Deep Periodontal Pockets Research Articles

Comprehensive treatment for severe periodontitis with pathologic tooth migration−related bimaxillary protrusion: A case report with 3-year follow-up

Background and OverviewPatients with severe periodontitis often experience pathologic tooth migration (PTM), which impairs esthetics and leads to occlusal disharmony (for example, premature contacts and traumatic occlusion) that can further exacerbate periodontitis. The authors describe a patient who exhibited severe periodontitis with PTM-related bimaxillary protrusion. This report includes 3-year clinical outcomes after periodontal regenerative therapy, implant-anchored orthodontic therapy, and implant prosthodontics intended to achieve both functional and esthetic improvements. Case DescriptionA 63-year-old woman sought treatment with the chief complaint of maxillary anterior tooth mobility. Clinical examination revealed excessive tooth mobility, deep periodontal pockets, and infrabony defects in all teeth. All teeth exhibited PTM; the mandibular anterior teeth exhibited marked protrusion caused by the progression of periodontitis. After initial periodontal therapy, periodontal regenerative therapy was performed in all molar regions. At 6 and 9 months postoperatively, comprehensive orthodontic treatment was initiated for the mandible and maxilla, respectively, using orthodontic anchorage devices to achieve acceptable functional occlusion. After orthodontic treatment, staged guided bone regeneration was performed and dental implants were placed in the severely resorbed maxillary anterior ridge. This comprehensive treatment yielded favorable periodontal conditions, stable occlusion, and good esthetic outcomes. Conclusions and Practical ImplicationsFavorable esthetics, stable occlusion, and highly cleansable periodontal tissues were achieved with well-planned interdisciplinary and comprehensive treatment, although the patient had severe periodontitis and PTM-related bimaxillary protrusion.

Compositional Data Analysis of Periodontal Disease Microbial Communities

Periodontal disease (PD) is a chronic, progressive polymicrobial disease that induces a strong host immune response. Culture-independent methods, such as next-generation sequencing (NGS) of bacteria 16S amplicon and shotgun metagenomic libraries, have greatly expanded our understanding of PD biodiversity, identified novel PD microbial associations, and shown that PD biodiversity increases with pocket depth. NGS studies have also found PD communities to be highly host-specific in terms of both biodiversity and the response of microbial communities to periodontal treatment. As with most microbiome work, the majority of PD microbiome studies use standard data normalization procedures that do not account for the compositional nature of NGS microbiome data. Here, we apply recently developed compositional data analysis (CoDA) approaches and software tools to reanalyze multiomics (16S, metagenomics, and metabolomics) data generated from previously published periodontal disease studies. CoDA methods, such as centered log-ratio (clr) transformation, compensate for the compositional nature of these data, which can not only remove spurious correlations but also allows for the identification of novel associations between microbial features and disease conditions. We validated many of the studies’ original findings, but also identified new features associated with periodontal disease, including the genera Schwartzia and Aerococcus and the cytokine C-reactive protein (CRP). Furthermore, our network analysis revealed a lower connectivity among taxa in deeper periodontal pockets, potentially indicative of a more “random” microbiome. Our findings illustrate the utility of CoDA techniques in multiomics compositional data analysis of the oral microbiome.

Quiste de la bifurcación bucal mandibular. Análisis sistemático de la literatura y reporte de un caso

Introducción: El quiste de la bifurcación bucal mandibular (QBBM) es una lesión quística de origen odontogénico, que se presenta en relación con la superficie bucal del primer y segundo molar mandibular, con características clínicas, radiográficas e histológicas similares a otras entidades patológicas de la mandíbula relacionadas a procesos inflamatorios. Clínicamente suelen presentarse como una inflamación en el vestíbulo de la región de primeros y segundos molares vitales, con presencia de bolsas periodontales profundas. Existe controversia en la etiología exacta y el tratamiento por lo que el presente estudio tiene como objetivo discutir las características clínicas y radiográficas del QBBM, el diagnóstico diferencial y su tratamiento el cual difiere si la enucleación quística incluye o no la extracción dental. Metodología: Se realizó una revisión sistemática de la literatura en distintas bases digitales, recopilando información relevante que justifique los hallazgos del presente caso. Resultados: En este caso en particular ciertas características como la proyección del esmalte en la zona de la bifurcación fue un indicativo claro del QBBM. El tratamiento de elección fue la enucleación del quiste con la extracción de la pieza dentaria.

Evaluation of multiple subgingival irrigations with 10% povidone-iodine after scaling and root planing: a randomized clinical trial.

This 6-month randomized controlled study aimed at evaluating the clinical outcomes of multiple irrigations of 10% povidone-iodine (PVP-I) as an adjunct to full-mouth scaling and root planing (SRP) in the treatment of chronic periodontitis. Seventeen patients were included. A split-mouth design randomly assigned one side as the test side (SRP + PVP-I) and the other side as the control side (SRP + NaCl). After full-mouth SRP, the control side received subgingival irrigation with 10 mL 0.9% NaCl solution. The test side received 10 mL of PVP-I 10%. Plaque Index (PI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) parameters were assessed at baseline and after 3 and 6 months. During recall visits (3 and 6 months), residual deep periodontal pockets of ≥ 6 mm were cleaned with the same protocol and randomization. PI, BOP, PPD, and CAL were improved in both sides after 6 months. No significant differences were seen between control and test sides for the all clinical parameters after 6 months. Multiple subgingival irrigations of 10% PVP-I or 0/9% NaCl combined to one-stage full mouth SRP in patients with chronic periodontitis showed a reduction of all clinical parameters until 6 months. There was a trend in favor of the povidone group for PPD. ( 2021;52:496-504; doi: 10.3290/j.qi.b1044059).

Smoking and periodontal disease severity, probing pocket depth and bleeding on probing

Background and Objective: The purpose of the present study was to investigate whether severity of disease process differed between smokers and nonsmokers and to study characteristic differences in pattern of periodontal disease in smokers in a group of known chronic periodontitis patients. Materials and Methods: The study included 150 individuals in an age range of 35–60 years wherein periodontal evaluation including probing pocket depth (PPD) and bleeding on probing (BOP) was performed using Williams's periodontal probe. For both the parameters (PPD and BOP), mean scores were calculated from different quadrants of the oral cavity while the results obtained were subjected to statistical analysis. Results: The mean percentage of sites that presented with BOP was higher for nonsmokers compared with smokers. Furthermore, smokers had more number of pockets and pockets with increased PPD. On analysis of buccal and lingual sides, also, it was observed that smokers had more number of sites with PPD of ≥5 mm than nonsmokers. Conclusion: From the results, it could be concluded that smoking is associated with more severe periodontal attachment and bone loss and deeper periodontal pockets.

Using national register data to estimate the heritability of periodontitis.

To identify whether periodontal traits derived from electronic dental records are biologically informative and heritable. The study included 11,974 adult twins (aged 30-92years) in the Swedish Twin Registry. Periodontal records from dental examinations were retrieved from a national register and used to derive continuous measures of periodontal health. A latent class approach was used to derive categorial measures of periodontal status. The correlation patterns in these traits were contrasted in monozygotic and dizygotic twin pairs using quantitative genetic models to estimate the heritability of the traits. For continuous traits, heritability estimates ranged between 41.5% and 48.3% with the highest estimates for number of missing tooth surfaces and rate of change in number of deep periodontal pockets (≥6mm). For categorial traits, the latent class approach identified three classes (good periodontal health, mild periodontitis signs and severe signs of periodontitis) and there was a clear difference in the hazard for subsequent tooth loss between these three classes. Despite this, the class allocations were only slightly more heritable than a conventional dichotomous disease definition (45.2% vs. 42.6%). Periodontitis is a moderately heritable disease. Quantitative periodontal traits derived from electronic records are an attractive target for future genetic association studies.

Prospective Longitudinal Changes in the Periodontal Inflamed Surface Area Following Active Periodontal Treatment for Chronic Periodontitis.

Periodontal disease is a chronic inflammatory disease of the periodontal tissue. The periodontal inflamed surface area (PISA) is a proposed index for quantifying the inflammatory burden resulting from periodontitis lesions. This study aimed to investigate longitudinal changes in the periodontal status as evaluated by the PISA following the active periodontal treatment. To elucidate the prognostic factors of PISA, mixed-effect modeling was performed for clinical parameters, tooth-type, and levels of periodontal pathogens as independent variables. One-hundred-twenty-five patients with chronic periodontitis who completed the active periodontal treatment were followed-up for 24 months, with evaluations conducted at 6-month intervals. Five-times repeated measures of mean PISA values were 130+/−173, 161+/−276, 184+/−320, 175+/−417, and 209+/−469 mm2. Changes in clinical parameters and salivary and subgingival periodontal pathogens were analyzed by mixed-effect modeling. Plaque index, clinical attachment level, and salivary levels of Porphyromonas gingivalis were associated with changes in PISA at the patient- and tooth-level. Subgingival levels of P. gingivalis and Prevotella intermedia were associated with changes in PISA at the sample site. For most patients, changes in PISA were within 10% of baseline during the 24-month follow-up. However, an increase in the number of bleeding sites in a tooth with a deep periodontal pocket increased the PISA value exponentially.

Changes in clinical parameters following adjunctive local sodium hypochlorite gel in minimally invasive nonsurgical therapy (MINST) of periodontal pockets: a 6-month randomized controlled clinical trial

BackgroundThe mechanical disruption and removal of the subgingival biofilm represent the most important step in the treatment of periodontitis. However, in deep periodontal pockets, mechanical removal of the subgingival biofilm is difficult and frequently incomplete. Preliminary findings indicate that the use of amino acid buffered sodium hypochlorite (NaOCl) gel may chemically destroy the bacterial biofilm and facilitate its mechanical removal.ObjectivesTo clinically evaluate the efficacy of minimally invasive nonsurgical therapy (MINST) of periodontal pockets with or without local application of an amino acid buffered sodium hypochlorite (NaOCl) gel.Materials and methodsForty untreated patients diagnosed with severe/advanced periodontitis (i.e. stage III/IV) with a slow/moderate rate of progression (i.e. grade A/B) were randomly allocated in two treatment groups. In the test group, the periodontal pockets were treated by means of MINST and NaOCl gel application, while in the control group, treatment consisted of MINST alone. Full-mouth plaque scores (FMPS), full-mouth bleeding scores (FMBS), probing depths (PD), clinical attachment levels (CAL) and gingival recessions (GR) were assessed at baseline and at 6 months following therapy. The primary outcome variable was PD reduction at sites with PD ≥ 5 mm at baseline.ResultsAt 6 months, statistically significant differences between the two groups were found (p = 0.001) in terms of PD and CAL change. No statistically significant differences were found in terms of GR (p = 0.81). The number of sites with PD ≥ 5 mm and BOP (+) decreased statistically significantly (p = 0.001), i.e. from 85.3 to 2.2% in the test group and from 81.6 to 7.3% in the control group, respectively. Statistically significant differences between test and control groups were recorded at 6 months (p = 0.001). MINST + NaOCl compared to MINST alone decreased statistically significantly (p = 0.001) the probability of residual PDs ≥ 5 mm with BOP− (14.5% vs 18.3%) and BOP+ (2.2% vs. 7.2%).ConclusionsWithin their limits, the present results indicate that (a) the use of MINST may represent a clinically valuable approach for nonsurgical therapy and (b) the application of NaOCl gel in conjunction with MINST may additionally improve the clinical outcomes compared to the use of MINST alone.Clinical relevanceIn patients with untreated periodontitis, treatment of deep pockets by means of MINST in conjunction with a NaOCl gel may represent a valuable approach to additionally improve the clinical outcomes obtained with MINST alone

Effect of Full-mouth Disinfection Protocol on Glycaemic Control and Subgingival Microbiota in Patients with Type 1 and Type 2 Diabetes.

To evaluate the effect of a full-mouth disinfection protocol (FMD) on periodontal parameters, glycaemic control and subgingival microbiota of periodontal patients with type 1 and type 2 diabetes, as well as those without diabetes. This study included 33 patients with periodontitis. Eleven of them were type 1 diabetes patients, 11 were type 2 diabetes patients, and 11 were non-diabetics. At baseline and 3 months after the FMD, the periodontal parameters of each patient were recorded, samples of capillary blood for the chairside assessment of HbA1c were taken, and plaque samples from the two deepest periodontal pockets were collected to test for the presence of Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythia (Tf) and Treponema denticola (Td). Bleeding on probing (BOP), probing pocket depth (PPD), clinical attachment level (CAL) and glycated haemoglobin (HbA1c) decreased statistically significantly (p < 0.05) in all three groups 3 months after FMD. Only the proportion of Pg in the control group decreased statistically significantly (p < 0.05), while the proportion of other bacteria decreased or remained the same, whereby the differences were not statistically significant. Moreover, the proportion of Aa in type 1 diabetics increased statistically significantly (p < 0.05). The FMD protocol improves periodontal parameters and glycaemic control of type 1 and type 2 diabetes patients with periodontitis.

Hydrogen sulfide exacerbated periodontal inflammation and induced autophagy in experimental periodontitis

Hydrogen sulfide (H2S), the metabolite produced by gram-negative bacteria, is present in deep periodontal pockets of periodontitis patients at high concentrations. The harsh conditions in the diseased periodontium may stimulate a local autophagy response. However, how H2S participates in pathogenesis and whether H2S induces autophagy in periodontitis remain partially unknown. In this article, we determined the role of the slow-releasing H2S donor GYY4137 in experimental periodontitis and its possible regulation in autophagy involved. We found that GYY4137 dose-dependently decreased cell viability and increased the level of proinflammatory cytokines in LPS-stimulated human periodontal ligament cells (HPDLCs). Topically applied GYY4137 also exacerbated periodontal inflammation and alveolar bone loss in ligature-induced rats. Moreover, GYY4137 activated autophagy by upregulating the expression levels of the autophagy-related proteins LC3 and Beclin-1 and downregulating P62 in LPS-treated HPDLCs and inflamed periodontal tissues. Blocking autophagy with 3-methyladenine resulted in further increased expression of proinflammatory cytokines in LPS- and GYY4137-induced HPDLCs. Our results indicate that GYY4137 exerted proinflammatory effects and promoted autophagy in periodontitis, and the induced autophagy may function as a cytoprotective mechanism to prevent excessive inflammation.

The effects of a novel non-invasive application of platelet-rich fibrin on periodontal clinical parameters and gingival crevicular fluid transforming growth factor-β and collagen-1 levels: A randomized, controlled, clinical study.

Several potential benefits have been attributed to the platelet-rich fibrin (PRF), including enhanced tissue healing properties. In this study, we hypothesized that the application of PRF as an adjunct to conventional scaling and root planing (ScRp) would enhance the outcomes of non-surgical periodontal therapy. The present study was a split-mouth randomized controlled clinical trial design in 24 deep periodontal pockets in 12 patients with periodontitis. The pockets were randomly assigned as test or control. The test group received PRF as an adjunct to ScRp, whereas the control group received ScRp only. We measured periodontal clinical parameters at baseline, 3, and 6 months after the treatments. To study the initial healing in response to treatment, transforming growth factor-β (TGF-β) and collagen-1 (Col-1) in gingival crevicular fluid (GCF) were measured using enzyme-linked immunosorbent assay at baseline, third, seventh, and 14th days. The test group showed a significantly greater pocket reduction, higher clinical attachment gain, and less gingival recession than the control group at 3 and 6 months. The test Col-1 levels (1.27 ± 1.05, 1.35 ± 0.76, 0.97 ± 0.53ng/site) and TGF-β levels (11.93 ± 2.68, 12.54 ± 3.66, 17.19 ± 11.66 pg/site) were higher than the control Col-1 levels (0.76 ± 0.20, 0.84 ± 0.24, 0.57 ± 0.19ng/site) and TGF-β levels (6.34 ± 1.67, 6.35 ± 3.44, 7.51 ± 2.85 pg/site) at all measurement days respectively. Non-surgical application of the PRF as an adjunct to conventional ScRp may effectively improve the periodontal clinical parameters via increasing expression of the GCF TGF-β and Col-1 levels.

Efficacy of the additional use of subgingival air polishing with erythritol powder in the treatment of periodontitis patients: a randomized controlled clinical trial

To date, scarce evidence exists around the application of subgingival air polishing during treatment of severe periodontitis. The aim of this study was to evaluate the benefits of subgingival air polishing during non-surgical treatment of deep bleeding pockets in stages III-IV periodontitis patients MATERIALS AND METHODS: Forty patients with stages III-IV periodontitis were selected, and pockets with probing depth (PD) 5-9mm and bleeding on probing (BoP) were selected as experimental sites. All patients underwent a full-mouth session of erythritol powder supragingival air polishing and ultrasonic instrumentation. Test group received additional subgingival air polishing at experimental sites. The proportion of experimental sites shifting to PD ≤ 4 mm and no BoP at 3months (i.e., non-bleeding closed pockets, NBCPs) was regarded as the primary outcome variable. The proportion of NBCP was comparable between test and control group (47.9 and 44.7%, respectively). Baseline PD of 7-9 mm, multi-rooted teeth and the presence of plaque negatively influenced the probability of obtaining NBCP. The additional application of subgingival air polishing does not seem to provide any significant clinical advantage in achieving closure at moderate to deep bleeding pockets in treatment of stages III-IV periodontitis patients. The study was registered on Clinical Trials.gov (NCT04264624). While air polishing can play a role in biofilm removal at supragingival and shallow sites, ultrasonic root surface debridement alone is still the choice for initial treatment of deep bleeding periodontal pockets.

Chemical cleansing as an adjunct to subgingival instrumentation with ultrasonic and hand devices in deep periodontal pockets: a randomized controlled study.

PurposeThe aim of this randomized clinical trial was to assess whether chemical cleansing using a sulfonic/sulfuric acid gel solution (HBX) as an adjunct to scaling and root planing (SRP) resulted in a decrease in residual plaque and calculus in deep periodontal pockets compared to SRP alone.MethodsFifty-six patients with 56 hopeless posterior teeth, scheduled for extraction due to severe periodontitis, were enrolled in this study. Each tooth was randomly assigned to 1 of the 2 experimental procedures. The test teeth were subjected to the irrigation of the subgingival area with HBX for 2 minutes, followed by SRP with hand and ultrasonic instruments for 14 minutes, and then extracted. The control teeth received only mechanical instrumentation before extraction. Residual biofilm was evaluated on photographs and measured as total area and percentage of root surface covered by remaining plaque (RP) or calculus (RC) after treatment.ResultsThe initial pocket depth (PD) and total subgingival root surface area were similar between the 2 treatment groups. After treatment, the total subgingival root area covered by RP and RC was statistically significantly larger (P<0.001) in the control group than in the test group. The test teeth showed a lower percentage of RP, but a higher percentage of RC than the control teeth (both P<0.001). Complete calculus removal was achieved in 42% of the control teeth surfaces and in 25% of the test teeth surfaces for a PD of 4 mm.ConclusionsThe additional chemical cleansing with HBX resulted in a statistically significant improvement in bacterial plaque removal during SRP of deep pockets, but it was not effective in reducing calculus deposits.

Subgingival microbiota in a population with and without cognitive dysfunction

ABSTRACT Aim: The aim of this study was to compare the subgingival microbiota of people with Alzheimer´s disease (AD), mild cognitive impairment (MCI), subjective cognitive decline (SCD) and cognitively healthy individuals. Materials and methods: The study population was recruited from 2013 to 2017 and comprised 132 cases recently diagnosed with AD (n = 46), MCI (n = 40) or SCD (n = 46), and 63 cognitively healthy controls. Subgingival samples were collected, and the microbiotas were characterized by 16S rRNA gene sequencing. Results: The relative abundance of the ten most common genera did not differ between the cases and control groups. However, the microbial richness and evenness were higher in cases than in controls and differed across the four groups. The variables with the greatest influence on the microbial community composition were related to periodontal disease followed by body mass index, study group affiliation and smoking. Ten taxa exhibited significant differences between case participants and controls. Two Operational Taxonomic Units were particularly abundant in AD compared to controls: Slackia exigua, which was also associated with deep periodontal pockets, and a Lachnospiraceae [G-7] bacterium. Conclusion: It is concluded that in individuals with cognitive impairment or AD, the subgingival microbiota exhibits shifts typical of periodontal disease.

Association of Tooth Loss and Risk of Lung Cancer in a Greek Adult Population: A Case Control Study

Aim: The purpose of the current case-control study was to assess the possible relationships between the number of missing teeth and the risk of lung carcinoma in out-patients Greek individuals of three private practices. Materials and Methods: The study sample consisted of 155 cases diagnosed with various histological types of lung carcinoma and 450 age, gender and socio-economic status matched controls. Data on oral health and the number of missing teeth were obtained through dental examination and questionnaire including aspects of their medical and dental history. Odds ratios (OR’s) and 95% Confidence Intervals (95%CI’s) were assessed using a logistic regression model adjusted for possible confounders. Results: The multivariate regressionanalysis model application showed that smoking (p=0.000, OR= 3.192, 95%CI= 2.065-4.933), deepperiodontalpockets(p= 0.048, OR= 1.89,95%CI=1.221-2.927) and a number of missing teeth more than four (p=0.032, OR=1.67, 95% CI= 0.489-1.953 and p= 0.047, OR=1.884, 95%CI= 0.495-1.209) were statistically significantly associated with risk for LC development. Conclusion: Individuals with deep periodontal pockets and a number of missing teeth more than four were at significantly higher risk for lung carcinoma.

Subgingival air-polishing treatment in patients with aggressive periodontitis

Background/Aim. Periodontal tissue maintenance therapy is an important phase of the overall periodontal disease therapy. This paper aims to determine subgingival air-polishing efficacy with glycine powder in putative paropathogens reduction, plaque index, gingival bleeding index and probing depth. Methods. The study included 44 patients with aggressive periodontitis of both sexes, aged between 21 and 50, divided into two groups. Subgingival air-polishing was applied in the first group and sonic scaling in the control (second) group. Biofilm samples were taken from 5 deepest periodontal pockets before the therapy and 3 and 15 months after it. Paropathogens Aggreggatibacter actinomy-cetemcomitans, Porphyromonas gingivalis, Tannerella forsithya, Prevotella intermedia, Treponema denticola were detected by PCR analysis. Results. Paropathogens values were decreased after applied treatments. There was a statistically significant reduction in the mean value of full-mouth plaque (FMPS), from 43.00 to 14.90 (first group) and from 44.71 to 15.54 (second group), full-mouth bleeding score (FMBS) from 42.55 to 13.85 (first group) and from 43.04 to 15.17 (second group), as well as in probing depth from 3.40 to 2.64 (first group) and from 3.85 to 2.91 (second group), three months after the therapy. Conclusion. Subgingival air-polishing successfully reduces putative paropathogens and clinical parameters three months after the treatment.

A Case of Mandibular Prognathism with Generalized Aggressive Periodontitis and Crowding

Aggressive periodontitis during adolescence has a poor prognosis due to rapid alveolar bone resorption. Few studies have investigated long-term follow-up after surgical orthodontic treatment performed in conjunction with that for invasive periodontitis. Here, we report a case of mandibular prognathism accompanied by generalized aggressive periodontitis and crowding. A 31-year-old woman was referred to our department for treatment of masticatory dysfunction due to reverse overjet. The patient exhibited a class III molar relationship, protrusion of the ANB of －6.0°, and severe maxillary crowding. Initial periodontal examination revealed deep periodontal pockets and extensive inflammation. Mandibular prognathism accompanied by generalized aggressive periodontitis and crowding was diagnosed. Therefore, it was necessary to adopt an interdisciplinary approach involving surgical, orthodontic, and periodontal treatment. Prior to commencement of orthodontic treatment, plaque control, scaling, and root planing of all teeth were performed by a periodontist to suppress inflammation and reduce probing depth. During pre-surgical orthodontic treatment, the maxillary first premolars were extracted to reduce crowding of the maxillary incisors. To correct the mandibular prognathism, the mandible was repositioned by sagittal split ramus osteotomy. Proper occlusion of the incisors and maximum intercuspation were achieved by post-surgical orthodontic treatment. After completion of active orthodontic treatment, acceleration of inflammation was observed together with aggravated resorption of the alveolar bone surrounding the molars. However, reduction of probing depth and inflammation were observed after scaling and root planing. The surgical-orthodontic treatment time was 1 year and 11 months, which was followed by a 2-year retention period. There was no tooth loss due to periodontitis, and an overall satisfactory outcome was achieved.

Putative periodontal pathogens in persisting periodontal pockets of endodontic origin.

Background:The microbial profile of endodontically treated teeth, presenting with a persisting deep periodontal pocket, secondary to a primary endodontic lesion, draining through the gingival crevice, has received very less attention. This observational study was done to evaluate if these sites with persisting pockets of endodontic origin persist because they have acquired bacteria which are considered as putative periodontal pathogens.Materials and Methods:Subgingival plaque samples were collected from fifty patients diagnosed with a primary endodontic and a secondary periodontal lesion that persisted even after completion of the root canal treatment. Clinical parameters such as probing pocket depth, clinical attachment level, plaque index, furcation, and tooth mobility were recorded. Real-time polymerase chain reaction was used to determine the possible association between six bacteria, which are frequently associated with periodontal and endodontic lesions.Results:The mean cycle threshold value for Treponema denticola (Td) was found to be 33.74, and for Enterococcus faecalis (Ef), it was 34.39. With regard to clinical attachment loss, Td (P < 0.04) and Parvimonas micra (P < 0.05) had a significant correlation.Conclusion:Ef (92%) and Td (86%) were found to be most prevalent. Porphyromonas gingivalis and Tannerella forsythia were in minimal to nonexistent levels.

Antimicrobial Photodynamic Therapy Using Curcumin Photosensitizer in Conjunction with Periodontal Open Flap Debridement. Pilot Clinical Study with Real-Time PCR Bacterial Assessment

Aim: To evaluate the effect of using antimicrobial photodynamic therapy (A-PDT) with curcumin in conjunction with open flap debridement (OFD) in the treatment of deep periodontal pockets. The primary objective was the clinical evaluation via assessment of the changes in clinical periodontal parameters. The secondary objective was the quantification of the pocket total bacterial load by Real-Time PCR. Subjects and methods: Group A included 7 patients who received OFD in conjunction with A-PDT using LED and curcumin paste (2%) as a photosensitizer. Group B included 7 patients who received OFD followed by application of curcumin paste (2%) but without photoactivation. Group C included 7 patients who received OFD alone. Clinical evaluation included plaque index (PI), gingival bleeding index (BI), probing depth (PD) and clinical attachment level (CAL). Microbiological evaluation involved collection of gingival crevicular fluid (GCF) samples for total bacterial load (TBL) analysis by real-time PCR Results: Regarding the percent change in PD and CAL, the greatest percent decrease value was recorded in group A while the least percent decrease was in group C. The difference between groups was statistically significant. Regarding percent change of TBL by time, the greatest percent decrease value was recorded in group A. Conclusion: Within the limitations of our study, the photoactivation of the curcumin used in conjunction with OFD may lead to greater PD reduction, greater CAL gain and greater TBL reduction when compared to OFD alone or OFD with curcumin without photoactivation.

Association of oral HPV16 infection with periodontal inflammation and the oral microbiome in older women.

The present preliminary study aimed to investigate the association between oral human papillomavirus type 16 (HPV16) DNA prevalence and periodontal inflammation in older women. The association between oral HPV16 infection and oral health status has not been fully elucidated in older Japanese women. The present study investigated older women aged ≥60 years who visited Hiroshima University Hospital. The present study excluded subjects with clinical factors affecting HPV infection, such as current smoking, oral cancer and pre-malignant lesions, and immunodeficiency. Finally, 46 female patients (mean age, 74.6 years) were analyzed. Quantitative PCR analysis was performed to detect HPV16 DNA in oral rinse samples. A total of 4 participants (8.7%) were HPV16 DNA positive. There was a significant association between the HPV16 DNA positivity rate and bleeding on probing (P=0.03). Additionally, Prevotella intermedia positive cases exhibited a significantly higher HPV16 DNA positivity rate than negative cases (33.3 vs 3.8%). Furthermore, analysis of 16S ribosomal RNA in bacterial flora was performed to examine microbiome diversity in participants with ≥6 mm periodontal pockets and bleeding on probing. Importantly, the average percentage of Porphyromonas was significantly higher in HPV16 DNA positive cases compared with in HPV16 DNA negative cases (5.57 vs. 1.44%). By contrast, the average percentage of Veillonella was significantly lower in HPV16 DNA positive cases than in HPV16 DNA negative cases (2.43 vs. 8.51%). Prevotella was also lower in HPV16 DNA positive cases than in HPV16 DNA negative cases (4.0 vs. 8.23%). These results indicated that people with both deep periodontal pocket inflammation and oral HPV16 infection may not have Prevotella- or Veillonella-dominant oral microbiomes, and their microbiomes may exhibit their own distinctive characteristics. In conclusion, the results suggested that oral HPV16 infection may be associated with periodontal inflammation in older Japanese women. Further research is required to clarify the detailed association between oral HPV infection and the oral microbiome.