[Show abstract][Hide abstract] ABSTRACT: Enterococci have gained significance as the cause of nosocomial infections; they occur as food contaminants and have also been linked to dental diseases. E. faecalis has a great potential to spread virulence as well as antibiotic resistance genes via horizontal gene transfer. The integration of food-borne enterococci into the oral biofilm in-vivo has been observed. Therefore, we investigated the virulence determinants and antibiotic resistance of 97 E. faecalis isolates from the oral cavity, food, and clinical specimens. In addition, phenotypic expression of gelatinase and cytolysin were tested, in-vitro biofilm formation was quantified and isolates were compared for strain relatedness via pulsed field gel electrophoresis (PFGE). Each isolate was found to possess two or more virulence genes, most frequently gelE, efaA, and asa1. Notably, plaque/saliva isolates possessed the highest abundance of virulence genes, the highest levels of phenotypic gelatinase and hemolysin activity and concurrently a high ability to form biofilm. The presence of asa1 was associated with biofilm formation. The biofilm formation capacity of clinical and plaque/saliva isolates was considerably higher than that of food isolates and they also showed similar antibiotic resistance patterns. These results indicate that the oral cavity can constitute a reservoir for virulent E. faecalis strains possessing antibiotic resistance traits and at the same time distinct biofilm formation capabilities facilitating exchange of genetic material.
Full-text · Article · Jan 2016 · Frontiers in Microbiology
[Show abstract][Hide abstract] ABSTRACT: Objectives
The correlation between caries and the oral prevalence of Candida spp. in children is contradictory in literature. Thereby, authors focused on Candida albicans as the most isolated Candida species from the oral cavity. Therefore, the aim of the present study was to compare caries-free and caries-bearing children regarding their oral carriage of Candida spp.
Material and methods
Twenty-six caries-free (CF group) and 26 caries-active children (CA group) were included into this study. Three different types of specimens were assessed, saliva and plaque, and in the case of caries, infected dentine samples were microbiologically analyzed for aerobic and anaerobic microorganisms and their counts. Special attention was given to the differentiation between C. albicans and Candida dubliniensis. Additionally, different biochemical tests, VITEK 2 (VITEK®2, bioMérieux, Marcy-l’Etoile, France) and 16S and 18S ribosomal DNA (rDNA) sequencing, were applied for identification.
The detection of C. albicans did not differ between the CF and CA groups. C. dubliniensis was never detected in any specimen of the CF group, but occurred in one quarter of the CA group (27 % in plaque, 23 % in saliva), thus leading to a statistically significant difference between the two groups (p < 0.05). In six of these cases, C. dubliniensis was detected concomitantly in saliva and plaque and once only in plaque. CA group harbored statistically more Streptococcus mutans than the control group revealing a correlation between S. mutans and C. dubliniensis regarding the caries group.
This is the first study reporting a frequent detection of C. dubliniensis in caries-active children, which could have been underestimated so far due to difficulties in differentiation between this yeast species and C. albicans.
Microbiological diagnostic—especially of oral Candida species—is an important determinant for identifying etiological factors of dental caries in children.
Full-text · Article · Dec 2015 · Clinical Oral Investigations
[Show abstract][Hide abstract] ABSTRACT: Purpose:
To determine whether fluorosed areas of teeth can be successfully treated with resin infiltration and whether the results are long lasting.
Materials and methods:
For the present case of mild to moderate dental fluorosis, the microinvasive resin infiltration technique was chosen, following suboptimal results of in-office vital tooth bleaching to improve the aesthetic appearance of the affected teeth.
Six months after treatment, the white opaque and brown discolourations remain masked.
This case report demonstrates that resin infiltration is an agreeable option for this type of tooth discolouration, rather than choosing more invasive, conventional procedures. More studies need to be completed to determine longer-term outcomes of the technique.
No preview · Article · Sep 2014 · Oral health & preventive dentistry
[Show abstract][Hide abstract] ABSTRACT: Objectives:
To clinically evaluate the healing of mandibular Miller Class I and II isolated gingival recessions treated with the modified coronally advanced tunnel (MCAT) in conjunction with an enamel matrix derivative (EMD) and subepithelial connective tissue graft (SCTG).
Method and materials:
Sixteen healthy patients (13 women and 3 men) exhibiting one isolated mandibular Miller Class I and II gingival recessions of a depth of ≥ 3 mm, were consecutively treated with the MCAT in conjunction with EMD and SCTG. Treatment outcomes were assessed at baseline and at 12 months postoperatively. The primary outcome variable was complete root coverage (CRC) (eg, 100% root coverage).
Postoperative pain and discomfort were low and no complications such as postoperative bleeding, allergic reactions, abscesses, or loss of SCTG were observed. At 12 months, statistically significant (P < .0001) root coverage was obtained in all 16 defects. CRC was measured in 12 out of the 16 cases (75%) while in the remaining 4 defects root coverage amounted to 90% (in two cases) and 80% (in two cases), respectively. Mean root coverage was 96.25%. Mean keratinized tissue width increased from 1.98 ± 0.8 mm at baseline to 2.5 ± 0.9 mm (P < .0001) at 12 months, while mean probing depth did not show any statistically significant changes (ie, 1.9 ± 0.3 mm at baseline vs 1.8 ± 0.2 mm at 12 months).
Within their limits, the present results indicate that the described treatment approach may lead to predictable root coverage of isolated mandibular Miller Class I and II gingival recessions.
No preview · Article · Sep 2014 · Quintessence international (Berlin, Germany: 1985)
[Show abstract][Hide abstract] ABSTRACT: Ende der 1970er und Anfang der 1980er Jahre wurde der entzündliche Charakter parodontaler Erkrankungen mehrfach bewiesen, und mehrere klassische klinische Studien konnten ein Aufhalten der parodontalen Destruktion nach erfolgter kausaler Therapie belegen. Durch die Regeneration verloren gegangener parodontaler Gewebe wird die Bildung von Wurzelzement, parodontalem Ligament und Alveolarknochen angestrebt. Dadurch soll die Prognose der betroffenen Zähne langfristig gebessert werden. In dieser Hinsicht wurde in den letzten Jahrzenten eine Vielzahl an regenerativen Materialien und chirurgischen Techniken entwickelt.
No preview · Article · Sep 2014 · Der Freie Zahnarzt
[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: The use of antibacterial photodynamic therapy (aPDT) additionally to scaling and root planing (SRP) has been shown to positively influence the clinical outcomes. However, at present, it is unknown to what extent aPDT may represent a potential alternative to the use of systemic antibiotics in nonsurgical periodontal therapy in patients with aggressive periodontitis (AP). The aim of this study was to evaluate the outcomes following nonsurgical periodontal therapy and additional use of either aPDT or amoxicillin and metronidazole (AB) in patients with AP.
Thirty-six patients with AP displaying at least three sites with pocket depth (PD) ≥6 mm were treated with SRP and either systemic administration of AB for 7 days or with two episodes of aPDT. The following clinical parameters were evaluated at baseline and at 6 months: plaque index (PI), bleeding on probing (BOP), PD, gingival recession (GR) and clinical attachment level (CAL).
Thirty-five patients have completed the 6-month evaluation. At 6 months, mean PD was statistically significantly reduced in both groups (from 5.0 ± 0.8 to 3.0 ± 0.6 mm with AB and from 5.1 ± 0.5 to 3.9 ± 0.8 mm with aPDT (p < 0.001)). AB yielded statistically significantly higher improvements in the primary outcome parameter PD (p < 0.001) when compared to aPDT. The number of pockets ≥7 mm was reduced from 141 to 3 after AB (p < 0.001) and from 137 to 45 after aPDT (p = 0.03). Both therapies resulted in statistically significant reductions in all parameters compared to baseline.
While both treatments resulted in statistically significant clinical improvements, AB showed statistically significantly higher PD reduction and lower number of pockets ≥7 mm compared to aPDT.
In patients with AP, the two times application of aPDT in conjunction with nonsurgical periodontal therapy cannot be considered an alternative to the systemic use of amoxicillin and metronidazole.
No preview · Article · Feb 2014 · Clinical Oral Investigations
[Show abstract][Hide abstract] ABSTRACT: There is confusion over the definition of the term "viability state(s)" of microorganisms. "Viability staining" or "vital staining techniques" are used to distinguish live from dead bacteria. These stainings, first established on planctonic bacteria, may have serious shortcomings when applied to multispecies biofilms. Results of staining techniques should be compared with appropriate microbiological data.
Many terms describe "vitality states" of microorganisms, however, several of them are misleading. Authors define "viable" as "capable to grow". Accordingly, staining methods are substitutes, since no staining can prove viability.The reliability of a commercial "viability" staining assay (Molecular Probes) is discussed based on the corresponding product information sheet: (I) Staining principle; (II) Concentrations of bacteria; (III) Calculation of live/dead proportions in vitro. Results of the "viability" kit are dependent on the stains' concentration and on their relation to the number of bacteria in the test. Generally this staining system is not suitable for multispecies biofilms, thus incorrect statements have been published by users of this technique.To compare the results of the staining with bacterial parameters appropriate techniques should be selected. The assessment of Colony Forming Units is insufficient, rather the calculation of Plating Efficiency is necessary. Vital fluorescence staining with Fluorescein Diacetate and Ethidium Bromide seems to be the best proven and suitable method in biofilm research.Regarding the mutagenicity of staining components users should be aware that not only Ethidium Bromide might be harmful, but also a variety of other substances of which the toxicity and mutagenicity is not reported.
The nomenclature regarding "viability" and "vitality" should be used carefully.The manual of the commercial "viability" kit itself points out that the kit is not suitable for natural multispecies biofilm research, as supported by an array of literatureResults obtained with various stains are influenced by the relationship between bacterial counts and the amount of stain used in the test. Corresponding vitality data are prone to artificial shifting.As microbiological parameter the Plating Efficiency should be used for comparison.Ethidium Bromide is mutagenic. Researchers should be aware that alternative staining compounds may also be or even are mutagenic.
[Show abstract][Hide abstract] ABSTRACT: The aims of this double-blind, controlled, crossover study were to assess the influence of food preservatives on in situ dental biofilm growth and vitality, and to evaluate their influence on the ability of dental biofilm to demineralize underlying enamel over a period of 14 days.
Twenty volunteers wore appliances with six specimens each of bovine enamel to build up intra-oral biofilms. During four test cycles of 14 days, the subjects had to place the appliance in one of the assigned controls or active solutions twice a day for a minute: negative control 0.9 % saline, 0.1 % benzoate (BA), 0.1 % sorbate (SA) and 0.2 % chlorhexidine (CHX positive control). After 14 days, the biofilms on two of the slabs were stained to visualize vital and dead bacteria to assess biofilm thickness (BT) and bacterial vitality (BV). Further, slabs were taken to determine mineral loss (ML), by quantitative light-induced laser fluorescence (QLF) and transversal microradiography (TMR), moreover the lesion depths (LD).
Nineteen subjects completed all test cycles. Use of SA, BA and CHX resulted in a significantly reduced BV compared to NaCl (p < 0.001). Only CHX exerted a statistically significant retardation in BT as compared to saline. Differences between SA and BA were not significant (p > 0.05) for both parameters. TMR analysis revealed the highest LD values in the NaCl group (43.6 ± 44.2 μm) and the lowest with CHX (11.7 ± 39.4 μm), while SA (22.9 ± 45.2 μm) and BA (21.4 ± 38.5 μm) lay in between. Similarly for ML, the highest mean values of 128.1 ± 207.3 vol% μm were assessed for NaCl, the lowest for CHX (-16.8 ± 284.2 vol% μm), while SA and BA led to values of 83.2 ± 150.9 and 98.4 ± 191.2 vol% μm, respectively. With QLF for both controls, NaCl (-33.8 ± 101.3 mm(2) %) and CHX (-16.9 ± 69.9 mm(2) %), negative values were recorded reflecting a diminution of fluorescence, while positive values were found with SA (33.9 ± 158.2 mm(2) %) and BA (24.8 ± 118.0 mm(2) %) depicting a fluorescence gain. These differences were non-significant (p > 0.05).
The biofilm model permited the assessment of undisturbed oral biofilm formation influenced by antibacterial components under clinical conditions for a period of 14 days. An effect of BA and SA on the demineralization of enamel could be demonstrated by TMR and QLF, but these new findings have to be seen as a trend. As part of our daily diet, these preservatives exert an impact on the metabolism of the dental biofilm, and therefore may even influence demineralization processes of the underlying dental enamel in situ.
Full-text · Article · Aug 2013 · Clinical Oral Investigations
[Show abstract][Hide abstract] ABSTRACT: Summary The aim of this randomized, controlled clinical study was to compare the short-term effects of nonsurgical periodontal therapy with the additional administration of systemic antibiotics (AB) and the same therapy with additional photodynamic therapy (PDT) in the treatment of patients with aggressive periodontitis (AP). Thirty-six patients with AP received full-mouth nonsurgical periodontal treatment (SRP) and were then randomly divided into two groups of 18 subjects each. Group AB received amoxicillin and metronidazole three times a day for 7 days. Group PDT received two applications of PDT on the day of SRP as well as at follow-up after 7 days. The following clinical parameters were measured at baseline and 3 months after therapy: plaque index (PLI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). After 3 months, PD was significantly reduced in both groups (from 5.0 ± 0.8 mm to 3.2 ± 0.4 mm with AB, and 5.1± 0.5 mm to 4.0 ± 0.8 mm with PDT; both p < 0.001), while AB revealed significantly lower values compared to PDT (p = 0.001). In both groups, GR was not significantly changed. CAL was significantly reduced in both groups (PDT: 5.7±0.8 mm to 4.7±1.1 mm; p = 0.011; AB: 5.5 ±1.1 mm to 3.9± 1.0 mm; p < 0.001) and differed significantly between the groups (p = 0.025). The number of residual pockets (PD ≥4 mm) and positive BOP was reduced by AB from 961 to 377, and by PDT from 628 to 394. Pockets with PD ≥ 7 mm were reduced by AB from 141 to 7, and by PDT from 137 to 61. After 3 months, both treatments led to statistically significant clinical improvements. The systemic administration of antibiotics, however, resulted in significantly higher reduction of PD and a lower number of deep pockets compared to PDT.
No preview · Article · Jul 2013 · Schweizerische Monatsschrift für Zahnmedizin = Revue mensuelle suisse d'odonto-stomatologie = Rivista mensile svizzera di odontologia e stomatologia / SSO
[Show abstract][Hide abstract] ABSTRACT: Objective:
The objective of the study is to compare the clinical, microbiological and host-derived effects in the non-surgical treatment of initial peri-implantitis with either adjunctive local drug delivery (LDD) or adjunctive photodynamic therapy (PDT) after 12 months.
Materials and methods:
Forty subjects with initial peri-implantitis, that is, pocket probing depths (PPD) 4-6 mm with bleeding on probing (BoP) and radiographic bone loss ≤2 mm, were randomly assigned to two treatment groups. All implants were mechanically debrided with titanium curettes and with a glycine-based powder airpolishing system. Implants in the test group (N = 20) received adjunctive PDT, whereas minocycline microspheres were locally delivered into the peri-implant pockets of control implants (N = 20). At sites with residual BoP, treatment was repeated after 3, 6, 9 and 12 months. The primary outcome variable was the change in the number of peri-implant sites with BoP. Secondary outcome variables included changes in PPD, clinical attachment level (CAL), mucosal recession (REC) and in bacterial counts and crevicular fluid (CF) levels of host-derived biomarkers.
After 12 months, the number of BoP-positive sites decreased statistically significantly (P < 0.05) from baseline in both groups (PDT: 4.03 ± 1.66-1.74 ± 1.37, LDD: 4.41 ± 1.47-1.55 ± 1.26). A statistically significant (P < 0.05) decrease in PPD from baseline was observed at PDT-treated sites up to 9 months (4.19 ± 0.55 mm to 3.89 ± 0.68 mm) and up to 12 months at LDD-treated sites (4.39 ± 0.77 mm to 3.83 ± 0.85 mm). Counts of Porphyromonas gingivalis and Tannerella forsythia decreased statistically significantly (P < 0.05) from baseline to 6 months in the PDT and to 12 months in the LDD group, respectively. CF levels of IL-1β decreased statistically significantly (P < 0.05) from baseline to 12 months in both groups. No statistically significant differences (P > 0.05) were observed between groups after 12 months with respect to clinical, microbiological and host-derived parameters.
Non-surgical mechanical debridement with adjunctive PDT was equally effective in the reduction of mucosal inflammation as with adjunctive delivery of minocycline microspheres up to 12 months. Adjunctive PDT may represent an alternative approach to LDD in the non-surgical treatment of initial peri-implantitis.
No preview · Article · Apr 2013 · Clinical Oral Implants Research
[Show abstract][Hide abstract] ABSTRACT: Objective: The aim of this double-blind, controlled, cross-over study was to evaluate the effect of a zinc containing glass-ionomer cement on the in situ biofilm formation and to compare it to enamel and a glass ionomer cement without zinc ions
Method: Fifteen volunteers wore individual acrylic appliances in which six sterilised discs were inserted: two of bovine enamel, two of GIC ChemFil and two of GIC Equia to build up intra-oral biofilms. During two test cycles (48 hours and 96 hours) the subjects had to wear the appliances continuously. After each test cycle the developed biofilms were removed from the splint, the adhering biofilm was detached from the slab with a sterile probe and streaked on an object slide. Then the biofilm was vital stained based on the use of fluoresceindiacetate and ethidium bromide. Finally an image analysis software (AxioVision 4, Carl Zeiss, Göttingen, Germany) discriminating between green and red pixels was used to calculate the vitality of the bacterial biofilm flora, which means the percentage of vital bacteria in the total flora (VF%).
On enamel the highest vitality amounts (90.01±6.65 and 81.42±18.40) were detected which were not different at both time points (p=0.100). The glass ionomer cement without zinc (Equia) exerted lower vitality values both after 48 hours (83.66±7.29) and after 96 hours (74.04±13.04) compared to enamel. Only after 48 hours the reduction was significantly different compared to enamel (p=0.046). The glass ionomer with zinc ions (ChemFil) revealed the lowest values after 48 and 96 hours (74.86±6.25 and 61.36±17.81). The reductions compared to enamel were significant at all time points (p<0.001 and 0.008). Compared to Equia a significant difference was detected after 48 hours (p=0.004).
A significant antibacterial effect of the glass ionomer cement with zinc ions could be seen compared to enamel.
[Show abstract][Hide abstract] ABSTRACT: Objective: To evaluate clinically the results following treatment of deep intrabony defects with either platelet-rich gel (PRG) or an enamel matrix derivative (EMD).
Method: Twenty four patients suffering from advanced chronic periodontitis, and each of whom displayed one advanced intrabony defect were randomly treated with either PRG (test) or EMD (Emdogain, Straumann, Basel, Switzerland) (control). Clinical parameters were evaluated at baseline and at 1 year after treatment. The primary outcome variable was the clinical attachment level (CAL).
Result: The test sites showed a reduction in mean probing depth (PD) from 8.8 ± 1.9 mm to 4.4 ± 0.9 mm (p<0.001) at 1 year. In the control group mean PD was reduced from 8.9 ± 1.2 mm to 4.5 ± 0.8 mm (p<0.001). In the test group mean CAL changed from 9.8 ± 2.6 mm to 6.4 ± 1.9 mm at 1 year (p<0.001). In the control group mean CAL changed from 9.88 ± 2.0 mm to 6.4 ± 1.9 mm (p<0.001). No statistically significant differences in any of the investigated parameters were observed between the two groups at 1 year.
Conclusion: The present study has shown that (i) 1 year after regenerative surgery, both treatments resulted in statistically significant PD reductions and CAL gains and (ii) PRG and EMD may result in comparable clinical outcomes.
[Show abstract][Hide abstract] ABSTRACT: Objective: to compare the adjunctive effects in the non-surgical treatment of periimplantitis with either local drug delivery (LDD) or photodynamic therapy (PDT).
Method: Forty subjects with initial periimplantitis, i.e. pocket probing depths (PPD) 4–6 mm with bleeding on probing (BoP) and crestal bone loss 0.5-2 mm were randomly assigned to two treatment groups. After mechanical debridement, test implant sites (N=20) received adjunctive PDT, whereas minocycline microspheres were locally delivered at sites of control implants (N=20). At sites with residual BoP, treatment was repeated after 3, 6 and 9 months. The primary outcome variable was the change in the number of sites with BoP. Secondary outcome variables were changes in PPD, clinical attachment level (CAL), mucosal recession (REC) and changes in microbiological and host-derived parameters.
Result: After 12 months, the number of BoP-positive sites decreased statistically significantly (p<0.05) from baseline in the PDT (4.03 ± 1.66 to 1.74 ± 1.37) and LDD (4.41 ± 1.47 to 1.55 ± 1.26) group, respectively. A statistically significant (p<0.05) decrease in PPD from baseline was observed at PDT-treated sites up to 9 months (4.19 ± 0.55 mm to 3.89 ± 0.68 mm) and up to 12 months at LDD-treated sites (4.39 ± 0.77 mm to 3.83 ± 0.85 mm). The presence of Porphyromonas gingivalis and Tannerella forsythia decreased statistically significantly (p<0.05) from baseline to 9 months in the PDT group and up to 12 months in the LDD group. After 12 months, the concentration in the crevicular fluid of interleukin-1β decreased statistically significantly (p<0.05) from baseline in both groups. No statistically significant differences were observed between both groups after 12 months with respect to clinical, microbiological and host-derived parameters.
Conclusion: Non-surgical mechanical debridement with adjunctive use of PDT was equally effective as the adjunctive use of LDD in the treatment of initial periimplantitis up to 12 months.
[Show abstract][Hide abstract] ABSTRACT: Background and objective:
Molecular biological methods for the detection of periodontitis-associated bacteria based on DNA amplification have many advantages over classical culture techniques. However, when it comes to assessing immediate therapeutic success, e.g. reduction of viable bacteria, DNA-based polymerase chain reaction is unsuitable because it does not distinguish between live and dead bacteria. Our objective was to establish a simple RNA-based method that is easily set up and allows reliable assessment of the live bacterial load.
Material and methods:
We compared conventional quantitative real-time PCR (qPCR), propidium monoazide-qPCR and reverse transcription qPCR (RT-qPCR) for the detection of periodontal pathogens after antibiotic treatment in vitro. Applicability was tested using clinical samples of subgingival plaque obtained from patients at different treatment stages.
The bacterial load was remarkably stable over prolonged periods when assessed by conventional qPCR, while both propidium monoazide intercalation as well as cDNA quantitation showed a decline according to decreasing numbers of viable bacteria after antibiotic treatment. Clinical samples of subgingival plaque were directly subjected to DNase I treatment and RT without previous extraction or purification steps. While the results of the DNA- and RNA-based methods are comparable in untreated patients, the classical qPCR frequently detected substantial bacterial load in treated patients where RT-qPCR no longer indicates the presence of those pathogens. The disagreement rates ranged between 4 and 20% in first visit patients and 8-50% in the group of currently treated patients.
We propose to use RNA-based detection methods to verify the successful eradication of periodontal pathogens.
Full-text · Article · Feb 2013 · Journal of Periodontal Research
[Show abstract][Hide abstract] ABSTRACT: Background:
Regenerative periodontal surgery using the combination of enamel matrix derivative (EMD) and natural bone mineral (NBM) with and without addition of platelet-rich plasma (PRP) has been shown to result in substantial clinical improvements, but the long-term effects of this combination are unknown.
The goal of this study was to evaluate the long-term (5-year) outcomes after regenerative surgery of deep intrabony defects with either EMD + NBM + PRP or EMD + NBM. Twenty-four patients were included. In each patient, one intrabony defect was randomly treated with either EMD + NBM + PRP or EMD + NBM. Clinical parameters were evaluated at baseline and 1 and 5 years after treatment. The primary outcome variable was clinical attachment level (CAL).
The sites treated with EMD + NBM + PRP demonstrated a mean CAL change from 10.5 ± 1.6 to 6.0 ± 1.7 mm (P <0.001) at 1 year and 6.2 ± 1.5 mm (P <0.001) at 5 years. EMD + NBM-treated defects showed a mean CAL change from 10.6 ± 1.7 to 6.1 ± 1.5 mm (P <0.001) at 1 year and 6.3 ± 1.4 mm (P <0.001) at 5 years. At 1 year, a CAL gain of ≥4 mm was measured in 83% (10 of 12) of the defects treated with EMD + NBM + PRP and in 100% (all 12) of the defects treated with EMD + NBM. Compared to baseline, in both groups at 5 years, a CAL gain of ≥4 mm was measured in 75% (nine of 12 in each group) of the defects. Four sites in the EMD + PRP + NBM group lost 1 mm of the CAL gained at 1 year. In the EMD + NBM group, one defect lost 2 mm and four other defects lost 1 mm of the CAL gained at 1 year. No statistically significant differences in any of the investigated parameters were observed between the two groups.
Within their limits, the present results indicate that: 1) the clinical outcomes obtained with both treatments can be maintained up to a period of 5 years; and 2) the use of PRP does not appear to improve the results obtained with EMD + NBM.
Full-text · Article · Jan 2013 · Journal of Periodontology
[Show abstract][Hide abstract] ABSTRACT: Anhand der Daten der DMS-Studien III und IV zeichnet sich ein stetiger Rückgang sowohl an kariösen Erkrankungen als auch an Zahnverlusten ab. In Bezug auf Parodontalerkrankungen ist jedoch das Gegenteil der Fall. Zwischen 1997 und 2005 stieg in Deutschland die Prävalenz der mittelschweren und schweren Parodontalerkrankungen bei 35- bis 40-jährigen Erwachsenen von 46,3 auf 73,2% und bei Senioren von 64,1 auf 87,8%. Diese Entwicklung verdeutlicht den enorm großen Handlungsbedarf bezüglich der Prophylaxe, Diagnose und Therapie von Parodontalerkrankungen. Der folgende Artikel beschäftigt sich mit den Grundlagen der Prophylaxe und der risikoorientierten, individuellen Nachsorge bei Parodontitispatienten, da eben diese unterstützende Parodontaltherapie (UPT) in Kombination mit einer regelmäßigen Mundhygiene den Schlüssel für einen langfristigen Therapieerfolg darstellt.
[Show abstract][Hide abstract] ABSTRACT: Objective:
To investigate the efficacy, tolerability, and long-term color stability of tooth whitening using two different bleaching techniques: an at-home tray technique (5.0% H2O2) and an over-the-counter strip technique (5.3% H2O2).
Method and materials:
Thirty subjects were included in this two-cell, parallel, examiner-blinded, randomized clinical trial. Shade evaluations were performed with a value-oriented VITA shade guide. The null hypothesis was that there would be no differences between the groups and no improvements from baseline with regard to tooth shade. Bleaching sensitivity, gingival irritation, and patient acceptance were recorded on a visual analog scale (VAS). Scanning electron microscopy (SEM) was performed to detect any enamel surface changes.
After bleaching, both treatments demonstrated significant improvements in tooth shade (P < .001 for both groups). At the 18-month recall, tooth shade remained significantly lighter than at baseline (P = .006 for tray group; P = .001 for strip group). However, a relapse of the tooth shade was observed compared with the immediate postbleaching result (P < .05). VAS data yielded no significant differences between groups regarding bleaching sensitivity and gingival irritation. None of the teeth studied showed detectable enamel surface changes. Patient acceptance was statistically significantly higher in the tray group compared with the strip group (P < .05).
Both techniques demonstrated significant and comparable levels of tooth shade improvement after 2 weeks and 18 months. Each treatment caused similar, transient oral adverse effects.
No preview · Article · Sep 2012 · Quintessence international (Berlin, Germany: 1985)
[Show abstract][Hide abstract] ABSTRACT: Background:
The purpose of the present study is to evaluate the 10-year results following treatment of intrabony defects treated with an enamel matrix protein derivative (EMD) combined with either a natural bone mineral (NBM) or β-tricalcium phosphate (β-TCP).
Twenty-two patients with advanced chronic periodontitis and displaying one deep intrabony defect were randomly treated with a combination of either EMD + NBM or EMD + β-TCP. Clinical evaluations were performed at baseline and at 1 and 10 years. The following parameters were evaluated: plaque index, bleeding on probing, probing depth, gingival recession, and clinical attachment level (CAL). The primary outcome variable was CAL.
The defects treated with EMD + NBM demonstrated a mean CAL change from 8.9 ± 1.5 mm to 5.3 ± 0.9 mm (P <0.001) and to 5.8 ± 1.1 mm (P <0.001) at 1 and 10 years, respectively. The sites treated with EMD + β-TCP showed a mean CAL change from 9.1 ± 1.6 mm to 5.4 ± 1.1 mm (P <0.001) at 1 year and 6.1 ± 1.4 mm (P <0.001) at 10 years. At 10 years two defects in the EMD + NBM group had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. In the EMD + β-TCP group three defects had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. Compared with baseline, at 10 years, a CAL gain of ≥3 mm was measured in 64% (i.e., seven of 11) of the defects in the EMD + NBM group and in 82% (i.e., nine of 11) of the defects in the EMD + β-TCP group. No statistically significant differences were found between the 1- and 10-year values in either of the two groups. Between the treatment groups, no statistically significant differences in any of the investigated parameters were observed at 1 and 10 years.
Within their limitations, the present findings indicate that the clinical improvements obtained with regenerative surgery using EMD + NBM or EMD + β-TCP can be maintained over a period of 10 years.
No preview · Article · Aug 2012 · Journal of Periodontology
[Show abstract][Hide abstract] ABSTRACT: The aim of this study has been to compare the clinical and radiographic outcome of periodontal intrabony defect treatment by open flap debridement alone or in combination with nanocrystalline hydroxyapatite bone substitute application. Thirty patients diagnosed with advanced periodontits were divided into two groups: the control group (OFD), in which an open flap debridement procedure was performed and the test group (OFD+NHA), in which defects were additionally filled with nanocrystalline hydroxyapatite bone substitute material. Plaque index (PI), gingival index (GI), bleeding on probing (BOP), pocket depth (PD), gingival recession (GR) and clinical attachment level (CAL) were measured prior to, then 6 and 12months following treatment. Radiographic depth and width of defects were also evaluated. There were no differences in any clinical and radiographic parameters between the examined groups prior to treatment. After treatment, BOP, GI, PD, CAL, radiographic depth and width parameter values improved statistically significantly in both groups. The PI value did not change, but the GR value increased significantly after treatment. There were no statistical differences in evaluated parameters between OFD and OFD+NHA groups 6 and 12months after treatment. Within the limits of the study, it can be concluded that the additional use of nanocrystalline hydroxyapatite bone substitute material after open flap procedure does not improve clinical and radiographic treatment outcome.
Full-text · Article · Jun 2012 · Annals of anatomy = Anatomischer Anzeiger: official organ of the Anatomische Gesellschaft