[Show abstract][Hide abstract] ABSTRACT: The aim of the present systematic review and meta-analysis was to assess the clinical efficacy of regenerative periodontal surgery of intrabony defects using a combination of enamel matrix derivative (EMD) and bone graft compared with that of EMD alone.
The Cochrane Oral Health Group specialist trials, MEDLINE, and EMBASE databases were searched for entries up to February 2014. The primary outcome was gain of clinical attachment (CAL). Weighted means and forest plots were calculated for CAL gain, probing depth (PD), and gingival recession (REC).
Twelve studies reporting on 434 patients and 548 intrabony defects were selected for the analysis. Mean CAL gain amounted to 3.76 ± 1.07 mm (median 3.63 95 % CI 3.51-3.75) following treatment with a combination of EMD and bone graft and to 3.32 ± 1.04 mm (median 3.40; 95 % CI 3.28-3.52) following treatment with EMD alone. Mean PD reduction measured 4.22 ± 1.20 mm (median 4.10; 95 % CI 3.96-4.24) at sites treated with EMD and bone graft and yielded 4.12 ± 1.07 mm (median 4.00; 95 % CI 3.88-4.12) at sites treated with EMD alone. Mean REC increase amounted to 0.76 ± 0.42 mm (median 0.63; 95 % CI 0.58-0.68) at sites treated with EMD and bone graft and to 0.91 ± 0.26 mm (median 0.90; 95 % CI 0.87-0.93) at sites treated with EMD alone.
Within their limits, the present results indicate that the combination of EMD and bone grafts may result in additional clinical improvements in terms of CAL gain and PD reduction compared with those obtained with EMD alone. The potential influence of the chosen graft material or of the surgical procedure (i.e., flap design) on the clinical outcomes is unclear.
The present findings support the use of EMD and bone grafts for the treatment of intrabony periodontal defects.
[Show abstract][Hide abstract] ABSTRACT: Objective: To evaluate salivary and microbial biomarkers in gingivitis patients using a powered toothbrush/irrigator combination or a manual toothbrush over a period of 8 weeks.
Method: This was a single-center, randomized, parallel, examiner-blind, 8-week, controlled clinical trial. 60 adult subjects with evidence of dental plaque and gingivitis (minimum of 15 bleeding on probing positive sites) were randomly assigned to either use a powered toothbrush/irrigator combination (Oral-B® Professional Care Oxyjet 1000 Center, Test) or a regular manual toothbrush (Oral-B® Indicator 35, Control). Subjects were stratified at baseline according to age, smoking status, gingivitis-, and plaque-index to balance and randomly assign the treatment groups. Subjects from both groups used standard fluoridated toothpaste (Blend-a-Med Classic). In both groups, tooth brushing was performed twice daily at home following manufacturer's instructions and no interdental cleaning aids had to be used. At Baseline and at Week-2, Week-4 and Week-8, whole saliva was collected by passive drawling while gingival crevicular fluid (GCF) and dental plaque were collected at the mesiobuccal sites of teeth 16 and 17. Oral fluid biomarkers included levels of Interleukin1-beta (IL1-beta), Matrix Metalloproteinase-3 (MMP-3), and MMP-8, while microbial data included Campylobacter rectus, Capnocytophaga sp., Eikenella corrodens, Eubacterium nodatum, and Parvimonas micra. Between-groups comparisons were performed using analysis of covariance with baseline as covariate.
Result: No between treatment differences were statistically significant for both oral fluid and pathogen biomarker at any visit with the exception of IL1-beta at Week-8, where the Test group exhibited significantly (p=0.0313) lower mean levels of IL1-beta in GCF than Control.
Conclusion: The use of a powered toothbrush/irrigator combination resulted in lower levels of gingival inflammation as indicated by a lower level of IL1-beta in GCF at Week-8 when compared to the use of a regular manual toothbrush.
[Show abstract][Hide abstract] ABSTRACT: Objective:
To evaluate early wound healing, tooth staining and patient acceptance of two different post-surgical maintenance protocols.
After a surgical intervention (implant placement or periodontal surgery), 40 patients were randomly included in two groups and were instructed in two different post-surgical maintenance protocols. Patients were assigned to 2 weeks rinsing with 0.05% CHX/herbal extract combination (test) or 0.1% CHX solution (control). Early-wound healing was evaluated clinically and immunologically. Staining effects and patient acceptance were evaluated using VAS questionnaire.
63% of all surgical interventions consisted of an open-flap debridement while in the rest of 37% an dental implant was placed. Both groups showed comparable wound-healing profiles. No statistically significant differences could be observed in terms of the Early-Wound-Healing and Plaque Indices between the 2 groups. Plaque regrowth was comparable in the 2 groups (p=0.4123). No statistically significant changes between week 1 and week 2 were found in terms of tooth staining in the 2 groups at both visits (p=0.1668) and between week 1 and week 2 (test: p=0.5675; control: p=0.2458). In the test group statistical significant more patients reported tooth stain (p>0.0001) and have been annoyed by this (p>0.0001). Patients in control group documented irritation of taste reaching trend to statistical significance at week 1. However, in week 2 the results were statistically significant (p=0.0042).
Both chlorhexidine supplements showed equal healing properties and inhibition of plaque formation. Tooth stain occurred with both mouthwashes but there was a trend towards statistical significance with the lower CHX concentration/herbal extract. Patients were annoyed by increased staining and taste irritation occurred more frequently in the group using higher CHX concentrations.
[Show abstract][Hide abstract] ABSTRACT: Objectives: The primary goal in cause-related periodontitis treatment is to remove hard and soft bacterial deposits which should result in a smooth and biocompatible root surface. In addition, repeated instrumentation may lead to loss of tooth substance and thus, it should be avoided. The purpose of this in-vitro-study was to evaluate surface roughness and substance loss after four different treatment modalities.
Methods: Multi-species biofilms have been formed on standardized dentine specimens for 3.5 d. Thereafter, the dentine specimens were placed into artificial pockets and different treatments (air-polishing AIR-Flow Master with PERIO-FLOW System using erythritol (APE), air-polishing using erythritol combined with chlorhexidine digluconate (APE-CHX), hand instrumentation by using curettes (CUR) and ultrasonication (US)) were used. Biofilm formation and treatments were repeated four times. Before and after one (1×) and five (5×) treatments, surface roughness (Ra and Rz) and the thickness of the dentine specimens were measured. Statistical analysis was made by using ANOVA with Post-Hoc LSD.
Results: Substance loss (loss of thickness) was the highest when applying CUR (20±21 µm after 1×, 128±40 µm after 5×), all other treatments caused only a loss of thickness up to 8 µm (1×) and 14 µm (5×). The difference of CUR to the others treatments was each significant (p<0.01 after 1×, p<0.001 after 5×). After 5× the surface roughness was higher for CUR (Ra, Rz) and for US (Rz) than for the untreated control (each p< 0.05), no difference was found for APE and APE-CHX in comparison with the control.
Conclusion: Mechanical debridement by using APE and APE-CHX results in smooth surfaces and prevents substance loss.
The study was funded by EMS, Nyon, Switzerland.
[Show abstract][Hide abstract] ABSTRACT: Objective: The primary goal in cause-related periodontitis treatment is to remove hard and soft bacterial deposits which should result in a surface preventing recolonisation. The purpose of this in-vitro-study was to evaluate removal and reformation of a multi-species biofilm after four different treatment modalities.
Multi-species biofilms consisting of 12 species being associated with periodontitis have been formed on standardized dentine specimens for 3.5 d. Subsequently, the dentine specimens were placed into artificial pockets and different treatments (air-polishing AIR-Flow Master with PERIO-FLOW System using erythritol (APE), air-polishing using erythritol combined with chlorhexidine digluconate (APE-CHX), hand instrumentation by using curettes (CUR) and ultrasonication (US)) were applied. Biofilm formation and treatment were repeated four times. After one (1×) and five (5×) treatments, the counts (log10) of the remaining bacteria as well as those in the recolonized biofilm (total numbers as well as Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola) were determined. Statistical analysis was made by using ANOVA with Post-Hoc LSD.
Result: 1× and 5× treatment by CUR reduced the total bacterial counts by 2 log10 cfu (each p<0.01), APE and US by about 3 log10 and APE-CHX by 4 log10 cfu (each p<0.001). Recolonization did not show any difference for the total counts after 1× treatment, after 5× treatment total counts were less after US and APE (each p<0.01) and after APE-CHX (p<0.001). A. actinomycetemcomitans recolonized less in the biofilm after 1× APE-CHX. After 5×treatment, the recolonization of T. forsythia and T. denticola in biofilm was decreased after all treatments, those of all four in more detail determined pathogens was reduced but not completely prevented after APE-CHX.
Conclusion: The cleaning efficacy is more pronounced when using air-polishing or US. The addition of CHX to APE acts bactericidal and inhibits reformation of biofilm.
[Show abstract][Hide abstract] ABSTRACT: Background
Dental implants have become essential in reconstructive dentistry. Primary healing is determined by the design of their surface. The aim of this pilot study has been to investigate whether the morphology of the sandblasted and acid-etched (SLA®) surface remains unaffected after the insertion process into human bone.Materials and Methods
Two edentulous-atrophied human jaw specimens were used. Six brand new Straumann Standard RN implants with an SLA® surface and having a diameter of 3.3 mm and a length of 12 mm were inserted. Another two implants of the same type, but not inserted into bone, served as a reference. After explantation, the four implants were cleaned in an ultrasonic bath and two were left uncleaned. All eight implants were inspected by SEM for qualitative surface changes.ResultsAll four implants showed relevant changes of the topography at the apical thread flanks. The non-cleaned implants showed an almost complete coverage of the surface by a honeycomb-like structure, consistent with bone residues. The reference implants showed no changes.DiscussionThe results indicate that, for the osseointegration of dental implants, subtractive modifications of implant surfaces are less important than the reestablishment of the destroyed TiO2 layer. Further studies of other implant surfaces are required to verify the present results.
Clinical Oral Implants Research 07/2014; DOI:10.1111/clr.12449 · 3.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: To evaluate clinically the long-term results following treatment of deep intrabony defects with a combination of Platelet Rich Plasma (PRP) + a natural bone mineral (NBM) + a bioresorbable collagen membrane (GTR) to NBM + GTR.
Method: Sixteen patients suffering from advanced chronic periodontitis, and each of whom displayed one advanced intrabony defect were randomly treated with either PRP+NBM+GTR (test) or NBM+GTR (control). Clinical parameters were evaluated at baseline, at 1 year and 7 years after treatment. The primary outcome variable was clinical attachment level (CAL).
Results: The test sites showed a reduction in mean probing depth (PD) from 8.5±1.4 mm to 3.0 ± 0.5 mm (p<0.001) at 1 year and to 3.6 ± 0.7 mm (p<0.001) at 7 years, respectively. In the control group mean PD was reduced from 8.5 ± 1.7 mm to 3.1 ± 1.1 mm at 1 year (p<0.00) and to 3.4 ± 1.1 mm at 7 years. In the test group mean CAL changed from 10.4 ± 1.9 mm to 5.5 ± 0.9 mm at 1 year (p<0.001) and to 5.8 ± 1.4 mm at 7 years, respectively. In the control group mean CAL changed from 10.3 ± 2.2 mm to 5.4 ± 1.5 mm at 1 year (p<0.001) and to 6.3 ± 2.0 mm at seven years. No statistically significant differences in any of the investigated parameters were observed between the two groups at 1 and 7 years.
Conclusion: Both treatments resulted in significant PPD reductions and CAL gains. The present results have shown that the clinical improvements obtained with both treatments can over a period of 7 years.
[Show abstract][Hide abstract] ABSTRACT: Objective: Connective tissue grafts are frequently applied together with Emdogain® for root coverage. It is, however, unknown whether fibroblasts from the gingiva and from the palate respond similarly to Emdogain®. To evaluate the effect of Emdogain® on fibroblast from palatal and gingival connective tissue by using a genome-wide microarray approach.
Methods: Human palatal and gingival fibroblasts were exposed to Emdogain® and RNA subjected to microarray analysis followed by gene ontology screening with DAVID functional annotation clustering, KEGG pathway analysis, and the STRING functional protein association network. Microarray results were confirmed by qRT-PCR analysis.
Results: Transcription levels of 106 genes were at least 5-fold changed in both, gingival and palatal fibroblasts upon exposure to Emdogain®. Gene Ontology screening assigned the respective genes into 118 biological processes, six cellular components, eight molecular functions, and five pathways. Among the striking pattern was the changing expression of ligands targeting the TGF-β and gp130 receptor family, as well as the mesenchymal epithelial transition. Moreover, Emdogain® caused expression changes of receptors for chemokines, lipids and hormones, and transcription factors such as smad-3, PPARγ and ETS.
Conclusion: The present data suggest that Emdogain® causes substantial alterations in gene expression with a similar pattern in palatal and gingival fibroblasts.
[Show abstract][Hide abstract] ABSTRACT: Objective:
Several studies focus on a relationship between periodontitis (PA) and rheumatoid arthritis (RA). Citrullination of proteins and peptides by human peptidylarginine-deiminases (PAD) followed by generation of antibodies is an important factor in RA. Recently a PAD has been purified from Porphyromonas gingivalis (PPAD) being unique in bacteria. The aim of this case-control study was to determine activities of PAD and PPAD in periodontium and serum antibody levels against citrullinated epitopes of PPAD in RA patients.
Gingival crevicular washes of 52 RA patients (48 with PA (RA-PA) and 4 without (RA-NoPA)) and 44 individuals without RA (NoRA, 28 with PA (NoRA-PA) and 16 without PA (NoRA-NoPA)) have been evaluated for activities of PAD and PPAD and for presence of Porphyromonas gingivalis. Serum has been analyzed for antibodies against citrullinated epitopes of PPAD.
PAD activity has been detected in 25 (48%) of RA patients (24 RA-PA) and in 24 (55%) of NoRA (19 NoRA-PA). PPAD activity has been measured in 30 (58%) of RA-patients (29 RA-PA) and in 21 (50%) of No-RA-patients (19 NoRA-PA). Enzyme activities were significantly higher in NoRA-PA compared with NoRA-NoPA (p=0.022; p=0.004). PPAD activity correlated neither with PAD activity nor with counts of P. gingivalis. In contrast PPAD activity has also been detected in 16 out of 38 P. gingivalis negative samples. PPAD positive but P. gingivalis negative samples showed high antibody levels against citrullinated epitopes of PPAD.
Peptidylarginine-deiminases are active within the periodontium and can citrullinate proteins and peptides. P. gingivalis seems to be able to release PPAD acting in sites not colonized by the species. The citrullination by human PAD and PPAD may generate antibodies after breaking immunotolerance in susceptible individuals.
[Show abstract][Hide abstract] ABSTRACT: Background and Objective
Connective tissue grafts are frequently applied, together with Emdogain®, for root coverage. However, it is unknown whether fibroblasts from the gingiva and from the palate respond similarly to Emdogain. The aim of this study was therefore to evaluate the effect of Emdogain® on fibroblasts from palatal and gingival connective tissue using a genome-wide microarray approach.Material and Methods
Human palatal and gingival fibroblasts were exposed to Emdogain® and RNA was subjected to microarray analysis followed by gene ontology screening with Database for Annotation, Visualization and Integrated Discovery functional annotation clustering, Kyoto Encyclopedia of Genes and Genomes pathway analysis and the Search Tool for the Retrieval of Interacting Genes/Proteins functional protein association network. Microarray results were confirmed by quantitative RT-PCR analysis.ResultsThe transcription levels of 106 genes were up-/down-regulated by at least five-fold in both gingival and palatal fibroblasts upon exposure to Emdogain®. Gene ontology screening assigned the respective genes into 118 biological processes, six cellular components, eight molecular functions and five pathways. Among the striking patterns observed were the changing expression of ligands targeting the transforming growth factor-beta and gp130 receptor family as well as the transition of mesenchymal epithelial cells. Moreover, Emdogain® caused changes in expression of receptors for chemokines, lipids and hormones, and for transcription factors such as SMAD3, peroxisome proliferator-activated receptor gamma and those of the ETS family.Conclusion
The present data suggest that Emdogain® causes substantial alterations in gene expression, with similar patterns observed in palatal and gingival fibroblasts.
Journal of Periodontal Research 05/2014; 50(1). DOI:10.1111/jre.12186 · 2.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: The effect of moxifloxacin was compared with ofloxacin and doxycycline against bacteria associated with periodontitis within a biofilm (single strain and multi-species population) in vitro.
Method: Minimal inhibitory concentrations (MICs) and minimal bactericidal concentrations (MBCs) of moxifloxacin, ofloxacin and doxycyline were determined against single strains and multi-species populations in planktonic state. Single-species biofilms of two Porphyromonas gingivalis and two Aggregatibacter actinomycetemcomitans strains and a multi-species biofilm consisting of 12 species were formed for 3 days. The minimal biofilm eradication concentrations (MBECs) were determined after exposing the biofilms to the antibiotics (0.002 – 512 mg/l) for 18 h, addition of nutrient broth for 3 d and subsequent subcultivation. Photographs were taken by using scanning electron microscopy.
Result: The MICs and MBCs did not differ between ofloxacin and moxifloxacin against A. actinomycetemcomitans, moxifloxacin was more effective against anaerobes and the multi-species population. The single-species biofilms were eradicated by moderate concentrations of the antibiotics, the lowest MBECs were always determined for moxifloxacin (2-8 µg/ml). MBECs against the multi-species biofilms were 128 μg/ml, > 512 μg/ml and > 512 μg/ml for moxifloxacin, ofloxacin and doxycycline, respectively.
Moxifloxacin is more effective against anaerobes than ofloxacin. It is able to kill bacteria within biofilms although the necessary concentration against a multi-species biofilm is high. Moxifloxacin in a topical formulation may have potential as an adjunct to mechanical removal of the biofilms.
The present study was supported in part by Bayer Innovation GmbH, Leverkusen, Germany. The authors declare that they have no conflicts of interest.
Annual Meeting of the IADR Continental European Division 2013; 09/2013
[Show abstract][Hide abstract] ABSTRACT: Objective: Rheumatoid arthritis (RA) frequently affects the temporomandibular joint (TMJ) and masticatory muscles. The aim of this pilot study was to evaluate the presence of temporomandibular dysfunction and orofacial pain in patients with RA in relation to their periodontal status.
21 patients suffering of RA (DAS ≥ 3.2) were investigated for their periodontal condition (pocket depths, clinical attachment level, plaque and bleeding index) and TMJ affections (pain, sound, deviation, limitation). Furthermore, extra- and intraoral masticatory muscles were evaluated for pain at pressure; occlusal relationship, interferences and premature contacts were registered.
Thirteen patients (62%, mean age 52.61±11.25, 11 women) were diagnosed with moderate to severe forms of chronic periodontitis. There were no significant statistical differences regarding the number, sex, age, oral hygiene status of the patients in both groups (RA group, RA and periodontitis group). 69% of the patients with periodontitis and RA and 62.5% of the RA patients were diagnosed with discal displacement. 52% of the patients exhibited articular pain at the TMJ palpation, the majority being in the periodontitis group (64%); 45% of the periodontitis patients also suffered of muscular pain. Most patients (76.2%) had pain at the intraoral palpation of the masticatory muscles, 11 (52%) also showing pain at the extraoral palpation. Furthermore 62% of the patients (85% with periodontitis) presented TMJ sounds during mouth opening. Interferences or premature contacts were registered in all patients.
Patients with RA and periodontitis showed significantly more symptoms for orofacial pain and affections of the TMJ as compared to patients suffering only of RA. The early diagnosis and treatment of periodontitis might prevent the development of TMJ dysfunction and orofacial pain.
Annual Meeting of the IADR Continental European Division 2013; 09/2013
[Show abstract][Hide abstract] ABSTRACT: The objective of this study is to evaluate the effects of a paste-like bone substitute material with easy handling properties and improved mechanical stability on periodontal regeneration of intrabony defects in dogs.
Mandibular and maxillary first and third premolars were extracted, and three-wall intrabony defects were created on second and fourth premolars. After a healing period of 3 months, acute type defects were filled with a paste-like formulation of deproteinized bovine bone mineral (DBBM) (particle size, 0.125-0.25 mm) in a collagenous carrier matrix (T1), pulverized DBBM (particle size, 0.125-0.25 mm) without the carrier (T2), or Bio-Oss® granules (particle size, 0.25-1.00 mm) as control (C). All defects were covered with a Bio-Gide® membrane. The dogs were sacrificed after 12 weeks, and the specimens were analyzed histologically and histometrically.
Postoperative healing of all defects was uneventful, and no histological signs of inflammation were observed in the augmented and gingival regions. New cementum, new periodontal ligament, and new bone were observed in all three groups. The mean vertical bone gain was 3.26 mm (T1), 3.60 mm (T2), and 3.81 mm (C). That of new cementum was 2.25 mm (T1), 3.88 mm (T2), and 3.53 mm (C). The differences did not reach statistical significance. The DBBM particles were both incorporated in new bone and embedded in immature bone marrow.
The results of this preclinical study showed that the 0.125-0.25-mm DBBM particles in a powder or paste formulation resulted in periodontal regeneration comparable to the commercially available DBBM. Osteoconductivity, in particular, was not affected by DBBM size or paste formulation.
The improved handling properties of the paste-like bone substitute consisting of small DBBM particles embedded in a collagen-based carrier hold promise for clinical applications.
[Show abstract][Hide abstract] ABSTRACT: Guided tissue regeneration (GTR) with bioabsorbable collagen membranes (CM) is commonly used for the treatment of periodontal defects. The objective of this systematic review of randomized clinical trials was to assess the clinical efficacy of GTR procedures with CM, with or without bone substitutes, in periodontal infrabony defects compared with that of open flap debridement (OFD) alone. Primary outcomes were tooth loss and gain in clinical attachment level (CAL). Screening of records, data extraction, and risk-of-bias assessments were performed by two reviewers. Weighted mean differences were estimated by random effects meta-analysis. We included 21 reports on 17 trials. Risk of bias was generally high. No data were available for the primary outcome tooth loss. The summary treatment effect for change in CAL for GTR with CM compared with OFD was 1.58 mm (95% CI, 1.27 to 1.88). Despite large between-trial heterogeneity (I(2) = 75%, p < .001), all trials favored GTR over OFD. No differences in treatment effects were detected between trials of GTR with CM alone and trials of GTR with CM in combination with bone substitutes (p for interaction, .31). GTR with CM, with or without substitutes, may result in improved clinical outcomes compared with those achieved with OFD alone. Our findings support GTR with CM for the treatment of infrabony periodontal defects.
Journal of dental research 07/2013; 92(9). DOI:10.1177/0022034513496428 · 4.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Epidemiologic and clinical studies have indicated that diabetes is a risk factor for periodontal disease progression and healing. The aim of the present study was to evaluate short-term healing after enamel matrix derivative (EMD) application in combined supra/infrabony periodontal defects in diabetic rats.
Thirty male Wistar rats were initially divided into two groups, one with streptozotocin-induced diabetes and another one with healthy (non-diabetic) animals. Bony defects were surgically created on the mesial root of the first maxillary molars. After root surface planing and EDTA conditioning, EMD was applied to the roots at one side of the maxillae, while those on the contralateral sides were left untreated. Animals were killed 3 wk after surgery, and block sections were prepared for histologic and histomorphometric analysis.
There was statistically significant more gingival recession in diabetic animals than in non-diabetic animals. The length of the junctional epithelium was significantly shorter in the EMD-treated sites in both diabetic and normoglycemic rats. Sulcus depth and length of supracrestal soft connective tissue showed no statistically significant differences between groups. In all animals, new bone formation was observed. Although new bone occurred more frequently in healthy animals, the extent of new bone was not significantly different between groups. In none of the teeth, a layer of new cementum was detectable. EMD had no influence on bone or cementum regeneration. Adverse reactions such as excessive inflammation due to bacterial root colonization, ankylosis and bone fractures were exclusively observed in diabetic animals, irrespective of EMD treatment.
Within the limits of the present study, it can be concluded that periodontal healing was impaired in streptozotocin-induced diabetic rats. EMD had no beneficial effects on new bone and cementum formation during short-term healing in this defect model and could not ameliorate the adverse effects in the systemically compromised animals.
Journal of Periodontal Research 04/2013; 49(1). DOI:10.1111/jre.12084 · 2.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In the past few years indications for the use of the air polishing technology have been expanded from supragingival use (airflow) to subgingival air polishing (perioflow) by the development of new low-abrasive glycine-based powders and devices with a subgingival nozzle. Several studies on the subgingival use of air polishing have been completed. On 7 June 2012, during the Europerio 7 Congress in Vienna, a consensus conference on mechanical biofilm management took place aiming to review the current evidence from the literature on the clinical relevance of the subgingival use of air polishing and to make practical recommendations for the clinician. Bernita Bush (Bern), Prof Johannes Einwag (Stuttgart), Prof Thomas Flemmig (Seattle), Carmen Lanoway (Munich), Prof Ursula Platzer (Hamburg), Prof Petra Schmage (Hamburg), Brigitte Schoeneich (Zurich), Prof Anton Sculean (Bern), Dr Clemens Walter (Basel), and Prof Jan Wennström (Gothenburg) discussed under the moderation of Klaus-Dieter Bastendorf and Christian Becker (both ADIC Association for Dental Infection Control) the available clinical studies to reach a consensus on available clinical evidence. This paper summarizes the main conclusions of the consensus conference and points to the clinical relevance of the findings for the dental practitioner.
[Show abstract][Hide abstract] ABSTRACT: Objective: Recent review articles have shown that open debridement is more effective in the treatment of peri-implantitis than closed therapy. However, surgery may result in marginal recession and compromise esthetics. The purpose of this study was to assess the efficacy of nonsurgical antimicrobial photodynamic therapy (aPDT) in moderate vs severe defects. Method and Materials: The study encompassed 16 patients with a total of 18 ailing implants. Ten of these implants showed moderate bone loss (< 5 mm; Group 1) and eight implants severe defects (5 through 8 mm; Group 2). All implants received aPDT without surgical intervention. At baseline and 2 weeks, 3 months, and 6 months after therapy, peri-implant health was assessed including sulcus bleeding index (SBI), probing depth (PD), distance from implant shoulder to marginal mucosa (DIM), and clinical attachment level (CAL). Radiographic evaluation of distance from implant to bone (DIB) allowed comparison of peri-implant hard tissues after 6 months. Results: Baseline values for SBI were comparable in both groups. Three months after therapy, in both groups, SBI and CAL decreased significantly. In contrast, after 6 months, CAL and DIB increased significantly in Group 2, not in Group 1. However, DIM-values were not statistically different 6 months after therapy in both groups. Conclusion: Within the limits of this 6-month study, nonsurgical aPDT could stop bone resorption in moderate peri-implant defects but not in severe defects. However, marginal tissue recession was not significantly different in both groups at the end of the study. Therefore, especially in esthetically important sites, surgical treatment of severe peri-implantitis defects seems to remain mandatory.
[Show abstract][Hide abstract] ABSTRACT: Objective: Thermal Nd:YAG laser energy is well known for the purpose of blood coagulation. However, little is known about the bleeding frequency following laser-assisted oral surgery in patients on coumarin drugs. Therefore, the purpose of this study was to compare retrospectively the frequency of bleeding complications following Nd:YAG laserassisted versus conventional local coagulation of blood in oral surgery. Method and Materials: In October 2002, minor oral surgical interventions were found to be indicated in a total of 45 cardiac risk patients. In Group 1, blood coagulation was yielded in 24 patients with a Nd:YAG laser system, whereas in Group 2, treatment was performed in 21 patients with conventional means of local hemostasis. All therapies were performed continuing anticoagulant therapy between November 2002 and March 2003. Clinical data were recorded retrospectively from patient charts in May 2007. Results: In both Groups 1 and 2, a total of two bleeding complications were recorded. However, local re-interventions were sufficient for local hemostasis. Conclusion: These results indicate that Nd:YAG laser-assisted local hemostasis was not able to prevent bleeding complications completely. Within the limitations of this retrospective study it was concluded that in patients with anticoagulant treatment undergoing minor oral surgery, Nd:YAG laser-assisted local hemostasis is not superior to conventional methods of blood coagulation with respect to the frequency of bleeding complications.