-surgical treatment of ERR. CBCT is very useful for evaluating the true nature and severity of absorption lesions in root resorption. It is the first complete case report from China about non-surgical treatment of severe ERR along with a relatively long term follow-up. PMID:25031758

Pre- and post-treatment experiences of fear, anxiety, and pain among chronic periodontitis patients treated by scaling and root planing per quadrant versus one-stage full-mouth disinfection: a 6-month randomized controlled clinical trial.

PubMed

Santuchi, Camila Carvalho; Cortelli, Sheila Cavalca; Cortelli, José Roberto; Cota, Luís Otávio Miranda; Alencar, Camila Oliveira; Costa, Fernando Oliveira

2015-11-01

To relate the clinical effects of two different forms of non-surgical periodontal therapy - scaling and root planing per quadrant (SRP-Q) and one-stage full-mouth disinfection (FMD) - to patient-based outcomes such as fear, anxiety, and pain of moderate chronic periodontitis patients. Dental Fear Survey (DFS) and Dental Anxiety Scale (DAS) questionnaires and Visual Analogue Scale (VAS) were applied to 78 patients randomized into two groups: SRP-Q (n = 37) and FMD (n = 41). Periodontal clinical parameters: probing pocket depth (PD), clinical attachment level (CAL), plaque index (PI), and gingival index (GI) were monitored at baseline and 6 months after treatment. Data were statistically analysed by chi-square, Fisher's exact, Mann-Whitney, Wilcoxon tests, Pearson's correlation, and Cluster analysis. All periodontal clinical parameters improved from baseline to 6 months. Patients with higher fear and anxiety showed a worse clinical periodontal status before and after treatment (mean CAL, PI, and GI). After both types of treatment, fear and anxiety decreased (FMD: p = 0.019; SRP-Q: p = 0.043) with no differences between the groups. Pain did not differ between groups (FMD: 20.6 ± 19.0 and SRP: 20.7 ± 20.0; p = 0.930). In moderate chronic periodontitis patients, SRP-Q and FMD provided periodontal clinical improvements and similar experiences of fear, anxiety, and pain. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Quality of Life in Patients with Knee Osteoarthritis: A Commentary on Nonsurgical and Surgical Treatments

PubMed Central

Farr II, Jack; Miller, Larry E.; Block, Jon E.

2013-01-01

Knee osteoarthritis (OA) has a significant negative impact on health-related quality of life (HRQoL). Identification of therapies that improve HRQoL in patients with knee OA may mitigate the clinical, economic, and social burden of this disease. The purpose of this commentary is to report the impact of knee OA on HRQoL, describe the change in HRQoL attributable to common knee OA interventions, and summarize findings from clinical trials of a promising therapy. Nonsurgical therapies do not reliably modify HRQoL in knee OA patients given their general inability to alleviate physical manifestations of OA. Surgical knee OA interventions generally result in good to excellent patient outcomes. However, there are significant barriers to considering surgery, which limits clinical utility. Therapies that most effectively control OA-related pain with a low risk: benefit ratio will likely have the greatest benefit on HRQoL with greater rates of patient adoption. Initial clinical trial findings suggest that less invasive joint unloading implants hold promise in bridging the therapeutic gap between nonsurgical and surgical treatments for the knee OA patient. PMID:24285987

Periodontal and periimplant maintenance: a critical factor in long-term treatment success.

PubMed

Shumaker, Nicholas D; Metcalf, Brett T; Toscano, Nicholas T; Holtzclaw, Dan J

2009-09-01

Periodontal maintenance (PM) is a critical factor in the long-term success of both periodontal and dental implant therapy. Studies have shown both modern periodontal and dental implant therapies are effective in maintaining natural teeth and replacing lost teeth, respectively. However, without a regular program of clinical reevaluation, plaque control, oral hygiene instruction, and reassessment of biomechanical factors, the benefits of treatment often are lost and inflammatory disease in the form of recurrent periodontitis or periimplantitis may result. This article reviews the goals, types, and appropriate frequency of PM in periodontal and dental implant therapy, as well as the incidence and etiology of periimplant disease and strategies for management when recurrent disease develops during the maintenance phase of treatment.

Cell- and Gene-Based Therapeutic Strategies for Periodontal Regenerative Medicine

PubMed Central

Rios, Hector F.; Lin, Zhao; Oh, BiNa; Park, Chan Ho; Giannobile, William V.

2012-01-01

Inflammatory periodontal diseases are a leading cause of tooth loss and are linked to multiple systemic conditions, such as cardiovascular disease and stroke. Reconstruction of the support and function of affected tooth-supporting tissues represents an important therapeutic endpoint for periodontal regenerative medicine. An improved understanding of periodontal biology coupled with current advances in scaffolding matrices has introduced novel treatments that use cell and gene therapy to enhance periodontal tissue reconstruction and its biomechanical integration. Cell and gene delivery technologies have the potential to overcome limitations associated with existing periodontal therapies, and may provide a new direction in sustainable inflammation control and more predictable tissue regeneration of supporting alveolar bone, periodontal ligament, and cementum. This review provides clinicians with the current status of these early-stage and emerging cell- and gene-based therapeutics in periodontal regenerative medicine, and introduces their future application in clinical periodontal treatment. The paper concludes with prospects on the application of cell and gene tissue engineering technologies for reconstructive periodontology. PMID:21284553

Manual Physical Therapy for Non-Surgical Treatment of Adhesion-Related Small Bowel Obstructions: Two Case Reports

PubMed Central

Rice, Amanda D.; King, Richard; Reed, Evette D’Avy; Patterson, Kimberley; Wurn, Belinda F.; Wurn, Lawrence J.

2013-01-01

Background: Adhesion formation is a widely acknowledged risk following abdominal or pelvic surgery. Adhesions in the abdomen or pelvis can cause or contribute to partial or total small bowel obstruction (SBO). These adhesions deter or prevent the passage of nutrients through the digestive tract, and may bind the bowel to the peritoneum, or other organs. Small bowel obstructions can quickly become life-threatening, requiring immediate surgery to resect the bowel, or lyse any adhesions the surgeon can safely access. Bowel repair is an invasive surgery, with risks including bowel rupture, infection, and peritonitis. An additional risk includes the formation of new adhesions during the healing process, creating the potential for subsequent adhesiolysis or SBO surgeries. Objective: Report the use of manual soft tissue physical therapy for the reversal of adhesion-related partial SBOs, and create an initial inquiry into the possibility of nonsurgical lysis of adhesions. Case Reports: Two patients presenting with SBO symptoms due to abdominal adhesions secondary to abdominal and pelvic surgery were treated with manual soft tissue physical therapy focused on decreasing adhesions. Conclusions: Successful treatment with resolution of symptom presentation of partial SBO and sustained results were observed in both patients treated. PMID:26237678

Periodontal cosmetic surgery.

PubMed

Oringer, R J; Iacono, V J

1999-07-01

Periodontal plastic procedures are performed to prevent or correct anatomical, developmental, traumatic, or plaque induced defects of the gingiva, alveolar mucosa, or bone. The majority of these procedures are performed in combination with restorative and/or orthodontic therapy with the primary goal of enhancing aesthetics. In this review some of the more prominent techniques currently available to address mucogingival deficiencies including pedicle grafts, free soft tissue grafts, and combination grafts are illustrated. In addition, potential complications associated with periodontal plastic procedures are discussed.

Periodontal therapy using local delivery of antimicrobial agents.

PubMed

Niederman, Richard; Abdelshehid, George; Goodson, J Max

2002-10-01

Antimicrobial agents, systemic and/or local, are thought by some to be effective agents for treating periodontal infections. Here the authors determine the costs and benefits of local delivery agents for treating periodontal disease. Applying this cost-benefit analysis to patient care, however, will depend upon a clinician's expertise and a patient's value system.

Effects of periodontitis on the development of asthma: The role of photodynamic therapy.

PubMed

Candeo, Larissa Carbonera; Rigonato-Oliveira, Nicole Cristine; Brito, Aurileia Aparecida; Marcos, Rodrigo Labat; França, Cristiane Miranda; Fernandes, Kristianne Porta Santos; Mesquita-Ferrari, Raquel Agnelli; Bussadori, Sandra Kalil; Vieira, Rodolfo Paula; Lino-Dos-Santos-Franco, Adriana; Ligeiro-Oliveira, Ana Paula; Horliana, Anna Carolina Ratto Tempestini

2017-01-01

To evaluate whether periodontitis modulates lung inflammation in an experimental model of asthma as well as the photodynamic therapy (PDT) is associated with a reduction of lung inflammation. Seventy-two BALB/c male mice (~2 months) were randomly divided into 8 groups (n = 9): Basal, Periodontitis (P), P+PT, P+PT+PDT, Asthma (A), A+P, A+P+PT, and A+P+PT+PDT. Periodontitis was induced by using the ligature technique and asthma was induced by ovalbumin (OVA). PT was performed with curettes and PDT with methylene blue (0.005%), λ = 660nm, with a radiant exposure of 318J/cm2. After 43 days, euthanasia was carried out prior to lung and mandible morphological analyzes. All of the manipulations of the animals were performed by only one operator. The total and differential cell counts and cytokines IL-4, IL-5, IL-10, IFN-γ, TNF-α, IL-1β, and IL-6 were evaluated in the bronchoalveolar lavage (BAL) and in the serum. Mucus and alkaline phosphatase were also quantified. Statistical analyzes were performed by a blinded statistician. One-way analysis of variance (ANOVA) was employed, followed by the Student-Newman-Keuls test. Periodontitis group (P) increased alkaline phosphatase and bone resorption (p<0.05), validating the experimental model of periodontitis. The A group and the P group increased the total amount of cells (p <0.05) in the BAL. However, in the A+P group, there was a decrease in these cells, except for in the A+P+PT+PDT group (p<0.05). The asthma group increased the Th2 cytokines and P group increased the Th1 cytokine profile, and A+P+PT+PDT group increased IL-10 cytokine. Mucus was increased for the A and P groups. In conclusion, periodontitis in the asthmatic mice reduced the inflammatory migrated cells in the BAL (eosinophils, lymphocytes, macrophages). In addition, it reduced the levels of the IL-4 and TNF-α cytokines, which was also accompanied by a decreased mucus production. After PDT treatment the total cell count increased however, this increase was

Extracorporeal shock wave therapy in periodontics: A new paradigm.

PubMed

Venkatesh Prabhuji, Munivenkatappa Lakshmaiah; Khaleelahmed, Shaeesta; Vasudevalu, Sujatha; Vinodhini, K

2014-05-01

The quest for exploring new frontiers in the field of medical science for efficient and improved treatment modalities has always been on a rise. Extracorporeal shock wave therapy (ESWT) has been enormously used in medical practice, principally, for the management of urolithiasis, cholelithiasis and also in various orthopedic and musculoskeletal disorders. The efficacy of ESWT in the stimulation of osteoblasts, fibroblasts, induction of neovascularization and increased expression of bone morphogenic proteins has been well documented in the literature. However, dentistry is no exception to this trend. The present article enlightens the various applications of ESWT in the field of dentistry and explores its prospective applications in the field of periodontics, and the possibility of incorporating the beneficial properties of shock waves in improving the treatment outcome.

Compliance and its role in successful treatment of an advanced periodontal case: review of the literature and a case report.

PubMed

Soolari, Ahmad

2002-05-01

Periodontal disease is a chronic disease that is perceived by many patients to be nonthreatening. Periodontal therapy has been shown to be less effective if a regular periodontal maintenance schedule is not followed after completion of active therapy. Periodontal maintenance is an integral part of successful periodontal therapy.

The periodontal abscess: a review.

PubMed

Herrera, D; Roldán, S; Sanz, M

2000-06-01

The periodontal abscess is a frequent periodontal condition in which periodontal tissues may be rapidly destroyed. Its importance is based on the possible need of urgent care, the affectation of tooth prognosis, and the possibility of infection spreading. There is scant information in the scientific literature regarding this condition and most of it has been published as case reports and text books, where conclusions are not evidence-based, but rather empirical observations made by recognised clinicians. The aim of this review was to critically analyse all available information on this subject in the dental and medical literature, including information on its prevalence, proposed etiologies and pathogenesis, diagnosis, microbiology and treatment alternatives. The periodontal abscess is the 3rd most frequent dental emergency, and it is specially prevalent among untreated periodontal patients and periodontal patients during maintenance. Different etiologies have been proposed, and 2 main groups can be distinguished, depending on its relation with periodontal pockets. In the case of a periodontitis-related abscess, the condition may appear as an exacerbation of a non-treated periodontitis or during the course of periodontal therapy. In non-periodontitis related abscesses, impaction of foreign objects, and radicular abnormalities are the 2 main causes. The abscess microflora seems to be similar to that of adult periodontitis, and it is dominated by gram-negative anaerobic rods, including well-known periodontal pathogens. Complications and consequences include tooth loss and the spread of the infection to other body sites. Diagnosis and treatment is mainly based on empiricism, since evidence-based data are not available. The role of systemic antibiotics, in the treatment of periodontal abscesses, is especially controversial.

Periodontitis treatment improves systemic lupus erythematosus response to immunosuppressive therapy.

PubMed

Fabbri, Cristiana; Fuller, Ricardo; Bonfá, Eloisa; Guedes, Lissiane K N; D'Alleva, Paulo Sergio R; Borba, Eduardo F

2014-04-01

Periodontal disease (POD) may affect rheumatic diseases severity, but there are no data regarding the effect of its treatment on disease activity in SLE patients under immunosuppressive therapy. Forty-nine consecutive SLE patients (SLEDAI ≥ 2) with POD and under corticosteroid and cyclophosphamide pulse therapy (IVCYC) were selected. Periodontal assessment included bleeding gingival index (BGI), probing depth (PD), and probing attachment level (PAL). At entry, POD was defined as BGI > 1 and patients were assigned to groups according to the availability of odontological intervention in TREATED (n = 32) and NOT TREATED (n = 17). SLEDAI and POD parameters were determined at entry and after 3 months. Age, female gender, and race were alike among TREATED and NOT TREATED (p > 0.05). Both groups had also comparable disease duration (10.7 ± 6.8 vs. 11.0 ± 6.6, p = 0.83), IVCYC number (5.8 ± 4.8 vs. 4.5 ± 4.8, p = 0.17), and SLEDAI (5.9 ± 4.2 vs. 6.3 ± 4.3, p = 0.73) as well as POD parameters [BGI (40.8 ± 31.0 vs. 40.7 ± 36.2 %, p = 0.89), PD (1.7 ± 1.8 vs. 1.5 ± 0.60 mm, p = 0.80), and PAL (2.5 ± 1.9 vs. 1.9 ± 1.1 mm, p = 0.18)]. At the end of the study, TREATED group had a significant improvement in SLEDAI (5.9 ± 4.2 vs. 3.4 ± 3.3, p = 0.04) with a paralleled reduction in BGI (40.8 ± 31.0 vs. 15.2 ± 17.2 %, p < 0.01), PD (1.7 ± 1.8 vs. 1.1 ± 0.3 mm, p < 0.01), and PAL (2.5 ± 1.9 vs. 1.7 ± 0.9 mm, p < 0.01). In contrast, SLEDAI (6.3 ± 4.3 vs. 6.0 ± 5.5, p = 0.40) and POD parameters [BGI (p = 0.33), PD (p = 0.91), and PAL (p = 0.39)] remained largely unchanged in NOT TREATED group. Periodontal disease treatment seems to have a beneficial effect in controlling disease activity in SLE patients under immunosuppressive therapy. Therefore, management of this modifiable risk factor is

Regeneration of periodontal tissues using allogeneic periodontal ligament stem cells in an ovine model.

PubMed

Mrozik, Krzysztof Marek; Wada, Naohisa; Marino, Victor; Richter, Ward; Shi, Songtao; Wheeler, Donna L; Gronthos, Stan; Bartold, P Mark

2013-11-01

To investigate the capacity of allogeneic periodontal ligament stem cells (PDLSCs) to regenerate periodontal tissues using an ovine periodontal defect model. Surgically created zero-wall dehiscence periodontal defects created in Merino sheep were filled with 1 × 10(7) allogeneic PDLSCs attached to Gelfoam(®), Gelfoam alone or left untreated. After 4 weeks, histological analysis was performed to assess periodontal regeneration. Allogeneic PDLSCs were well tolerated by recipient animals. The mean area of new alveolar bone was significantly greater in the PDLSC + Gelfoam treatment group compared with the defect-alone group. The PDLSC + Gelfoam and Gelfoam-only treatment groups displayed significantly greater length of new cementum and percentage of cementum regrowth compared with the defect-alone group. New Sharpey's fibers were generally more organized and significantly thicker within the PDLSC + Gelfoam treatment group. The PDLSC + Gelfoam treatment group also showed a trend of increased Sharpey's fiber attachment length compared with the Gelfoam-only and defect-alone groups. These studies support the potential use of allogeneic PDLSC preparations as viable therapies for periodontal regeneration in the clinical setting.

Endo-periodontal lesion--endodontic approach.

PubMed

Jivoinovici, R; Suciu, I; Dimitriu, B; Perlea, P; Bartok, R; Malita, M; Ionescu, C

2014-01-01

Endo-perio lesions might be interdependent because of the vascular and anatomic connections between the pulp and the periodontium. The aim of this study is to emphasise that primary endodontic lesion heals after a proper instrumentation, disinfection and sealing of the endodontic space. The primary endodontic lesion with a secondary periodontal involvement first requires an endodontic therapy and, in the second stage, a periodontal therapy. The prognosis is good, with an adequate root canal treatment; it depends on the severity of the periodontal disease, appropriate healing time and the response to the treatment. A correct diagnosis is sometimes difficult; an accurate identification of the etiologic factors is important for an adequate treatment. Primary perio-endo lesion may heal after a proper disinfection and sealing of the endodontic system, the one-year follow-up radiograph showing bonny repair. Invasive periodontal procedures should be avoided at that moment. The microorganisms and by-products from the infected root canal may cross accessory and furcal canals and determine sinus tract and loss of attachment. In both clinical cases presented in this article, successful healing was obtained after a proper disinfection and sealing of the endodontic system.

Progress in surgical and nonsurgical approaches for hepatocellular carcinoma treatment.

PubMed

Yegin, Ender Gunes; Oymaci, Erkan; Karatay, Emrah; Coker, Ahmet

2016-06-01

Hepatocellular carcinoma (HCC) is a complex and heterogeneous malignancy, frequently occurs in the setting of a chronically diseased organ, with multiple confounding factors making its management challenging. HCC represents one of the leading causes of cancer-related mortality globally with a rising trend of incidence in some of the developed countries, which indicates the need for better surgical and nonsurgical management strategies. PubMed database was searched for relevant articles in English on the issue of HCC management. Surgical resection represents a potentially curative option for appropriate candidates with tumors detected at earlier stages and with well-preserved liver function. The long-term outcome of surgery is impaired by a high rate of recurrence. Surgical approaches are being challenged by local ablative therapies such as radiofrequency ablation and microwave ablation in selected patients. Liver transplantation offers potential cure for HCC and also correction of underlying liver disease, and minimizes the risk of recurrence, but is reserved for patients within a set of criteria proposed for a prudent allocation in the shortage of donor organs. Transcatheter locoregional therapies have become the palliative standard allowing local control for intermediate stage patients with noninvasive multinodular or large HCC who are beyond the potentially curative options. The significant survival benefit with the multikinase inhibitor sorafenib for advanced HCC has shifted the direction of research regarding systemic treatment toward molecular therapies targeting the disregulated pathways of hepatocarcinogenesis. Potential benefit is suggested from simultaneous or sequential multimodal therapies, and optimal combinations are being investigated. Despite the striking progress in preclinical studies of HCC immunotherapy and gene therapy, extensive clinical trials are required to achieve successful clinical applications of these innovative approaches. Treatment

Treatment of periodontal intrabony defects using autologous periodontal ligament stem cells: a randomized clinical trial.

PubMed

Chen, Fa-Ming; Gao, Li-Na; Tian, Bei-Min; Zhang, Xi-Yu; Zhang, Yong-Jie; Dong, Guang-Ying; Lu, Hong; Chu, Qing; Xu, Jie; Yu, Yang; Wu, Rui-Xin; Yin, Yuan; Shi, Songtao; Jin, Yan

2016-02-19

Periodontitis, which progressively destroys tooth-supporting structures, is one of the most widespread infectious diseases and the leading cause of tooth loss in adults. Evidence from preclinical trials and small-scale pilot clinical studies indicates that stem cells derived from periodontal ligament tissues are a promising therapy for the regeneration of lost/damaged periodontal tissue. This study assessed the safety and feasibility of using autologous periodontal ligament stem cells (PDLSCs) as an adjuvant to grafting materials in guided tissue regeneration (GTR) to treat periodontal intrabony defects. Our data provide primary clinical evidence for the efficacy of cell transplantation in regenerative dentistry. We conducted a single-center, randomized trial that used autologous PDLSCs in combination with bovine-derived bone mineral materials to treat periodontal intrabony defects. Enrolled patients were randomly assigned to either the Cell group (treatment with GTR and PDLSC sheets in combination with Bio-oss(®)) or the Control group (treatment with GTR and Bio-oss(®) without stem cells). During a 12-month follow-up study, we evaluated the frequency and extent of adverse events. For the assessment of treatment efficacy, the primary outcome was based on the magnitude of alveolar bone regeneration following the surgical procedure. A total of 30 periodontitis patients aged 18 to 65 years (48 testing teeth with periodontal intrabony defects) who satisfied our inclusion and exclusion criteria were enrolled in the study and randomly assigned to the Cell group or the Control group. A total of 21 teeth were treated in the Control group and 20 teeth were treated in the Cell group. All patients received surgery and a clinical evaluation. No clinical safety problems that could be attributed to the investigational PDLSCs were identified. Each group showed a significant increase in the alveolar bone height (decrease in the bone-defect depth) over time (p < 0.001). However

The effects of IL-10 gene polymorphism on serum, and gingival crevicular fluid levels of IL-6 and IL-10 in chronic periodontitis.

PubMed

Toker, Hulya; Gorgun, Emine Pirim; Korkmaz, Ertan Mahir; Yüce, Hatice Balci; Poyraz, Omer

2018-01-01

Anti-inflammatory cytokines play a crucial role in periodontitis by inhibiting synthesis of pro-inflammatory cytokines. The purpose of this study was to evaluate the effect of interleukin-10 (-597) gene polymorphism and genotype distributions on chronic periodontitis (CP) development and IL-6 and IL-10 levels in gingival crevicular fluid (GCF) and serum before and after non-surgical periodontal treatment. The study population consisted of 55 severe generalized CP patients as CP group and 50 healthy individuals as control group. Plaque index, gingival index, probing depth and clinical attachment level were recorded and GCF and blood samples were taken at both the baseline and the sixth week after non-surgical periodontal treatment. PCR-RFLP procedure was used for gene analyses and cytokine levels were measured via ELISA. IL-10 genotype distribution was significantly different between CP and control groups (p=0.000, OR:7, 95%CI, 2.83-60.25). Clinical measurements significantly improved in the CP group after periodontal treatment (p<0.05). Periodontal treatment significantly decreased GCF IL-6 and IL-10 levels. No significant difference was found in clinical parameters between IL-10 AA and AC+CC genotypes at both the baseline and the sixth week (p>0.05). Sixth week GCF IL-10 levels were significantly lower in patients carrying IL-10 AC+CC genotype compared to the patients carrying IL-10 AA genotype (p<0.05). Serum IL-6 and IL-10 levels were lower in patients carrying the IL-10 AA genotype compared to patients with IL-10 AC+CC genotype, but the difference was not significant (p>0.05). IL-10 AA genotype carriers had lower IL-6 and IL-6/10 levels in serum; however, GCF IL-6/10 levels were similar in both genotypes. Within the limitations of our study, a possible association between IL-10(-597) gene polymorphism and CP might be considered.

Antimicrobial photodynamic therapy minimizes the deleterious effect of nicotine in female rats with induced periodontitis.

PubMed

Gualberto, Erivan Clementino; Theodoro, Letícia Helena; Longo, Mariellén; Novaes, Vivian Cristina Noronha; Nagata, Maria José Hitomi; Ervolino, Edilson; Garcia, Valdir Gouveia

2016-01-01

The aim of this study was to compare the use of antimicrobial photodynamic therapy (aPDT) as an adjunct to scaling and root planing (SRP) in the treatment of experimentally induced periodontitis in female rats that were systemically treated with or without nicotine. Female rats (n = 180) were divided into two groups: vehicle administration (Veh) and nicotine administration (Nic). Mini-pumps containing either vehicle or nicotine were implanted in the rats 30 days before the induction of experimental periodontitis (EP). EP was induced by placing a cotton ligature around the left mandibular first molar. After 7 days, the ligature was removed, and the rats were randomly divided into three treatment subgroups: SRP (only SRP), DL (SRP plus diode laser), and aPDT (SRP plus aPDT). The aPDT consisted of phenothiazine photosensitizer deposition followed by diode laser irradiation. Ten rats from each subgroup were euthanized at 7, 15, and 30 days after treatment. Alveolar bone loss (ABL) in the furcation region was evaluated using histological, histometric, and immunohistochemical analyses. The rats that were treated with nicotine showed more ABL compared to those treated with vehicle. In both the Veh and Nic groups, SRP plus aPDT treatment resulted in reduced ABL, smaller numbers of both TRAP- and RANKL-positive cells, and higher numbers of PCNA-positive cells compared to SRP treatment alone. aPDT was an effective adjunctive therapy for the treatment of periodontitis in female rats regardless of whether they received nicotine.

Differentiated embryonic chondrocytes 1 expression of periodontal ligament tissue and gingival tissue in the patients with chronic periodontitis.

PubMed

Hu, Shenlin; Shang, Wei; Yue, Haitao; Chen, Ruini; Dong, Zheng; Hu, Jinhua; Mao, Zhao; Yang, Jian

2015-04-01

To evaluate the DEC1 expression of periodontal ligament tissue and gingival tissue in the patients with chronic periodontitis. 20 non-smoking patients with chronic periodontitis and 20 healthy individuals were enrolled. Periodontal ligament tissue and gingival tissue samples from healthy subjects were collected during teeth extraction for orthodontic reason or the third molar extraction. The parallel samples from patients with chronic periodontitis were obtained during periodontal flap operations or teeth extraction as part of periodontal treatment. The DEC1 expression and the alkaline phosphatase (ALP) activity of both the periodontal ligament tissue and gingival tissue were determined by Western blot, Immunohistochemistry and ALP Detection Kit. The DEC1 expression of periodontal ligament tissue in the patients with chronic periodontitis decreased significantly along with the decreased ALP activity. On the contrary, the DEC1 expression of gingival tissue in the patients with chronic periodontitis increased significantly. Further study found that the DEC1 expression of gingival tissue increased mainly in the suprabasal layer of gingival epithelial cells but decreased in the gingival connective tissue of the patients with chronic periodontitis. The DEC1 expression decreases in the periodontal ligament tissue which is related to the osteogenic capacity, whereas the DEC1 expression increases in the suprabasal layer of gingival epithelial cells which are involved in immune inflammatory response in the patients with chronic periodontitis. The findings provide a new target to explore the pathology and the therapy of periodontitis. Copyright © 2014 Elsevier Ltd. All rights reserved.

Periodontal healing by periodontal ligament cell sheets in a teeth replantation model.

PubMed

Zhou, Yefang; Li, Yusheng; Mao, Ling; Peng, Hao

2012-02-01

Successful transplantation of avulsed teeth is to restore the attachment and regenerate the periodontal support. Different strategies have been applied in treatment from modification of teeth storage, antibiotic usage to peridontium tissue replacement. We developed a novel periodontal ligament cell-sheet delivery system to apply on delayed replanted teeth in promoting periodontal healing in a canine model. Autologous periodontal ligament (PDL) fibroblasts were isolated from extracted premolars of beagle dog. The cell-sheets were fabricated using normal culture dish after stimulation of extracellular matrix formation. Teeth were surgically extracted and attached soft tissues were removed. After root canal treatment, the root of teeth were wrapped by the PDL cell-sheets and replanted back to prior socket accordingly whilst teeth without cell sheets as a control. Eight weeks after surgery, the animals were sacrificed and decalcified specimens were prepared. Regeneration of periodontal tissue was evaluated through histology assay. Multi-layered PDL cell-sheet could be attached on tooth root and most cells on sheet-tooth constructs were viable before replantation. Minimum clinical signs of inflammation were observed in experiment. PDL cell-sheets group show significant higher occurrence of favourable healing (88.4%) than control group with low healing (5.3%). Periodontal ligament and cememtum tissue regeneration was observed in the experimental group, and the regenerated tissues showed high collagen type III, type I and fibronectin expression. The periodontal ligament cell-sheets fabricated through normal cell culture dish has a potential for regeneration of periodontal ligament and may become a novel therapy for avulsed teeth replantation. Copyright © 2011 Elsevier Ltd. All rights reserved.

Extracorporeal shock wave therapy in periodontics: A new paradigm

PubMed Central

Venkatesh Prabhuji, Munivenkatappa Lakshmaiah; Khaleelahmed, Shaeesta; Vasudevalu, Sujatha; Vinodhini, K.

2014-01-01

The quest for exploring new frontiers in the field of medical science for efficient and improved treatment modalities has always been on a rise. Extracorporeal shock wave therapy (ESWT) has been enormously used in medical practice, principally, for the management of urolithiasis, cholelithiasis and also in various orthopedic and musculoskeletal disorders. The efficacy of ESWT in the stimulation of osteoblasts, fibroblasts, induction of neovascularization and increased expression of bone morphogenic proteins has been well documented in the literature. However, dentistry is no exception to this trend. The present article enlightens the various applications of ESWT in the field of dentistry and explores its prospective applications in the field of periodontics, and the possibility of incorporating the beneficial properties of shock waves in improving the treatment outcome. PMID:25024562

Periodontal treatment with an Er:YAG laser compared to ultrasonic instrumentation: a pilot study.

PubMed

Sculean, Anton; Schwarz, Frank; Berakdar, Mohammad; Romanos, George E; Arweiler, Nicole B; Becker, Jürgen

2004-07-01

The aim of the present study was to compare the effectiveness of an Er:YAG laser to that of ultrasonic scaling for non-surgical periodontal treatment. Twenty patients with moderate to advanced periodontal disease were randomly treated in a split-mouth design with a single episode of subgingival debridement using either an Er:YAG laser device (160 mJ/pulse, 10 Hz) combined with a calculus detection system with fluorescence induced by 655 nm InGaAsP diode laser radiation (ERL), or an ultrasonic instrument (UI). Clinical assessments of full-mouth plaque score (FMPS), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL) were made at baseline and at 3 and 6 months following therapy. No differences in any of the investigated parameters were observed at baseline between the two groups. The mean value of BOP decreased in the ERL group from 40% at baseline to 17% after 6 months (P<0.0001) and in the UI group from 46% at baseline to 15% after 6 months (P<0.0001). The sites treated with ERL demonstrated mean CAL gain of 1.48 +/- 0.73 mm (P<0.001) and of 1.11 +/- 0.59 mm (P<0.001) at 3 and 6 months, respectively. The sites treated with UI demonstrated mean CAL gain of 1.53 +/- 0.67 mm (P<0.001) and of 1.11 +/- 0.46 mm (P<0.001) at 3 and 6 months, respectively. No statistically significant differences were observed between the groups (P>0.05). Within the limits of the present study, it can be concluded that both therapies led to significant improvements of the investigated clinical parameters.

Periodontal management of patients with cardiovascular diseases. American Academy of Periodontology.

PubMed

1996-06-01

Periodontists are often called upon to provide periodontal therapy for patients with a variety of cardiovascular diseases. Safe and effective periodontal treatment requires a general understanding of the underlying cardiovascular diseases, their medical management, and necessary modifications to dental/periodontal therapy that may be required. In this informational paper more common cardiovascular disorders will be discussed and dental management considerations briefly described. This paper is intended for the use of periodontists and members of the dental profession.

An update on periodontic-orthodontic interrelationships

PubMed Central

Dannan, Aous

2010-01-01

Talking about periodontic-orthodontic interrelationships is related primarily to the 1960s, where a generalized increase in salivary bacterial counts, especially Lactobacillus, had been shown after orthodontic band placement. The purpose of this article is to provide the dental practitioner with basic understanding of the interrelationship between periodontics and orthodontics by means of representing classical studies, and, to give an update on this topic by demonstrating the most recent opinions concerning periodontic-orthodontic interrelationships. Specific areas reviewed are the ability of orthodontic treatment to afford some degree of protection against periodontal breakdown, short-term and long-term effects of orthodontic treatment on the periodontium, and some mucogingival considerations. Topics considering orthodontic treatment in periodontally compromised patients were not included in this review. While past studies have shown that orthodontic treatment can positively affect the periodontal health, recent reviews indicate an absence of reliable evidence for the positive effects of orthodontic therapy on patients’ periodontal status. Periodontic-orthodontic interrelationships are still controversial issues. However, a standard language between the periodontist and the orthodontist must always be established to eliminate the existing communications barrier, and to improve the outcomes of the whole treatment. PMID:20922083

An update on periodontic-orthodontic interrelationships.

PubMed

Dannan, Aous

2010-01-01

Talking about periodontic-orthodontic interrelationships is related primarily to the 1960s, where a generalized increase in salivary bacterial counts, especially Lactobacillus, had been shown after orthodontic band placement. The purpose of this article is to provide the dental practitioner with basic understanding of the interrelationship between periodontics and orthodontics by means of representing classical studies, and, to give an update on this topic by demonstrating the most recent opinions concerning periodontic-orthodontic interrelationships. Specific areas reviewed are the ability of orthodontic treatment to afford some degree of protection against periodontal breakdown, short-term and long-term effects of orthodontic treatment on the periodontium, and some mucogingival considerations. Topics considering orthodontic treatment in periodontally compromised patients were not included in this review. While past studies have shown that orthodontic treatment can positively affect the periodontal health, recent reviews indicate an absence of reliable evidence for the positive effects of orthodontic therapy on patients' periodontal status. Periodontic-orthodontic interrelationships are still controversial issues. However, a standard language between the periodontist and the orthodontist must always be established to eliminate the existing communications barrier, and to improve the outcomes of the whole treatment.

Oxidative Stress and Antioxidant System in Periodontitis

PubMed Central

Wang, Yue; Andrukhov, Oleh; Rausch-Fan, Xiaohui

2017-01-01

Periodontitis is a common inflammatory disease, which is initiated by bacterial infection and subsequently progressed by aberrant host response. It can result in the destruction of teeth supporting tissues and have an influence on systemic health. When periodontitis occurs, reactive oxygen species, which are overproduced mostly by hyperactive neutrophils, could not be balanced by antioxidant defense system and cause tissues damage. This is characterized by increased metabolites of lipid peroxidation, DNA damage and protein damage. Local and systemic activities of antioxidants can also be influenced by periodontitis. Total antioxidant capacity, total oxidant status and oxidative stress index have been used to evaluate the oxidative stress associated with periodontitis. Studies have confirmed that inflammatory response in periodontitis is associated with an increased local and systemic oxidative stress and compromised antioxidant capacity. Our review focuses on increased oxidative stress in periodontal disease, specifically, on the relationship between the local and systemic biomarkers of oxidative stress and periodontitis and their association with the pathogenesis of periodontitis. Also, the relationship between periodontitis and systemic inflammation, and the effects of periodontal therapy on oxidative stress parameters will be discussed. PMID:29180965

Review paper: DNA delivery strategies to promote periodontal regeneration.

PubMed

Elangovan, Satheesh; Karimbux, Nadeem

2010-07-01

Periodontal diseases are caused by bacteria with an inflammatory component that result in the loss of bone and soft tissue around the neck of the teeth. Recent therapies allow clinicians to regenerate some of the lost structures of the periodontium. Regeneration of these lost supporting structures is a highly orchestrated process, involving various cellular and molecular players, leading to the complete restoration of the periodontium (the tooth-supporting apparatus). The introduction of growth factors has positively influenced the clinical outcome of the existing regenerative procedures but the supra-physiological doses and the high cost associated with these growth factors can be drawbacks. Gene therapy may offer some interesting advantages to current therapies. In the field of periodontology, several studies have been conducted to explore the efficacy of delivering the DNA of key growth factors using viral vectors in both periodontal and peri-implant bone regeneration. Relatively few studies have explored the application of nonviral gene therapy in periodontal regeneration. This article is aimed at reviewing the studies conducted so far using viral and nonviral gene delivery approaches to achieve periodontal and peri-implant bone regeneration.

Effects of periodontitis on the development of asthma: The role of photodynamic therapy

PubMed Central

Marcos, Rodrigo Labat; França, Cristiane Miranda; Vieira, Rodolfo Paula

2017-01-01

To evaluate whether periodontitis modulates lung inflammation in an experimental model of asthma as well as the photodynamic therapy (PDT) is associated with a reduction of lung inflammation. Seventy-two BALB/c male mice (~2 months) were randomly divided into 8 groups (n = 9): Basal, Periodontitis (P), P+PT, P+PT+PDT, Asthma (A), A+P, A+P+PT, and A+P+PT+PDT. Periodontitis was induced by using the ligature technique and asthma was induced by ovalbumin (OVA). PT was performed with curettes and PDT with methylene blue (0.005%), λ = 660nm, with a radiant exposure of 318J/cm2. After 43 days, euthanasia was carried out prior to lung and mandible morphological analyzes. All of the manipulations of the animals were performed by only one operator. The total and differential cell counts and cytokines IL-4, IL-5, IL-10, IFN-γ, TNF-α, IL-1β, and IL-6 were evaluated in the bronchoalveolar lavage (BAL) and in the serum. Mucus and alkaline phosphatase were also quantified. Statistical analyzes were performed by a blinded statistician. One-way analysis of variance (ANOVA) was employed, followed by the Student-Newman-Keuls test. Periodontitis group (P) increased alkaline phosphatase and bone resorption (p<0.05), validating the experimental model of periodontitis. The A group and the P group increased the total amount of cells (p <0.05) in the BAL. However, in the A+P group, there was a decrease in these cells, except for in the A+P+PT+PDT group (p<0.05). The asthma group increased the Th2 cytokines and P group increased the Th1 cytokine profile, and A+P+PT+PDT group increased IL-10 cytokine. Mucus was increased for the A and P groups. In conclusion, periodontitis in the asthmatic mice reduced the inflammatory migrated cells in the BAL (eosinophils, lymphocytes, macrophages). In addition, it reduced the levels of the IL-4 and TNF-α cytokines, which was also accompanied by a decreased mucus production. After PDT treatment the total cell count increased however, this increase was

Efficacy of local drug delivery of Achyranthes aspera gel in the management of chronic periodontitis: A clinical study.

PubMed

Boyapati, Ramanarayana; Gojja, Prathibha; Chintalapani, Srikanth; Nagubandi, Kirankumar; Ramisetti, Arpita; Salavadhi, Shyam Sunder

2017-01-01

Periodontitis is an inflammatory disease of microbial origin. Locally delivered antimicrobials reduce subgingival flora. Achyranthes aspera gel has antimicrobial, antioxidant, anti-inflammatory, and immunostimulant effects. To evaluate the efficacy of local drug delivery of A. aspera gel in the management of chronic periodontitis. Thirty patients with chronic periodontitis were considered in the study and categorized into two equal groups (Group A: scaling and root planing (SRP) with A. aspera gel, Group B: SRP with placebo gel). Patients were enlisted from the Department of Periodontics, Mamata Dental College and Hospital. The clinical parameters (gingival index, bleeding on probing, probing pocket depth, and clinical attachment level) were recorded at baseline and 3 months. All the obtained data were sent for statistical analyses using SPSS version 18. The periodontitis and the Achyranthes were statistically analyzed. A comparison of clinical parameters for test group and control group from baseline to 3 months was done using paired t -test. Intergroup comparison for both the groups was done using independent sample t -test. A. aspera gel when delivered locally along with SRP showed a beneficial effect. A. aspera gel as a non-surgical local drug delivery system proved to be without any side effects in the management of periodontitis. A. aspera gel has strong anti-inflammatory effects in addition to its antioxidant activity.

Efficacy of local drug delivery of Achyranthes aspera gel in the management of chronic periodontitis: A clinical study

PubMed Central

Boyapati, Ramanarayana; Gojja, Prathibha; Chintalapani, Srikanth; Nagubandi, Kirankumar; Ramisetti, Arpita; Salavadhi, Shyam Sunder

2017-01-01

Context: Periodontitis is an inflammatory disease of microbial origin. Locally delivered antimicrobials reduce subgingival flora. Achyranthes aspera gel has antimicrobial, antioxidant, anti-inflammatory, and immunostimulant effects. Aims: To evaluate the efficacy of local drug delivery of A. aspera gel in the management of chronic periodontitis. Materials and Methods: Thirty patients with chronic periodontitis were considered in the study and categorized into two equal groups (Group A: scaling and root planing (SRP) with A. aspera gel, Group B: SRP with placebo gel). Patients were enlisted from the Department of Periodontics, Mamata Dental College and Hospital. The clinical parameters (gingival index, bleeding on probing, probing pocket depth, and clinical attachment level) were recorded at baseline and 3 months. Statistical Analysis Used: All the obtained data were sent for statistical analyses using SPSS version 18. Results: The periodontitis and the Achyranthes were statistically analyzed. A comparison of clinical parameters for test group and control group from baseline to 3 months was done using paired t-test. Intergroup comparison for both the groups was done using independent sample t-test. Conclusions: A. aspera gel when delivered locally along with SRP showed a beneficial effect. A. aspera gel as a non-surgical local drug delivery system proved to be without any side effects in the management of periodontitis. A. aspera gel has strong anti-inflammatory effects in addition to its antioxidant activity. PMID:29386800

Diabetes and periodontal diseases.

PubMed

1996-02-01

This position paper on diabetes mellitus was prepared by the Research, Science and Therapy Committee of The American Academy of Periodontology. It is intended to: 1) update members of the dental profession on the diagnosis and medical management of patients with diabetes mellitus; 2) summarize current knowledge on the relation between diabetes mellitus and periodontal diseases; 3) provide an overview of factors in diabetic patients relevant to understanding the pathogenesis of periodontal diseases in these subjects; 4) outline special considerations associated with treatment of periodontal diseases in diabetic patients; and 5) discuss possible approaches to the management of diabetic emergencies in the dental office. Reliance on this position paper in patient management will not guarantee a successful outcome. Periodontal diseases often involve numerous and complex causes and symptoms. Ultimately, decisions regarding the diagnosis and treatment of disease in an individual patient must be made by the treating practitioner in light of the specific facts presented by that patient.

Effects of periodontal treatment on lung function and exacerbation frequency in patients with chronic obstructive pulmonary disease and chronic periodontitis: a 2-year pilot randomized controlled trial.

PubMed

Zhou, Xuan; Han, Jing; Liu, Zhiqiang; Song, Yiqing; Wang, Zuomin; Sun, Zheng

2014-06-01

To evaluate the direct effects of periodontal therapy in Chronic Obstructive Pulmonary Disease (COPD) patients with chronic periodontitis (CP). In a pilot randomized controlled trial, 60 COPD patients with CP were randomly assigned to receive scaling and root planing (SRP) treatment, supragingival scaling treatment, or oral hygiene instructions only with no periodontal treatment. We evaluated their periodontal indexes, respiratory function, and COPD exacerbations at baseline, 6 months, 1, and 2 years. Compared with the control group, measurements of periodontal indexes were significantly improved in patients in two treatment groups at 6-month, 1-year, and 2-year follow-up (all p < 0.05). Overall, the means of forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) and FEV1 were significantly higher in the two therapy groups compared with the control group during the follow-up (p < 0.05). In addition, the frequencies of COPD exacerbation were significantly lower in the two therapy groups than in the control group at 2-year follow-up (p < 0.05). Our preliminary results from this pilot trial suggest that periodontal therapy in COPD patients with CP may improve lung function and decrease the frequency of COPD exacerbation. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Periodontal Therapy in Dogs Using Bone Augmentation Products Marketed for Veterinary Use.

PubMed

Angel, Molly

Periodontal disease is extremely common in companion animal practice. Patients presenting for a routine oral examination and prophylaxis may be found to have extensive periodontal disease and attachment loss. Vertical bone loss is a known sequela to periodontal disease and commonly involves the distal root of the mandibular first molar. This case report outlines two dogs presenting for oral examination and prophylaxis with general anesthesia. Both patients did not have any clinical symptoms of periodontal disease other than halitosis. Both patients were diagnosed with three-walled vertical bone loss defects of one or both mandibular first molars utilizing dental radiography as well as periodontal probing, measuring, and direct visual inspection. These defects were consistent with periodontal disease index stage 4 (>50% attachment loss). The lesions were treated with appropriate root planing and debridement. Bone augmentation products readily available and marketed for veterinary use were then utilized to fill the defects to promote both the re-establishment of normal alveolar bone height and periodontal ligament reattachment to the treated surface. Follow-up assessment and owner dedication is critical to treatment outcome. Both patients' 6 mo follow-up examinations radiographically indicated bone repair and replacement with visible periodontal ligament space.

Longitudinal Improvement in Periodontal Parameters between RPD Abutment Teeth with Direct and Indirect Retainers, after Periodontal Therapy.

PubMed

Almeida, Mariana Linhares; Tôrres, Ana Clara Soares de Paiva; de Oliveira, Kleiton Clécio; Calderon, Patrícia Dos Santos; Carreiro, Adriana da Fonte Porto; Gurgel, Bruno César de Vasconcelos

2018-03-06

To evaluate the effect of basic periodontal treatment on clinical periodontal parameters associated with abutment teeth of patients with mandibular Kennedy class I removable partial dentures (RPD) 18 months after treatment. Thirty patients with periodontal disease were treated and evaluated according to the following periodontal parameters: visible plaque index (VPI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), clinical attachment loss (CAL), and keratinized mucosa (KM). These parameters were compared between abutment teeth with direct and indirect retainers at baseline, and after 6 and 18 months. Data were analyzed by Friedman Test and Wilcoxon Test for all variables. Most patients (n = 26; 86.7%) included in the study were female and had a mean age of 61 years (±7.54). Results showed that VPI and BOP decreased over time, and that VPI values were higher in abutment teeth with direct retainers (p = 0.001). There was a reduction in PD after 6 months, which was maintained up to 18 months. In general, abutment teeth with direct retainers had significantly higher values for PD, GR, and CAL (p = 0.029). Data also indicated that the parameters for VPI, BOP, and PD improved; however, abutment teeth with direct retainers presented smaller improvements, compared with abutment teeth with indirect retainers, which presented significant improvements for almost all variables. Periodontal treatment and oral hygiene care of patients were adequate for maintenance of adequate periodontal conditions, regardless of the use of prostheses. © 2018 by the American College of Prosthodontists.