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To review the literature on the periodontal implications of malocclusion and fixed orthodontic appliances.

Aim: To update the competences and learning outcomes and their evaluation, educational methods and education quality assurance for the training of contemporary specialists in periodontology, including the impact of the 2018 Classification of Periodontal and Peri‐implant Diseases and Conditions (2018 Classification hereafter) and the European Federation of Periodontology (EFP) Clinical Practice Guidelines (CPGs). Methods: Evidence was gathered through scientific databases and by searching for European policies on higher education. In addition, two surveys were designed and sent to program directors and graduates. Results: Program directors reported that curricula were periodically adapted to incorporate advances in diagnosis, classification, treatment guidelines and clinical techniques, including the 2018 Classification and the EFP CPGs. Graduates evaluated their overall training positively, although satisfaction was limited for training in mucogingival and surgical procedures related to dental implants. Traditional educational methods, such as didactic lectures, are still commonly employed, but they are now often associated with more interactive methods such as case‐based seminars and problem‐based and simulation‐based learning. The evaluation of competences/learning outcomes should employ multiple methods of assessment. Conclusion: An update of competences and learning outcomes of specialist training in periodontology is proposed, including knowledge and practical application of the 2018 Classification and CPGs. Harmonizing specialist training in periodontology is a critical issue at the European level. [ABSTRACT FROM AUTHOR]

Background: Periodontal diseases are associated with dysbiosis in the oral microbial communities. Managing oral biofilms is therefore key for preventing these diseases. Management protocols often include over‐the‐counter antimicrobial mouth rinses, which lack data on their effects on the oral microbiome's ecology, bacterial composition, metabolic activity, and dysbiosis resilience. This study examined the efficacy of antimicrobial mouth rinses to halt dysbiosis in in vitro oral biofilms under periodontitis‐simulating conditions. Methods: Multispecies oral biofilms were grown on hydroxyapatite discs (HADs) and rinsed daily with one of six mouth rinses. Positive and negative controls were included. After three rinses, biofilms were analyzed with viability quantitative polymerase chain reaction and visualized using scanning electron microscopy. Supernatants of rinsed biofilms were used for metabolic activity analysis. In addition, human oral keratinocytes were exposed to rinsed biofilms to assess their inflammatory response. All outputs were analyzed for correlation using Spearman coefficient. Results: Product‐related changes were observed in the rinsed biofilms. Three of the six tested mouth rinses could significantly prevent dysbiosis with ≥30% reduction in pathobiont abundance relative to the control. These biofilms had lower metabolic activity, and the exposed human oral keratinocyte produced less interleukin‐8. Interleukin‐8 production correlated to both pathobiont quantity and the metabolic activity of the biofilms. Conclusion: Some mouth rinses could support biofilm resilience and stop dysbiosis evolution in the biofilm model, with a clear product‐related effect. Such mouth rinses can be considered for patients under maintenance/supportive periodontal therapy to prevent/delay disease recurrence. Others are more useful for different periodontal therapy stages. [ABSTRACT FROM AUTHOR]

In the past decades, personalized regenerative medicine has gained increased attention. Autologous platelet concentrates (APCs) such as PRP, PRGF, and L‐PRF, all serving as a source of a large variety of cells and growth factors that participate in hard and soft tissue healing and regeneration, could play a significant role in regenerative periodontal procedures. This narrative review evaluated the relative impact of APCs in alveolar ridge preservation, sinus floor augmentation, and the regeneration of bony craters around teeth, both as a single substitute or in combination with a xenograft. L‐PRF has a significant beneficial effect on alveolar ridge preservation (bone quality). The data for PRGF are less convincing, and PRP is controversial. L‐PRF can successfully be used as a single substitute during transcrestal (≥3.5 mm bone gain) as well as 1‐stage lateral window sinus floor elevation (>5 mm bone gain). For PRGF and especially PRP the data are very scarce. In the treatment of bony craters around teeth, during open flap debridement, L‐PRF as a single substitute showed significant adjunctive benefits (e.g., >PPD reduction, >CAL gain, >crater depth reduction). The data for PRP and PRGF were non‐conclusive. Adding PRP or L‐PRF to a xenograft during OFD resulted in additional improvements (>PPD reduction, >CAL gain, >bone fill), for PRGF no data were found. Autologous platelet concentrates demonstrated to enhance bone and soft tissue healing in periodontal regenerative procedures. The data for L‐PRF were most convincing. L‐PRF also has the advantage of a greater simplicity of production, and its 100% autologous character. [ABSTRACT FROM AUTHOR]

Background/objectives To systematically review the available evidence concerning the risk factors for gingival recessions (GR) after orthodontic treatment (OT). Data collection and analysis Data was obtained and collected by systematically searching 3 data bases: Pubmed, EMBASE, and Web of Science until 20 April 2023. Controlled trials, cohort, case-control or cross-sectional studies describing GR or clinical crown height (CCH) after OT were included. The risk of bias in the selected studies was evaluated with the methodological index for non-randomized studies. Results Forty-eight articles were included, investigating the following six risk factors for GR: 1. OT (n = 21), 2. Type of orthodontic intervention (n = 32), 3. Patient's baseline occlusal and skeletal characteristics (n = 14), 4. Mucogingival characteristics (n = 10), 5. Oral hygiene (n = 9), and 6. Others (n = 12). Significantly higher prevalence, severity and extent of GR were found in orthodontic patients by 10/15, 4/10, and 2/2 articles respectively. 10/16 articles reported significantly more GR and increased CCH in patients where orthodontic incisor proclination was performed. The evidence surrounding maxillary expansion and orthodontic retention was too heterogeneous to allow for? definitive conclusions. Pre-treatment angle classification, ANB, overjet, overbite, arch width and mandibular divergence were found not to be associated with GR (9/14), while pre-treatment crossbite, symphysis height and width were (5/7 studies). A thin gingival biotype, presence of previous GR, baseline width of keratinized gingiva and facial gingival margin thickness were correlated with increased risk of GR after OT by nine articles, while pocket depth was not. Oral hygiene, sex, treatment duration, and oral piercings were found not to be linked with GR in orthodontic patients, while GR was reported to increase with age in orthodontic patients by 50 per cent of the articles investigating this factor. The mean risk of bias for comparative and not comparative studies was 14.17/24 and 9.12/16. Limitations The selected studies were quite heterogeneous regarding study settings, variables reported and included very limited sample sizes. Conclusion Although studies regarding the risk factors for GR are relatively abundant, they are very heterogeneous concerning design, studied factors, methodology and reporting, which often leads to contradictory results. Uniform reporting guidelines are urgently needed for future research. PROSPERO Registration CRD42020181661. Funding This research received no funding. [ABSTRACT FROM AUTHOR]

The purpose of this study was to perform an integrative review on the effects of cranberry and grape seed extracts concerning the disinfection of root canals maintaining the strength of the remnant tooth tissues' structure. A bibliographical search was carried out on the PubMed electronic platform using the following key terms: cranberry, grape seed, vaccinium macrocarpon, proanthocyanidin, antibacterial, antimicrobial, decontamination, disinfection, bacteria removal, bacteria eradication, bacteria elimination, endodontic, root canal, faecalis, and strength. The inclusion criteria involved articles published in the English language, until March, 2022, reporting the antibacterial effect of grape seed and cranberry extracts. Of 185 studies identified, 13 studies were selected for the present review. The grape seed extract (GSE), composed of proanthocyanidins, showed an antioxidant activity against the main bacteria found in endodontic secondary infection. The percentage of bacteria removal was recorded at around 96.97% by using GSE. Studies on cranberry extracts, which are composed of proanthocyanidins, revealed antimicrobial effects against bacteria related to periodontitis and dental caries. Additionally, GSE or cranberry allowed the dentin collagen cross-linking that preserved the 3D collagen network leading to the maintenance of the strength of the remnant tooth structure. However, the contaminated smear layer could not be removed by using only GSE or cranberry. Cranberry extracts and GSE revealed a significant antimicrobial activity in endodontic disinfection without changing the mechanical properties of the remnant dentin tissues. Furthermore, those components can be associated with traditional compounds to enhance their antimicrobial effects and eliminate the smear layer. [ABSTRACT FROM AUTHOR]

Objective: Chlorhexidine mouthrinses are marketed in different formulations. This study aimed at investigating qualitative and quantitative changes in in‐vitro multispecies oral biofilms, induced by different chlorhexidine‐containing mouthrinses. Background data: Earlier studies comparing chlorhexidine mouthrinses are either clinical studies or in‐vitro studies assessing the antimicrobial efficacy of the mouthrinses. However, no clear investigations are available regarding ecological impact of different chlorhexidine formulations on in‐vitro multispecies oral biofilms after rinsing with different chlorhexidine formulations. Methods: Nine commercially available chlorhexidine mouthrinses were selected. Multispecies oral communities (14 species) were grown for 48 h in a Biostat‐B Twin bioreactor. After that, they were used to develop biofilms on the surface of hydroxyapatite disks in 24‐well pates for 48 h. Biofilms were then rinsed once or multiple times with the corresponding mouthrinse. Biofilms were collected before starting the rinsing experiment and every 24 h for 3 days and vitality quantitative PCR was performed. The experiment was repeated 3 independent times on 3 different days and the results were analyzed using a linear mixed model. Results: The mouthrinses provoked different effects in terms of change in total viable bacterial load (VBL), ecology, and community structure of the multispecies biofilms. There was no relation between chlorhexidine concentrations, presence, or absence of cetylpyridinium chloride and/or alcohol, and the observed effects. Some tested chlorhexidine mouthrinses (MC, HG, HH, and HI) strongly lowered the total VBL (≈1007 Geq/ml), but disrupted biofilm symbiosis (≥40% of the biofilms communities are pathobionts). On the other hand, other tested chlorhexidine mouthrinses (MD, ME, and HF) had limited impact on total VBL (≥1010 Geq/ml), but improved the biofilm ecology and community structure (≤10% of the biofilms communities are pathobionts). Conclusion: Not all chlorhexidine mouthrinses have the same effect on oral biofilms. Their effect seems to be strongly product dependent and vary according to their compositions and formulations. [ABSTRACT FROM AUTHOR]

Determination of bacterial community composition in synthetic communities is critical for understanding microbial systems. The community composition is typically determined through bacterial plating or through PCR-based methods, which can be labor-intensive, expensive, or prone to bias. Simultaneously, flow cytometry has been suggested as a cheap and fast alternative. However, since the technique captures the phenotypic state of bacterial cells, accurate determination of community composition could be affected when bacteria are co-cultured. We investigated the performance of flow cytometry for quantifying oral synthetic communities and compared it to the performance of strain specific qPCR and 16S rRNA gene amplicon sequencing. Therefore, axenic cultures, mock communities and co-cultures of oral bacteria were prepared. Random forest classifiers trained on flow cytometry data of axenic cultures were used to determine the composition of the synthetic communities, as well as strain specific qPCR and 16S rRNA gene amplicon sequencing. Flow cytometry was shown to have a lower average root mean squared error and outperformed the PCR-based methods in even mock communities (flow cytometry: 0.11 ± 0.04; qPCR: 0.26 ± 0.09; amplicon sequencing: 0.15 ± 0.01). When bacteria were co-cultured, neither flow cytometry, strain-specific qPCR, nor 16S rRNA gene amplicon sequencing resulted in similar community composition. Performance of flow cytometry was decreased compared with mock communities due to changing phenotypes. Finally, discrepancies between flow cytometry and strain-specific qPCR were found. These findings highlight the challenges ahead for quantifying community composition in co-cultures by flow cytometry.IMPORTANCEQuantification of bacterial composition in synthetic communities is crucial for understanding and steering microbial interactions. Traditional approaches like plating, strain-specific qPCR, and amplicon sequencing are often labor-intensive and expensive and limit high-throughput experiments. Recently, flow cytometry has been suggested as a swift and cheap alternative for quantifying communities and has been successfully demonstrated on simple bacterial mock communities. However, since flow cytometry measures the phenotypic state of cells, measurements can be affected by differing phenotypes. Especially, changing phenotypes resulting from co-culturing bacteria can have a profound effect on the applicability of the technique in this context. This research illustrates the feasibility and challenges of flow cytometry for the determination of community structure in synthetic mock communities and co-cultures.

This study prospectively evaluated the effect of keratinized mucosa (KM) on the healing of the peri- implant tissues after resective surgical therapy for peri-implantitis. It addressed the question of whether the absence of KM has a negative effect on peri-implant tissue stability after treatment. Patients referred to a private practice for peri-implantitis treatment were surgically treated with resective flap surgery and implantoplasty. They were followed for 3 years and measurements at implant level included presence of plaque, bleeding on probing, probing pocket depth, radiographically visible bone loss and the presence and width of KM before therapy, 3 month post-operatively, 1 year, 2 years, and 3 years after the surgical intervention. All clinical parameters improved and marginal bone levels remained stable 3 years after therapy. The width of the KM decreased significantly after the therapy. Soft tissue recession was frequently observed. The absence of KM does not seem to have a negative effect on healing after therapy for the studied period of 3 years. The authors conclude that resective surgery combined with implantoplasty seems to be a reliable method for arresting the progression of peri-implantitis.

Purpose: This study investigates the effects of daily consumption of a probiotic ayran drink on gingival inflammation and the development of experimental gingivitis., Materials and Methods: This randomised, double-blind, placebo-controlled trial involved 54 volunteer students. The participants were randomly assigned to two groups: the control group received regular ayran for 42 days, while the test group received probiotic enriched ayran (including Lactobacillus acidophilus and Bifidobacterium bifidum) for 42 days twice a day. After 42 days, mechanical plaque control was stopped for 5 days. The plaque index (PI), gingival index (GI), probing bleeding (BOP), and probing depth (PPD) were measured at baseline, day 42, and day 47. At the same time, gingival crevicular fluid was taken for matrix metalloproteinase-8 examination., Results: The mean scores of BOP, GI, PI, and MMP-8 levels increases in both groups following the 5-day experimental gingivitis period compared to baseline and day 42. Patients using probiotic ayran had significantly less PI, GI, BOP scores and MPP-8 values (p = 0.002; p 0.001; p 0.001; p = 0.001; p = 0.001, respectively) at day 47 compared to the control group. No statistically significant differences in probing pocket depth (PPD) were observed at any time point., Conclusion: The present study suggests that daily consumption of a probiotic ayran drink containing Lactobacillus acidophilus and Bifidobacterium bifidum statistically significantly lowers clinical and immunological markers of gingival inflammation.

In order to evaluate the therapeutic advantages of various autologous platelet concentrates (APC) as a single biomaterial during alveolar ridge preservation (ARP), a systematic review with meta-analyses was conducted. PubMed, EMBASE, Web of Science, and Scopus were screened for randomized controlled trials (RCTs) that were released prior to 2024. The selected papers compared an APC with either unassisted healing (blood clot) or another biomaterial during ARP (third molars were not included). The outcome parameters included alveolar bone dimension alterations, soft tissue healing, and post-op pain intensity. The search yielded 35 papers (33 studies), one applying platelet-rich plasma (PRP), six using plasma rich in growth factors (PRGF), and 28 using leukocyte- and platelet-rich fibrin (L-PRF). These studies showed a large heterogeneity (e.g., outcome parameters, timing, surgical approach, and inclusion criteria), which hindered drawing strong conclusions. In most studies, however, ARP with PRP, PRGF, and L-PRF alone produced faster soft tissue healing, less post-extraction pain, less alveolar ridge resorption, more socket bone fill, and a higher bone density when compared to unassisted (spontaneous) healing. The ultimate benefit appears to be significantly influenced by the surgical approach. Limited literature exists comparing APC with other biomaterials for ARP, resulting in inconclusive data. APC application for ARP is a promising strategy to improve soft and hard tissue healing and reduce post-extraction pain., (© 2024 The Author(s). Periodontology 2000 published by John Wiley & Sons Ltd.)

Background/objectives: To systematically review the available evidence concerning the risk factors for gingival recessions (GR) after orthodontic treatment (OT)., Data Collection and Analysis: Data was obtained and collected by systematically searching 3 data bases: Pubmed, EMBASE, and Web of Science until 20 April 2023. Controlled trials, cohort, case-control or cross-sectional studies describing GR or clinical crown height (CCH) after OT were included. The risk of bias in the selected studies was evaluated with the methodological index for non-randomized studies., Results: Forty-eight articles were included, investigating the following six risk factors for GR: 1. OT (n = 21), 2. Type of orthodontic intervention (n = 32), 3. Patient's baseline occlusal and skeletal characteristics (n = 14), 4. Mucogingival characteristics (n = 10), 5. Oral hygiene (n = 9), and 6. Others (n = 12). Significantly higher prevalence, severity and extent of GR were found in orthodontic patients by 10/15, 4/10, and 2/2 articles respectively. 10/16 articles reported significantly more GR and increased CCH in patients where orthodontic incisor proclination was performed. The evidence surrounding maxillary expansion and orthodontic retention was too heterogeneous to allow for? definitive conclusions. Pre-treatment angle classification, ANB, overjet, overbite, arch width and mandibular divergence were found not to be associated with GR (9/14), while pre-treatment crossbite, symphysis height and width were (5/7 studies). A thin gingival biotype, presence of previous GR, baseline width of keratinized gingiva and facial gingival margin thickness were correlated with increased risk of GR after OT by nine articles, while pocket depth was not. Oral hygiene, sex, treatment duration, and oral piercings were found not to be linked with GR in orthodontic patients, while GR was reported to increase with age in orthodontic patients by 50 per cent of the articles investigating this factor. The mean risk of bias for comparative and not comparative studies was 14.17/24 and 9.12/16., Limitations: The selected studies were quite heterogeneous regarding study settings, variables reported and included very limited sample sizes., Conclusion: Although studies regarding the risk factors for GR are relatively abundant, they are very heterogeneous concerning design, studied factors, methodology and reporting, which often leads to contradictory results. Uniform reporting guidelines are urgently needed for future research., Prospero Registration: CRD42020181661., Funding: This research received no funding., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

This narrative review celebrates Europe's contribution to the current knowledge on systemically administered antimicrobials in periodontal treatment. Periodontitis is the most frequent chronic noncommunicable human disease. It is caused by dysbiotic bacterial biofilms and is commonly treated with subgingival instrumentation. However, some sites/patients do not respond adequately, and its limitations and shortcomings have been recognized. This has led to the development of alternative or adjunctive therapies. One is the use of antimicrobials to target bacteria in subgingival biofilms in the periodontal pocket, which can be targeted directly through the pocket entrance with a locally delivered antibiotic or systemically by oral, intravenous, or intramuscular methods. Since the early 20th century, several studies on systemic antibiotics have been undertaken and published, especially between 1990 and 2010. Europe's latest contribution to this topic is the first European Federation of Periodontology, S3-level Clinical Practice Guideline, which incorporates recommendations related to the use of adjuncts to treat stage I-III periodontitis. Understanding the etiopathogenesis of periodontal diseases, specifically periodontitis, has influenced the use of systemic periodontal antibiotic therapy. Randomized clinical trials and systematic reviews with meta-analyses have demonstrated the clinical advantages of adjunctive systemic antimicrobials. However, current recommendations are restrictive due to concerns about antibiotic misuse and the increase in microbial antibiotic resistance. European researchers have contributed to the use of systemic antimicrobials in the treatment of periodontitis through clinical trials and by providing rational guidelines. Nowadays, European researchers are exploring alternatives and directing clinical practice by providing evidence-based guidelines to limit the use of systemic antimicrobials., (© 2023 The Authors. Periodontology 2000 published by John Wiley & Sons Ltd.)