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Platelet-rich fibrin (PRF), a second-generation platelet concentrate, has been the focus of intensive research endeavors over the past 2 decades. Over the years, however, numerous reports have inaccurately reported relative centrifugal force (RCF) values, which has caused considerable confusion in the field. Furthermore, the use of trade names such as leukocyte and platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF) has further confused many readers, since studies have not always used centrifugation parameters with equal rotor sizes, angulation of tubes, and/or tube design. This has led to considerable misperception in the report of relative centrifugal force. Herein is described necessary parameters pivotal for the future report of RCF in studies related to PRF, which include: 1) dimensions of the rotor (radius at the clot and end of the tube); 2) rotor angulation for the tube holder; 3) revolutions per minute (RPM) and time; 4) RCF value calculated at either the RCF-minimum, RCF-clot, or RCF-maximum; 5) composition and size of tubes used to produce PRF; and 6) centrifugation model used. This editorial aims to minimize confusion in the field and create more transparent research reporting RCF values in future studies.

BACKGROUND: A broader understanding of the immune inflammatory profile of peri-implant diseases could be helpful in the development of host-targeted preventive and therapeutic strategies. The aim of this study is to answer two clinical questions: 1) whether patients with peri-implantitis (PP) present higher prevalence of any specific inflammatory cytokine in peri-implant crevicular fluid (PICF) compared with healthy patients; and 2) whether local inflammation measured in PICF can be used as a predictor for incipient PP. METHODS: A systematic review of the literature on the most common cytokines released in PICF in healthy and PP-affected sites was conducted from 1996 up to and including October 2013 using predefined search strategies. Cross-sectional and prospective longitudinal studies were considered. Meta-analyses were done separately for healthy, mucositis (MU), and PP outcomes. RESULTS: Interleukin (IL)-1β was the most studied cytokine (n = 12), followed by tumor necrosis factor (TNF)-α (n = 10). Other cytokines were also linked to PP, such as IL-4, IL-6, IL-8, IL-10, IL-12, and IL-17. Statistical differences were revealed when IL-1β release was compared between healthy implant sites and PP (P = 0.001) or MU sites (P = 0.002), respectively; when PP and MU were compared, no statistical differences could be detected (P = 0.80). For TNF-α release, significant differences were found between healthy and PP implants (P = 0.02). CONCLUSIONS: PICF containing inflammatory mediators, such as IL-1β and TNF-α, can be used as additional criteria for a more robust diagnosis of peri-implant infection. Additionally, once the inflammatory process is installed, no differences were found between peri-implant MU and PP. ispartof: Journal of Periodontology vol:86 issue:5 pages:631-645 ispartof: location:United States status: published

Background: Only recently the concept of prebiotics has been introduced in oral health. Few potential oral prebiotics have already been identified in dual species competition assays, showing a stimulatory effect on beneficial bacteria and by this suppressing the outgrowth of pathogenic species. This study aimed to validate the effect of previously identified potential prebiotic substrates on multispecies cultures by shifting the biofilm composition towards a more beneficial species dominated microbiota. Methods: A chemostat culture containing 14 model oral bacterial species was used to grow biofilms for 24 hours which subsequently were treated with prebiotic solutions three times a day for 3 consecutive days. Further the influence of environmental factors such as pH, nutrient availability, oxygen concentration and prebiotic dose on the efficacy of the prebiotic substances was investigated. Results: Three potential prebiotic substrates N-acetyl-D-mannosamine, succinic acid and Met-Pro were able to bring the beneficial proportion to > 95%. While the pH of the prebiotic solution did not have an influence on the prebiotic effect, the interplay of nutrient availability, oxygen concentration and prebiotic treatment resulted in significant changes of the microbial composition identifying N-acetyl-D-mannosamine as the most promising oral prebiotic substrate. Showing a clear dose dependent effect, concentrations of N-acetyl-D-mannosamine of 1.0 and 1.5 M resulted in a biofilm composition of 97% beneficial species. Conclusion: Introducing the prebiotic concept in oral health might reveal a valid approach for treatment and prevention of oral diseases and promote oral health.

BACKGROUND: There has been an explosion in research into possible associations between periodontitis and various systemic diseases and conditions.AIM: To review the evidence for associations between periodontitis and various systemic diseases and conditions, including chronic obstructive pulmonary disease (COPD), pneumonia, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer, and to document headline discussions of the state of each field. Periodontal associations with diabetes, cardiovascular disease and adverse pregnancy outcomes were not discussed by working group 4.RESULTS: Working group 4 recognized that the studies performed to date were largely cross-sectional or case-control with few prospective cohort studies and no randomized clinical trials. The best current evidence suggests that periodontitis is characterized by both infection and pro-inflammatory events, which variously manifest within the systemic diseases and disorders discussed. Diseases with at least minimal evidence of an association with periodontitis include COPD, pneumonia, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer. The working group agreed that there is insufficient evidence to date to infer causal relationships with the exception that organisms originating in the oral microbiome can cause lung infections.CONCLUSIONS: The group was unanimous in their opinion that the reported associations do not imply causality, and establishment of causality will require new studies that fulfil the Bradford Hill or equivalent criteria. Precise and community-agreed case definitions of periodontal disease states must be implemented systematically to enable consistent and clearer interpretations of studies of the relationship to systemic diseases. The members of the working group were unanimous in their opinion that to develop data that best inform clinicians, investigators and the public, studies should focus on robust disease outcomes and avoid surrogate endpoints. It was concluded that because of the relative immaturity of the body of evidence for each of the purported relationships, the field is wide open and the gaps in knowledge are large.

In the past few decades, more patients have been treated orthodontically, but no longitudinal study has compared orthodontic bands and brackets microbiologically and clinically.This longitudinal trial (split-mouth design) included 24 patients. Microbiology (sub- and supragingival), probing depth (PD), bleeding on probing (BOP), and gingival crevicular fluid flow (GCF) were assessed at baseline (band placement) and at weeks 18 (bracket bonding) 20, 24, and 36. A statistical comparison was made over time and among the banded, bonded, and control sites.The aerobe/anaerobe ratio of sub- and supragingival colony forming units decreased significantly (relatively more anaerobes) over the study period for the banded and bonded sites (P0.001). This decrease was accompanied by significant elevations in PD, BOP, and GCF. These changes occurred faster after bonding compared to banding. No significant changes were observed 18 weeks after banding with the exception of increased PD (P0.001). At week 36, all microbial and clinical variables at the bonded site had changed significantly in the negative direction (P0.001) compared to week 18. The control sites did not show any significant changes over time, indicating that the effects were localized.The placement of fixed orthodontic appliances had a significant impact on microbial and clinical variables. The changes occurred faster at the bonded sites compared to the banded sites, probably because wire insertion caused difficulties in approximal cleaning. Over the long term, banding did not lead to more adverse microbial and periodontal effects than bonding.

Morning breath odor is an often-encountered complaint. This double-blind, crossover, randomized study aimed to examine the bad breath-inhibiting effect of 3 commercially available mouthrinses on morning halitosis during an experimental period of 12 days without mechanical plaque control.Twelve medical students with a healthy periodontium refrained from all means of mechanical plaque control during 3 experimental periods of 12 days (with intervening washout periods of at least 3 weeks). A professional oral cleaning preceded each period. During each experimental period, as the only oral hygiene measure allowed, the students rinsed twice a day with one of the following formulations in a randomized order: CHX-Alc (a 0.2% chlorhexidine [CHX] solution); CHX-NaF (CHX 0.12% plus sodium fluoride 0.05%); or CHX-CPC-Zn (CHX 0.05% plus cetylpyridinium chloride 0.05% plus zinc lactate 0.14%). After 12 days, morning breath was scored via volatile sulfur compound (VSC) level measurements of the mouth air and organoleptic ratings of the mouth air, the expired air, and a scraping of the tongue coating. At the 12-day visit, a questionnaire (subjective ratings) was completed and samples taken from both the tongue coating and the saliva for anaerobic and aerobic culturing and vitality staining. The de novo supragingival plaque formation was also recorded. All parameters were correlated with the baseline registrations.Although oral hygiene during the 3 experimental periods was limited to oral rinses, bad breath parameters systematically improved, with the exception of a slight increase in VSC levels while using CHX-Alc, a finding which was associated with the direct influence of the CHX on the sulfide monitor. The oral microbial load after the use of CHX-NaF remained unchanged, while for the CHX-Alc and CHX-CPC-Zn, significant reductions in both aerobic and anaerobic colony forming units (CFU)/ml were noticed in comparison with baseline data for both tongue coating and saliva samples. The composition of microflora, on the other hand, did not reveal significant changes. The supragingival plaque formation was inhibited, in descending order, by CHX-Alc, CHX-CPC-Zn, and CHX-NaF. The subjective scores for the rinses indicated a higher appreciation for CHX-CPC-Alc and CHX-NaF because of a better taste and fewer side effects.The results of this study demonstrate that morning halitosis can be successfully reduced via daily use of mouthrinses. CHX-Alc and CHX-CPC-Zn mouthrinses result in a significant reduction of the microbial load of tongue and saliva.

Impaction of front teeth (often upper canines) can result in esthetic, functional, and phonetic problems, in addition to root resorption and chronic or acute infections. Most impacted front teeth can be extruded orthodontically after minor periodontal surgery. The purpose of this retrospective study was to examine the periodontal outcome of surgically exposed and orthodontically extruded impacted teeth compared with the spontaneously erupted contralateral teeth.A total of 38 patients, who had been treated by a combined surgical and orthodontic approach (closed eruption technique by same periodontist and 2 associated orthodontists), underwent a periodontal re-examination after 4 to 10 years. Periodontal parameters (plaque and gingivitis indices, probing depth, bleeding on probing, gingival recession and width, bone level, and root resorption) of the orthodontically extruded teeth (test) were scored and compared with those of the contralateral naturally erupted teeth (control) in a masked set-up.No significant differences could be detected between test and control teeth, except for the gingival width, which was 1 mm larger for the spontaneously erupted teeth.The data indicate that orthodontic extrusion of impacted front teeth does not jeopardize their periodontal health. This procedure appears to be a satisfactory alternative to extraction and/or transplantation.

The present study compared 2 different methods (direct versus indirect evaluation) for the quantification of the adhesion of Porphyromonas gingivalis strains to in vitro cultured mono-layers of pocket epithelium.The indirect culture viability assay (calculation of colony forming units) was compared to a direct microscopic evaluation using a novel fluorescent stain. The fluorescent kit was found to stain both bacteria and epithelial cells and enabled a differentiation between dead and living cells.Comparing the visual to the culture data, a high and significant correlation was found (Pearson's correlation = 0.75; P0.001). The adhesion capacity was in general higher for dead epithelial cells than for living cells (P0.01). Although comparable numbers of bacteria of 2 P. gingivalis strains (Pg 4 and Pg 5) were applied, Pg 4 showed a significantly lower adhesion capacity. This intra-strain variability was observed by the culture assay (2.3 x 10(6) versus 7.8 x 10(6)+/-2.7 x 10(6); P0.01) and by the direct microscopy (P0.01) for both live and dead epithelial cells. A second goal was to see whether there was a difference in the amount of bacterial adherence to mono- and multi-layers of in vitro cultured epithelium. No significant differences were found for the 5 examined P. gingivalis strains. However, interstrain differences in adhesion capacity were evident for both tissues.This study highlights the reproducibility of a direct microscopic evaluation of bacterial adhesion to in vitro cultured epithelial cells, and suggests both intrastrain (P. gingivalis) and inter-cell (live versus dead) variation in adhesion capacity. Studies are needed to determine the extent to which P. gingivalis strain variation is reflected in variation of other strains in humans.

Recent studies showed the clinical benefits of a one stage full-mouth disinfection, when compared to the worldwide standard treatment strategy of consecutive root planings per quadrant without proper disinfection of the remaining intraoral niches. The purpose of this study was to investigate the microbiological benefits of such a one stage full-mouth disinfection with special attention to all intraoral niches for periodontopathogens and to evaluate the perception by the patients of the new treatment strategy.Sixteen patients with early-onset periodontitis and 24 patients with severe adult periodontitis were randomly assigned to test and control groups. The control group was scaled and root planed, per quadrant, at 2-week intervals and given oral hygiene instructions. The test group received the one stage full-mouth disinfection treatment. At baseline and after 1, 2, 4, and 8 months, microbiological samples were taken from all niches (tongue, mucosa, saliva, and pooled samples from single- and multi-rooted teeth). The samples were cultured on selective and non-selective media. Patient perception of the treatment was evaluated using a questionnaire.In comparison to the standard therapy, the one stage full-mouth disinfection resulted in significant additional microbial improvements. The test group showed larger reductions in the proportions of spirochetes and motile organisms in the subgingival flora, and more significant reductions in the density of key pathogens, with even the eradication of P. gingivalis. The beneficial effects in the other niches were primarily restricted to the number of colony-forming units/ml of black-pigmented bacteria, especially on the mucosa and in the saliva and to a lesser extent on the tongue. Both treatments were well tolerated by the patients and the overall severity rating for both therapies was comparable, although 4 quadrants were treated within 24 hours in the test group versus only 1 in the control group. The full-mouth disinfection approach resulted more frequently in a slight increase of body temperature, especially after the second day.These findings support the benefit of a one stage full-mouth disinfection in the treatment of patients with either chronic adult or early-onset periodontitis.

Oral malodor affects a large proportion of the population and may be the cause of a significant social and psychological handicap. This pilot study aimed to examine whether a 1-stage full-mouth disinfection in periodontitis patients (scaling and root planing of all pockets within 24 hours together with the application of chlorhexidine to all intra-oral niches followed by chlorhexidine mouth rinsing for 2 months) resulted in a significant improvement in malodor when compared to a fractionated periodontal therapy (consecutive root planings per quadrant, at a 1 to 2 week interval). The baseline and outcome data concerning oral malodor were linked to the presence of tongue coating and to its roughness (fissures). Twenty-four patients with severe periodontitis were randomly allocated to test and control groups. At baseline and after 1 and 2 months, the concentration of volatile sulfur compounds (VSC) in the mouth was measured and organoleptic ratings (expired air and total mouth air) were given. Plaque samples were collected from the dorsum of the tongue to calculate the number of colony forming units (CFU) per ml (anaerobic culturing) as well as the number of pigmented CFU/ml. Both the baseline organoleptic ratings and the VSC scores correlated well with the presence of tongue coating but not with the tongue roughness. Because a correlation between tongue coating and its microbial load could not be detected, it was hypothesized that the tongue coating per se, and not the bacteria, might be responsible for the malodor. The 1-stage full-mouth disinfection resulted in a faster and additional reduction in the organoleptic ratings of the oral malodor, even after 2 months. This might be explained by the improved periodontal outcome and/or the more significant reduction in the CFU/ml of pigmented species. In contrast to the organoleptic ratings, which were significantly reduced in both treatment groups (when compared to baseline), the VSC levels remained unchanged. This pilot study indicates that a 1-stage full-mouth disinfection has, in comparison to a standard periodontal therapy, additional beneficial effects in the treatment of oral malodor.

The purpose of this study was to evaluate the safety and clinical efficacy of controlled-release tetracycline-containing fibers in patients with refractory periodontitis versus the preceding classical treatment. One hundred twenty-one sites in 20 patients were followed from baseline to 6 months after fiber insertion. Each selected site was > or = 5 mm deep and bled on probing. All 20 patients had at least one site > or = 7 mm which bled on probing. Those pockets remained after intense and repeated conventional therapy (scaling and root planing and often surgery), often including the use of systemic antibiotics. This treatment period, the so-called control period, preceded the experimental period by at least 3 years, when the fibers were placed. Both treatments (in control and test period) were performed in the Department of Periodontology at the University Hospital in Leuven. At the start of the experimental period, all pockets > or = 5 mm were treated by the placement of fibers impregnated with 25% tetracycline. The fibers were removed after 10 days. Probing depth, clinical attachment level, gingival recession, and bleeding on probing were recorded at baseline, and at 1, 3, and 6 months following treatment. Analysis of data from all sites indicated that a significant decrease in probing depth and gain in attachment were present at all follow-up visits. The mean probing depth reduction for sites > or = 7 mm was 3.2 mm at month 6, with a gain in attachment of 2.7 mm, while this was -1.0 mm and -1.9 mm, respectively, during the preceding control period. The fraction of bleeding pockets was reduced from 77% to 27% and from 80% to 77% during the experimental and control periods, respectively. No significant adverse side-effects were observed, except for a transient redness at fiber removal in 2 sites. Fiber insertion appeared to be time-consuming even when the operator was familiarized with the procedure. The results of this study prove that tetracycline-impregnated fibers can reduce probing depth significantly for a period of 6 months in patients not responding to thorough and repeated classical periodontal treatment.

A classical treatment for chronic adult periodontitis consists of four to six consecutive sessions of scaling and root planing at a 1- to 2-week interval. Such a so-called "quadrant or sextant therapy" might result in a reinfection of a previously disinfected area by bacteria from an untreated region. The purpose of this study was to investigate, over an 8-month period, the clinical benefits of full-mouth disinfection within a 24-hour period in the control of chronic periodontitis. Ten adult patients with advanced chronic periodontitis were randomly assigned to a test and a control group. The control group received the standard scheme of initial periodontal therapy, consisting of scaling and root planing of the four quadrants was performed within 24 hours and immediately followed by a thorough supra- and subgingival chlorhexidine application to limit any transfer of bacteria. The latter involved tongue brushing with a 1% chlorhexidine gel for 60 seconds, mouthrinsing with a 0.2% chlorhexidine solution twice for 60 seconds, repeated subgingival irrigation of all pockets with a 1% chlorhexidine gel (3 times within 10 minutes), and mouthrinsing twice daily with a 0.2% chlorhexidine solution during 2 weeks. In addition, both groups received thorough oral hygiene instructions. The plaque index, gingival index, probing depth, gingival recession, and bleeding on probing were recorded prior to professional cleaning and at 1, 2, 4, and 8 months afterwards. Although the test group scored higher plaque indices than the control group, especially at months 2 and 4, the gingival index and bleeding tendency showed similar improvements with time. However, when the gingival/plaque ratio was considered, the latter was lower in the test group at all follow-up visits. For pocketsor = 7 mm, full-mouth disinfection showed a significantly (P = 0.01) higher reduction in probing depth at each follow-up visit with, at month 8, a reduction of 4 mm (from 8 mm to 4 mm), in comparison to 3 mm (from 8 mm to 5 mm) for the classical therapy. The increase in gingival recession in the full-mouth disinfection group remained below 0.7 mm, while in the control group it reached 1.9 mm after 8 months. This resulted in a gain of clinical attachment level of 3.7 mm for the test group versus 1.9 mm for the control group. A radiographical examination also indicated a superior improvement for the test group when compared to the control group. This pilot study suggests that a full-mouth disinfection in one day results in an improved clinical outcome in chronic periodontitis as compared to scalings per quadrant at 2-week intervals over several weeks.

The sterile abutments of 2-stage implants offer a unique model to study intraoral transmission and bacterial colonization patterns in the oral cavity. This study aimed to examine, by means of differential phase contrast microscopy, parameters that influence the intra-oral colonization of these abutments. In part one, 159 partially edentulous patients were examined to determine the influence on the microbial composition around implants of the following parameters: 1) the relative location of the teeth in relation to the implants; 2) the microbial composition of the subgingival plaque around these teeth; and 3) the frequency of deep pockets around the natural dentition. The results indicate that the subgingival flora around the implants harbored more spirochetes and motile rods when teeth were present in the same jaw (P0.05) and/or when the pockets around them harbored a pathogenic flora (P0.05). In part two, the impact of periodontitis around the remaining teeth and of probing depth around the implants on the composition of the peri-implant subgingival flora was investigated. Thirty-one partially edentulous implant patients were classified according to their periodontal condition into 3 groups: healthy (n = 17), chronic periodontitis (n = 11), and refractory periodontitis (n = 3). The samples from deep pockets (or = 4 mm) around implants showed significant increases in the total proportion of spirochetes and motile organisms when compared to samples from healthy subjects (1.2%) or in chronic periodontitis patients (21.0%), or to patients suffering from refractory periodontitis (31.5%). For shallow pockets (4 mm) significant differences were only detected between subjects with a healthy periodontium (1.0%) or chronic periodontitis (2.4%), and refractory periodontitis cases (19.7%). The present findings confirm the transmission of microorganisms from teeth to implants, and thereby highlight the importance of periodontal health around the natural dentition before as well as after implant installation.

The influence of surface free energy on supra- and subgingival plaque microbiology was examined in 9 patients with functional fixed prostheses supported by endosseous titanium implants. Two abutments (trans-mucosal part of the 2 stage implant) were replaced by either a new titanium abutment or a fluor-ethylene-propylene (FEP) coated abutment per subject. After 3 months of habitual oral hygiene, plaque samples were taken. Supragingival plaque was examined by means of differential phase-contrast microscopy, whereas for the subgingivial plaque additional analyses (DNA probes analysis, culturing) were performed. The subgingival samples were taken by paper-points and by scraping of the subgingival abutment surface. Differential phase-contrast microscopy showed a significant difference in plaque composition, especially when supragingival plaque was considered (P = 0.05). FEP coated abutments frequently harbored more coccoid microorganisms, whereas spirochetes or motile organisms were only detected around titanium abutments. Subgingivally, the number of colony forming units (CFU) in paper-points was comparable for both types of abutments. If the to-the-abutment-adhering plaque was considered, the number of CFU was 5 times higher on the titanium abutments than on the FEP coated abutments. However, this difference did not reach a statistical level of significance (P = 0.38). The DNA probe analysis of the subgingival plaque collected with paper-points showed a slightly higher frequency and concentration of perio-pathogens around the titanium abutments. However, the inter-substratum differences were smaller than the inter-subject differences. The latter seemed to be related to patient's dental status.(ABSTRACT TRUNCATED AT 250 WORDS)

Enamel matrix derivative (EMD) is commonly used in periodontal therapy. The aim of this systematic review is to give an updated answer to the question of whether the additional use of EMD in periodontal therapy is more effective compared with a control or other regenerative procedures.A literature search in MEDLINE (PubMed) for the use of EMD in periodontal treatment was performed up to May 2010. The use of EMD in treatment of intrabony defects, furcations, and recessions was evaluated. Only randomized controlled trials with ≥1 year of follow-up were included. The primary outcome variable for intrabony defects was the change in clinical attachment level (CAL), for furcations the change in horizontal furcation depth, and for recession complete root coverage.After screening, 27 studies (20 for intrabony defects, one for furcation, and six for recession) were eligible for the review. A meta-analysis was performed for intrabony defects and recession. The treatment of intrabony defects with EMD showed a significant additional gain in CAL of 1.30 mm compared with open-flap debridement, EDTA, or placebo, but no significant difference compared with resorbable membranes was shown. The use of EMD in combination with a coronally advanced flap compared with a coronally advanced flap alone showed significantly more complete root coverage (odds ratio of 3.5), but compared with a connective tissue graft, the result was not significantly different. The use of EMD in furcations (2.6 ± 1.8 mm) gave significantly more improvement in horizontal defect depth compared with resorbable membranes (1.9 ± 1.4 mm) as shown in one study.In the treatment of intrabony defects, the use of EMD is superior to control treatments but as effective as resorbable membranes. The additional use of EMD with a coronally advanced flap for recession coverage will give superior results compared with a control but is as effective as a connective tissue graft. The use of EMD in furcations will give more reduction in horizontal furcation defect depth compared with resorbable membranes.

This multicenter prospective study on the use of an implant system involved 9 centers and reports on the periodontal aspects after 3 years of observation. A total of 558 implants in 159 patients with 197 bridges all independent from natural teeth were originally included. Because of failures and patient withdrawals the number of implants was reduced to 460 and bridges to 174. The cumulative success rate for implants, starting from implant placement, is 94.3% after 2 years and 93.9% after 3 years indicating a leveling of implant loss. Failures concentrated in patients with a high plaque index. The loss of marginal bone was during the second and third years only 0.03 mm per year as an average while it was 0.4 mm during the first year. There were no reports of intense gingival inflammation in any of the patients and the plaque and gingivitis index behaved similarly around abutments and teeth. The probing pocket depth was significantly reduced over the observation time. The resistance towards marginal bone loss around these implants confirms the previous studies on fully edentulous patients.

This study aimed to compare, in vivo, a conventional pocket probe with an automatic, computerized, constant force, electronic probe with a discrimination ability up to 0.1 mm. Sixteen adults with moderate chronic periodontitis and free of supra- and subgingival calculus participated in this study. Eight patients were examined by 2 investigators who used both the conventional and the automatic probes, for a total of 4 probings per subject. The remaining 8 patients were examined 4 times by investigator 1, twice with each probe. For each patient the Ramfjord teeth were examined and 6 sites were considered per tooth. Although the pocket depth measurements recorded by the manual probe were consistently deeper than those of the electronic probe, a good correlation was found between both recordings. Moreover, intra- and inter-examiner comparisons showed comparable standard deviations for both probes and small differences in absolute scores. The conventional probe was slightly more reproducible whereas the automated probe had the advantage of automatic registration. The results indicate that both probes can be considered as valuable in clinical practice.

Since smoking is an established risk factor for the development of periodontitis, the present study investigated whether nicotine and cotinine can make epithelial cells more prone to colonization by periodontopathogens.Primary epithelial cell mono-layers were inoculated with nicotine and cotinine prior to adhesion experiments with Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. The number of bacteria associated with cells inoculated or not with nicotine or cotinine were assessed by an indirect culture viability assay. The same experimental set-up was used for assessing HeLa cells exposed to cigarette smoke extract (CSE).Primary epithelial cells inoculated with concentrations of nicotine and cotinine, found in smokers and non smokers, did not show significant differences (P0.05) in colonization susceptibility to A. actinomycetemcomitans. When these concentrations were increased to 1 mg/ml, a significant (P0.05) and species-specific effect of the colonization susceptibility of epithelial cells was observed: It increased for A. actinomycetemcomitans, while it decreased for P. gingivalis. For both species the effects were more pronounced for nicotine, although this was not statistically significant. The change in colonization susceptibility did not result from alterations of the bacterial viability due to nicotine or cotinine. Treatment of HeLa cells with CSE also led to a species-specific variation in colonization tendency; i.e., increased for A. actinomycetemcomitans (P0.05), but not for P. gingivalis.The susceptibility of epithelial cells to become colonized by either A. actinomycetemcomitans or P. gingivalis could be altered by nicotine, cotinine, or CSE in a time-dependent, species-specific manner. Whether these findings that support the hypothesis of an increased patient susceptibility for bacterial adhesion to epithelial cells in smokers are clinically relevant remains to be proven.

To investigate the possible role of beta-defensins in gingival health and periodontal disease, we examined the effect of several stimuli on the expression of interleukin-8 (IL-8), human beta-defensin-1, -2, -3, and -4 (hBD) in primary human diseased gingival epithelial (HGE) cell cultures from periodontitis patients by quantitative TaqMan reverse transcription polymerase chain reaction (RT-PCR).Several strains of the periodontopathogens Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis were added to the cells, as well as the oral commensal bacteria Fusobacterium nucleatum and Escherichia coli. The induction by the proinflammatory stimuli phorbol 12-myristate 13-acetate (PMA) and tumor necrosis factor-alpha (TNF-alpha) was also tested.In addition to the published observations (PMA induces hBD-2 and -4; TNF-alpha induces hBD-2 and -3), it was found that PMA can upregulate hBD-1 and hBD-3, whereas TNF-alpha can induce hBD-4. The commensal bacteria were significant inducers of hBD-2, hBD-3, and IL-8. The pathogen P. gingivalis induced hBD-1 and hBD-3 at different time points than the commensals, but no induction of IL-8 and hBD-2 could be observed. These data fit with the chemokine paralysis theory. A correlation was found between the pathogenicity of different serotypes of A. actinomycetemcomitans and the induction profiles of defensins and IL-8.The results suggest that a correlation can be found in diseased oral epithelium between the defensin profiles that are induced and the pathogenicity of the oral bacterial strains.

Bad breath is often caused by periodontitis and/or tongue coating. This study followed the impact of initial periodontal therapy on several halitosis-related outcome variables over a 6-month period. Organoleptic ratings are often uncomfortable for the patient and have several disadvantages. They are, for instance, influenced by external parameters (e.g., food intake and cosmetics) and need to be calibrated among researchers worldwide. A second aim was to evaluate the reliability of saliva incubation as an in vitro indirect test for breath recording.In this double-blind, randomized, medium-term, parallel study 45 moderate periodontitis patients without obvious tongue coating were enrolled. Besides a one-stage, full-mouth disinfection and oral hygiene improvement (including daily tongue scraping), patients were instructed to rinse daily for 6 months with one of the following products (randomly allocated): chlorhexidine (CHX) 0.2% + alcohol, CHX 0.05% + cetyl pyridinium chloride (CPC) 0.05% without alcohol (a new formulation), or a placebo solution. At baseline and 3 and 6 months, a series of parameters were recorded including: concentration of volatile sulfide compounds (VSC), tongue coating, and an estimation of the microbial load (at anterior and posterior parts of the tongue, saliva, dental plaque). The intraoral VSC ratings were compared to in vitro VSC recordings and organoleptic evaluations of the headspace air from 1 and 2 hours incubated saliva (0.5 ml, 37 degrees C, anaerobic chamber).Even though the initial VSC values were not high (+/-90 ppb with only 18 patients revealing more than 100 ppb), significant (P0.05) reductions could be achieved in the CHX and CHX + CPC group, and to a lower extent in the placebo group (P = 0.10). Tongue scraping resulted in a significant reduction (Por =0.05) of the tongue coating up to month 6 in the placebo and CHX + CPC group, but not in the CHX group (confusion due to staining). The CHX and CHX + CPC group showed, in comparison to baseline, significant (P0.001) reductions in the number of anaerobic species in the supragingival plaque, in the saliva, and on the anterior part of the tongue. For the posterior part of the tongue the microbial changes remainedor =0.3 log values (P0.05). For the placebo group, the microbial changes never reached a level of significance (or =0.3 log values). A strong correlation was found between the intraoral VSC ratings and the 1-hour (r = 0.48, P0.0001; r = 0.54, P = 0.0003 for baseline data only) and 2-hour (r = 0.43, P0.0001) VSC production of incubated saliva. The latter also correlated very strongly (r = 0.71) with the number of anaerobic species in the saliva. The VSC values and organoleptic ratings of the incubated saliva also correlated strongly with each other (r = 0.64 for 1-hour and 0.73 for 2-hour incubation).The results of this study indicate that in patients with moderate periodontitis, initial periodontal therapy including tongue scraping did not have a significant effect on the microbial load of the tongue and had only a weak impact on the VSC level, except when combined with a mouthrinse. Saliva incubation can be used as an indirect way to score breath odor. It offers simplicity, objectivity, and is less invasive.

937 Background: Breath odor is scored by different techniques, each with its own shortcomings. Organoleptic ratings are uncomfortable for the patient, subjective, influenced by external parameters including food and cosmetics, and especially lack international calibration. Portable sulphide monitors are relatively expensive and neglect several major malodorous molecules (e.g., butyric and propionic acids, putrescine, and cadaverine). Gas chromatography necessitates expensive devices and experienced technicians. This pilot study explored the applicability of a new technique (saliva incubation) by comparing its discrimination power, in a morning bad breath inhibition study of antiseptics, to those of hydrogen sulphide (H2S) measurement devices and organoleptic ratings. Methods: After a professional cleaning, 8 periodontally healthy students abstained from all means of mechanical plaque control for 5 experimental periods of 7 days, with intervening washout periods of at least 2 weeks. During each experimental period, the students rinsed only twice daily with different antiseptics. At day 7, morning breath was scored clinically (volatile sulphide compound [VSC] level and organoleptic ratings), and 1.5 ml of saliva was collected and divided between 3 glass tubes that were sealed and incubated (37°C, anaerobic chamber). Immediately after collection and after 3 and 6 hours of incubation, the headspace air in one of the tubes was examined for VSC production and organoleptic measurements. Results: The investigations of the incubated saliva correlated well with the 7-day intraoral VSC recordings and organoleptic ratings (P ≤0.005). Moreover, evaluations showed a similar interproduct ranking for their efficacy in malodor control. The power analyses indicated a higher discrimination power for the saliva incubation test than for the intraoral registrations. Conclusions: The strong correlation between odor production of incubated saliva and clinical assessments suggests that the saliva incubation test may be used as an indirect method to measure oral malodor and can be employed to investigate the antimalodor effectiveness of oral hygiene products. J Periodontol 2003;74:937-944.

Implants replacing missing teeth provide advantages over clinical orthodontic treatment as compensation for reaction forces is no longer necessary and the lack of teeth is immediately resolved.A total of 38 two-stage implants were inserted (16 in maxilla, 22 in mandible) in 10 partially edentulous patients with orthodontic problems. Osseointegration and marginal bone levels were assessed via intra-oral radiographs taken at the abutment stage and at the completion of the orthodontic treatment and also via probing depth, measurement of recession toward the implant/abutment (I/A) interface, and sulcus bleeding index, recorded after completion of orthodontic treatment.In the maxilla, the cumulative survival rate was 87.1% after 2 years; for the mandible, it remained 100%. Mean amount of bone loss was 1.6 mm for maxilla and 0.8 mm for mandible. No correlation could be found between directions of orthodontic forces and marginal bone loss. Mean percentage of bleeding sites was 38.5% and 25%, respectively, for implants in the maxilla and mandible. Attachment level was 1.2 mm (SD: 1.2) below I/A interface after completion of the orthodonic treatment.No significant marginal bone loss was present. Using implants during orthodontics can result in an easier and more predictable treatment. J Periodontol 2004;75:176-181.

Periopathogens and cariogenic species survive more than 48 hours on toothbrushes even under dry storage. This study examined a decontamination of toothbrushes by means of the bactericidal effect of different toothpastes or a special coating of the tufts.Eight untreated periodontitis patients were professionally brushed, using a new toothbrush per quadrant and 3 different toothpastes containing either amine/stannous fluoride (AmF/SnF2), amine fluoride (AmF), or a mild surfactant as major antibacterial component (excipient), or no paste (C). The brushes were rinsed and stored dry at room temperature. At different time intervals, 4 tufts per toothbrush were processed for selective and non-selective culturing procedures. The protocol was repeated comparing AmF/SnF2 and C with 2 toothbrushes with coated tufts (coat1 and coat2).At baseline, C brushes (n = 16) harbored 10(7), 10(8), and 10(6) colony forming units (CFU) of aerobic, anaerobic, and black pigmented species, respectively. After 24 hours 10(6) CFU of aerobic and anaerobic species could still be cultured from 14 of the 16 brushes. Black-pigmented species remained detectable up to 4 hours; detection frequencies for Fusobacterium nucleatum and Streptococcus mutans at 24 hours were 5/16. With AmF/SnF2 and AmF toothpaste the number of adhering bacteria was already 2 log lower at baseline (P0.05), but not for the excipient (0.5 log, P = 0.7). With AmF/SnF2 no vital species could be detected after 8 hours. AmF reduced the bacterial survival rate significantly more than the excipient, but less than AmF/SnF2 (P0.05). The bactericidal effect of coat1 and coat2 was negligible when compared to C (P0.20), and clearly inferior to the AmF/SnF2 paste (P0.0001). After 24 hours these brushes still harbored10(5) CFU.Toothpastes can significantly reduce contamination of toothbrushes, but their bactericidal activity is dependent on their composition. Coated tufts failed to limit the bacterial contamination.

Recent studies reported significant, additional clinical and microbiological improvements when severe adult periodontitis was treated via the one-stage full-mouth (OSFM) disinfection approach, instead of a standard treatment scheme with staged instrumentation per quadrant. The OSFM disinfection involves dealing with the remaining oropharyngeal niches such as tonsils, saliva, tongue, and mucosa. The OSFM disinfection procedure involves scaling and root planing of all pockets within 24 hours in combination with chlorhexidine application to all oropharyngeal niches (chairside and at home for 2 months). This study aimed to compare the microbiological shifts with the OSFM approach versus standard therapy.Nineteen patients with advanced chronic periodontitis (AP) and 12 patients with early-onset periodontitis (EOP) were randomly assigned to the test and control groups. The control group (9 AP patients, 6 EOP patients) was scaled and root planed, per quadrant, with 2-week intervals. The test group (10 AP patients and 6 EOP patients) underwent OSFM disinfection treatment. At baseline and after 2, 4, and 8 months, pooled subgingival plaque samples were taken from single- and multi-rooted teeth. The presence and levels of 30 subgingival taxa were determined using whole genomic DNA probes and checkerboard DNA-DNA hybridization.Both treatments resulted in important reductions of the pathogenic species up to 8 months after therapy, both for their detection level and frequency. The OSFM disinfection resulted in an additional improvement, especially in the AP group. P. gingivalis and B. forsythus were reduced below detection level. The number of beneficial species remained nearly unchanged.The OSFM disinfection results in supplementary reductions of periodontal pathogens even after 8 months in the treatment of patients with advanced or early-onset periodontitis.

In order to study inter-individual differences in bacterial adhesion/invasion of periodontal tissues, an in vitro model for culturing multi-layered pocket epithelium without feeder layers or stromal equivalents (including the evaluation of their cytokeratin profiles) was developed.Pocket epithelium was collected and grown until confluent in Falcon flasks using keratinocyte-serum free medium (KSFM), without a feeder layer. In the second passage, oral keratinocytes were re-grown in a 2 compartment system using either a clear polyester (transwell-clear [TCL]) or a collagen (transwell-col [TCO]) membrane as culture surface. After the first week, the calcium concentration was raised to 1.2 mM and in half the wells, the KSFM was supplemented with 10% fetal calf serum (FCS). Histology and immunohistochemistry were performed after 1, 2, and 3 weeks of additional growth.In general, all conditions resulted in a structured epithelium consisting of 3 to 5 layers, but important differences were observed between the membrane types and between the media. CK4 was rarely and only lightly expressed while CK18 and 19 (characteristic of junctional epithelium) were very strongly expressed in the older (2 and 3 weeks) cultures. CK13 and 14 (characteristic of any stratifiable epithelial cell) also tended to increase over time; CK13 seemed to be stronger in KSFM with FCS while the contrary was true for CK14. The multi-layer created by the combination TCL/KSFM + 10% FCS resembled a junctional epithelium most, while that grown on TCO without FCS mimicked the sulcular epithelium.It seems possible to create a histiotypic culture resembling either periodontal pocket or junctional epithelium without the use of stromal equivalents or feeder layers which make this approach more cumbersome. This multi-layered culture offers a model to investigate the permeability of pocket epithelium and the adhesion and penetration of bacteria under well-defined environmental conditions.

A standard treatment strategy for periodontal infections often consists of 4 consecutive sessions of scaling and root planing (per quadrant, at 1- to 2-week intervals), without proper disinfection of the remaining intra-oral niches for periodontopathogens. This could theoretically lead to a reinfection of previously disinfected pockets by bacteria from an untreated region/niche. This study aimed to investigate, over an 8-month period, the clinical benefits of a one stage full-mouth disinfection in the control of severe periodontitis.Sixteen patients with early-onset periodontitis and 24 patients with severe adult periodontitis were randomly assigned to test and control groups. The control group was scaled and root planed, per quadrant, at 2-week intervals and given standard oral hygiene instructions. A one stage full-mouth disinfection (test group) was sought by scaling and root planing the 4 quadrants within 24 hours in combination with the application of chlorhexidine to all intra-oral niches for periodontopathogens. Besides oral hygiene, the test group also rinsed twice daily with a 0.2% chlorhexidine solution and sprayed the tonsils with a 0.2% chlorhexidine spray, for 2 months. The plaque index, gingival index, probing depth, bleeding on probing, gingival recession, and clinical attachment level were recorded at baseline and at 1, 2, 4, and 8 months afterwards.The one stage full-mouth disinfection resulted, in comparison to the standard therapy, in a significant (P0.001) additional probing depth reduction and gain in attachment up to 8 months. For initial pocketsor =7 mm, the "additional" probing depth reduction at the 8 month follow-up was 1.2 mm for single-rooted and 0.9 mm for multi-rooted teeth, with corresponding additional gains in attachment of 1.0 mm and 0.8 mm, respectively. The additional improvements were observed for all subgroups (adult periodontitis, generalized early-onset cases, smokers), with the largest differences in the non-smoking adult periodontitis patients.These findings suggest that a one stage full-mouth disinfection results in an improved clinical outcome for the treatment of chronic adult or early-onset periodontitis as compared to scaling and root planing per quadrant at 2-week intervals.

In patients with severe peridontitis, lower incisors are prone to terminal breakdown. This study assessed the longevity of composite-bonded resin/natural teeth (reinforced only with a stainless steel mesh) as replacements for periodontally lost lower incisors.Besides the longevity of the restoration, the periodontal condition of the abutment teeth, and the general satisfaction of the patient were evaluated retrospectively via a phone interview, in combination with an analysis of the patient's clinical dental file.The cumulative proportion of survival rate of these composite restorations was 80% after 5 years of function. No statistically significant difference was found between the survival distribution of one- and two-pontic bridges (P = 0.66). The abutment teeth demonstrated stable probing depths and a negligible loss in attachment (0.1 mm/year). The satisfaction ratings were also favorable.The data seem to suggest that composite bonding of 1 or 2 teeth can be considered a semi-permanent rehabilitation for the replacement of 1 or 2 periodontally lost lower incisors.

The aim of this in vivo study was to evaluate the influence of 5- to 6-year-old direct composite additions on the marginal periodontal tissues. Composite additions were directly placed on 79 intact maxillary anterior teeth in 19 patients (12 to 19 years) by one operator using an ultrafine midway-filled densified resin composite. All patients were recalled 5 to 6 years later for a periodontal evaluation. Plaque index, gingivitis index, and probing depth were measured at the buccal-approximal sites of all unilaterally restored teeth (n=51). An intra-individual comparison was made between the periodontal health of the treated versus the intact sites. The plaque index (P=0.029) and gingivitis index (P=0.008) were significantly higher for the treated sites compared to the intact sites. The difference in probing depth nearly reached the level of significance (P=0.059). In conclusion, 5-to 6-year-old direct composite additions have a negative influence on marginal periodontal health, which consisted of increased plaque retention, gingival inflammation, and periodontal destruction.

The recognition of the microbial origin and the specificity of periodontal infections has resulted in the development of several adjunctive therapies (antibiotics and/or antiseptics) to scaling and root planing in the treatment of chronic adult periodontitis. This article aims to review the "additional" effect of a subgingival irrigation with chlorhexidine, or a local or systemic application of tetracycline or metronidazole, performed in combination with a single course of scaling and root planing in patients with chronic adult periodontitis. All treatment modalities are compared with scaling and root planing, based on their impact on: the probing depth (PD); total number of colony forming units per ml (CFU/ml); the proportions and/or the detection-frequency of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia; and/or on the percentages of cocci, spirochetes, motile, and other micro-organisms on dark field microscopy examination. All treatment modalities, including scaling and root planing without additional chemical therapy, resulted in significant reductions in the probing depth and the proportions of periodontopathogens, at least during the first 8 weeks post-therapy. However in comparison to a single course of scaling and root planing, the supplementary effect of adjunctive therapies seems to be limited. In general, only the irrigation with chlorhexidine 2%, the local application of minocycline, and the systemic use of metronidazole (in case of large proportions of spirochetes) or doxycycline (in case of large proportions of A. actinomycetemcomitans) seem to result in a prolonged supplementary effect when compared to scaling and root planing. Therefore, the use of antibiotics on a routine basis, especially in a systemic way, in the treatment of chronic adult periodontitis, can no longer be advocated, considering the increasing danger for the development of microbial resistance.

Periodontal probes have previously been shown to harbor several bacterial types or species after probing periodontally diseased pockets. This study aims to identify and quantify periodontopathogens that may adhere to a periodontal probe by culturing techniques. It also examines the probe's roughness on its capability to collect bacteria, comparing Merrit-B probes (with deep indentations) with TPS probes (with smooth surfaces). From the differential phase contrast microscopy findings it was seen that, while paper-points harbored nearly 50% motile rods or spirochetes, the periodontal probes were just at, or below, the 20% threshold level for pathogenicity (23.6% for the Merrit-B probe and 11.3% for the TPS probe). The cultural data showed that paper-points had significantly higher (P0.05) numbers of anaerobic bacteria than the 2 probe types, which still harbored up to 10(7) CFU. No significant differences could be detected between the probes. When specific periodontopathic species were considered, it was seen that for all species, even for Actinobacillus actinomycetemcomitans or Porphyromonas gingivalis, the detection frequency was comparable for the 3 sampling devices. However, the levels of Prevotella intermedia and Campylobacter rectus was significantly higher in samples from paper-points (P0.05), but still their numbers reached even 10(5) on the probes. Differences among the 2 probe types were again negligible. Periodontal probes harbor relatively high numbers of bacteria found in periodontal pockets and may be able to carry them over to other sites. Further studies are needed to determine if, and to what extent, transmission occurs during periodontal probing.

The undisturbed supragingival plaque formation was recorded twice over a 100 hours period in 14 healthy dental students; first after induction of gingival inflammation and a second time starting from a healthy gingiva. During each experimental segment plaque formation was recorded on 42 randomly selected and clean teeth at the start and after 6, 12, 24, 30, 36, 48, 54, 60, 72, 84, and 96 hours. Four hours later all teeth up to the first molars were examined. The presence of disclosable plaque was calculated planimetrically as percent of the total labial surface area of the tooth. The rate of plaque formation was found to be significantly greater (P = 0.001) in the presence of gingival inflammation (+ 29.0%). Moreover, this study indicates an important variation in the plaque growth rate within the dentition; the highest scores were found for the upper premolars, the upper molars, and the lower front teeth. Finally, the rate of plaque formation was found to decrease during the night.

Since plaque plays a major role in the development of periodontal inflammation, special attention is paid to its composition and quantity. Several indices have been designed for the quantification of the supragingival plaque. The aim of the present study was to compare the utility and discriminating power of five such plaque indices. In 14 subjects, three teeth were selected randomly on which the undisturbed plaque formation was studied over a period of 96 hours. This examination was performed twice, the first time after induction of gingivitis and a second time starting with a healthy gingiva. It is known that in the presence of gingival inflammation, the plaque growth rate slightly increases. Plaque formation was estimated at several visits with the following indices: Harrap index, Quigley and Hein index, Navy index modified by Clemmer and Barbano, Navy index modified by Hancock and Wirthlin, and a planimetrical plaque scoring system. The path of the plaque growth curve was found to depend on the selected plaque index, going from an exponential curve (planimetry) over an sigmoidal curve (Harrap index, Navy index modified by Hancock and Wirthlin) to a nearly linear relation (Quigley and Hein, Navy index modified by Clemmer and Barbano). By comparing the plaque scores on patients with healthy gingiva with those from patients with inflamed gingiva, it was found that the planimetrical plaque index had a clearly higher discriminating power. It was concluded that the choice of an index for the measurement of the plaque extension depends on the goals of the study.

The plaque-removing effect of a convex-shaped multitufted brush was compared with that of a conventional flat multitufted brush. Two group (five and seven dental students, respectively), well instructed in the modified Bass technique, participated in a blind, splitmouth, crossover study during two consecutive experimental periods of 96 hours of undisturbed plaque growth. After each of these periods, a supervised brushing session was performed, followed by toothpick utilization. Plaque removal was evaluated using the modified Navy Plaque Index (MNPI) and planimetry. A 4% erythrosin solution was used as a disclosing agent. Planimetrically, the flat Oral B brush appeared significantly more effective than the convex shaped Ph brush (P less than 0.001). This superiority was even enhanced after the use of toothpicks (P less than 0.0005). The differences between the brushes, however, were too small to be detected by the less discriminating MNPI. Although it has been claimed that the convex brush could assure approximal plaque control, the results indicate that for the convex-shaped, as well as for the flat brush, an approximal aid is essential for good plaque control. The hypothesis that the design of the convex-shaped brush could facilitate the modified Bass technique for the average patient could not be proven in this study.