Periotest values and occlusion

Bei 43 Patienten mit marginaler Parodontitis wurden an 905 Zähnen die Perio-testwerte ohne Okklusion und in maximaler Interkuspidation ermittelt. An klini-schen Befunden wurden die quantitativ meßbaren Parameter Tiefe der Sulcus-taschen, Rezession, Papillenblutungsindex, Knochenabbau und die qualitativen Merkmale Kippung, Füllung, Schliffflächen im Okklusionsfeld und exzentrische Schliffflächen erhoben. Der Knochenabbau wurde durch Ausmessen von Mundfilmen bestimmt. Multiple lineare Regressionsrechnungen zwischen Periotestwert ohne Okklusion und Differenz der Periotestwerte in maximaler Interkuspidation und ohne Okklusion als abhängigen Variablen und den quantitativen Parametern als unabhängige Variablen ergab Koeffizienten der Determination von 61 % für den Pe-riotestwert ohne Okklusion und 40 % für die Periotestwertdifferenz. Der Einfluß des Knochenabbaus dominierte deutlich gegenüber dem Einfluß der übrigen quantitativen Parameter. Der Einfluß der traumatischen Parameter Kippung, Füllung und Schliffflächen auf die Regression zwischen Periotestwertdifferenzen und Knochenabbau wird dargestellt. Signifikant höhere Periotestwertdifferenzen bei Zahnkippungen bringen ein okklusales Trauma zum Ausdruck. Schliffflächen im Okklusionsfeld haben traumatische Bedeutung. Exzentrische Schliffflächen wirken ebenfalls traumatisierend bei parodontal progredient geschädigten Zähnen. Okklusionsstörungen können bei bestehender marginaler Parodontitis zu verstärktem Knochenabbau führen.Numerous experiments have been carried out in order to identify occlusal trauma as an etiologic factor in the pathogenesis of periodontopathies. With Periotest (http://www.periotest.de/) an instrument is available to quantify occlusal overstressing. In 905 teeth and 43 patients with periodontitis the Perio-test values were determined without occlusal contact and under maximum habitual occlusion. Clinical parameters like probing depth, recession, papillary bleeding index, bone resorption and qualitative such as tipped tooth, filling, abrasion facets in the occlusal areas and eccentric abrasion facets were evaluated. Bone resorption was determined based on intraoral radiographs. Multi-ple linear regression calculations between standard Periotest values (Periotest value without tooth contact) or Periotest value differences (the difference between Periotest values under maximum habitual occlusion and without occlusal contact) as dependent variables and the quanti-tative parameters as independent variables resulted in determination coefficients of 61 for the Periotest value without occlusal contact and 40 for the Periotest value difference. The influence of bone resorption clearly dominated over all other quantitative parameters. Occlusal parameters as tipped teeth, restorations and abrasion facets were explored in teeth without bone resorption and without pathological pockets. Significantly higher Periotest values and significantly more negative Periotest value differences in tipped teeth were interpreted as a possible source of occlusal trauma. Less negative Periotest value differences in teeth with ec-centric abrasion facets indicate reduced intercuspidation. Abrasion facets in the occlusal areas tend to cause higher stressing. Restorations had no effect on Periotest values and Periotest value differences

Significant Short-Term Shifts in the Microbiomes of Smokers With Periodontitis After Periodontal Therapy With Amoxicillin & Metronidazole as Revealed by 16S rDNA Amplicon Next Generation Sequencing

The aim of this follow-up study was, to compare the effects of mechanical periodontal therapy with or without adjunctive amoxicillin and metronidazole on the subgingival microbiome of smokers with periodontitis using 16S rDNA amplicon next generation sequencing. Fifty-four periodontitis patients that smoke received either non-surgical periodontal therapy with adjunctive amoxicillin and metronidazole (n = 27) or with placebos (n = 27). Subgingival plaque samples were taken before and two months after therapy. Bacterial genomic DNA was isolated and the V4 hypervariable region of the bacterial 16S rRNA genes was amplified. Up to 96 libraries were normalized and pooled for Illumina MiSeq paired-end sequencing with almost fully overlapping 250 base pairs reads. Exact ribosomal sequence variants (RSVs) were inferred with DADA2. Microbial diversity and changes on the genus and RSV level were analyzed with non-parametric tests and a negative binomial regression model, respectively. Before therapy, the demographic, clinical, and microbial parameters were not significantly different between the placebo and antibiotic groups. Two months after the therapy, clinical parameters improved and there was a significantly increased dissimilarity of microbiomes between the two groups. In the antibiotic group, there was a significant reduction of genera classified as Porphyromonas, Tannerella, and Treponema, and 22 other genera also decreased significantly, while Selenomonas, Capnocytophaga, Actinomycetes, and five other genera significantly increased. In the placebo group, however, there was not a significant decrease in periodontal pathogens after therapy and only five other genera decreased, while Veillonella and nine other genera increased. We conclude that in periodontitis patients who smoke, microbial shifts occurred two months after periodontal therapy with either antibiotics or placebo, but genera including periodontal pathogens decreased significantly only with adjunctive antibiotics

The Role of Polymorphisms at the Interleukin-1, Interleukin-4, GATA-3 and Cyclooxygenase-2 Genes in Non-Surgical Periodontal Therapy

Periodontitis is a multifactorial disease. The aim of this explorative study was to investigate the role of Interleukin-(IL)-1, IL-4, GATA-3 and Cyclooxygenase-(COX)-2 polymorphisms after non-surgical periodontal therapy with adjunctive systemic antibiotics (amoxicillin/metronidazole) and subsequent maintenance in a Caucasian population. Analyses were performed using blood samples from periodontitis patients of a multi-center trial (ClinicalTrials.gov NCT00707369=ABPARO-study). Polymorphisms were analyzed using quantitative real-time PCR. Clinical attachment levels (CAL), percentage of sites showing further attachment loss (PSAL) ≥1.3 mm, bleeding on probing (BOP) and plaque score were assessed. Exploratory statistical analysis was performed. A total of 209 samples were genotyped. Patients carrying heterozygous genotypes and single-nucleotide-polymorphisms (SNP) on the GATA-3-IVS4 +1468 gene locus showed less CAL loss than patients carrying wild type. Heterozygous genotypes and SNPs on the IL-1A-889, IL-1B +3954, IL-4-34, IL-4-590, GATA-3-IVS4 +1468 and COX-2-1195 gene loci did not influence CAL. In multivariate analysis, CAL was lower in patients carrying GATA-3 heterozygous genotypes and SNPs than those carrying wild-types. For the first time, effects of different genotypes were analyzed in periodontitis progression after periodontal therapy and during supportive treatment using systemic antibiotics demonstrating a slight association of GATA-3 gene locus with CAL. This result suggests that GATA-3 genotypes are a contributory but non-essential risk factor for periodontal disease progression

Effect of periodontal therapy on adipokine biomarkers in overweight

Abstract Aim The aim of this study was to evaluate the effect of non‐surgical periodontal therapy on circulating levels of the systemic inflammation‐associated biomarkers orosomucoid (ORM), high‐sensitivity C‐reactive protein (hsCRP), chemerin, and retinol‐binding protein 4 (RBP4) in overweight or normal‐weight patients with periodontitis at 27.5 months after therapy. Materials and methods This exploratory subanalysis includes patients from the ABPARO‐trial (ClinicalTrials.gov NCT00707369). The per‐protocol collective provided untreated periodontitis patients with high (≥28 kg/m2) or moderate (21–24 kg/m2) BMI. Out of the per‐protocol collective, 80 patients were randomly selected and stratified for BMI group, sex, and treatment group (antibiotics/placebo), resulting in 40 overweight and normal‐weight patients. Patients received non‐surgical periodontal therapy and maintenance at 3‐month intervals. Plasma samples from baseline and 27.5 months following initial treatment were used to measure the concentrations of ORM, hsCRP, chemerin, and RBP4. Results At the 27.5‐month examination, ORM and hsCRP decreased noticeably in the overweight group (ORM: p = .001, hsCRP: p = .004) and normal‐weight patients (ORM: p = .007, hsCRP: p < .001). Chemerin decreased in the overweight group (p = .048), and RBP4 concentrations remained stable. Conclusion Non‐surgical periodontal therapy reduced systemically elevated inflammation‐associated biomarkers in periodontitis patients. These improvements were more pronounced in overweight patients than in normal‐weight patients

Do we treat our patients or rather periodontal microbes with adjunctive antibiotics in periodontal therapy? A 16S rDNA microbial community analysis

Hagenfeld D, Koch R, Jünemann S, et al. Do we treat our patients or rather periodontal microbes with adjunctive antibiotics in periodontal therapy? A 16S rDNA microbial community analysis. PLOS ONE. 2018;13(4): e0195534

Is progression of periodontitis relevantly influenced by systemic antibiotics? : a clinical randomized trial

Aim: We investigated the long-term impact of adjunctive systemic antibiotics on periodontal disease progression. Periodontal therapy is frequently supplemented by systemic antibiotics, although its impact on the course of disease is still unclear. Material & Methods: This prospective, randomized, double-blind, placebo-controlled multi-centre trial comprising patients suffering from moderate to severe periodontitis evaluated the impact of rational adjunctive use of systemic amoxicillin 500 mg plus metronidazole 400 mg (3x/day, 7 days) on attachment loss. The primary outcome was the percentage of sites showing further attachment loss (PSAL) ≥1.3 mm after the 27.5 months observation period. Standardized therapy comprised mechanical debridement in conjunction with antibiotics or placebo administration, and maintenance therapy at 3 months intervals. Results: From 506 participating patients, 406 were included in the intention to treat analysis. Median PSAL observed in placebo group was 7.8% compared to 5.3% in antibiotics group (Q25 4.7%/Q75 14.1%; Q25 3.1%/Q75 9.9%; p < 0.001 respectively). Conclusions: Both treatments were effective in preventing disease progression. Compared to placebo, the prescription of empiric adjunctive systemic antibiotics showed a small absolute, although statistically significant, additional reduction in further attachment loss. Therapists should consider the patient's overall risk for periodontal disease when deciding for or against adjunctive antibiotics prescription

PCoA scatterplots of Bray-Curtis dissimilarities for placebo and antibiotic samples before and after periodontal therapy.

<p>For each treatment modality samples are visualized by dots, which are colored red when taken before or blue when taken after therapy. The ordination was constructed using a Bray-Curtis distance matrix. Principal component 1 (Axis 1) and principal component 2 (Axis 2) are plotted on the x- and y-axes, respectively. The percentage of variation explained by the plotted principal coordinates is indicated on the axes.</p

Bubble chart of aRSV abundance changes after periodontal therapy classified on genus level for the antibiotic group based on a negative binomial regression model.

<p>Bubbles represent 110 aRSVs belonging to 52 uniquely named genera (x-axis) that showed statistically noticeably changes (y-axis) in the antibiotic group after therapy on a log2-scale. All aRSVs unclassified on genus level are grouped together in an unclassified genus bin (NA). The sizes of the bubbles represent the mean relative aRSV abundance over all samples before therapy. Those aRSVs with ≥ 10 log2fold and ≤ -10 log2fold changes were marked as triangles on their respective y-axis section. All aRSVs belonging to a genus that includes species previously described by Socransky and colleagues [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0195534#pone.0195534.ref004" target="_blank">4</a>] are colored according to their complex affiliation.</p