Treatment Of Severe Periodontitis Research Articles

The Treatment of Severe Periodontitis Using a Local Antiseptic Desiccant and Subgingival Mechanical Instrumentation: A Pilot Study.

This randomized, split-mouth, controlled clinical study assessed the additional clinical benefits of a local desiccant antimicrobial agent (HY) combined with subgingival mechanical instrumentation (SRP) vs. SRP alone in treating severe periodontitis. Patients with stages III and IV periodontitis received full-mouth periodontal examinations at baseline and after a three-month follow-up. Two randomly selected hemiarches in each periodontitis patient were treated with SRP plus HY and were included in the test group, while the other two hemiarches received only SRP and were included in the control group. In thirty patients, the analyses of the evolution of the periodontal parameters over time showed statistically significant mean differences for the probing depths and clinical attachment level values resulting from all the examined sites, as well as from the interproximal sites (p < 0.001) in both the test and control groups. The intergroup comparisons of the same four parameters showed no significant differences (p = 0.322, p = 0.36, p = 0.516, and p = 0.509, respectively). Based on these study results, no additional benefits were obtained after HY subgingival applications.

Aesthetic consideration in patient management of severe periodontitis aggravated by oral dexamethasone

Background: The treatment of severe periodontitis must consider immune responses and local conditions, including the aesthetical aspects. The tooth loss in the anterior area can lead to a psychological issue in some patients, and the daily use of dexamethasone contributes greatly to the severity of aesthetical aspects. Periodontal treatments must be cautious of these aesthetical effects. Purpose: To report the aesthetical consideration in patient management of severe periodontitis aggravated by oral dexamethasone. Case: The 44-year-old female patient reported having tooth mobility in the upper right and left central incisor and lower right and left posterior. Due to the condition, the central anterior needed to be extracted. The patient had seafood allergies and consumed oral dexamethasone periodically to prevent allergic reactions for two years. Case management: The initial periodontal therapy was designed prior to the tooth extraction, socket preservation, and immediate denture on teeth 11 and 21. A metal frame combined with an acrylic denture was designed to support the tooth splint and replace the teeth on the mandible. The patient was treated with 20 mg of sub-antimicrobial-dose doxycycline twice a day for three months, and vitamin E was prescribed once a day. Since dexamethasone may contribute to immune response and osteoclastogenesis, dexamethasone was replaced by cetirizine. Conclusion: The treatment of severe chronic periodontitis must consider immune responses, local conditions, and aesthetical aspects. In this case, the use of dexamethasone might worsen the periodontal breakdown. However, the periodontal treatment, use of host modulation therapy, and replacement of dexamethasone with cetirizine are expected to improve these conditions.

Efficacy of surgical periodontal treatment with and without photobiomodulation in the treatment of severe periodontitis: An evaluation of periodontal, microbiological, and cytokine levels

AimTo compare the efficacy of surgical periodontal treatment (SPT) alone and PDT-assisted surgery in participants with severe periodontitis. Material and methodsThe present clinical trial was completed by 64 participants (n = 32 each). The selection was made according to predefined inclusion and exclusion criteria. Patients in group A were treated with SPT only and participants in group B were treated with SPT adjunct to PDT. Microbiological assessment of P.Gingivalis; T. Forsythia and T.Denticola were evaluated using cultural analysis and periodontal parameters plaque score (PSc), bleeding on probing (BoP) periodontal depth (PD), and clinical attachment loss (CAL) at baseline and post-treatment at 6 months and 12 months were performed. The gingival crevicular fluid (GCF) was collected for the estimation of IL-1β and tumor necrosis factor-alpha (TNF-α) using an enzyme-linked immunosorbent assay (ELISA). For intra-group comparison and post hoc correction, Student's t-test along with Bonferroni was used. For the difference between follow-ups, an analysis of variance (ANOVA) multiple rank tests were incorporated. ResultsThe mean age of participants in the SPT group was 55.25±4.6yrs. Whereas, participants treated with PDT adjunct to SPT were 54.88±3.6yrs. Periodontal parameters (BoP, PD, PSc, CAL) showed no significant difference at baseline. At 6 months and 12 months follow-up, a significant difference in all parameters (BoP, PD, PSc, and CAL) was found in participants treated with SPT alone and PDT adjunct to SPT (p<0.05). Inflammatory biomarkers at 6-month and 12-month follow-ups, a statistically significant difference in the level of biomarkers (IL-1β and TNF-α) were observed in both groups from baseline (p<0.05). However, at baseline, no significant difference was noted in both groups (p> 0.05). The microbiological assessment showed a significant drop in the bacterial count in participants treated with both regimes i.e., SPT alone and PDT adjunct to SPT. ConclusionPhotodynamic therapy (PDT) adjunct to surgical periodontal treatment (SPT) in severe periodontitis improves microbiological and periodontal parameters and lowers the level of proinflammatory cytokines.

Clinical substantiation of the use of connective tissue graft transplantation technique as a surgical stage for deepening the oral cavity opening in the treatment of periodontitis

The aim of the work was to evaluate the effectiveness of vestibuloplasty with free gingival graft transplantation in patients with small oral cavity opening in the treatment of severe periodontitis.&#x0D; The study group consisted of 14 patients who, in the period from 2020 to 2022, on the basis of the Department of Maxillofacial Surgery of the RUDN, 14 operations were performed to deepen the vestibule of the oral cavity with the insertion of a free graft from the palate. The measurements were carried out before and 6 months after the surgical treatment with a graduated periodontal probe, the surgical operation was preceded by a conservative stage of treatment.&#x0D; Following the results of the vestibuloplasty operation, the depth of the vestibule in the study group increased by an average of 3.63 times (from 1.32 to 5.06 mm). An increase in the depth of the vestibule of the oral cavity was observed in all cases of treatment.&#x0D; The conclusion is made about the effectiveness of using this technique in the treatment of periodontitis with destructive changes in periodontal tissues in the frontal part of the mandible.

Efficacy of the additional use of subgingival air-polishing with erythritol powder in the treatment of periodontitis patients: a randomized controlled clinical trial. Part II: effect on sub-gingival microbiome

ObjectivesTo 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 effect on the health-related and periodontitis-related subgingival microbiome of air-polishing during non-surgical treatment of deep bleeding pockets in stage III–IV periodontitis patients.Materials and methodsForty patients with stage III–IV periodontitis were selected, and pockets with probing depth (PD) 5–9 mm and bleeding on probing 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. Subgingival microbial samples were taken from the maxillary experimental site showing the deepest PD at baseline. Primary outcome of the first part of the present study was the 3-month change in the number of experimental sites. Additional analysis of periodontal pathogens and other sub-gingival plaque bacteria sampled at one experimental site at baseline and 3 months following treatment was performed through a real-time quantitative PCR microarray.ResultsIn the test group, a statistical increase of some health-related species was observed (Abiotropha defectiva, Capnocytophaga sputigena, and Lautropia mirabilis), together with the decrease of pathogens such as of Actinomyces israelii, Catonella morbi, Filifactor alocis, Porphyromonas endodontalis, Sele-nomonas sputigena, Tannerella forsythia, Treponema denticola, and Treponema socranskii. In the control group, statistical significance was found only in the decrease of Filifactor alocis, Tannerella forsythia, and Treponema socranskii.ConclusionsThe addition of erythritol-chlorhexidine powder seems to cause a shift of the periodontal micro-biome toward a more eubiotic condition compared to a conventional treatment. The study was registered on Clinical Trials.gov (NCT04264624).Clinical relevanceSubgingival air-polishing could help re-establishing a eubiotic microbioma in deep bleeding periodontal pockets after initial non-surgical treatment.

Combination of Nd:YAG and Er:YAG lasers in non-surgical periodontal therapy: a systematic review of randomized clinical studies.

Lasers are increasingly utilized in the non-surgical treatment of periodontal disease. The aim of the present systematic review with meta-analysis was to investigate the combination use of Nd:YAG and Er:YAG laser therapy in the treatment of severe periodontitis. A systematic review of the literature including searches in PubMed/Medline, Cochrane Library, Google Scholar, and Grey Literature databases, as well as manual searches, was performed until November 1, 2021. Only studies a combination of lasers during non-surgical treatment of pockets ≥ 6mm were included. The eligibility criteria for meta-analysis comprised randomized controlled trials (RCTs) comparing the use of combination laser therapy with/without adjunctive mechanical for the non-surgical management of periodontitis. From 57 initial articles, 6 full-text articles were assessed for eligibility. Two studies were excluded, one study was not a randomized clinical trial (case series), and one study was an in vitro study. Four RCTs were included in the meta-analysis. It was shown that combination of Nd:YAG and Er:YAG may be beneficial for non-surgical periodontal therapy with an additional average reduction in pocket depth and clinical attachment level reported at 1.01 and 0.77 mm respectively when compared to controls. The findings suggest that the combination of Nd:YAG and Er:YAG lasers may lead to additional clinical improvements compared to nonsurgical treatment alone. Future research is needed to substantiate these findings and optimize clinical guidelines including more specific laser protocols. Preliminary data suggest favorable outcomes following the combination of Nd:YAG and Er:YAG lasers for non-surgical periodontal therapy.

Proposed protocol for treatment of severe periodontitis without platelet transfusion in patients with aplastic anemia: a case report

BackgroundAplastic anemia is an intractable disease characterized by pancytopenia, susceptibility to infection, and difficulty in achieving hemostasis. In patients with severe periodontal disease and aplastic anemia, spontaneous bleeding from the gingival tissue due to thrombocytopenia and during brushing is common, which may further exacerbate dental issues. Comprehensive periodontal treatment for patients with aplastic anemia is highly challenging and requires collaboration with a hematologist. Here, we discuss the case of a patient with aplastic anemia and severe periodontitis who was successfully treated in collaboration with our hematology department.Case presentationA 36-year-old Japanese woman with chief complaints of spontaneous gingival bleeding, pain, and increasing tooth mobility consulted our department. She had developed pancytopenia at age 11 years and was later diagnosed with aplastic anemia, making her susceptible to infection due to leukopenia. The results of the initial periodontal examination led to a diagnosis of severe generalized periodontitis (generalized stage IV grade C periodontitis) caused by leukopenia and poor oral hygiene. We adopted a comprehensive treatment plan, including invasive dental procedures. The patient exhibited no postoperative bleeding due to aplastic anemia-induced thrombocytopenia and experienced a good outcome.ConclusionsBoth physicians and dentists should be aware that immunocompromised patients with aplastic anemia are at risk of developing severe periodontitis with severe alveolar bone resorption if the condition is combined with poor oral hygiene. Even in the presence of aplastic anemia, patients with severe periodontitis can undergo comprehensive dental treatment, including dental extraction and periodontal surgery, if bleeding and susceptibility to infection are controlled. This requires the cooperation of the patient and hematologists and can ultimately contribute to improving the patient’s quality of life.

Clinical Effect of Combined Periodontal and Pulp Treatment and Pure Periodontal Treatment for Severe Periodontitis

Clinical Effect of Combined Periodontal and Pulp Treatment and Pure Periodontal Treatment for Severe Periodontitis

Clinical Effect and Aesthetic Observation of All-on-4 Immediate Loading Implant Denture in Severe Periodontitis.

Objective To explore the clinical effect and aesthetics of All-on-4 immediate loading implant denture in severe periodontitis. Methods Totally, 60 patients with dentition loss caused by severe periodontitis who were admitted to our hospital from February 2017 to February 2019 were selected. The patients were randomly divided into the observation group (n = 30) and the control group (n = 30) according to different restoration methods. The control group was used in traditional implant restoration treatment, and the observation group was used in All-on-4 immediate loading implant denture restoration. The clinical effect, periodontal index, aesthetic effect, and complications of the two groups were compared, and the levels of serum leptin (LEP), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and interleukin-6 (IL-6) were measured. Results The total effective rate of the observation group (83.33%) was higher than that of the control group (60.00%) (P < 0.05). After treatment, the plaque index, gingival sulcus bleeding index, and depth of exploration of the two groups were lower than those before treatment (P < 0.05), and there was no significant difference between the two groups (P > 0.05). After treatment, the serum LEP, TNF-α, CRP, and IL-6 in both groups were lower than before treatment, and the serum LEP, TNF-α, CRP, and IL-6 in the observation group were lower than that in the control group (P < 0.05). The aesthetic rate of teeth in the observation group (90.00%) was higher than that in the control group (66.67%) (P < 0.05). There was no significant difference in the total incidence of complications between the two groups (P > 0.05). Conclusion All-on-4 immediate loading implant denture has a good effect in the treatment of severe periodontitis, which is conducive to maintaining periodontal health, reducing the level of inflammation, improving aesthetics, and has high safety.

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.

Can treatment of severe periodontitis in patients with ST-segment elevation myocardial infarction improve endothelial function?

Design This is a parallel-group, unicentric, randomised, assessor-blinded, superiority trial with equal allocation ratio to evaluate and compare the effects of periodontal treatment on endothelial function, measured by a flow-mediated dilation of brachial artery, in patients with a recent ST-segment elevation myocardial infarction (STEMI).Study population The study population included a total of 48 patients who were recruited from a hospital in Brazil. Patients who had a recent episode of acute STEMI and also exhibited severe periodontal disease were included, while exclusion criteria included factors like patients who were <30 years old, HIV-positive, had chronic inflammatory or neoplastic diseases, pregnant, significant dental loss (<8 teeth remaining) etc. After seeking consent, patients were randomised to two groups: patients in the intervention group were provided with periodontal treatment while no treatment was given to patients in the control group. Patients were assessed for the primary outcome (flow-mediated dilation [FMD] in the brachial artery), secondary outcomes (periodontal health and inflammatory markers) and other safety outcomes after six months of intervention.Data analysis Data was analysed using the intention-to-treat principle, wherein t-tests and chi-square tests were used to compare baseline variables between groups, while dependent t-test was used for within-group comparisons. The Mann-Whitney test was used to compare cytokine levels from baseline to six-month follow-up. Effect sizes were presented along with their respective p values and confidence intervals. Lastly, a sensitivity analysis was also carried out by taking stringent p values for establishing significance (p = 0.025).Results Statistically significant improvement was seen in FMD values among patients who received periodontal treatment (from 9.0 ± 4.4% at baseline to 12.1 ± 5.6% at follow-up; p = 0.01), while the patients in the control group exhibited a non-significant change in FMD values (from 12.2 ± 7.2% at baseline to 11.9 ± 4.0% at follow-up; p = 0.79). Group difference for observed 'FMD variation' was initially found to be significant (3.4%, CI = 0.6-5.8% and using generalised estimating equation p = 0.03). However, on repeating the analysis by taking stringent p values for establishing significance (p = 0.025), non-significant difference in FMD variation was seen. In the intervention group, all periodontal health parameters significantly improved over a period of six months (p <0.001, for all parameters) while inflammatory markers in both groups exhibited non-significant differences for the study period. No adverse outcomes were reported.Conclusions Treatment of periodontitis among patients with a recent episode of STEMI significantly improves the endothelial function as shown by improved FMD.

Clinical and Radiographic Evaluation of Combined Treatment with Bisphosphonate Plus Platelet-Rich Fibrin versus Platelet-Rich Fibrin Alone for Severe Periodontitis with Furcation Defects

Background: This research assessed the clinical and radiographic evaluation of treatment with PRF plus bisphosphonate, compared to alone PRF in treatment of severe periodontitis with furcation defects. Methodology : This randomized, controlled radiological and clinical study enrolled 50 patients. All patients were given oral health instructions, oral prophylaxis, root planning, and relief of trauma from occlusion. The sites for therapy with PRF and PRF plus bisphosphonate were chosen randomly by the coin toss method. After they had received 6 weeks of presurgical therapy, patients underwent further clinical assessments by using different indices and assessment of level of attachment Radiographic outcomes were bone defect height, defect width, and defect depth; these were used to determine the bone defect volume. Results: This study revealed with positive results in all clinical assessments in the PRF plus bisphosphonate, as compared to PRF alone group with significant p value of less than 0.05. All radiographic parameters showed greater degrees of reduction in the parameters of platelet-rich fibrin plus bisphosphonate group, compared to the platelet-rich fibrin alone group; however, only the defect width of bone and defect volume were statistically significantly reduced in the platelet-rich fibrin plus bisphosphonate group, in comparison to the platelet-rich fibrin. Conclusion: Platelet-rich fibrin plus bisphosphonate therapy was beneficial in regeneration of periodontal ligament and improvement of periodontal status.

Two different antibiotic protocols as adjuncts to one-stage full-mouth ultrasonic debridement to treat generalized aggressive periodontitis: A pilot randomized controlled clinical trial.

To assess the clinical and microbiological responses of amoxicillin + metronidazole (AMX + MET) versus clarithromycin (CLM) as adjuncts to one-stage full-mouth ultrasonic debridement (FMUD) in the treatment of generalized aggressive periodontitis (GAgP). For this parallel, double-masked, pilot randomized clinical trial, 46 patients with GAgP were selected and randomly assigned into two groups: AMX+MET group (n=23): FMUD associated with AMX (500mg three times a day) and MET (400mg three times a day) for 7 days; and CLM group (n=23): FMUD associated with CLM (500mg twice a day) for 7 days. Clinical parameters were evaluated at baseline, 3, and 6 months post-treatment. The levels of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Fusobacterium nucleatum from subgingival biofilm were determined by quantitative polymerase chain reaction. Both treatments significantly improved all clinical parameters compared with baseline and promoted a significant reduction of A. actinomycetemcomitans and P. gingivalis counts (P>0.05). CLM succeeded in decreasing T. forsythia at 6 months (P<0.05), but no antibiotic was able to reduce F. nucleatum. There was no difference between the two protocols regarding the reported adverse effects (P>0.05). The results suggest that CLM is not superior than AMX + MET in the treatment of GAgP. However, this antibiotic led to good clinical outcomes and may be a possible alternative to AMX+MET in the treatment of severe periodontitis in young patients. Future studies with larger sample sizes are needed to confirm this statement (NCT02969928).

The ideal time of systemic metronidazole and amoxicillin administration in the treatment of severe periodontitis: study protocol for a randomized controlled trial

BackgroundThe combination of systemic metronidazole (MTZ) and amoxicillin (AMX) with scaling and root planing (SRP) has shown to be an effective periodontal treatment. However, some essential issues associated with the use of these antibiotics remain unanswered, such as the ideal time of administration during the course of periodontal treatment. Although these agents are often prescribed after the healing phase of the SRP procedure, there is biological plausibility to support its use in conjunction with the mechanical treatment. However, to date, no placebo controlled randomized clinical trial (RCT) has directly compared these two protocols. Therefore, the aim of this RCT is to compare the clinical, microbiological and immunological effects of the adjunctive systemic MTZ + AMX administered in different phases of the treatment of severe periodontitis.MethodsSubjects with severe periodontitis (n = 180) are being randomly assigned into three groups (n = 60/group): (i) SRP-only (control group), SRP in combination with 400 mg MTZ + 500 mg AMX, starting (ii) at the first SRP session (active phase group), or (iii) after 3 months of its completion (healing phase group). All volunteers are receiving clinical and microbiological evaluation at baseline, 3, 6 and 12 months, and immunological assessment at baseline and 12 months post-therapy. Nine subgingival biofilm samples are being collected per subject and analyzed for counts and proportions of 40 bacterial species by checkerboard DNA-DNA hybridization, and six gingival crevicular fluid samples are being collected and analyzed for the levels of 20 chemokines by multiplex immunoassay. The primary outcome variable is the number of volunteers reaching the clinical endpoint for treatment (≤ 4 sites with probing depth ≥5 mm) at 1 year post-therapy. Differences in clinical, microbiological and immunological parameters among groups and over time will be evaluated using analysis of variance, analysis of covariance and the Chi-square and Tukey tests. Microbiological and immunological analyses will be performed using adjustments for multiple comparisons. Statistical significance will be set at 5%.Trial registrationClinicalTrials.gov, NCT02954393. Registered on 3 November 2016.

Treatment of severe periodontitis with a laser and light-emitting diode (LED) procedure adjunctive to scaling and root planing: a double-blind, randomized, single-center, split-mouth clinical trial investigating its efficacy and patient-reported outcomes at 1year.

Broad methodological heterogeneity makes the literature on the clinical effects of laser treatment in periodontitis, both as monotherapy and adjunct to non-surgical therapy, which is difficult to interpret. The present split-mouth study was performed: (i) to determine the efficacy and safety of a photoablative-photodynamic diode laser therapy, including antiseptic LED irradiation, in adjunct to scaling and root planing (iPAPD+SRP) vs. sham-treatment+SRP for the treatment of diffuse severe periodontitis and (ii) to estimate the patient-reported outcomes. Twenty-four patients with severe periodontitis were treated with iPAPD+SRP or sham-treatment+SRP. iPAPD+SRP consisted of the following: (1) intra-/extra-pocket de-epithelization with photoablative λ 810nm laser, (2) disinfection with λ 405nm LED, (3) SRP, and (4) 10 weekly antiseptic/anti-inflammatory photodynamic treatments with λ 635nm laser and 0.1% toluidine blue as photosensitizer. Clinical and cytofluorescent periodontal markers and patient-reported results were analyzed. At 1-year follow-up, both groups showed a significant reduction of several severity markers of periodontitis, namely probing depth (PD) and bleeding on probing (BoP), as well as of bacteria, polymorphonuclear cells, erythrocytes and damaged epithelial cells in exfoliative samples, as compared with day 0. The quadrants subjected to iPAPD+SRP showed significantly better values of these parameters as well as of clinical attachment level (CAL) as compared with those undergoing sham-treatment+SRP. The patients' perceived pain/discomfort, and overall liking was also in favor of the iPAPD+SRP treatment. This study confirms the efficacy of combined phototherapy in adjunct to SRP which had emerged from previous clinical trials, extending its field of application to severe periodontitis.

Adjunctive antimicrobial chemotherapy based on hydrogen peroxide photolysis for non-surgical treatment of moderate to severe periodontitis: a randomized controlled trial

Treatment of severe periodontitis with non-surgical therapy remains challenging in dentistry. The present study aimed to evaluate the clinical efficacy of hydrogen peroxide (H2O2) photolysis-based antimicrobial chemotherapy adjunctively performed with root debridement (RD) for moderate to severe periodontitis. A randomized controlled trial was conducted that included 53 patients with 142 test teeth. The test teeth were randomly assigned to one of three treatment groups: Group 1, RD + H2O2 photolysis; Group 2, RD followed by administration of a local drug delivery system (minocycline chloride gel); or Group 3, RD alone. Clinical and microbiological examination were performed for up to 12 weeks following treatment. Probing pocket depth (PPD) and bleeding on probing (BoP) were improved after each treatment session. At 12 weeks, Group 1 had achieved significantly lower PPDs than the other groups, though there were no significant differences in BoP between Group 1 and the other groups. Counts of Porphyromonas gingivalis, a known periodontal pathogen, in Group 1 were significantly lower than those in Group 3, and were comparable to those in Group 2. Therefore, it is suggested that H2O2 photolysis treatment can be used as a novel adjunctive antimicrobial chemotherapy for non-surgical periodontal treatment.

Regarding the treatment of severe periodontitis

Regarding the treatment of severe periodontitis

Proefschriften 25 jaar na dato 31. Zwartgepigmenteerde mondbacteriën in humane mondinfecties

In 1986, oral microbiology, and especially the microbiology of periodontal infections, was of central importance. Interest in periodontology was growing rapidly and with it, interest in developments in microbiology and the immunology of infectious diseases of the periodontium. At national and international meetings discussions took place concerning the role of the newly discovered bacterial species Actinobacillus actinomycetemcomitans and the role of antibiotics in the treatment of severe periodontitis. Since the 1980s, much has changed in periodontology, not least of all as a result of a new specialism: oral implantology. With it, a new disease also came into existence: peri-implantitis.

Antimicrobial profiles of periodontal pathogens isolated from periodontitis patients in the Netherlands and Spain

Antimicrobial resistance of periodontal pathogens towards currently used antibiotics in periodontics has been investigated in a previous study. Microbial resistance in the periodontal microflora was more frequently observed in Spanish patients in comparison with Dutch patients. The aim of the present study was to compare antimicrobial susceptibility profiles of five periodontal bacteria isolated from periodontitis patients in Spain and in The Netherlands. Subgingival plaque samples from adult patients with periodontitis were collected and cultured on selective and non-selective plates. Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum and Micromonas micros were isolated and used for minimal inhibitory concentration tests using the Epsilometer (E-test) technique. Eight different antibiotics were tested on all bacterial isolates. MIC50 and MIC90 values for each antibiotic and each species were determined and the percentage of resistant strains was calculated. Significantly higher MIC values were noted in Spanish strains of F. nucleatum for penicillin, ciprofloxacin, of P. intermedia for penicillin, amoxicillin and tetracycline, of M. micros for tetracycline, amoxicillin and azithromycin, and of P. gingivalis for tetracycline and ciprofloxacin. Based on breakpoint concentrations, a higher number of resistant strains in Spain were found in F. nucleatum for penicillin, amoxicillin and metronidazole, in Prevotella intermedia for tetracycline and amoxicillin, and in A. actinomycetemcomitans for amoxicillin and azithromycin. Resistance of P. gingivalis strains was not observed for any of the antibiotics tested both in Spain and The Netherlands. Differences exist in the susceptibility profiles of periodontal pathogens isolated from periodontitis patients in Spain and in The Netherlands. This implicates that antibiotic susceptibility testing is necessary to determine efficacy of antimicrobial agents. Also, clinical studies with antibiotics should take these differences into account. The information from the present study indicates that it may not be possible to develop uniform protocols for usage of antibiotics in the treatment of severe periodontitis in the European Union.

Microbiology in diagnosis and treatment planning in periodontics

Periodontitis is considered a multifactorial infectious disease in which bacteria play an essential role. It has become clear that not all patients with periodontitis harbour the same subgingival microflora, and so far, a limited number of species have been recognised as indicators for progression of periodontal breakdown. These findings are the basis for the use of clinical periodontal microbiology. Microbiological information can assist in diagnosis and treatment planning in periodontics, and is essential for the rational use of topical and systemic antimicrobial treatment. Different antimicrobial regimes have been proposed as adjuncts to mechanical periodontal treatment. This article reviews the current knowledge on periodontal microbiology, different techniques to test for marker bacteria and the use of antibiotics in the treatment of severe periodontitis.