Toward Personalized Oral Diagnosis: Distinct Microbiome Clusters in Periodontitis Biofilms

Periodontitis is caused by pathogenic subgingival microbial biofilm development and dysbiotic interactions between host and hosted microbes. A thorough characterization of the subgingival biofilms by deep amplicon sequencing of 121 individual periodontitis pockets of nine patients and whole metagenomic analysis of the saliva microbial community of the same subjects were carried out. Two biofilm sampling methods yielded similar microbial compositions. Taxonomic mapping of all biofilms revealed three distinct microbial clusters. Two clinical diagnostic parameters, probing pocket depth (PPD) and clinical attachment level (CAL), correlated with the cluster mapping. The dysbiotic microbiomes were less diverse than the apparently healthy ones of the same subjects. The most abundant periodontal pathogens were also present in the saliva, although in different representations. The single abundant species Tannerella forsythia was found in the diseased pockets in about 16–17-fold in excess relative to the clinically healthy sulcus, making it suitable as an indicator of periodontitis biofilms. The discrete microbial communities indicate strong selection by the host immune system and allow the design of targeted antibiotic treatment selective against the main periodontal pathogen(s) in the individual patients.

Clinical parameters in soft tissue adjunctive periodontal procedures for orthodontic patients: surgical laser vs scalpel -: A systematic review

ABSTRACT Objectives To systematically review existing literature regarding clinical parameters comparing surgical laser and conventional surgery with scalpel for soft tissue adjunctive periodontal procedures in orthodontic patients. Methods and Materials MEDLINE, Scopus, Web of Science, The Cochrane Library, LILACS, Bibliografia Brasileira de Odontologia (Brazilian Dental Literature - BBO), Embase, Open Grey, Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Coordination for the Improvement of Higher Education Personnel - CAPES), and Google Scholar were searched up to December 2020 without language restriction. Clinical trials comparing clinical parameters from surgical laser and conventional surgery with scalpel for soft tissue adjunctive periodontal procedures in orthodontic patients were selected. Risk of bias (RoB) assessments were performed using the Cochrane RoB2 tool. Narrative syntheses were performed, and the certainty of evidence was determined using the GRADE tool. Results Five randomized clinical trials were included. One study was rated as low RoB, whereas others presented some concerns or high RoB. The studies were highly heterogeneous in relation to the procedure performed, laser protocol, outcomes evaluated, and follow-up periods. In general, regardless of the procedure and laser protocol used, the studies did not show significant differences between laser and scalpel for the outcomes of probing pocket depth, clinical crown length, gingival index, and relapse rate. Pain and bleeding were significantly lower with the use of laser compared with the scalpel. The certainty of evidence ranged from moderate to very low. Conclusions The existing literature on the subject is scarce and very heterogeneous and has methodological limitations. Based on the available evidence, it is not possible to draw definitive conclusions about the beneficial effect of laser use in orthodontic patients.

A Comparative Evaluation between the Efficacy of Scaling & Root Planing (SRP) with Local Delivery of Chlorhexidine Gluconate and SRP Alone in Periodontal Pocket Reduction Therapy

Aim: The aim of the present study was to compare the efficacy of locally delivered chlorhexidine as an adjunct to scaling and root planning (SRP) & SRP alone in bringing reduction of pocket depth in the treatment of moderate to severe periodontitis patients. Materials and Methods: A total number of 15 patients both males and females in the age group of 30-55 years were selected with total number of 30 sites with periodontal probing pocket depth measuring 5-8mm in different quadrant of the mouth. A randomized, double blind, controlled clinical trial design was followed for the study. On one side scaling and root planning was done and on the other side scaling and root planning was done along with local delivery of chlorhexidine glugocate then the patient was examined after 0, 45, and 60 days using The clinical parameters the Plaque Index (PI), gingival index (GI), Bleeding on probing (BOP), Clinical attachment level (CAL) and Probing pocket depth (PPD). Statistical Analysis: Student paired T-test has been carried out for this present study. Results: The mean reduction of Plaque Index score between 0-45 day between control site and test site was 1.58±0.11 and the mean reduction of Plaque Index score between 0-60 day between control site and test site was 2.42±0.34 which is found not significant. At the Control site the mean plaque index score on 0 day was 2.2, on 45th day was 1.88 and on 60th day was 1.82. At the test site the mean plaque index score on 0 day was 2.6, on 45th day was 1.82 and on 60thday was 1.59. There was change from the base line values of mean plaque index between the control sites and test sites but was not significant. Conclusion: There was improvement in all the clinical parameters of the test sites in comparison to the control sites from base line to 60 days, but the adjunctive use of chlorhexidine showed a significant improvement only on the clinical attachment level.

COMPARATIVE EVALUATION OF EFFICACY OF SCALING AND ROOT PLANING WITH AND WITHOUT CHLORHEXIDINE CHIP AND DIODE LASER IN CHRONIC PERIODONTITIS PATIENTS

Introduction: The motive of the present study is to comparatively measure the competence and effectiveness of diode laser and chlorhexidine chip as adjuncts to the scaling and root planing procedure, in patients with chronic periodontitis. Aim: To evaluate the efficacy of diode laser and chlorhexidine chip before and after scaling and root planing in the management of chronic periodontitis. The objective is to compare the efficacy of chlorhexidine chip and diode laser before and after scaling and root planning on clinical parameters. Study and design: Randomized clinical trial with split mouth design done in the Department of Periodontics and Implantology. Materials and methods: Twenty chronic periodontitis patients having a probing pocket depth of 5mm-7mm on at least one interproximal site in each quadrant of the mouth were selected 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). All subjects received a clinical periodontal examination by single examiner who recorded all the variables by manual procedure. Clinical parameters namely 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 one-way ANOVA followed by Post Hoc Analysis. Results: The differences in PPD reduction and CAL gain between control group and CHX chip and combination groups were statistically significant (p<0.05) at three months, whereas, the diode laser group did not show any significant difference from the control group. Conclusion: Within the limitations in the present study, the following conclusions were derived, i.e., chlorhexidine local delivery alone or in combination with diode laser decontamination is effective in improving oral hygiene, reducing gingival inflammation, reducing probing pocket depth and improving clinical attachment levels when used as adjuncts to scaling and root planing in non-surgical periodontal therapy of patients with chronic periodontitis. Keywords: Diode laser decontamination, Local drug delivery, Scaling and root planing.

High-resolution ultrasonography of gingival biomarkers for periodontal diagnosis in healthy and diseased subjects

Periodontal disease affects nearly 50% of Americans but diagnostic methods have remained the same for decades. Periodontal examination via physical probing provides critical metrics such as pocket depth, clinical attachment level, and gingival recession; however, this practice is time consuming, variable, and often painful. In this study, we investigated high-frequency ultrasound (40 MHz) for the image-based measurement of periodontal metrics. Imaging was performed at midbuccal sites for a set of periodontally healthy (n = 10) and diseased (n = 6) subjects and image-based measurements were compared to gold-standard physical probing measurements. Human operators identified relevant markers (e.g., cementoenamel junction, gingival margin, alveolar bone crest) in B-mode ultrasound images from 66 teeth to calculate gingival height and alveolar bone level. These metrics were correlated to clinical measurements of probing pocket depth and clinical attachment level for disease staging (1.57-mm bias and 0.25-mm bias, respectively). Interoperator bias was negligible (<0.1 mm) for gingival height measurements and 0.45 mm for alveolar bone level measurements. The ultrasonographic measurements of gingival height and alveolar bone level served as effective diagnostic surrogates for clinical probing measurements while offering more detailed anatomical information and painless operation.

Comparing Nanohydroxyapatite Graft and Other Bone Grafts in the Repair of Periodontal Infrabony Lesions: A Systematic Review and Meta-Analysis

Objective: To compare the results of periodontal infrabony lesions treated using nanohydroxyapatite (NcHA) graft with other bone grafts (BGs). Methods: Four electronic databases were searched including PubMed (NLM), Embase (Ovid), Medline, and Dentistry and Oral Sciences (EBSCO). The inclusion criteria included randomised controlled clinical trials (RCTs) and controlled clinical trials (CCTs). The clinical results of NcHA were compared with other BGs. For clinical attachment level (CAL) gain, probing pocket depth (PPD) decrease, and gingival recession (REC) change, weighted averages and forest plots were computed. Results: Seven RCTs fulfilled the selection criteria that were included. When NcHA was compared to other BGs, no clinically significant differences were found in terms of each outcome assessed, except the REC change for synthetic BGs as compared to NcHA. Conclusions: The use of an NcHA graft showed equivalent results compared to other types of BGs. To further validate these findings, future studies are required to compare the NcHA and various BGs over longer time periods and in furcation deficiencies.

Aesthetic Outcomes of Early Occlusal Loaded SLA Dental Implants with Hydroxyl Ion Modified Surface—A 12 Months Prospective Study

Background: Many efforts have been made recently to arrange a newer, more hydrophilic and more osteoconductive implant surface. One of the possible options in this matter is modification with hydroxyl ion. Materials and Methods: Forty implants with the diameters 3.5 and 4.0 mm were inserted as a single missing tooth restoration protocol in the frontal aspect of the maxilla. All implants were loaded early in a 4 week period. Prior to and during the surgery, the following indices were considered: height of keratinized tissue, the thickness of soft tissue, and the initial level of bone tissue. After 12 months, the implant and the tissues in its direct vicinity were evaluated once more with the following indices: marginal bone loss (MBL), height of keratinized tissue (HKT), probing pocket depth (PPD), pink and white aesthetics scores (PES, WES), as well as pain sensations combined with the procedure (VAS). All results were related to the diameter of the implant and thickness of periodontal biotype. Results: High aesthetic outcomes were reported regardless of soft tissue thickness and implant diameter. The VAS score was higher for the 4.0 implant group, and the thickness of soft tissue had no influence on VAS. In case of implantation in thin or soft tissue, higher MBL levels were reported (0.26 mm), while in case of a thick phenotype, MBL was 0.06 mm. Conclusions: Hydrophilic surface implants can be used for a protocol of early functional occlusal loading. The initial thickness of soft tissue does not influence aesthetic outcomes and does not raise pain perception, although it may elevate crestal bone resorption.

Evaluation of the Efficacy of Coenzyme Q10 in the Management of Chronic Periodontitis: A Clinical Study

Aim The present study was aimed to clinically evaluate the effectiveness of coenzyme Q10 (CoQ10) in the management of chronic periodontitis. Materials and Methods A total of 60 patients aged between 30 and 60 years with bleeding on probing and probing pocket depth (PPD) of 3 to 5 mm were selected and divided into three groups, with group I receiving scaling and root planing, group II CoQ10 formulation for 6 weeks, and group III receiving both scaling and root planning, followed by coenzyme Q10 administration for 6 weeks. PPD, relative attachment level (RAL), and gingival index were recorded in all the groups at baseline, 6 weeks, and 3 months, respectively. The data was statistically analyzed using Kruskal–Wallis, Mann–Whitney, and Wilcoxon signed rank tests. Result Intragroup comparison showed statistically significant difference (p ≤ 0.05) between the clinical parameters of all the groups at all time intervals, whereas intergroup comparison of all the parameters showed high statistically significant difference (p ≤ 0.001) in group III at various time intervals followed by group I and group II. Conclusion It was concluded from the study that CoQ10 is a useful adjunct in treating chronic periodontitis by boosting the host resistance to periodontal disease.

The Effect of Three Surgical Therapies to Increase Keratinized Mucosa Surrounding Dental Implants with Peri-Implantitis: A Pilot Study

Background and Objectives: The purpose of this pilot study was to evaluate the clinical outcomes of three different methods for increasing the keratinized mucosa (KM) surrounding dental implants with peri-implantitis. Materials and methods: Twenty implant sites with peri-implantitis were divided into: (1) porcine collagen matrix (CM) group: seven implant sites; (2) apically positioned flap (APF) group: eight implant sites; and (3) free gingival graft (FGG) group: five implant sites. The KM width and clinical parameters (probing pocket depth (PPD) and bleeding on probing (BOP)) were measured at time points: before surgery (T0) and 30 (T1), 60 (T2), 90 (T3), and 180 (T4) days after surgery. Results: Regarding KM width, all the groups had significant differences for increasing horizontal and vertical KM width. The CM and FGG groups had greater KM than the APF group. There was a decrease in PPD in all three groups. APF and FGG showed significant differences in PPD at T1 and T2 compared to T0. Only the FGG group showed a significant difference in PPD at T3 and T4 compared with that at T0. BOP values were also reduced in all the groups at T1–T4 compared to T0. The APF and FGG groups showed a significant decrease in BOP. Conclusions: Three surgical therapies presented favorable results for increasing the KM surrounding implants. Compared with the FGG group, the CM showed similar results in increasing the KM around the dental implants with peri-implantitis.

Periodontitis and Helicobacter pylori Infection: Eradication and Periodontal Therapy Combination

Objectives This study was aimed to assess (1) the prevalence of salivary and gastric Helicobacter pylori (HP) infection in patients with and without periodontitis, (2) the prevalence of HP infection in patients with periodontitis according to its clinical classification, (3) the effect of periodontitis treatment in patients with or without gastric HP infection, and (4) if gastric HP eradication in combination with periodontitis treatment influences periodontitis clinical outcome. Materials and Methods Thirty-three adults with periodontitis treated by quadrant scaling and root planning (QSRP). The simplified plaque index (PI), bleeding on probing index (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were assessed pretreatment and 3 months of posttreatment. The patients were tested for oral and gastric HP. Gastric HP (+) patients received eradication therapy. A control group of 32 periodontically healthy volunteers was tested for oral and gastric HP. Saliva samples were evaluated by real-time polymerase chain reaction (rtPCR); gastric HP was detected by urea breath test (UBT). Statistical Analysis Normality of variables assessed by the Kolmogorov–Smirnov test, while the differences of pre- and post-treatment were analyzed by paired samples t-test. Differences between subgroups were compared by a Student’s t-test or a Mann–Whitney U-test. Comparisons of nominal variables were made by Pearson’s Chi-square test. Results No saliva samples were positive for HP. Gastric HP was detected in six patients with periodontitis and seven controls (p > 0.05). HP infection affected patients with higher disease stages and grades. All HP (+) patients underwent successful eradication treatment. All clinical periodontitis indices improved following QSRP. HP (+) patients who received QSRP as adjunctive to eradication treatment showed improvement in BOP (p < 0.001), PI (p < 0.013), and CAL (p < 0.004) compared with HP (−) patients who received QSRP alone. Conclusion Periodontitis was not associated with gastric HP infection. Saliva was not a gastric HP supply reservoir. Gastric HP infection was associated with advanced stages and degrees of periodontitis. Although all periodontal clinical markers improved after QSRP, BOP, PI, and CAL, they were further improved when combined with eradication treatment. Periodontal evaluation and treatment combined with HP eradication are recommended in patients with HP gastric infection.