Journal of Clinical Periodontology最新文献

Background and Aim

Effective oral hygiene using different mechanical means is mainly dependent on the patient. Mouthwashes containing antimicrobial agents have been developed to be used as an adjunct to mechanical supragingival plaque control. The aim of this umbrella review is to evaluate and compare the long-term efficacy of commonly used, commercially available daily mouthwashes in plaque control and gingival inflammation.

Methods

The current umbrella review was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions using the PICOS format. The search was conducted in four databases: PubMed, Scopus, Cochrane and Web of Science. Nine systematic reviews/meta-analyses (SRs/MAs) on the long-term efficacy of commercially available mouthwashes (low-concentration chlorhexidine [CHX], cetylpyridinium chloride [CPC], mouthwashes with essential oils [EOs], fluoride and oxygen-releasing mouthwashes) were included.

Results

The results revealed that in all SRs/MAs, the prolonged daily use of mouthwashes helped in reducing plaque and gingival inflammation indices but not always with statistical significance.

Conclusions

Results of the present study indicate that the long-term use of mouthwashes containing EOs seems to give the best results in both reducing plaque levels and improving gingivitis indices among all tested formulations.

Trial Registration: PROSPERO Registration Number CRD 42024618552

Aim

To compare the clinical and microbiological outcomes after the use of systemic antimicrobials as adjuncts to periodontal surgery in patients with periodontitis stage III and IV positive for Porphyromonas gingivalis.

Material and Methods

Patients positive for P. gingivalis at the re-evaluation 6 weeks after subgingival instrumentation and with probing depths (PD) ≥ 6 mm in more than two teeth per quadrant were randomly allocated to periodontal surgery with adjunctive systemic azithromycin (AZI) or metronidazole (MET). Clinical and microbiological outcomes were evaluated at 6, 12 and 48 months after surgery.

Results

Forty-three subjects were included, with 40 and 36 completing follow-ups at 12 and 48 months, respectively. Clinical outcomes improved and remained stable over time in both groups. No statistically significant differences were observed between groups for PD reductions at 12 or 48 months. At 48 months, P. gingivalis was detected in 80% (AZI) and 70.6% (MET). At the final visit, no differences in clinical endpoints were observed between patients harbouring P. gingivalis and those who were not.

Conclusions

Slight differences were observed between the groups, with clinical outcomes improving and remaining stable over time following surgical treatment. Neither protocol suppressed P. gingivalis beyond detection limit 48 months after treatment.

Aim

To evaluate the effect of the adjunctive use of a resorbable collagen membrane in the reconstructive surgical therapy of peri-implantitis.

Material and Methods

Forty-three patients (43 implants) diagnosed with peri-implantitis underwent surgical treatment using a reconstructive approach, which included a bone substitute material with (test) or without (control) a resorbable collagen membrane. Supportive peri-implant treatment was administered biannually during the 3-year follow-up period. Clinical outcomes, such as probing pocket depth (PPD), bleeding on probing (BOP), suppuration on probing (SOP), marginal mucosal level (REC) and keratinised mucosa width (KM), were recorded at baseline, as well as at 6, 12 and 36 months. Radiographic marginal bone levels (MBLs) and patient-reported outcomes (PROs) were also evaluated. The primary outcome was a composite measure consisting of PPD ≤ 5 mm, absence of BOP/SOP and buccal REC of ≤ 1 mm. A second composite outcome, termed ‘disease resolution’, was also assessed, defined as PPD ≤ 5 mm, BOP at ≤ 1 site and complete absence of SOP.

Results

Out of the 43 participants, 8 were lost to follow-up, 2 experienced implant loss and 1 was surgically re-treated. At 3 years, the composite outcome was achieved for 25.0% of implants (test: 17.6%; control: 27.8%), while disease resolution was achieved for 31.2% (test: 29.4%; control: 27.8%). Overall, PPD and BOP were reduced by 3.6 ± 3.2 mm and 37.5% ± 42.1%, respectively. Changes in buccal REC and KM were 0.5 ± 1.3 and 1.1 ± 1.5 mm, respectively. An overall bone gain (MBL change) of 1.0 ± 2.2 mm was observed. PROs were favourable. No statistically significant differences were observed between groups.

Conclusion

Adding a collagen membrane to a bone substitute material in the surgical treatment of peri-implantitis did not yield any benefits regarding clinical, radiographic or patient-reported outcomes.

Trial Registration: ISRCTN67095066 (https://www.isrctn.com/ISRCTN67095066)

Objective

To evaluate the stability changes of two dental implant designs over 6 weeks of healing.

Materials and Methods

Patients with edentulous sites who had undergone tooth extraction more than 2 months earlier were randomly assigned to receive either tapered (BLX) or cylindrical (BL) implants (SLA/Roxolid, Straumann, Switzerland). Implant stability was assessed via the maximum insertion torque (MIT), implant stability tests (ISTs) and implant stability quotient (ISQ). ISTs were conducted immediately (T1), on Day 2 (T2) and weekly for 6 weeks (T3–T8); ISQ was measured at T1 and T8.

Results

Eighty-five implants were placed in 66 patients (45 BLX, 40 BL). BLX implants showed a significantly higher mean MIT (42.35 ± 13.43 N·cm) than BL implants (30.63 ± 6.01 N·cm, p < 0.001). Both designs demonstrated similar stability trends. At T8, BL implants had significantly higher ISQ and IST values (75.21 ± 0.93 and 79.69 ± 1.11) than BLX (72.23 ± 0.88 and 76.06 ± 1.04, p = 0.02), while there were no differences at earlier time points. A moderate positive correlation was observed between ISQ and IST (r = 0.56, p < 0.001).

Conclusion

Both implant designs provided high and lasting stability during early healing, establishing their suitability for various prosthetic loading protocols.

Trial Registration: Thai Clinical Trials Registry (TCTR) TCTR20210628006 (https://www.thaiclinicaltrials.org/export/pdf/TCTR20210628006) and TCTR 20230826014 (https://www.thaiclinicaltrials.org/export/pdf/TCTR20230826014)

Aim

To investigate longitudinal changes in salivary extracellular vesicle (EV) sub-populations and their associated cytokine profiles following non-surgical periodontal therapy (NSPT) in patients with Stage III–IV periodontitis.

Materials and Methods

This exploratory study recruited 25 patients, and unstimulated saliva samples were collected at baseline, 3 months (T1) and 6 months (T2) post-NSPT. Clinical parameters, including probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP) and plaque index (PI), were recorded. Salivary host EVs were isolated using bead-based immunoaffinity capture method and analysed for sub-population markers and cytokine cargo.

Results

Significant improvements in PPD, CAL, BOP and PI were observed at T1 and T2 compared to baseline (p < 0.05). Subgroup analysis identified five suboptimal responders with persistent deep pockets (≥ 4 sites with ≥ 5 mm) at T1 and T2. At 6 months, levels of CD63+, CD24+ and CD142+ host EVs, as well as host EV-associated interleukin (IL)-6 and IL-2, were reduced compared to baseline, while IL-5 and IL-10 levels were elevated. Our exploratory analysis showed that suboptimal responders exhibited higher expressions of CD81+, CD326+, CD45+ and CD133+ host EVs at T1 compared to responders.

Conclusions

This exploratory study demonstrated that NSPT led to clinical improvements accompanied by changes in the composition and cytokine cargo of salivary host EVs. Alterations in salivary host EV sub-populations and cytokine profiles may have potential utility as biomarkers for monitoring treatment outcomes in periodontitis.

Aim

To explore the local co-occurrence patterns between caries and periodontal parameters (probing depth [PD] and clinical attachment loss [CAL]) and assess whether restorations/caries are spatially associated with poorer periodontal outcomes in a German adult population.

Materials and Methods

Cross-sectional data from the German Oral Health Study (DMS V, 2014), consisting of 966 adults (35–44 years old) and 1042 seniors (65–75 years old), were analysed. Periodontal examinations were conducted on 12 index teeth (three surfaces), while caries status was evaluated across all tooth surfaces. The relationship between periodontal health and caries was analysed using hierarchical regression models.

Results

Strong associations were found between filled surfaces and increased PD and CAL at both tooth and surface levels. In seniors, crowns and fillings were associated with higher PD (β = 0.330–0.372) and CAL (β = 0.207–0.368). Surface-level analyses also showed that early caries lesions were correlated with worse periodontal outcomes (PD: β = 0.224–0.591; CAL: β = 0.167–0.744).

Conclusion

The findings suggest that early caries lesions and restorations may be linked to poorer periodontal health. These associations were consistent across different surfaces and age groups, highlighting a potential spatial link between caries and periodontal disease.

Aim

This study aimed to compare the microbial communities across four oral sample types—saliva, oral rinse, subgingival plaque and gingival crevicular fluid (GCF)—and to identify disease-associated microbiota in periodontitis.

Methods

Oral samples were collected from 150 adults, each providing four types of samples in the same visit. Saliva (5 mL) and oral rinse (10 mL, 30-s swish) were collected prior to clinical examination. Subgingival plaque was sampled using a curette from the two deepest pockets, followed by GCF collection via 20-s insertion of gingival retraction cords at the same sites. All samples underwent 16S rRNA (V3–V4) sequencing. Site-specific microbial profiles were evaluated across all participants. For disease comparisons, only individuals with clear periodontal status (periodontally healthy, n = 41; stage III/IV periodontitis, n = 43) were included, excluding stage I/II cases (n = 66).

Results

Saliva and oral rinse formed one microbial cluster; plaque and GCF formed another. Alpha diversity was found increased in disease, except in GCF. Beta diversity showed the most distinct disease-related shift in GCF. Red complex pathogens and GCF-specific differentially abundant taxa were markedly enriched in periodontitis.

Conclusions

GCF yielded the clearest microbial differentiation between health and periodontitis, supporting its diagnostic utility.

Aim

To explore periodontitis-induced changes in the femoral artery microbiota and their impact on the immune system, seeking to clarify the mechanisms underlying the link between periodontitis and peripheral arterial diseases (PADs).

Materials and Methods

A ligature-induced periodontitis mouse model was used. 2bRAD sequencing for microbiome (2bRAD-M) was applied to analyse the femoral artery microbiota, and single-cell RNA sequencing (scRNA-seq) was used to characterise the arterial immune microenvironment.

Results

Periodontitis significantly altered the femoral artery microbiota. There was increase in the relative abundance of anaerobic bacteria and reduction in aerobic and facultative anaerobic bacteria. Lipopolysaccharide (LPS) concentrations in both blood and the femoral artery were elevated. scRNA-seq showed an increase in fatty acid binding protein 4 (FABP4⁺) endothelial cells (ECs). FABP4⁺ ECs were more responsive to LPS, which promoted neutrophil infiltration and T-cell differentiation.

Conclusion

These findings identify FABP4⁺ ECs as key mediators in the connection between periodontitis and PADs. The study provides new insights into the systemic effects of periodontitis and offers a basis for developing preventive and therapeutic strategies for periodontitis-associated vascular diseases.

Aim

To evaluate treatment outcomes following implantoplasty or the use of rotating titanium brushes in the surgical therapy of peri-implantitis.

Materials and Methods

Thirty patients with peri-implantitis in need of surgical treatment were enrolled in a 12-month randomised clinical trial with a non-inferiority set-up. Surface decontamination was performed using either titanium brushes (test group) or implantoplasty (control group). Clinical and radiographic parameters as well as patient-reported outcomes (Oral Health Impact Profile-14; OHIP-14) were evaluated.

Results

At 12 months, the composite outcome was achieved in 6/15 implants in the test group and in 4/15 in the control group. Probing pocket depth (PPD) values decreased by 3.6 ± 1.5 mm (test) and 3.3 ± 1.2 mm (control), demonstrating non-inferiority of the test procedure. Additional bone loss was observed in the control group (0.7 ± 1.2 mm), while bone levels remained unchanged in the test group (0.0 ± 0.6 mm). Baseline PPD (p = 0.044) and the presence of an adjacent implant affected by peri-implantitis (p = 0.033) were relevant factors for pocket closure (PPD ≤ 5 mm at 12 months). Time for surface decontamination was significantly less in the test (3 min 1 s) when compared to the control group (5 min 27 s) (p = 0.006). OHIP-14 scores were statistically indifferent.

Conclusion

Both groups showed favourable outcomes, demonstrating non-inferiority of titanium brushes to implantoplasty.

Trial Registration: The trial was registered with the Clinical Research Information Service of the National Research Institute of Health (South Korea), no. KCT007900. (https://cris.nih.go.kr/cris/search/detailSearch.do?seq=23346&search_page=L)