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Additional file 2. Informed consent term.

Additional file 1. SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents*.

ispartof: Huisarts Nu vol:50 pages:192-196 status: published

BACKGROUND The recently introduced 2017 World Workshop on the classification of periodontitis, incorporating stages and grades of disease, aims to link disease classification with approaches to prevention and treatment, as it describes not only disease severity and extent but also the degree of complexity and an individual's risk. There is, therefore, a need for evidence-based clinical guidelines providing recommendations to treat periodontitis. AIM The objective of the current project was to develop a S3 Level Clinical Practice Guideline (CPG) for the treatment of Stage I-III periodontitis. MATERIAL AND METHODS This S3 CPG was developed under the auspices of the European Federation of Periodontology (EFP), following the methodological guidance of the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The rigorous and transparent process included synthesis of relevant research in 15 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and consensus, on those recommendations, by leading experts and a broad base of stakeholders. RESULTS The S3 CPG approaches the treatment of periodontitis (stages I, II and III) using a pre-established stepwise approach to therapy that, depending on the disease stage, should be incremental, each including different interventions. Consensus was achieved on recommendations covering different interventions, aimed at (a) behavioural changes, supragingival biofilm, gingival inflammation and risk factor control; (b) supra- and sub-gingival instrumentation, with and without adjunctive therapies; (c) different types of periodontal surgical interventions; and (d) the necessary supportive periodontal care to extend benefits over time. CONCLUSION This S3 guideline informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat periodontitis and to maintain a healthy dentition for a lifetime, according to the available evidence at the time of publication.

Bioactive glass is an attractive biomaterial that has shown excellent osteogenic and angiogenic effects for oral bone repairing procedures. However, anti-biofilm potential related to such biomaterial has not been completely validated, mainly against multispecies biofilms involved in early tissue infections. The aim of the present study was to evaluate the anti-biofilm effect of 58S bioactive glass embedding calcium bromide compounds at different concentrations. Bioactive glass containing 0, 5, or 10wt% CaBr2 was synthesized by alkali sol-gel method and then characterized by physco-chemical and scanning electron microscopy (SEM). Then, samples were tested by microbiological assays using optical density, real time q-PCR, and SEM. Bioactive glass particles showed accurate chemical composition and an angular shape with a bimodal size distribution ranging from 0.6 to 110 μm. The mean particle size was around 29 μm. A significant anti-biofilm effect was recorded for 5wt% CaBr2-doped bioactive glass against S. mitis, V. parvula, P. gingivais, S. gordoni, A. viscosus, F, nucleatum, P. gingivais. F. nucleatum and P. gingivalis. Such species are involved in the biofilm structure related to infections on hard and soft tissues in the oral cavity. The incorporation of calcium bromide into bioactive glass can be a strategy to enhance the anti-biofilm potential of bioactive glasses for bone healing and infection treatment. Key words: Bioactive glass, anti-biofilm, bromide, sol-gel synthesis, bone infection, bone healing ispartof: Journal of Biomedical Materials Research A vol:105 issue:7 pages:1994-2003 ispartof: location:United States status: published

OBJECTIVES: To evaluate clinical, radiographic, microbiologic, and biomechanical parameters related to bone remodeling around implants with external hexagon (EH) and Morse-taper (MT) connections.MATERIALS AND METHODS: Twelve totally edentulous patients received four custom-made implants in the interforaminal region of the mandible. Two of those implants had the same macroscopic design, but different prosthetic connections. All patients received an immediate implant-supported prosthesis. Clinical parameters (periimplant probing pocket depth (PPD), modified gingival index (mGI), and mucosal thickness (MTh)) were evaluated at 12 months follow-up. The distance between the top of the implant and the first bone-to-implant contact (IT-FBIC) was evaluated on standardized digital peri-apical radiographs acquired at 1, 3, 6, and 12 months follow-up. Samples of the subgingival microbiota were collected 1, 3, and 6 months after implant loading and used for the quantification of Tanerella forsythia, Porphyromonas gingivalis, Aggragatibacter actinomycetemcomitans, Prevotella intermedia, and Fusobacterium nucleatum. Further, 36 computerized-tomography based finite element (FE) models were accomplished, simulating each patient under three loading conditions.RESULTS: The evaluated clinical parameters were equal for EH and MT implants. Mean IT-FBIC was significantly different between the tested connections (1.17 ± 0.44 mm for EH, and 0.17 ± 0.54 mm for MT, considering all evaluated time periods). No significant microbiological differences could be observed between tested connections. FE analysis showed a significantly higher peak of equivalent (EQV) strain (p = 0.005) for EH (mean 3,438.65 µε) compared to MT (mean 840.98 µε) connection.CONCLUSIONS: Radiographic periimplant bone loss depends on the implant connection type. MT connections showed less periimplant bone loss, compared to EH connections.

During the last decade an increased interest in alternative, preventive, and therapeutic strategies in dentistry has arisen. Probiotics are living microorganisms which, if administered in sufficient amounts, provide a health benefit to the host. Their precise mechanisms of action have not been identified, but they are able to interfere with the imbalance occurring in biofilm-associated infections. In other fields of medicine, mainly in gastroenterology, their usefulness is already proven. Concerning oral threats, probiotic bacteria may reduce the numbers of pathogens associated with dental caries (mutans streptococci). Clinically, results are encouraging, but further research is needed to demonstrate apparent effects of certain probiotic strains on oral health as well as their desired concentration and vehicle. The use of probiotics in prevention and treatment of caries, periodontal diseases, halitosis, and other oral diseases needs to be further investigated. ispartof: Quintessence International vol:46 issue:3 pages:255-264 ispartof: location:Germany status: published

Objective: The impact of the implant position on the restorative outcome could justify guided surgery even for the single implants particularly in the aesthetic zone and especially when a simplified concept is available. Material and methods: Based on a plaster model, on which the soft tissues were mimicked (according to the thickness measured on a Cone-Beam CT), a tooth-supported, surgical template was prepared. The latter guided all drills so that even flapless implant insertion became possible. All implants were placed by students of the master-after-master training program in Periodontology. Results: The prospective cohort included a total of 34 implants, all of AstraTech (Osteospeed(®) ) type, which were successfully inserted in 29 patients, 16 flapless, 32 onestage. The marginal bone along the integrated implants remained stable over time, with 0.13 mm loss during the first year. The aesthetic parameters were reassuring. Conclusions: This simple model-based concept seems to be reliable for the guided placement of single implants and the pre-operative preparation of their restorations. To cite this article: Marcelis K, Vercruyssen M, Naert I, Teughels W, Quirynen M. Model-based guided implant insertion for solitary tooth replacement: a pilot study. Clin. Oral Impl. Res. xx, 2011; 000-000. doi: 10.1111/j.1600-0501.2011.02242.x. ispartof: Clinical oral implants research vol:23 issue:8 pages:999-1003 ispartof: location:Denmark status: published

As in other fields of healthcare, probiotics have been introduced for prevention and treatment of periodontal diseases. ispartof: Journal of Clinical Periodontology vol:38 issue:SUPPL. 11 pages:159-177 ispartof: location:United States status: published

Objective: The inherent deformation and two-dimensional nature of panoramic radiographs jeopardise their interpretation and quantitative measurements. This study aims to estimate the degree of underestimation of available mesio-distal bone in the premolar area (comparing panoramic radiographs with multi-slice/cone-beam computer tomography [CT]) to determine the prevalence, width, length and position of the bony canal [artery] in the lateral sinus wall and to explore the prevalence, width and length of another (newly detected) bony canal at the palatal aspect of the upper canine. Material and methods: The distance between the distal side of the canine/first premolar and the mesial side of the first molar or the anterior wall of the maxillary sinus was measured on panoramic radiographs and corresponding multi-slice/cone-beam CT images (65 patients). Measurements were made at apical, mid-radicular and crestal regions, parallel to the occlusal plane. The presence and dimensions of the two above-mentioned intra-osseous canals were verified on multi-slice CT scans (144 patients) using reformatted cross-sectional images and/or axial slices. Results: For all 65 patients, panoramic radiographs underscored the mesio-distal distance of available bone in the upper premolar region (mean 2.9 mm, range 0.1-7.5 mm). An intra-osseous canal in the lateral maxillary sinus wall was clearly visible in 49.5% of the cases (mean diameter 1.4 mm). In the canine region, a bony canal was obvious in 32.9% of the cases, with a mean diameter of 1.23 mm. For both canals, there was no correlation between diameter and patient's age. Conclusions: Based on the present data, cone-beam CT imaging can be recommended for visualising anatomical structures during planning of sinus augmentation procedures. To cite this article: Temmerman A, Hertelé S, Teughels W, Dekeyser C, Jacobs R, Quirynen M. Are panoramic images reliable in planning sinus augmentation procedures? Clin. Oral Impl. Res. xx, 2010; 000-000. ispartof: Clinical Oral Implants Research vol:22 issue:2 pages:189-194 ispartof: location:Denmark status: published

Recently, the predation of Bdellovibrio bacteriovorus on a periodontal pathogen has been described. The current study explores the potential antimicrobial activity of a range of predatory bacteria against key periodontal pathogens. A number of representatives from the Bdellovibrio, Bacteriovorax and Peredibacter lineages (called 'BALOs') were tested for their activity towards a group of key periodontal pathogens and an optimal multiplicity of infection was established. As the oral cavity contains a wide variety of bacteria that are not preyed upon, it was investigated if they can have an effect on the predation efficiency of BALOs. It was concluded that a number of important variables involved in bacterial predation are found to be compatible with the composition of the oral microbiota. This finding makes the case for continued study of the potential for BALOs to combat periodontal pathogens. ispartof: Molecular Oral Microbiology vol:26 issue:1 pages:52-61 ispartof: location:Denmark status: published

95% van het tandverlies wordt veroorzaakt door cariës en parodontitis. N aast zijn specifieke orale manifestaties, wordt parodontitis ook beschou wd als een risicofactor voor cardiovasculaire ziekten en voor ongunstige zwangerschapsresultaten. Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis en Tannerella forsythensis w orden beschouwd als de belangrijkste paropathogenen. De capaciteit van e en bacterie om aan zijn gastheer te hechten is belangrijk, vooral voor d e inductie van infectieuze ziekten, zoals gingivitis of periodontitis. O rale bacteriën en vooral pathogene bacteriën, zoals P. gingivali s en A. actinomycetemcomitans, hebben een grote batterij v an virulentiefactoren, waarvan één, de capaciteit is om harde intra -orale oppervlakken en/of de orale mucosa te koloniseren. Omdat bacterië n geen passieve toeschouwers zijn, zullen zij interageren met hun omgevi ng tijdens zulke kolonisatie en vice versa. Onze kennis over de invloed van microbiële interacties tijdens bacteriële kolonisatie van gastheerce llen is zeer beperkt, hoewel de processen betrokken bij individuële bact eriële adhesie aan gastheercellen vrij bekend zijn, zelfs voor paropatho genen. Deze worden tegenwoordig zelfs tot op een moleculair niveau onder zocht. De identificatie van factoren die kolonisatie van pathogenen onde rsteunen of onderdrukken kan helpen in het verder ontrafelen van het zie kteproces en in het ontwikkelen van nieuwe behandelingsstrategieën. Daar om onderzocht deze thesis de bacteriële kolonisatie van epitheliale cell en en specifiek de invloed van klinisch relevante modificerende factoren (roken, virale infectie en bacteriële interacties). In hoofdstuk 1 wordt het effect van nicotine, cotinine en sigaretten roo k extract (CSE) op epitheliale kolonisatie onderzocht. Wanneer de epithe liale cellen werden geïnoculeerd met serum concentraties van nicotine en cotinine werden geen veranderingen in bacteriële kolonisatie ontdekt. D oor niet fysiologische nicotine of cotinine concentraties of door CSE te gebruiken werden nochtans beperkte veranderingen uitgelokt. Hieruit bli jkt dat, vanuit in vitro standpunt, roken slechts op een beperkte manier de gevoeligheid van epitheliale cellen aan kolonisatie door paropathoge nen zal beïnvloeden. Het is echter duidelijk dat deze resultaten niet on tkrachten dat rokers in vivo meer door paropathogenen worden gekolo niseerd. Recente studies hebben de aanwezigheid van een brede waaier van virussen aangetoond in de parodontale pocket. Hoewel het niet duidelijk is of zi j betrokken zijn bij de ontwikkeling van parodontitis, toont hoofdstuk 2 in vitro aan dat hCMV interageert met de epitheliale kolonisatie v an A. actinomycetemcomitans. Een duidelijke virale dosis-resp ons en besmettingstijd afhankelijkheid invloed op bacteriële kolonisatie werd getoond. De relatieve verhoging van kolonisatie met een factor van 2 tot 2.5 ligt binnen de waaier van wat voor andere virale veroorzaakte veranderingen in bacteriële kolonisatie van cellen is gemeld. De result aten steunen de hypothese dat adhesie van A. actinomycetemcomita ns in vitro wordt verhoogd door hCMV. De betekenis van deze bevinding en in de ontwikkeling van agressieve parodontitis blijft onduidelijk. Ondanks een snelle toename van de kennis op vlak van paropathogeen-gasth eer interacties, blijft de rol van beneficiële microbiota in deze intera cties duister. Hoofdstukken 3 en 4 concentreerden zich op het vinden van bacteriële stammen die de kolonisatie van paropathogenen verhinderen en die zelfs reeds gekoloniseerd paropathogenen kunnen verwijderen van epi theliale cellen. Na het selecteren van de drie meest efficiënte stammen en het nader toelichten van sommige mogelijke mechanismen van interactie in vitro, werd hun efficiëntie getest in vivo. Het aanbrengen van deze speciës na rootplaning, als een bacteriële vervangingstherapie, vertraag de beduidend de rekolonisatie van parodontale pockets voor verscheidene paropathogenen. Zelfs een beter klinisch resultaat kon worden waargenome n wanneer deze zogenaamde beneficiële bacteriën werden aangebracht. De r esultaten van hoofdstukken 3 en 4 tonen duidelijk dat een gunstig effect van bacteriële vervangingstherapie, en in het bijzonder GPR, kan worden verwacht. Of de grenzen van GPR al zijn bereikt is hoogst onwaarschijnl ijk. Daarom worden de gegevens voorgelegd als een bewijs van het princip e eerder dan als een behandelingsbenadering die volgende week in patiënt en kan worden toegepast. De momenteel gebruikte technieken om bacteriële kolonisatie van cellen t e modelleren hebben geholpen in het ontrafelen van de interacties tussen pathogene bacteriën en hun gastheer. Nochtans, dringt het huidige beeld van parodontits als een polymicrobiële infectie de ontwikkeling van nie uwe technieken op om de complexe microbiële interacties te analyseren. Hoofdstuk 5 legt de nadruk op het labellen van twaalf verschillende A. actinomycetemcomitans stammen met Green Fluorescent Protein. D eze stammen kunnen in een later stadium worden gebruikt om het proces va n bacteriële kolonisatie van cellen in real time te observeren. De metin g van efficiëntie en frequentie van transformatie en electroporatie over leving tijdens transformatie van deze stammen, gaf extra informatie over de invloed van de genetische achtergrond van deze stammen op het laatst genoemde proces. Het overgaan naar meer complexe, multi-species adhesie experimenten maak t de ontwikkeling van nieuwe bacteriële kwantificatie technieken noodzak elijk. RT-PCR geeft de mogelijkheid om een vrijwel onbeperkt aantal spec ies in één adhesie experiment kwantitatief te bepalen. In hoofdstuk 6, werd een dergelijke techniek, gebaseerd op single copy genen, gevali deerd en geoptimaliseerd voor zijn gebruik in adhesie experimenten. Deze thesis heeft het belang van microbiële interacties op de kolonisati e door paropathogenen in vitro getoond. Dergelijke interacties kunnen ce llen meer gevoelig maken aan kolonisatie door paropathogenen hoewel zij ook in de preventie van rekolonisatie na parodontale therapie kunnen wor den gebruikt. status: published

Antibiotics have played a major role in the improvement of life expectancy in the last 50 years and have led many to believe that bacterial infections were about to vanish as a disease entity of any importance. Emerging problems resulting from a widespread use of antibiotics have modified the general perception of the capabilities of antimicrobial agents. Over the years, bacteria have become increasingly resistant to formerly potent antimicrobial agents, including some antiseptics. The use of antimicrobials may also disturb the delicate ecological equilibrium of the body, allowing the proliferation of resistant bacteria or non-bacterial micro-organisms. This shift may initiate new infections that are worse than the ones originally treated. No antimicrobial drug is absolutely non-toxic and the use of an agent carries accompanying risks. This paper discusses the development and occurrence of antimicrobial resistance in the subgingival flora towards antiseptics and local or systemic antibiotics and is focussed on the question: how can the outcome of periodontal therapy with/without antimicrobials be improved? ispartof: Oral diseases vol:9 issue:s1 pages:30-7 ispartof: location:FRANCE, LYON status: published