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    Clinical and Immunological Effects of Er,Cr:YSGG Laser in Nonsurgical Periodontal Treatment: A Randomized Clinical Trial. Erbil Deniz,Nazaroglu Kenan,Baser Ulku,İssever Halim,Mese Sevim,İsik Aysen G Photobiomodulation, photomedicine, and laser surgery The aim of this study was to compare the clinical and immunological results of nonsurgical periodontal treatment with or without the erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser. As lasers have begun to be used in dentistry, the Er,Cr:YSGG laser has started to attract attention in the field of periodontology. Fifty-nine nonsmoking patients with advanced chronic periodontitis were randomly allocated to a test group (full-mouth ultrasonic supra- and subgingival debridement+Er,Cr:YSGG laser application) and a control group (full-mouth ultrasonic supra- and subgingival debridement+root planing with Gracey curettes). The laser parameters were set as follows: 1.5 W output power, pulse mode H (pulse duration of 140 μs), pulse frequency of 20 Hz, and an air-water spray ratio of 10% air and 15% water. The instrumentation was performed until the operator felt that the root surfaces were adequately debrided. Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index, interleukin-1 beta (IL-1β), matrix metalloproteinase-8 (MMP-8), tissue inhibitor metalloproteinase-1 (TIMP-1), and MMP-8/TIMP-1 levels in gingival crevicular fluid were evaluated at baseline, 6 weeks, and 3 months postoperatively. There were statistically significant differences in PD, which was our primary outcome, and BOP between the groups at both examinations [ < 0.001 and  < 0.001 (for PD) and  = 0.048 and  < 0.001 (for BOP), respectively], in favor of the laser group. However, there were no significant differences among groups at any time for CAL gain ( = 563 and  = 369, respectively). No significant differences in MMP-8, TIMP-1, and MMP-8/TIMP-1 levels were detected among groups. There was a statistically significant difference for IL-1β levels among groups at 3-month evaluations in favor of the laser group. Using the Er,Cr:YSGG laser instead of hand instruments in nonsurgical periodontal treatment has shown additional improvements in terms of pocket reduction and gingival bleeding compared with traditional nonsurgical therapy. 10.1089/photob.2019.4748
    Antimicrobial photodynamic therapy vs. local minocycline in addition to non-surgical therapy of deep periodontal pockets: a controlled randomized clinical trial. Tabenski Laura,Moder Daniel,Cieplik Fabian,Schenke Frederike,Hiller Karl-Anton,Buchalla Wolfgang,Schmalz Gottfried,Christgau Michael Clinical oral investigations OBJECTIVES:To investigate the additional influence of either antimicrobial photodynamic therapy (aPDT; Helbo® Photodynamic Systems) or local application of minocycline microspheres (MC; Arestin, OraPharma) on clinical and microbiological healing results in deep periodontal pockets (PPD ≥6 mm) following non-surgical periodontal therapy (SRP). MATERIALS AND METHODS:Forty-five patients with chronic periodontitis were evaluated: test group aPDT + SRP (n = 15), positive control group MC + SRP (n = 15), and negative control group SRP-alone (n = 15). Clinical and microbiological healing parameters were recorded in every patient for four experimental teeth at baseline, 6 weeks, and 3, 6, and 12 months. Wilcoxon signed-rank test and Mann-Whitney U test were used for statistical analysis (α = 0.05). RESULTS:Significant improvements in clinical and microbiological parameters were found for all groups after 6 weeks and 3, 6, and 12 months. Differences between groups were not statistically significant. Changes after 12 months [median (25/75%)] are as follows: reduction in PPD [mm]: aPDT + SRP 2 (1/3), MC + SRP 3 (1/4), SRP-alone 2 (1/3); percentage of residual BOP positive teeth [%]: aPDT + SRP 75 (25/100), MC + SRP 33.3 (0/50), SRP-alone 66.7 (25/75). CONCLUSIONS:Within the limitations of this study, neither the applied aPDT system nor MC showed a significant additional influence on clinical and microbiological healing outcomes in deep periodontal pockets compared to SRP alone. CLINICAL RELEVANCE:In deep periodontal defects, the efficacy of non-surgical periodontal treatment seems not to be improved by adjunctive use of antimicrobial photodynamic therapy or minocycline microspheres. 10.1007/s00784-016-2018-6
    Local adjunct effect of antimicrobial photodynamic therapy for the treatment of chronic periodontitis in type 2 diabetics: split-mouth double-blind randomized controlled clinical trial. Castro Dos Santos Nídia Cristina,Andere Naira Maria Rebelatto Bechara,Araujo Cássia Fernandes,de Marco Andrea Carvalho,Dos Santos Lúcio Murilo,Jardini Maria Aparecida Neves,Santamaria Mauro Pedrine Lasers in medical science Diabetes has become a global epidemic. Its complications can have a significant impact on quality of life, longevity, and public health costs. The presence of diabetes might impair the prognosis of periodontal treatments due to its negative influence on wound healing. Antimicrobial photodynamic therapy (aPDT) is a local approach that can promote bacterial decontamination in periodontal pockets. The aim of this study was to investigate the local effect of adjunct aPDT to ultrasonic periodontal debridement (UPD) and compare it to UD only for the treatment of chronic periodontitis in type 2 diabetic patients. Twenty type 2 diabetic patients with moderate to severe generalized chronic periodontitis were selected. Two periodontal pockets with probing depth (PD) and clinical attachment level (CAL) ≥5 mm received UPD only (UPD group) or UPD plus adjunct aPDT (UPD + aPDT group). Periodontal clinical measures were collected and compared at baseline and 30, 90, and 180 days. After 180 days of follow-up, there were statistically significant reductions in PD from 5.75 ± 0.91 to 3.47 ± 0.97 mm in the UPD group and from 6.15 ± 1.27 to 3.71 ± 1.63 mm in the UPD + aPDT group. However, intergroup analysis did not reveal statistically significant differences in any of the evaluated clinical parameters (p > 0.05). The adjunct application of aPDT to UPD did not present additional benefits for the treatment of chronic periodontitis in type 2 diabetic patients. The ClinicalTrials.gov identifier of the present study is NCT02627534. 10.1007/s10103-016-2030-8
    Multiple sessions of antimicrobial photodynamic therapy associated with surgical periodontal treatment in patients with chronic periodontitis. Cadore Uislen B,Reis Marília B L,Martins Sergio H L,Invernici Marcos de M,Novaes Arthur B,Taba Mario,Palioto Daniela B,Messora Michel R,Souza Sergio L S Journal of periodontology BACKGROUND:This double-blind, randomized, controlled clinical trial assessed the efficacy of multiple sessions of antimicrobial photodynamic therapy (aPDT) as an adjunct to surgical periodontal treatment (ST) in patients with severe chronic periodontitis (SCP). METHODS:Sixteen patients with SCP were treated with aPDT+ST (test group, TG) or ST only (control group, CG), in a split-mouth design. aPDT was applied at 0, 2, 7, and 14 postoperative days only in TG. All patients were followed up for 90 days after surgery. The following clinical and microbiological parameters were assessed: clinical attachment level (CAL), probing depth (PD), gingival recession (GR), bleeding on probing (BOP), plaque index (PI), and count of 40 subgingival microbial species (checkerboard DNA-DNA hybridization). Data were collected at baseline (preintervention), at 60 days (30 days after the end of non-surgical therapy), and at 150 days (90 days after surgery). RESULTS:A significant reduction in PD was observed at 150 days for the TG, when compared with the CG (P ˂ 0.05). CAL gain was significantly higher in the TG at 60 and 150 days (P ˂ 0.05). Changes in the subgingival microbiota were similar between the groups (P ˃ 0.05), but the TG revealed a larger number of bacteria associated with periodontal disease at the end of the experiment compared with the CG (P < 0.05). CONCLUSION:Multiple sessions of aPDT as an adjunct to surgical periodontal treatment significantly improved clinical parameters at 90 postoperative days. 10.1002/JPER.18-0373
    Metronidazole and amoxicillin for patients with periodontitis and diabetes mellitus: 5-year secondary analysis of a randomized controlled trial. Cruz Daniele Ferreira da,Duarte Poliana Mendes,Figueiredo Luciene Cristina,da Silva Hélio Doyle Pereira,Retamal-Valdes Belén,Feres Magda,Miranda Tamires Szeremeske Journal of periodontology BACKGROUND:The aim of this study was to perform a 5-year follow-up analysis of a previously-published randomized trial (RCT) evaluating the 2-years effects of metronidazole (MTZ) plus amoxicillin (AMX) as adjuncts to scaling and root planing (SRP) in the treatment of periodontitis in type 2 diabetic patients. METHODS:Volunteers who received periodontal treatment in the aforementioned RCT were selected for clinical and microbiological evaluation. Patients did not receive regular supportive periodontal therapy (SPT) from 2 to 5 years post-treatment. RESULTS:Of the patients enrolled in the RCT, 43% entered this study (n = 10/control and 15/test group). Most of clinical parameter values, including the number of sites with probing depth ≥ 5 mm (primary outcome variable), were reduced at 5 years post-therapy when compared with baseline in the antibiotic-treated group (P < 0.05), but presented higher values than those at 2 years (P < 0.05). The mean proportions of microbial complexes did not differ between MTZ+AMX+SRP and SRP-only groups at 5 years post-treatment (P > 0.05). CONCLUSION:Diabetic patients treated with adjunctive MTZ+AMX were better maintained over a period of 5 years than those treated with SRP only. However, the clinical and microbiological benefits obtained up to 2 years post-treatment were not fully sustained in these patients who did not receive SPT between 2 and 5 years post-treatment. 10.1002/JPER.20-0196
    Efficacy of systemic antibiotics in nonsurgical periodontal therapy for diabetic subjects: a systematic review and meta-analysis. Souto Maria Luisa S,Rovai Emanuel S,Ganhito Juliana A,Holzhausen Marinella,Chambrone Leandro,Pannuti Cláudio M International dental journal OBJECTIVES:To evaluate the effects of systemic antibiotics as adjuncts to nonsurgical periodontal treatment (NSPT), as opposed to using NSPT alone, on periodontal clinical parameters of diabetic patients with periodontitis. MATERIALS AND METHODS:Randomised controlled trials with a follow-up of 3 months or more, assessing the effects of NSPT in combination with antibiotics, in diabetic patients with periodontitis were included. Trials published up to August 2016 were identified from MEDLINE, EMBASE and LILACS databases. Meta-analyses were conducted to determine changes in clinical attachment level (CAL), probing pocket depth (PPD), bleeding on probing (BOP) and gingival index (GI). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in this review. RESULTS:Of the 164 papers potentially admissible to this systematic review, 15 articles on 11 randomised clinical trials were considered as eligible. The results of the meta-analyses presented a modest additional benefit of 0.14 mm (95% confidence interval: 0.08-0.20) in reducing PPD but no further benefit in CAL gain. CONCLUSION:When the data for all antibiotic protocols were considered together for the treatment of periodontitis patients with DM, a significant, albeit small, reduction of PPD and no improvement in CAL gain was observed. When the antibiotic protocols were analysed separately, the combination of amoxicillin plus metronidazole yielded the best results for PPD. 10.1111/idj.12384
    Local levels of biomarkers after surgical and nonsurgical debridement of residual pockets and nonresidual sites in diabetic patients: a 12-month follow-up. Bezerra Joyce Pinho,Shaddox Luciana Machion,de Mendonca Adriana Cutrim,Bastos Marta Ferreira,de Miranda Tamires Szeremeske,Santos Vanessa Renata,Duarte Poliana Mendes General dentistry There is scarce evidence on suitable approaches for the treatment of unresponsive or residual periodontal sites in diabetic patients. This study assessed the effects of surgical debridement (SD) and nonsurgical debridement (NSD), associated with amoxicillin and metronidazole, on clinical and immunological outcomes of residual pockets and adjacent healthy sites in patients with type 2 diabetes. A split-mouth, randomized controlled trial was conducted in 21 patients presenting at least 2 residual pockets in contralateral quadrants 12 months after basic nonsurgical periodontal therapy. Patients received systemic antibiotics, and contralateral quadrants were assigned to receive SD or NSD. The changes in clinical parameters were evaluated from baseline to 12 months. Local levels of 14 cytokines and chemokines were measured with multiplex bead immunoassays at baseline and 3 and 12 months after therapy. There were no statistically significant differences between SD and NSD for changes in clinical parameters from baseline to 12 months (P > 0.05). There was a significantly greater increase in the levels of granulocyte-macrophage colony-stimulating factor and interleukin 6 from baseline to 3 months in the healthy sites adjacent to residual pockets receiving SD (P < 0.05). A significant decrease in the levels of monocyte chemoattractant protein-1 and macrophage inflammatory protein 1α occurred from baseline to 12 months in the residual pockets treated by SD (P < 0.05). In conclusion, SD and NSD resulted in similar clinical benefits at 12 months. The short-term increase in the levels of proinflammatory biomarkers in SD sites probably can be attributed to tissue trauma and healing, and the long-term decrease in the levels of chemotactic factors in residual pockets treated by surgery may reflect remission of infection and stable wound healing in these sites at 12 months.
    Systemic antimicrobials adjuvant to periodontal therapy in diabetic subjects: a meta-analysis. Grellmann Alessandra Pascotini,Sfreddo Camila Silveira,Maier Juliana,Lenzi Tathiane Larissa,Zanatta Fabricio Batistin Journal of clinical periodontology BACKGROUND:Adjuvant antibiotics have been suggested to improve periodontal therapy in diabetic subjects. AIM:The aim of this study was to systematically review randomized clinical trials assessing systemic antimicrobial use adjuvant to scaling and root planing (SRP) versus SRP alone in diabetic subjects. MATERIAL AND METHODS:The PubMed, Cochrane Central Register of Controlled Trials, EMBASE, TRIP, Web of Science and LILACS databases and the grey literature were searched through May 2015. Of 2534 potentially eligible studies, 13 were included in the systematic review. Weighted mean differences (WMDs) in probing depth (PD) reduction and clinical attachment level (CAL) gain (primary outcomes), and plaque index (PI) and bleeding on probing (BOP) reductions, were estimated using a random effect model. RESULTS:The WMD in PD reduction [-0.15 mm, n = 11, p = 0.001, 95% confidence interval (CI) -0.24, -0.06] favoured antibiotic use. WMDs in CAL gain, PI and BOP reductions (-0.14 mm, n = 9, p = 0.11, 95% CI -0.32, 0.03; 4.01%, n = 7, p = 0.05, 95% CI -0.04, 8.07; and -1.91%, n = 7, p = 0.39, 95% CI -6.32, 2.51 respectively) did not favour adjunctive antibiotic use. CONCLUSION:Adjunctive therapy may improve the efficacy of SRP in reducing PD in diabetic subjects. 10.1111/jcpe.12514
    The effects of chromium and vitamin D co-supplementation on insulin resistance and tumor necrosis factor-alpha in type 2 diabetes: a randomized placebo-controlled trial. Imanparast Fatemeh,Javaheri Javad,Kamankesh Fatemeh,Rafiei Fatemeh,Salehi Ashraf,Mollaaliakbari Zeinab,Rezaei Fatemeh,Rahimi Abbas,Abbasi Elnaz Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme The current study was conducted to assess the effects of simultaneous usage with vitamin D and chromium picolinate (CrPic) supplementations on homeostasis model assessment of insulin resistance (HOMA-IR), fasting blood glucose (FBS), hemoglobin A1c (HbA1c), tumor necrosis factor-α (TNF-α), and lipid profile in type 2 diabetes mellitus (T2DM). Ninety-two patients with T2DM were randomly allocated to the following 4 groups for 4 months: (I) placebo of vitamin D ( = 23); (II) vitamin D supplement at a dose of 50 000 IU/week ( = 23); (III) CrPic supplement at a dose of 500 μg/day ( = 23); and (IV) both vitamin D at a dose of 50 000 IU/week and CrPic at a dose of 500 μg/day ( = 23). HOMA-IR levels increased significantly in groups I and II after the intervention. However, this increase in group I was significantly higher than that in group II after the treatment. HOMA-IR levels were controlled in groups III and IV during the intervention. TNF-α decreased significantly in groups II, III, and IV after the intervention. FBS, HbA1c, and lipid profile did not change significantly in total groups after the intervention. It seems that chromium and vitamin D co-supplementation are probably effective in controlling HOMA-IR by decreasing TNF-α in T2DM. Chromium alone and/or in simultaneous pretreatment with vitamin D is more effective than vitamin D in controlling HOMA-IR in T2DM. Chromium and vitamin D alone and/or in simultaneous pretreatment decrease TNF-α in T2DM. 10.1139/apnm-2019-0113
    Tumor Necrosis Factor-Alpha: Role in Development of Insulin Resistance and Pathogenesis of Type 2 Diabetes Mellitus. Akash Muhammad Sajid Hamid,Rehman Kanwal,Liaqat Aamira Journal of cellular biochemistry Pathogenesis of type 2 diabetes mellitus (T2DM) and development of insulin resistance are characterized by multi-stimuli factors notably glucolipotoxicity, generation of reactive oxygen species (ROS), epigenetic factors, activation of various transcriptional mediated pathways along with the augmented levels of various pro-inflammatory cytokines. Among the various pro-inflammatory cytokines, tumor necrosis factor-alpha (TNF-α) is one the most important pro-inflammatory mediator that is critically involved in the development of insulin resistance and pathogenesis of T2DM. TNF-α is mainly produced in adipocytes and/or peripheral tissues, and induces tissue-specific inflammation through the involvement of generation of ROS and activation of various transcriptional mediated pathways. The raised level of TNF-α induces insulin resistance in adipocytes and peripheral tissues by impairing the insulin signaling through serine phosphorylation that leads to the development of T2DM. Anti-TNF-α treatment strategies have been developed to reduce the incidence of insulin resistance and development of T2DM. In this article, we have briefly described how TNF-α plays crucial role to induce insulin resistance and pathogenesis of T2DM. To block the inflammatory responses by blocking TNF-α and TNF-α signaling may be an effective strategy for the treatment of insulin resistance and T2DM. J. Cell. Biochem. 119: 105-110, 2018. © 2017 Wiley Periodicals, Inc. 10.1002/jcb.26174
    Periodontal health. Lang Niklaus P,Bartold P Mark Journal of clinical periodontology OBJECTIVES:To date there is a paucity of documentation regarding definitions of periodontal health. This review considers the histological and clinical determinants of periodontal health for both intact and reduced periodontium and seeks to propose appropriate definitions according to treatment outcomes. IMPORTANCE:Defining periodontal health is can serve as a vital common reference point for assessing disease and determining meaningful treatment outcomes. FINDINGS:The multifactorial nature of periodontitis is accepted, and it is recognized that restoration of periodontal health will be defined by an individual's response to treatment, taking into account allostatic conditions. CONCLUSIONS:It is proposed that there are 4 levels of periodontal health, depending on the state of the periodontium (structurally and clinically sound or reduced) and the relative treatment outcomes: (1) pristine periodontal health, with a structurally sound and uninflamed periodontium; (2) well-maintained clinical periodontal health, with a structurally and clinically sound (intact) periodontium; (3) periodontal disease stability, with a reduced periodontium, and (4) periodontal disease remission/control, with a reduced periodontium. 10.1111/jcpe.12936
    Comparison of periodontitis patients' classification in the 2018 versus 1999 classification. Graetz Christian,Mann Lucas,Krois Joachim,Sälzer Sonja,Kahl Maren,Springer Claudia,Schwendicke Falk Journal of clinical periodontology OBJECTIVES:We aimed to assess how the 2018 and 1999 classifications of periodontal diseases reflect (a) patients' characteristics, (b) disease severity/extent/progression and (c) tooth loss (TL) during observation period. METHODS:A total of 251 patients were followed over 21.8 ± 6.2 years. For the 1999 classification, using clinical attachment level (CAL), patients were classified as localized/generalized, mild/moderate/severe and aggressive/chronic periodontitis. For the 2018 classification, patients were staged according to their CAL or bone loss (BL) and the number of lost teeth (stages I-IV). Further factors like probing pocket depths (PPD) or furcation involvement modified the stage. The extent was sub-classified as generalized/localized. Patients were graded according to the BL/age index, smoking and/or diabetes. RESULTS:According to the 1999 classification, most patients suffered from generalized severe chronic periodontitis (203/251) or generalized aggressive periodontitis (45/251). Patients with aggressive periodontitis were younger and less often female or smokers. They showed similar TL (0.25 ± 0.22 teeth/patient*year) as generalized severe chronic periodontitis patients (0.23 ± 0.25 teeth/patient*year). According to the 2018 classification, most patients were classified as generalized III-C (140/251), III-B (31/251) or IV-C (64/251). Patients' age, smoking status, CAL, PPD and BL were well reflected. TL differed between IV-C (0.36 ± 0.47), generalized III-C (0.21 ± 0.24) and localized forms (0.10-0.15). CONCLUSIONS:Patients' characteristics, disease severity/extent/progression and TL were well reflected by the 2018 classification. 10.1111/jcpe.13157
    Supportive periodontal therapy in moderate-to-severe periodontitis patients: A two-year randomized clinical trial. Angst Patrícia Daniela Melchiors,Finger Stadler Amanda,Mendez Marina,Oppermann Rui Vicente,van der Velden Ubele,Gomes Sabrina Carvalho Journal of clinical periodontology AIM:Evaluate supportive periodontal therapy (SPT) consisting of oral prophylaxis with oral hygiene instructions as sole intervention (test) or combined with subgingival instrumentation removing/disrupting the subgingival biofilm (control). MATERIAL AND METHODS:Sixty-two treated periodontitis patients (50.97 ± 9.26 years, 24 smokers) were randomly assigned to receive, every 3 months during 2 years, either test or control treatment. Examination included periodontal probing depth (PPD), bleeding on probing (BOP) and clinical attachment loss (CAL). Generalized estimating equations were used for analyses. RESULTS:Baseline demographics and smoking were similar between groups. However, at baseline, mean PPD was greater in test group than in control group (2.32 mm vs. 2.17 mm, p = .03), but similar after 2 years (2.23 mm vs. 2.15 mm, respectively). With time, significant PPD and BOP decrease and CAL increase were observed although without significant differences between groups. At sites ≥ 5 mm, PPD decrease was greater in test group than in control group irrespective of sex and smoking habit (p = .034). The distribution of sites gaining or losing attachment ±2 mm was similar between groups. CONCLUSION:Oral prophylaxis with oral hygiene instructions alone or in combination with subgingival instrumentation was able to maintain the previously obtained periodontal condition to a comparable extent during 2 years of SPT. 10.1111/jcpe.13178
    The effect of the systemic folic acid intake as an adjunct to scaling and root planing on clinical parameters and homocysteine and C-reactive protein levels in gingival crevicular fluid of periodontitis patients: A randomized placebo-controlled clinical trial. Keceli H Gencay,Ercan Nuray,Karsiyaka Hendek Meltem,Kisa Ucler,Mesut Burcu,Olgun Ebru Journal of clinical periodontology AIM:To evaluate clinical and biochemical effects of adjunctive systemic folic acid (FA) intake with scaling and root planing (SRP) in periodontitis treatment. MATERIALS AND METHODS:Sixty periodontitis subjects (30 per group) were randomly assigned into study groups and treated with either SRP + placebo (SRP + P) or SRP + folic acid (SRP + F). In addition to clinical parameters (plaque index [PI], gingival index [GI], probing pocket depth [PPD], clinical attachment level [CAL] and gingival recession [GR]), gingival crevicular fluid (GCF) samples were obtained at baseline and post-treatment (PT) periods (one (PT-1), three (PT-3) and six (PT-6) months) for C-reactive protein (CRP) and homocysteine (Hcy) evaluation. RESULTS:Significant time-dependent reduction was detected at all clinical parameters for both groups (p < .001). Compared to SRP + P, CAL was lower in SRP + F at PT-1 (p = .004) and PT-3 (p = .035), whereas GR was lower at only PT-1 (p = .015). GCF volume and CRP did not show inter-group differences, whereas Hcy was higher in SRP + F at PT-3 (p = .044) and PT-6 (p = .041). GCF volume and Hcy showed reduction after treatment in both groups (p < .001). CONCLUSION:Both modalities exhibited clinical improvement and change in biochemical parameters. Adjunctive systemic FA intake may be recommended adjunctive to periodontitis treatment to reveal better outcomes. However, its impact mechanisms should be further enlightened. 10.1111/jcpe.13276
    Guest Editorial: Clarifications on the use of the new classification of periodontitis. Sanz Mariano,Papapanou Panos N,Tonetti Maurizio S,Greenwell Henry,Kornman Kenneth Journal of clinical periodontology This editorial provides clarifications on the application of the Stage and Grade classification of periodontitis. In particular it describes: (1) how to apply the extent criterion to the defined Stage of the disease; and (2) how to calculate tooth loss because of periodontitis in Stage III and IV cases presenting with evidently hopeless (irrational to treat) teeth with a clinical definition of such teeth. 10.1111/jcpe.13286
    Adjunctive effect of systemic antimicrobials in periodontitis therapy: A systematic review and meta-analysis. Teughels Wim,Feres Magda,Oud Valerie,Martín Conchita,Matesanz Paula,Herrera David Journal of clinical periodontology AIM:To answer the following PICOS questions: in patients with periodontitis, which is the efficacy of adjunctive systemic antimicrobials, in comparison with subgingival debridement plus a placebo, in terms of probing pocket depth (PPD) reduction, in randomized clinical trials with at least 6 months of follow-up? MATERIAL AND METHODS:A systematic search was conducted: 34 articles (28 studies) were included. Data on clinical outcome variables changes were pooled and analysed using weighted mean differences (WMDs), 95% confidence intervals (CI) and prediction intervals (PIs), in case of significant heterogeneity. RESULTS:For PPD, statistically significant benefits (p < .001) were observed in short-term studies (WMD = 0.448, 95% CI [0.324; 0.573], PI [-0.10 to 0.99]) and long-term studies (WMD = 0.485, 95% CI [0.322; 0.648], PI [-0.11 to 1.08]). Additionally, statistically significant benefits were also found for clinical attachment level, bleeding on probing, pocket closure and frequency of residual pockets. The best outcomes were observed for the combination of amoxicillin plus metronidazole, followed by metronidazole alone and azithromycin. Adverse events were more frequently reported in groups using systemic antimicrobials. CONCLUSIONS:The adjunctive use of systemic antimicrobials in periodontal therapy results in statistically significant benefits in clinical outcomes, with more frequent adverse events in test groups using systemic antimicrobials. 10.1111/jcpe.13264
    Adjunctive effect of mouthrinse on treatment of peri-implant mucositis using mechanical debridement: A randomized clinical trial. Philip Juliana,Laine Marja L,Wismeijer Daniël Journal of clinical periodontology AIM:To study effect of delmopinol hydrochloride (DEL) in comparison with chlorhexidine digluconate (CHX) and a placebo (PLA) in addition to non-surgical mechanical debridement in patients with peri-implant mucositis. MATERIALS AND METHODS:Eighty-nine patients with at least one implant diagnosed with peri-implant mucositis were randomly assigned to one of three study groups (DEL, CHX and PLA). Professional non-surgical mechanical debridement was performed at baseline. Mouth rinsing was carried out by the patients twice a day in addition to their regular oral hygiene practices. Assessments of efficacy were performed for the primary outcome - Implant bleeding on probing (IBOP%) and secondary outcomes - modified Bleeding Index (mBI) and modified Plaque Index (mPI) at 1 and 3 months. RESULTS:At 3 months, there was statistically significant reduction in IBOP% and mBI within the study groups compared to baseline. However, there was no statistically significant difference between the study groups at 3 months follow-up. Moreover, there was a statistically significant difference according to mPI at 1 month between the chlorhexidine and placebo group (p = .004). CONCLUSIONS:This study confirms that mechanical debridement combined with oral hygiene instruction is effective in treatment of peri-implant mucositis. The clinical effects between groups were comparable. 10.1111/jcpe.13295
    The correspondence of 3D supporting bone loss and crown-to-root ratio to periodontitis classification. Hong Hsiang-Hsi,Mei Chih-Chun,Liu Heng-Liang,Liang Chao-Hua,Lin Ching-Kai,Lee Fu-Ying,Chang Chung-Chieh Journal of clinical periodontology AIM:Assessing the application of three-dimensional clinical attachment loss (3D-CAL), 3D supporting bone loss (3D-SBL), supracrestal tissue attachment (STA), and crown-to-root ratio (CRR) in evaluating the 2017 periodontitis classification. MATERIALS AND METHODS:We analysed ninety single-rooted human premolars with micro-computed tomography. The amount of 3D-SBL, linear radiographic bone loss (RBL), and CRR corresponding to various periodontitis stages as well as the statistical significance was investigated. RESULTS:From a 3D perspective, the premolars with a 21% of 3D-SBL at 2.0 mm coronal root length (RL) and 15% RBL corresponded to the periodontitis stage I. Premolars with a 44% of 3D-SBL at coronal 4.2-4.4 mm RL and 33% RBL accorded with the periodontitis stage II. Excluding the consideration of STA, CRR = 5:6 and 4:3 were associated with the levels at 15% and 33% RBL, respectively. CONCLUSIONS:A greater percentage of 3D-CAL than that of 2D-CAL is significant at evaluated levels. It is feasible to correlate the 3D-SBL, 3D-CAL, and STA parameters to evaluate the stages of periodontitis severity. However, the current use of RBL and CAL as applied for staging in the 2017 classification might be inconsistent with the evaluated premolar roots length, when STA dimensions are considered. 10.1111/jcpe.13296
    Adjunctive laser or antimicrobial photodynamic therapy to non-surgical mechanical instrumentation in patients with untreated periodontitis: A systematic review and meta-analysis. Salvi Giovanni E,Stähli Alexandra,Schmidt Julia C,Ramseier Christoph A,Sculean Anton,Walter Clemens Journal of clinical periodontology AIM:To compare the adjunctive effects of lasers or antimicrobial photodynamic therapy (aPDT) to non-surgical mechanical instrumentation alone in untreated periodontitis patients. MATERIALS AND METHODS:Two focused questions were addressed using the Population, Intervention, Comparison and Outcome criteria as follows: in patients with untreated periodontitis, (a) does laser application provide adjunctive effects on probing pocket depth (PPD) changes compared with non-surgical instrumentation alone? and (b) does application of aPDT provide adjunctive effects on PPD changes compared with non-surgical instrumentation alone? Both randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) were included. Results of the meta-analysis are expressed as weighted mean differences (WMD) and reported according to the PRISMA guidelines. RESULTS:Out of 1,202 records, 10 articles for adjunctive laser and 8 for adjunctive aPDT were included. With respect to PPD changes, 1 meta-analysis including 2 articles (total n = 42; split-mouth design) failed to identify a statistically significant difference (WMD = 0.35 mm; 95%CI: -0.04/0.73; p = .08) in favour of adjunctive aPDT (wavelength range 650-700 nm). In terms of adjunctive laser application, a high variability of clinical outcomes at 6 months was noted. Two articles included patient-reported outcomes and 10 reported on the presence/absence of harms/adverse effects. CONCLUSIONS:Available evidence on adjunctive therapy with lasers and aPDT is limited by (a) the low number of controlled studies and (b) the heterogeneity of study designs. Patient-reported benefits remain to be demonstrated. 10.1111/jcpe.13236
    Subgingival instrumentation for treatment of periodontitis. A systematic review. Suvan Jeanie,Leira Yago,Moreno Sancho Federico Manuel,Graziani Filippo,Derks Jan,Tomasi Cristiano Journal of clinical periodontology OBJECTIVES:To evaluate the efficacy of subgingival instrumentation (PICOS-1), sonic/ultrasonic/hand instruments (PICOS-2) and different subgingival instrumentation delivery protocols (PICOS-3) to treat periodontitis. METHODS:Systematic electronic search (CENTRAL/MEDLINE/EMBASE/SCOPUS/LILACS) to March 2019 was conducted to identify randomized controlled trials (RCT) reporting on subgingival instrumentation. Duplicate screening and data extraction were performed to formulate evidence tables and meta-analysis as appropriate. RESULTS:As only one RCT addressed the efficacy of subgingival instrumentation compared with supragingival cleaning alone (PICOS-1), baseline and final measures from 9 studies were considered. The weighted pocket depth (PD) reduction was 1.4 mm (95%CI: 1.0 1.7) at 6/8 months, and the proportion of pocket closure was estimated at 74% (95%CI: 64-85). Six RCTs compared hand and sonic/ultrasonic instruments for subgingival instrumentation (PICOS-2). No significant differences were observed between groups by follow-up time point or category of initial PD. Thirteen RCTs evaluated quadrant-wise versus full-mouth approaches (PICOS-3). No significant differences were observed between groups irrespective of time-points or initial PD. Five studies reported patient-reported outcomes, reporting no differences between groups. CONCLUSIONS:Nonsurgical periodontal therapy by mechanical subgingival instrumentation is an efficacious means to achieve infection control in periodontitis patients irrespective of the type of instrument or mode of delivery. Prospero ID: CRD42019124887. 10.1111/jcpe.13245
    Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline. Sanz Mariano,Herrera David,Kebschull Moritz,Chapple Iain,Jepsen Søren,Beglundh Tord,Sculean Anton,Tonetti Maurizio S, Journal of clinical periodontology BACKGROUND:The recently introduced 2017 World Workshop on the classification of periodontitis, incorporating stages and grades of disease, aims to link disease classification with approaches to prevention and treatment, as it describes not only disease severity and extent but also the degree of complexity and an individual's risk. There is, therefore, a need for evidence-based clinical guidelines providing recommendations to treat periodontitis. AIM:The objective of the current project was to develop a S3 Level Clinical Practice Guideline (CPG) for the treatment of Stage I-III periodontitis. MATERIAL AND METHODS:This S3 CPG was developed under the auspices of the European Federation of Periodontology (EFP), following the methodological guidance of the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The rigorous and transparent process included synthesis of relevant research in 15 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and consensus, on those recommendations, by leading experts and a broad base of stakeholders. RESULTS:The S3 CPG approaches the treatment of periodontitis (stages I, II and III) using a pre-established stepwise approach to therapy that, depending on the disease stage, should be incremental, each including different interventions. Consensus was achieved on recommendations covering different interventions, aimed at (a) behavioural changes, supragingival biofilm, gingival inflammation and risk factor control; (b) supra- and sub-gingival instrumentation, with and without adjunctive therapies; (c) different types of periodontal surgical interventions; and (d) the necessary supportive periodontal care to extend benefits over time. CONCLUSION:This S3 guideline informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat periodontitis and to maintain a healthy dentition for a lifetime, according to the available evidence at the time of publication. 10.1111/jcpe.13290
    The systemic inflammatory response following hand instrumentation versus ultrasonic instrumentation-A randomized controlled trial. Johnston William,Paterson Michael,Piela Krystyna,Davison Emily,Simpson Annabel,Goulding Marilyn,Ramage Gordon,Sherriff Andrea,Culshaw Shauna Journal of clinical periodontology OBJECTIVE:This study sought to investigate whether the immediate systemic inflammatory response following full-mouth debridement differs following use of hand compared with ultrasonic instruments. METHODS:Thirty-nine periodontitis patients were randomized to treatment with full-mouth debridement using either hand or ultrasonic instrumentation completed within 24 hr. Serum and periodontal clinical parameters were collected at baseline, day 1, day 7 and day 90 post-treatment. Differences in systemic inflammatory markers were assessed using general linear models at each timepoint, corrected for age, gender, smoking status, body mass index and baseline levels of each marker. RESULTS:Across all patients, serum C-reactive protein increased at day 1, with no differences between hand and ultrasonic groups (p(adjusted) = .22). There was no difference between groups in interleukin-6 (p(adjusted) = .29) or tumour necrosis factor α (p(adjusted) = .53) at day 1. Inflammatory markers returned to baseline levels by day 7. Treatment resulted in equal and marked improvements in clinical parameters in both groups; however, total treatment time was on average shorter for ultrasonic instruments (p(adjusted) = .002). CONCLUSIONS:Ultrasonic instrumentation resulted in shorter treatment time with comparable clinical outcomes. Levels of serum C-reactive protein at day 1 were similar following debridement with hand or ultrasonic instruments. 10.1111/jcpe.13342
    Effects of adjunctive probiotic L. reuteri lozenges on S/RSD outcomes at molar sites with deep pockets. Pelekos Georgios,Acharya Aneesha,Eiji Nemoto,Hong Guang,Leung Wai Keung,McGrath Colman Journal of clinical periodontology AIM:To evaluate effects of probiotic Lactobacillus reuteri (L. reuteri) lozenges as an S/RSD adjunct on site-level changes at molars with deep pockets. MATERIALS AND METHODS:447 molar sites with pockets ≥ 5 mm from a previous randomized clinical trial of adjunctive L. reuteri lozenges for 28 days were analyzed. Multilevel mixed-effect models (MLM) were constructed to analyze site-level outcomes "change in CAL" and "pocket closure" (residual PPD < 5 mm) in placebo and probiotic groups at 90 and 180 days. Possible patient-, tooth-, and site-level predictors were analyzed as fixed-effects. RESULTS:Estimated change in CAL in probiotic (90 day: 0.87 mm, 180 day: 0.68 mm) was greater than placebo treated molar sites (90 day: 0.73 mm, 180 day: 0.66 mm) and the relative risk (RR) of pocket closure in the probiotic group (90 day: 1.7, 180 day: 1.6) was higher as compared to placebo. Furcation involvement and BOP at site predicted significantly worse treatment outcomes. CONCLUSION:As compared to S/RSD with placebo, a 28-day course of adjunctive probiotic L. reuteri lozenges improved CAL change at molar sites with ≥ 5 mm deep pockets and conferred a higher probability of shallow residual pocket depth. Presence of furcation-involvement and bleeding on probing worsened treatment outcomes. 10.1111/jcpe.13329
    Short-term comparison of two non-surgical treatment modalities of peri-implantitis: Clinical and microbiological outcomes in a two-factorial randomized controlled trial. Merli Mauro,Bernardelli Francesco,Giulianelli Erica,Carinci Francesco,Mariotti Giorgia,Merli Marco,Pini-Prato Giovanpaolo,Nieri Michele Journal of clinical periodontology AIM:To compare the efficacy of two different therapies (amino acid glycine abrasive powder and a desiccant material) and their combination in the non-surgical treatment of peri-implantitis. MATERIALS AND METHODS:This was an examiner-blind randomized clinical trial, with 2-factorial design with a follow-up of 6 months. The combination of the two factors resulted in four interventions: (a) non-surgical debridement alone (C); (b) non-surgical debridement and a desiccant material (H); (c) non-surgical debridement and glycine powder (G); and (d) non-surgical debridement, desiccant material and glycine powder (HG). RESULTS:Sixty-four patients with peri-implantitis were randomized, 16 for each intervention. After six months, two implants failed in the G intervention. Mean pocket depth reduction was higher in patients treated with the desiccant material (estimated difference: 0.5 mm; 95% CI from 0.1 to 0.9 mm, p = .0229) while there was no difference in the patients treated with glycine powder (estimated difference: 0.1 mm; 95% CI from -0.3 to 0.5 mm, p = .7333). VAS for pain during intervention and VAS for pain after one week were higher for patients treated with glycine powder (p = .0056 and p = .0339, respectively). The success criteria and other variables did not reveal differences between interventions. CONCLUSIONS:In this 6-month follow-up study, pocket reduction was more pronounced in patients using the desiccant material. Pain was higher in patients using glycine. All the interventions resulted in low success rate. 10.1111/jcpe.13345
    Three periodontitis phenotypes: Bone loss patterns, antibiotic-surgical treatment and the new classification. Delatola Chryssa,Loos Bruno G,Laine Marja L Journal of clinical periodontology AIM:To compare three periodontitis clusters (A, B and C) for alveolar bone loss (ABL) patterns, antibiotic prescriptions and surgeries and to relate them to the new classification of periodontitis. MATERIALS AND METHODS:ABL patterns, prescription of systemic antibiotics and the number of surgeries were retrieved for all patients (n = 353) in the clusters. Comparisons and possible predictors for antibiotics were assessed, and results also evaluated in relation to the new classification. RESULTS:Cluster A is characterized by angular defects often affecting the first molars and localized stage III/IV grade C periodontitis. Cluster B contains mainly localized or generalized stage III/IV, grade C patients. Cluster C contains mainly patients with generalized stage III/IV grade C periodontitis. Patients in cluster A received significantly more antibiotics compared to B and C (78% vs. 23% and 17%); the predictors for antibiotic prescription were young age and localized ABL. No differences in numbers of periodontal surgeries were observed between clusters (A = 1.0 ± 1.4, B = 1.3 ± 1.4 and C = 1.3 ± 1.5). CONCLUSIONS:Within stage III/IV grade C periodontitis, we could detect three clusters of patients. The distinct localized ABL pattern and younger age in cluster A presumably prompted clinicians to prescribe antibiotics. 10.1111/jcpe.13356
    One- versus two-stage crown lengthening surgical procedure for aesthetic restorative purposes: A randomized controlled trial. González-Martín Oscar,Carbajo Georgina,Rodrigo Marta,Montero Eduardo,Sanz Mariano Journal of clinical periodontology AIM:This randomized controlled trial aimed to assess the efficacy of a two-stage crown lengthening intervention (SCL) in the aesthetic zone compared with a one-stage crown lengthening procedure (CCL). MATERIALS AND METHODS:Thirty subjects were randomly assigned to either SCL (n = 15) or CCL (n = 15) groups. SCL consisted of full-thickness flaps followed by bone recontouring and gingivectomy 4 months postoperatively, if required. In CCL, osseous recontouring after submarginal incisions was performed, followed by flap repositioning. Records were obtained at baseline, 4 months (only in SCL), 6 months and 12 months. Primary outcome was the precision in achieving a pre-determined gingival margin position. Other outcomes considered were changes in the gingival margin position and keratinized tissue width (KTW) at 12 months, and patient-reported outcomes (PROMs). RESULTS:Surgical precision was comparable between groups (0.2 ± 0.4 mm in the CCL group and -0.2 ± 0.5 mm in the SCL group). Four patients in the SCL group (27.7%) did not require a second-stage surgery. KTW was significantly higher in the SCL group (6.3 ± 1.4 mm versus 5.0 ± 1.4 mm, p = 0.017). SCL resulted in a lower impact on quality of life when compared to the CCL group. CONCLUSIONS:Both approaches were highly accurate obtaining the desired crown length. SCL was associated with a lower reduction in KTW and more favourable oral health-related quality of life (OHIP-14). 10.1111/jcpe.13375
    Adjunctive local treatments for patients with residual pockets during supportive periodontal care: A systematic review and network meta-analysis. Wang Chen-Ying,Yang Yu-Hao,Li Hua,Lin Ping-Yi,Su Yu-Ting,Kuo Mark Yen-Ping,Tu Yu-Kang Journal of clinical periodontology AIM:This systematic review and network meta-analysis aimed to evaluate the efficacy of adjunctive locally delivered antimicrobials, compared to subgingival instrumentation alone or plus a placebo, on changes in probing pocket depth (PPD) and clinical attachment level (CAL), in patients with residual pockets during supportive periodontal care. MATERIALS AND METHODS:Literature search was performed with electronic databases and by hand until 31 May 2020. Primary outcome was the changes in PPD. The treatment effects between groups were estimated with weighted mean differences (WMD) with 95% confidence intervals (CI) and prediction intervals (PI) by using random-effects network meta-analysis. RESULTS:Twenty-two studies were included. Significantly greater PPD reduction was achieved in chlorhexidine chip group (WMD: 0.65 mm, 95% CI: 0.21-1.10) and tetracycline fibre group (WMD: 0.64 mm, 95% CI: 0.20-1.08) over 6-month follow-up. Other adjunctive antimicrobial agents achieved non-significant improvements compared to scaling and root planing alone. All differences between adjunctive therapies were statistically non-significant. Similar findings were observed for CAL gain. CONCLUSION:Adjunctive local antimicrobial agents achieved small additional PPD reduction and CAL gain in residual pockets for a follow-up of up to 6 months. Tetracycline fibre and chlorhexidine chip achieved better results than other antimicrobials. 10.1111/jcpe.13379
    Regenerative periodontal surgery and orthodontic tooth movement in stage IV periodontitis: A retrospective practice-based cohort study. Tietmann Christina,Bröseler Frank,Axelrad Tamar,Jepsen Karin,Jepsen Søren Journal of clinical periodontology AIM:Evaluation of the effectiveness of regenerative treatment of intra-bony defects in combination with consecutive orthodontic tooth movements in stage IV periodontitis. MATERIAL AND METHODS:A total of 526 intra-bony defects in 48 patients were analysed after regenerative therapy using collagen-deproteinized bovine bone mineral with or without collagen membrane or enamel matrix derivative followed by orthodontic tooth movement initiated 3 months after surgery. Changes in radiographic bone levels (BL) and probing pocket depths (PPD) were evaluated after 1 year and up to 4 years. RESULTS:Tooth loss amounted to 0.57%. Mean BL gain was 4.67 mm (±2.5 mm) after 1 year and 4.85 mm (±2.55 mm) after up to 4 years. Mean PPD was significantly reduced from 6.00 mm (±2.09 mm) at baseline to 3.45 mm (±1.2 mm) after 1 year, and to 3.12 mm (±1.36 mm) after 2-4 years. Pocket closure (PPD ≤4 mm) was accomplished in 87% of all defects. Adjunctive antibiotic therapy did not show any statistically significant impact on treatment outcomes. CONCLUSIONS:Within the limits of this retrospective study design, the findings suggest that the combination of regenerative treatment and consecutive orthodontic tooth movements resulted in favourable results up to 4 years. 10.1111/jcpe.13442
    Retrospective analysis of the long-term effect of subgingival air polishing in supportive periodontal therapy. Petersilka Gregor,Koch Raphael,Vomhof Anna,Joda Tim,Harks Inga,Arweiler Nicole,Ehmke Benjamin Journal of clinical periodontology AIM:Glycine powder air polishing (GPAP) procedure has become popular. Aim of the analysis was to compare the clinical outcomes during supportive periodontal therapy (SPT) of subgingival application of GPAP with those using sole conventional mechanical debridement (SC). MATERIAL AND METHODS:Over a median SPT period of 5.3 years (re-evaluation through last observation), the GPAP cohort (n = 263) received supra- and subgingival biofilm removal with GPAP. Supragingival calculus was removed using curets and sonic scalers here. Patients in the SC cohort (n = 264) were treated with sonic scalers, curets and rubber cup polishing only. Changes in, that is pocket probing depth (PPD) and furcation involvement were assessed retrospectively. A bootstrapping equivalence testing method in line with the principle of the two one-sided tests (TOST) procedure was used to compare clinical outcomes. RESULTS:The GPAP procedure was statistically equivalent to SC regarding the number of sites with stable PPDs (83.3%; IQR 68.8%, 91.0% vs. 84.0%; IQR 77.8%, 90.0%). However, in the GPAP cohort, a trend towards deterioration in furcation status (no equivalence) was noted. CONCLUSIONS:In periodontal maintenance, the use of GPAP instead of mechanical plaque removal does not improve the clinical outcome. It seems to be contraindicated to treat furcation defects with GPAP only. 10.1111/jcpe.13392
    Treatment of localized aggressive periodontitis alters local host immunoinflammatory profiles: A long-term evaluation. Branco-de-Almeida Luciana S,Cruz-Almeida Yenisel,Gonzalez-Marrero Yandy,Kudsi Rachad,de Oliveira Izabel C V,Dolia Bogdan,Huang Hong,Aukhil Ikramuddin,Harrison Peter,Shaddox Luciana M Journal of clinical periodontology AIM:To evaluate the local immunoinflammatory profiles in localized aggressive periodontitis patients (LAP) before and after periodontal treatment and maintenance. METHODS:Sixty-six African-Americans with LAP (7-21 years old) were included. After periodontal examination, all patients received periodontal treatment with mechanical debridement plus systemic amoxicillin/metronidazole for 7 days. Gingival crevicular fluid was collected from diseased and healthy sites at baseline and 3, 6, 12, and 24 months following treatment. Levels of 16 inflammatory/bone resorption markers were determined using Milliplex . Univariate and correlation analyses were performed among all parameters/biomarkers. Discriminant analyses (DA) evaluated profile differences between LAP diseased and healthy sites at each time point as compared to the baseline. RESULTS:Reductions in the clinical parameters (except for visible plaque) were observed at all time points compared to the baseline. Levels of IL-12p70, IL-2, IL-6, MIP-1α, RANKL, and OPG were reduced after treatment, and several cytokines/chemokines were correlated with clinical parameters reductions. DA showed that differences in the immunoinflammatory profiles between LAP diseased and healthy sites decreased after periodontal treatment compared to the baseline. CONCLUSIONS:Periodontal treatment modified the local immunoinflammatory profile of LAP sites in the long term, as suggested by changes in biomarkers from baseline, along with clinical stability of the disease. (Clinicaltrials.gov number, NCT01330719). 10.1111/jcpe.13404
    Effects of periodontal management for patients with type 2 diabetes on healthcare expenditure, hospitalization and worsening of diabetes: an observational study using medical, dental and pharmacy claims data in Japan. Shin Jung-Ho,Takada Daisuke,Kunisawa Susumu,Imanaka Yuichi Journal of clinical periodontology AIMS:To investigate the effects of regular periodontal management for people with type 2 diabetes on total healthcare expenditure, hospitalization and the introduction of insulin. MATERIALS AND METHODS:We collected data of individuals who were prescribed diabetes medications during the fiscal year 2015 from the claims database of a prefecture in Japan. We fitted generalized linear models that had sex, age, comorbidities and the status of periodontal management during the previous two years as predictors. RESULTS:A total of 16,583 individuals were enrolled. The annual healthcare expenditure in the third year was 4% less (adjusted multiplier 0.96, 95% confidence interval [CI] 0.92-1.00) in the group receiving periodontal management every year. The adjusted odds ratio (aOR) for all-cause hospitalization was 0.90 (95% CI: 0.82-0.98). The aOR of introducing insulin in the third year for those who had not been prescribed insulin during the previous two years (n = 13,222) was 0.77 (95% CI: 0.64-0.92) in the group receiving periodontal management every year. CONCLUSION:Regular periodontal management for diabetic people was associated with reduced healthcare expenditure, all-cause hospitalization and the introduction of insulin therapy. 10.1111/jcpe.13441
    Effect of compliance during periodontal maintenance therapy on c-reactive protein levels: a 6-year follow-up. Costa Fernando Oliveira,Esteves Lima Rafael Paschoal,Cortelli Sheila Cavalca,Costa Adriana Moreira,Cortelli José Roberto,Cota Luís Otávio Miranda Journal of clinical periodontology AIMS:To longitudinally evaluate the effects of compliance during periodontal maintenance therapy (PMT) on C-reactive protein (CRP) levels and its relation to periodontal status. MATERIALS AND METHODS:A subsample comprising of 30 matched pairs was taken from a previous 6-year longitudinal study under PMT. Pairs were composed of one regular (RC) and one irregular (IC) compliers, matched by age and sex. Periodontal parameters and plasma samples were collected at 3 times: T1[prior to active periodontal therapy (APT)], T2(after APT), and T3(after 6 years). CRP plasma levels were quantified using ELISA. RESULTS:RC presented better clinical periodontal status, lower recurrence of periodontitis (sites with PD ≥4 mm and CAL ≥3 mm, together with the persistence and/or presence of BOP and/or suppuration, during any of the subsequent recall evaluations) and significant reductions in CRP levels over time [(T1: RC = 3.64 ± 2.13 and IC = 3.92 ± 2.02 mg/L) and (T3: RC = 2.12 ± 1.39 mg/L and IC = 3.71 ± 1.82 mg/L)]. Logistic regression analysis demonstrated that individuals with periodontitis recurrence presented 2.19 higher chances of presenting altered CRP levels (values ≥3 mg/L- T2 to T3) than those without periodontitis recurrence (95%CI:1.16-3.27; p = 0.017). CONCLUSIONS:Higher CRP plasma levels were associated with higher recurrence of periodontitis and worse clinical periodontal parameters among IC when compared to RC. 10.1111/jcpe.13407
    [Investigation of the clinical effect of 65 μm glycine powder air-polishing(GPAP) after ultrasonic scaling during subgingival polishing]. Shi Zhao-Cheng,Wang Li-Ming,Song Zhi-Feng,Ao Sheng-Yao,Dong Cong Shanghai kou qiang yi xue = Shanghai journal of stomatology PURPOSE:To evaluate the clinical effect of 65 μm glycine powder air-polishing (GPAP) by comparing with sodium hydrogen carbonate after ultrasonic scaling during subgingival polishing. METHODS:Thirty-three patients who were systematically healthy were involved in this study. After ultrasonic scaling,they were randomly assigned to the experimental group or the control group. Patients in the control group were treated with rubber cup + sodium hydrogen carbonate, while patients in the experimental group were treated only with 65 μm GPAP therapy. The clinical parameters including probing depth(PD), bleeding index(BI), plaque index(PI), staining index(SI) were recorded at baseline, 1week, 1 month, 3 months and 6 months after treatment. The results were analyzed by paired sample Wilcoxon signed-rank test with SPSS 23.0 software package. RESULTS:Both methods had good clinical effects. PD, BI, PI and SI of the two groups at 1 month, 3 months and 6 months after treatment were significantly better than those at baseline (P<0.01). SI of the experimental groups was significantly lower than that of the control group at 1 month, 3 months and 6 months after treatment(P<0.01). CONCLUSIONS:The results indicated that 65 μm GPAP may be as effective as sodium hydrogen carbonate after ultrasonic scaling in removal of dental plaque and stain. 65 μm GPAP had the advantage of reducing restaining.
    Randomized controlled trial assessing efficacy and safety of glycine powder air polishing in moderate-to-deep periodontal pockets. Flemmig Thomas F,Arushanov Daniyel,Daubert Diane,Rothen Marilynn,Mueller Gregory,Leroux Brian G Journal of periodontology BACKGROUND:Supragingivally applied glycine powder air polishing (SupraGPAP) has been shown to remove biofilms in shallow periodontal pockets. This study assesses efficacy and safety of subgingivally applied glycine powder air polishing (SubGPAP) in moderate-to-deep periodontal pockets. METHODS:Patients with chronic periodontitis and intraoral Porphyromonas gingivalis (P. gingivalis) and Tannerella forsythia who completed initial therapy were randomly assigned to receive SubGPAP in periodontal pockets with probing depths of 4 to 9 mm, SupraGPAP in all other shallow periodontal sites, and at mucous membranes followed by removal of calculus using curets (full-mouth GPAP) or scaling and root planing followed by coronal polishing (SRP). Patients rinsed with 0.12% chlorhexidine gluconate after debridement, and twice daily, for 2 weeks. RESULTS:All 30 patients enrolled completed the baseline, day 10, and day 90 visits. SubGPAP resulted in significantly lower total viable bacterial counts in moderate-to-deep pockets when compared to SRP immediately after debridement and at day 10 (P <0.05). Total P. gingivalis counts in the oral cavity were significantly reduced after full-mouth GPAP compared to SRP at day 90 (P <0.05). Patients' comfort levels were high for both treatments. There were no adverse events related to full-mouth GPAP. CONCLUSIONS:The results indicate that SubGPAP is more efficacious in removing subgingival biofilm in moderate-to-deep periodontal pockets than SRP. Furthermore, full-mouth GPAP may result in a beneficial shift of the oral microbiota and appears to be well tolerated. 10.1902/jop.2011.110367
    The effect of supragingival glycine air polishing on periodontitis during maintenance therapy: a randomized controlled trial. Lu Hongye,He Lu,Zhao Yibing,Meng Huanxin PeerJ Background:Glycine air polishing has been proved to be safe, comfortable and time-saving. Whether it could substitute ultrasonic scaling to remove dental plaque biofilm during periodontal maintenance remains unclear. The purposes of this study were to evaluate the effect of supragingival glycine air polishing (SGAP) on the subgingival periodontal pathogens during maintenance therapy and to check the association of periodontal pathogens and clinical parameters. Methods:Twenty-three chronic periodontitis patients during their maintenance therapy were enrolled in the 12-week study. According to randomized split-mouth design, the test side was treated with SGAP (65 μm), while the control side was treated with supragingival ultrasonic scaling and polishing (SUSP) with rubber cup. Clinical examination including plaque index (PLI), probing depth (PD), bleeding index (BI) were performed at baseline and 12 weeks post-treatment. Sampling of the subgingival plaque at each investigational site (mesiobuccal site of the mandibular first molar) was performed at baseline and 2, 4, 8, 12 weeks after maintenance treatment. Four periodontal pathogens including , and were detected by 16S rDNA polymerase chain reaction. Results:Clinical status generally improved after treatment in both groups. PLI in both groups, PD in SGAP group and bleeding on probing (%) in SUSP group significantly decreased after treatment ( < 0.05). There was no significant difference of clinical parameters between two groups before and after treatment. The detection rates of , in both groups, in SUSP group and in SGAP group decreased after maintenance treatment in both groups, although no significant difference was found, and it rebound to baseline level at 12 weeks after maintenance treatment. There was no significant difference between SGAP group and SUSP group at any time point. -positive sites had significantly greater BI than -negative sites ( < 0.05). Discussion:Supragingival glycine air polishing had a reliable effect in removing subgingival dental plaque biofilm during maintenance period, and three months may be a proper maintenance interval for pockets not more than 5 mm. 10.7717/peerj.4371
    [Preliminary study of subgingival microorganism changes after glycine powder air-polishing treatment during periodontal maintenance phase]. Zhao Y B,Jin D S S,He L,Meng H X Zhonghua kou qiang yi xue za zhi = Zhonghua kouqiang yixue zazhi = Chinese journal of stomatology To research the variation of subgingival microorganisms after 65 μm glycine powder air-polishing (GPAP) in patients with periodontitis during periodontal maintenance phase and make comparison with conventional method. From Department of Periodontology, Peking University School and Hospital of Stomatology, twenty-one patients at the age of 35-72 (8 males and 13 females) who were systematically healthy were recruited in this study. According to splitting-mouth design, one side of a mouth was randomly assigned to the experiment group (21 patients, 248 teeth, 1 488 sites) with 65 μm GPAP therapy while the opposite side served as the control group (21 patients, 249 teeth, 1 494 sites) with ultrasonic scaling plus polishing paste therapy. The clinical periodontal parameters including probing depth (PD), bleeding index (BI), bleeding on probing (BOP) and plaque index (PLI) were recorded. Using sterile currette, the subgingival plaque samples were collected at the mesio-buccal site of the first or second molars at baseline, 2, 4, 8 and 12 weeks after therapy, respectively. After Congo red staining, the microorganisms were classified into cocci, bacilli and spirochetes and counted respectively. All clinical periodontal parameters have no difference between two groups at baseline and after treatment 12 weeks. In the experiment group and the control group, PD ([2.33±0.90] and [2.37±1.18] mm), BI (0.96±0.70 and 0.98±0.78) and PLI (0.00[1.00] and 0.00[1.00]) of two groups after treatment 12 weeks were better than those at baseline (PD: [2.48±1.17] and [2.46±0.99] mm; BI: 1.07±0.72 and 1.08±0.75; PLI: 0.00 [1.00] and 0.00 [1.00]) (0.05). But BOP(+)% was observably reduced only in the control group after treatment 12 weeks ([17.25±2.21]% vs [25.23±2.83]%) (0.05). The percentages of cocci, bacilli and spirochetes were stable and there were not significant differences between the two groups (>0.05). After 65 μm GPAP therapy, the differences of proportion of subgingival microorganisms are not significant, while the control group has the same trend. The spirochetes remained at a low level, but they rebounded fasterly in the test group than that in the control group. The results indicate that 65 μm glycine powder air-polishing has the similar clinical effects compared with ultrasonic scaling plus polishing paste. However, the clinical indications should be limited to the patients with shallow pockets and without obvious dental calculus. 10.3760/cma.j.issn.1002-0098.2017.07.004
    Simultaneous determination of linarin, naringenin and formononetin in rat plasma by LC-MS/MS and its application to a pharmacokinetic study after oral administration of Bushen Guchi Pill. Guo Panpan,Dong Lihua,Yan Wenying,Wei Jianceng,Wang Chunying,Zhang Zijian Biomedical chromatography : BMC A sensitive and reproducible liquid chromatography tandem mass spectrometry (LC-MS/MS) method was developed and validated for the simultaneous determination of linarin, naringenin and formononetin in rat plasma after addition of sulfamethoxazole as the internal standard (IS). Separation was carried out on a Diamonsil C18 column (150 × 4.6 mm, 5 µm) with liner gradient elution using methanol (A) and 0.5‰ formic acid aqueous solution (B). Detection was performed on a triple-quadrupole linear ion trap mass spectrometer with the negative ion electrospray ionization in multiple-reaction monitoring (MRM) mode. The MRM transitions were m/z 591.2 → 283.2, 271.0 → 150.9, 266.9 → 252.0 and 252.0 → 155.9 for linarin, naringenin, formononetin and IS, respectively. All analytes showed good linearity within the concentration range (r > 0.9973). The lower limits of quantitation of linarin, naringenin and formononetin were 0.64, 1.07 and 1.04 ng/mL, respectively. Intra-day and inter-day precisions of the investigated components exhibited an RSD within 9.96%, and the accuracy (relative error) ranged from -11.25 to 9.38% at all quality control levels. The developed method was successfully applied to a pharmacokinetic study of linarin, naringenin and formononetin in rats after oral administration of Bushen Guchi Pill. 10.1002/bmc.3267
    Tyrosine-protein phosphatase non-receptor type 2 inhibits alveolar bone resorption in diabetic periodontitis via dephosphorylating CSF1 receptor. Zhang Dongjiao,Jiang Yanfei,Song Dawei,Zhu Zhenkun,Zhou Cong,Dai Li,Xu Xin Journal of cellular and molecular medicine Tyrosine-protein phosphatase non-receptor type 2 (PTPN2) is an important protection factor for diabetes and periodontitis, but the underlying mechanism remains elusive. This study aimed to identify the substrate of PTPN2 in mediating beneficial effects of 25-Hydroxyvitamin D (25(OH)2D ) on diabetic periodontitis. 25(OH)2D photo-affinity probe was synthesized with the minimalist linker and its efficacy to inhibit alveolar bone loss, and inflammation was evaluated in diabetic periodontitis mice. The probe was used to pull down the lysates of primary gingival fibroblasts. We identified PTPN2 as a direct target of 25(OH)2D , which effectively inhibited inflammation and bone resorption in diabetic periodontitis mice. In addition, we found that colony-stimulating factor 1 receptor (CSF1R) rather than JAK/STAT was the substrate of PTPN2 to regulate bone resorption. PTPN2 direct interacted with CSF1R and dephosphorylated Tyr807 residue. In conclusion, PTPN2 dephosphorylates CSF1R at Y807 site and inhibits alveolar bone resorption in diabetic periodontitis mice. PTPN2 and CSF1R are potential targets for the therapy of diabetic periodontitis or other bone loss-related diseases. 10.1111/jcmm.14545
    Two-way relationship between diabetes and periodontal disease: a reality or a paradigm? Oberti L,Gabrione F,Nardone M,Di Girolamo M Journal of biological regulators and homeostatic agents Diabetes mellitus (DM) and periodontal disease (PD) are both chronic diseases. From one side, DM have an adverse effect on PD, and on the other side PD may influence DM. Systemic therapy of DM with glycaemic control, affects the progress of PD. Reversely treatment of PD combined with the administration of systemic antibiotics seems to have a double effect on diabetic patients reducing the periodontal infection and improving the glycaemic control. Inflammation, altered host responses, altered tissue homeostasis are common characteristic of both DM and PD. The potential common pathophysiologic pathways of direct or reverse relationship of DM and PD are still unknown and further and studies are needed to explore this relationship.
    Systemic Inflammatory Biomarkers and Their Association With Periodontal and Diabetes-Related Factors in the Diabetes and Periodontal Therapy Trial, A Randomized Controlled Trial. Geisinger Maria L,Michalowicz Bryan S,Hou Wei,Schoenfeld Elinor,Gelato Marie,Engebretson Steven P,Reddy Michael S,Hyman Leslie Journal of periodontology BACKGROUND:The present study evaluates effects of non-surgical periodontal treatment on serum biomarkers in patients with type 2 diabetes mellitus (t2DM) and chronic periodontitis who participated in the Diabetes and Periodontal Therapy Trial (DPTT); and associations among diabetes markers, serum biomarkers, and periodontal measures in these patients. METHODS:DPTT participants randomized to receive immediate or delayed non-surgical periodontal therapy were evaluated at baseline and 6 months. Serum samples from 475 participants with 6-month data were analyzed for the following biomarkers: 1) high sensitivity C-reactive protein; 2) E-selectin; 3) tumor necrosis factor (TNF)-α; 4) vascular cell adhesion molecule (VCAM); 5) interleukin (IL)-6; 6) IL-8; 7) intercellular adhesion molecule; and 8) IL-10. Changes in biomarker levels from baseline and correlations among biomarker levels and clinical findings were analyzed. RESULTS:No differences between treatment and control groups were observed for any biomarkers at baseline or 6 months (P >0.05 for all variables). VCAM levels increased by an average (standard deviation) of 17.9 (99.5); ng/mL (P = 0.006) and E-selectin decreased by 2.33 (16.08) ng/mL (P = 0.03) in the treatment group after 6 months. E-selectin levels were significantly correlated with DM-related variables (hemoglobin A1c [HbA1c] and fasting glucose) at baseline and with 6-month change in both groups; no significant correlations were found among periodontal clinical parameters and serum biomarkers or DM-related variables. Neither HbA1c or body mass index varied during the study period in either study group. CONCLUSIONS:Non-surgical periodontal therapy and periodontal disease severity were not associated with significant changes in serum biomarkers in DPTT participants during the 6-month follow-up. Correlations among changes in E-selectin, IL-6, and DM-related variables suggest that t2DM may be the primary driver of systemic inflammation in these patients. 10.1902/jop.2016.150727
    Impact of diabetes on clinical periodontal outcomes following non-surgical periodontal therapy. Hsu Yung-Ting,Nair Maya,Angelov Nikola,Lalla Evanthia,Lee Chun-Teh Journal of clinical periodontology AIM:This systematic review aimed to evaluate the impact of diabetes mellitus on clinical outcomes of non-surgical periodontal therapy. MATERIALS AND METHODS:Searches were conducted in electronic databases to screen studies published from January 1960 to August 2018. The included studies had at least two groups of patients: chronic periodontitis only (P) or both diabetes and chronic periodontitis (DMP). Outcomes of interest included the difference between the two groups in probing depth (PD) reduction and clinical attachment level (CAL) gain following non-surgical periodontal therapy. Meta-regression was conducted to evaluate the correlation between the outcomes of interest and contributing factors. RESULTS:A total of 12 studies with a follow-up period up to 6 months were included. There was no significant difference in PD reduction (p = 0.55) or CAL gain (p = 0.65) between the two groups. A positive association between PD reduction and baseline PD difference (p = 0.03), and a negative association between PD reduction and age (p = 0.04) were found. The level of HbA1c at baseline did not significantly affect the difference in PD reduction (p = 0.39) or CAL gain (p = 0.44) between two groups. CONCLUSIONS:Recognizing the study's limitations, we conclude that diabetes mellitus (HbA1c ≤ 8.5%) does not appear to significantly affect short-term clinical periodontal outcomes of non-surgical periodontal treatment. 10.1111/jcpe.13044
    Clinical and microbiological effects of scaling and root planing, metronidazole and amoxicillin in the treatment of diabetic and non-diabetic subjects with periodontitis: A cohort study. Duarte Poliana Mendes,Feres Magda,Yassine Lina Lameh Smeili,Soares Geisla Mary Silva,Miranda Tamires Szeremeske,Faveri Marcelo,Retamal-Valdes Belen,Figueiredo Luciene Cristina Journal of clinical periodontology AIM:To evaluate if non-diabetic subjects with periodontitis respond better than subjects with type 2 diabetes to the treatment protocol of scaling and root planing (SRP), metronidazole (MTZ) and amoxicillin (AMX). MATERIAL AND METHODS:Diabetic and nondiabetic subjects with severe periodontitis received SRP + MTZ (400 mg/thrice a day [TID]) + AMX (500 mg/TID) for 14 days. Subgingival biofilm samples were analyzed by checkerboard DNA-DNA hybridization for 40 bacterial species. Subjects were monitored at baseline, 3, 6 and 12 months post-therapy. RESULTS:Twenty-nine type 2 diabetics and 29 non-diabetic subjects participated of this study. Of the non-diabetics and diabetics, 68.9% and 75.9%, respectively, reached the clinical endpoint for treatment (≤4 sites with probing depth [PD] ≥5 mm) at 1 year post-therapy (p > 0.05). The diabetic group presented lower mean clinical attachment gain from baseline to 1 year post-therapy and higher mean proportions of the red and orange complexes than the non-diabetic group (p < 0.05). CONCLUSIONS:Non-diabetic subjects with severe periodontitis did not respond better than type 2 diabetic subjects to the treatment protocol of SRP + MTZ + AMX, both in terms of achieving the clinical endpoint for treatment and of PD improvement. Diabetic subjects exhibited a slightly worse microbiological response and showed a healing process more associated with gingival recession than the non-diabetics. 10.1111/jcpe.12994
    Undetected Dysglycemia Is an Important Risk Factor for Two Common Diseases, Myocardial Infarction and Periodontitis: A Report From the PAROKRANK Study. Norhammar Anna,Kjellström Barbro,Habib Natalie,Gustafsson Anders,Klinge Björn,Nygren Åke,Näsman Per,Svenungsson Elisabet,Rydén Lars Diabetes care OBJECTIVE:Information on the relationship among dysglycemia (prediabetes or diabetes), myocardial infarction (MI), and periodontitis (PD) is limited. This study tests the hypothesis that undetected dysglycemia is associated with both conditions. RESEARCH DESIGN AND METHODS:The PAROKRANK (Periodontitis and Its Relation to Coronary Artery Disease) study included 805 patients with a first MI and 805 matched control subjects. All participants without diabetes (91%) were examined with an oral glucose tolerance test. Abnormal glucose tolerance (AGT) (impaired glucose tolerance or diabetes) was categorized according to the World Health Organization. Periodontal status was categorized from dental X-rays as healthy (≥80% remaining alveolar bone height), moderate (79-66%), or severe (<66%) PD. Odds ratios (ORs) and 95% CIs were calculated by logistic regression and were adjusted for age, sex, smoking, education, marital status, and explored associated risks of dysglycemia to PD and MI, respectively. RESULTS:AGT was more common in patients than in control subjects (32% vs. 19%; < 0.001) and was associated with MI (OR 2.03; 95% CI 1.58-2.60). Undetected diabetes was associated with severe PD (2.50; 1.36-4.63) and more strongly in patients (2.35; 1.15-4.80) than in control subjects (1.80; 0.48-6.78), but not when categorized as AGT (total cohort: 1.07; 0.67-1.72). Severe PD was most frequent in subjects with undetected diabetes, and reversely undetected diabetes was most frequent in patients with severe PD. CONCLUSIONS:In this large case-control study previously undetected dysglycemia was independently associated to both MI and severe PD. In principal, it doubled the risk of a first MI and of severe PD. This supports the hypothesis that dysglycemia drives two common diseases, MI and PD. 10.2337/dc19-0018
    In type 2 diabetes with periodontitis, intensive periodontitis treatment improved glycemic control at 1 year. Punthakee Zubin Annals of internal medicine 10.7326/ACPJ201904160-040
    Adjunctive Local Delivery of Aloe Vera Gel in Patients With Type 2 Diabetes and Chronic Periodontitis: A Randomized, Controlled Clinical Trial. Pradeep A R,Garg Vibhuti,Raju Arjun,Singh Priyanka Journal of periodontology BACKGROUND:Herbal agents such as Aloe vera (AV) have been used in medical and dental therapy for thousands of years. AV has anti-inflammatory, antioxidant, antimicrobial, hypoglycemic, healing-promoting, and immune-boosting properties. This study aims to investigate the clinical effectiveness of locally delivered AV gel used as an adjunct to scaling and root planing (SRP) in the treatment of patients with type 2 diabetes mellitus (T2DM) and chronic periodontitis (CP). METHODS:Sixty patients with probing depth (PD) ≥ 5 mm and clinical attachment level (CAL) ≥ 3 mm were randomly divided into two groups. All patients underwent SRP. Placebo gel was locally delivered to group 1 and AV gel to group 2. Full-mouth plaque index (PI), modified sulcus bleeding index (mSBI), PD, and CAL were recorded at baseline and 3 and 6 months. RESULTS:Patients in group 2 showed significantly greater mean reductions in PI, mSBI, and PD and mean gain in CAL compared with those in group 1 from baseline to 3 months. Gain in CAL was significantly greater in group 2 at all time intervals versus group 1. CONCLUSION:Adjunctive use of locally delivered AV gel, in comparison to locally delivered placebo gel, is associated with greater reduction in PI, mSBI, and PD as well as more gain in CAL in patients with T2DM and CP. 10.1902/jop.2015.150161
    Efficacy of Local Antimicrobials in the Non-Surgical Treatment of Patients With Periodontitis and Diabetes: A Systematic Review. Rovai Emanuel S,Souto Maria Luisa S,Ganhito Juliana A,Holzhausen Marinella,Chambrone Leandro,Pannuti Claudio M Journal of periodontology BACKGROUND:Patients with diabetes present a worse response to periodontal treatment. Local antimicrobials as an adjunct to scaling and root planing (SRP) provide additional benefits in the treatment of periodontitis in healthy patients. This review aims to evaluate the effects of local antimicrobials as an adjunct to SRP, compared with SRP alone, on periodontal clinical parameters of patients with chronic periodontitis (CP) and diabetes mellitus (DM). METHODS:Only randomized controlled trials with: 1) at least 6 months of follow-up; 2) SRP, in combination with local antimicrobials; and 3) patients with periodontitis and DM were considered eligible. MEDLINE, EMBASE, and LILACS databases were searched for articles published up to January 2016. Random-effects meta-analyses were conducted for clinical attachment level (CAL), probing depth (PD), bleeding on probing, and gingival index change after treatment. RESULTS:Of 153 papers potentially relevant to this review, six were included. The majority of trials showed a significant PD reduction and CAL gain associated with use of local antimicrobials in patients with type 1 and type 2 DM. Only studies that included well-controlled patients and applied antimicrobials at the deepest sites or sites with baseline PD ≥5 mm presented significant PD reduction and CAL gain. CONCLUSION:In patients with DM and CP, use of local antimicrobials as an adjunct to SRP may result in additional benefits compared with SRP alone in PD reduction and CAL gain, especially in well-controlled individuals and deep sites. 10.1902/jop.2016.160214
    Diabetes Enhances IL-17 Expression and Alters the Oral Microbiome to Increase Its Pathogenicity. Xiao E,Mattos Marcelo,Vieira Gustavo Henrique Apolinário,Chen Shanshan,Corrêa Jôice Dias,Wu Yingying,Albiero Mayra Laino,Bittinger Kyle,Graves Dana T Cell host & microbe Diabetes is a risk factor for periodontitis, an inflammatory bone disorder and the greatest cause of tooth loss in adults. Diabetes has a significant impact on the gut microbiota; however, studies in the oral cavity have been inconclusive. By 16S rRNA sequencing, we show here that diabetes causes a shift in oral bacterial composition and, by transfer to germ-free mice, that the oral microbiota of diabetic mice is more pathogenic. Furthermore, treatment with IL-17 antibody decreases the pathogenicity of the oral microbiota in diabetic mice; when transferred to recipient germ-free mice, oral microbiota from IL-17-treated donors induced reduced neutrophil recruitment, reduced IL-6 and RANKL, and less bone resorption. Thus, diabetes-enhanced IL-17 alters the oral microbiota and renders it more pathogenic. Our findings provide a mechanistic basis to better understand how diabetes can increase the risk and severity of tooth loss. 10.1016/j.chom.2017.06.014
    Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International diabetes Federation and the European Federation of Periodontology. Sanz Mariano,Ceriello Antonio,Buysschaert Martin,Chapple Iain,Demmer Ryan T,Graziani Filippo,Herrera David,Jepsen Søren,Lione Luca,Madianos Phoebus,Mathur Manu,Montanya Eduard,Shapira Lior,Tonetti Maurizio,Vegh Daniel Diabetes research and clinical practice BACKGROUND:Diabetes and periodontitis are chronic non-communicable diseases independently associated with mortality and have a bidirectional relationship. AIMS:To update the evidence for their epidemiological and mechanistic associations and re-examine the impact of effective periodontal therapy upon metabolic control (glycated haemoglobin, HbA1C). EPIDEMIOLOGY:There is strong evidence that people with periodontitis have elevated risk for dysglycaemia and insulin resistance. Cohort studies among people with diabetes demonstrate significantly higher HbA1C levels in patients with periodontitis (versus periodontally healthy patients), but there are insufficient data among people with type 1 diabetes. Periodontitis is also associated with an increased risk of incident type 2 diabetes. MECHANISMS:Mechanistic links between periodontitis and diabetes involve elevations in interleukin (IL)-1-β, tumour necrosis factor-α, IL-6, receptor activator of nuclear factor-kappa B ligand/osteoprotegerin ratio, oxidative stress and Toll-like receptor (TLR) 2/4 expression. INTERVENTIONS:Periodontal therapy is safe and effective in people with diabetes, and it is associated with reductions in HbA1C of 0.27-0.48% after 3 months, although studies involving longer-term follow-up are inconclusive. CONCLUSIONS:The European Federation of Periodontology (EFP) and the International Diabetes Federation (IDF) report consensus guidelines for physicians, oral healthcare professionals and patients to improve early diagnosis, prevention and comanagement of diabetes and periodontitis. 10.1016/j.diabres.2017.12.001
    Diabetes Activates Periodontal Ligament Fibroblasts via NF-κB In Vivo. Zheng J,Chen S,Albiero M L,Vieira G H A,Wang J,Feng J Q,Graves D T Journal of dental research Diabetes mellitus increases periodontitis and pathogenicity of the oral microbiome. To further understand mechanisms through which diabetes affects periodontitis, we examined its impact on periodontal ligament fibroblasts in vivo and in vitro. Periodontitis was induced by inoculation of Porphyromonas gingivalis and Fusobacterium nucleatum in normoglycemic and diabetic mice. Diabetes, induced by multiple low-dose injections of streptozotocin increased osteoclast numbers and recruitment of neutrophils to the periodontal ligament, which could be accounted for by increased CXC motif chemokine 2 (CXCL2) and receptor activator of nuclear factor kappa B ligand (RANKL) expression by these cells. Diabetes also stimulated a significant increase in nuclear factor kappa B (NF-κB) expression and activation in periodontal ligament (PDL) fibroblasts. Surprisingly, we found that PDL fibroblasts express a 2.3-kb regulatory unit of Col1α1 (collagen type 1, alpha 1) promoter typical of osteoblasts. Diabetes-enhanced CXCL2 and RANKL expression in PDL fibroblasts was rescued in transgenic mice with lineage-specific NF-κB inhibition controlled by this regulatory element. In vitro, high glucose increased NF-κB transcriptional activity, NF-κB nuclear localization, and RANKL expression in PDL fibroblasts, which was reduced by NF-κB inhibition. Thus, diabetes induces changes in PDL fibroblast gene expression that can enhance neutrophil recruitment and bone resorption, which may be explained by high glucose-induced NF-κB activation. Furthermore, PDL fibroblasts express a regulatory element in vivo that is typical of committed osteoblasts. 10.1177/0022034518755697
    Mediation analysis of systemic inflammation on the association between periodontitis and glycaemic status. Torrungruang Kitti,Ongphiphadhanakul Boonsong,Jitpakdeebordin Supawadee,Sarujikumjornwatana Somchai Journal of clinical periodontology AIM:This cross-sectional study investigated the associations between periodontitis, systemic inflammation and glycaemic status. MATERIALS AND METHODS:The participants were divided into three groups: normoglycaemia, impaired fasting glucose (IFG) and diabetes. Multinomial logistic regression was used to examine the associations between periodontitis severity and glycaemic status, adjusting for potential confounders. Mediation analysis of four systemic inflammatory biomarkers, C-reactive protein (CRP), white blood cell count (WBC), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), was performed. RESULTS:This study comprised 2,036 participants, aged 39-66 years. Severe periodontitis was associated with IFG and diabetes with odds ratios of 1.6 (95% confidence interval [CI]: 1.1-2.4, p = .023) and 2.4 (95% CI: 1.3-4.5, p = .006), respectively. The CRP, WBC and PLR were associated with both periodontitis severity and glycaemic status (p < .05). In contrast, the NLR was associated with periodontitis severity (p < .05) but not glycaemic status (p > .05). The CRP, WBC and PLR mediated 8%, 13% and 6%, respectively, of the association between severe periodontitis and diabetes. Similar proportions mediated were observed for the periodontitis-IFG association. CONCLUSIONS:Our findings support the role of systemic inflammation as mediators of the associations between periodontitis and IFG or diabetes. 10.1111/jcpe.12884
    Association between periodontal condition and the development of type 2 diabetes mellitus-Results from a 15-year follow-up study. Myllymäki Ville,Saxlin Tuomas,Knuuttila Matti,Rajala Ulla,Keinänen-Kiukaanniemi Sirkka,Anttila Sirpa,Ylöstalo Pekka Journal of clinical periodontology AIM:To study whether periodontal condition is associated with the development of type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS:A population-based follow-up study was conducted among persons born in 1935 and living in the city of Oulu, Finland (n = 395). The baseline examinations were done during 1990-1992, and the follow-up examinations were done during 2007-2008. The data were gathered by questionnaires, laboratory tests and clinical measurements. Poisson regression models were used in the data analyses. RESULTS:The adjusted rate ratios (RR) with 95% confidence intervals (95% CI) for the incident T2DM among subjects with 4-5 mm deep periodontal pockets (n = 98), among subjects with 6 mm deep or deeper periodontal pockets (n = 91), and among edentulous subjects (n = 118) were 1.32 (95% CI: 0.69-2.53), 1.56 (95% CI: 0.84-2.92) and 1.00 (95% CI: 0.53-1.89), respectively, compared to dentate subjects without deepened (4 mm deep or deeper) periodontal pockets (n = 88). The adjusted RR per site (the number of sites with deepened periodontal pockets as a continuous variable) was 1.02 (95% CI: 1.00-1.04). CONCLUSIONS:Poor periodontal condition may be a predictor of the development of T2DM. However, the causality between periodontal condition and the development of T2DM remains uncertain. 10.1111/jcpe.13005
    Locally Delivered 0.5% Azithromycin as an Adjunct to Non-Surgical Treatment in Patients With Chronic Periodontitis With Type 2 Diabetes: A Randomized Controlled Clinical Trial. Agarwal Esha,Bajaj Pavan,Naik Savitha B,Pradeep A R Journal of periodontology BACKGROUND:Several epidemiologic studies have identified a greater incidence of periodontitis in patients with type 2 diabetes. Recent developments suggest that local delivery of antimicrobials into periodontal pockets improve periodontal health. The present study is designed to investigate the adjunctive effects of subgingivally delivered azithromycin (AZM; 0.5% concentration) as an adjunct to scaling and root planing (SRP) for treating chronic periodontitis in patients with type 2 diabetes. METHODS:A total of 63 patients were categorized into two treatment groups: 1) group 1: SRP + placebo gel and 2) group 2: SRP + 0.5% AZM. Clinical parameters were recorded at baseline and 3, 6, and 9 months; they included modified sulcus bleeding index (mSBI), plaque index (PI), probing depth (PD), and clinical attachment level (CAL). RESULTS:Both therapies resulted in significant improvements. Using a patient-based analysis, patients in group 2 treated with SRP + 0.5% AZM showed enhanced reductions in PI, GI, mSBI, and PD and gains in CAL (P <0.05) over 9 months compared with group 1. CONCLUSION:Although both treatment strategies seem to benefit the patients, the adjunctive use of 0.5% AZM as a controlled drug delivery system enhances the clinical outcome. 10.1902/jop.2012.120172
    Periodontitis as the risk factor of chronic kidney disease: Mediation analysis. Lertpimonchai Attawood,Rattanasiri Sasivimol,Tamsailom Suphot,Champaiboon Chantrakorn,Ingsathit Atiporn,Kitiyakara Chagriya,Limpianunchai Anusorn,Attia John,Sritara Piyamitr,Thakkinstian Ammarin Journal of clinical periodontology AIM:To determine sequences and magnitude of causality among periodontitis, diabetes and chronic kidney disease (CKD) by mediation analysis. METHODS:Ten-year-data were retrieved from the Electric Generation Authority of Thailand (EGAT) study. A cohort of 2,635 subjects was identified with no CKD at baseline. The interested outcome was CKD incidence defined as glomerular filtration rate <60 ml/min/1.73 m . The percentage of proximal sites with clinical attachment loss ≥5 mm was used to represent periodontitis. Mediation analysis with 1,000-replication bootstrapping was applied to two causal diagrams, diagram A (Periodontitis → Diabetes → CKD) and diagram B (Diabetes → Periodontitis → CKD). RESULTS:The cumulative incidence of CKD was 10.3 cases per 100 persons during 10-year period. In diagram A, each increasing percentage of proximal sites with severe periodontitis increased the adjusted odds ratio of CKD 1.010 (95% CI: 1.005, 1.015) and 1.007 (95% CI: 1.004, 1.013), by direct and indirect effect through diabetes, respectively. In diagram B, diabetes increased the odds of CKD twofold, with 6.5% of this effect mediated via periodontitis. CONCLUSIONS:Periodontitis had significant direct effect, and indirect effect through diabetes, on the incidence of CKD. Awareness about systemic morbidities from periodontitis should be emphasized. 10.1111/jcpe.13114
    Impact of Treating Oral Disease on Preventing Vascular Diseases: A Model-Based Cost-effectiveness Analysis of Periodontal Treatment Among Patients With Type 2 Diabetes. Choi Sung Eun,Sima Corneliu,Pandya Ankur Diabetes care OBJECTIVE:Previous randomized trials found that treating periodontitis improved glycemic control in patients with type 2 diabetes (T2D), thus lowering the risks of developing T2D-related microvascular diseases and cardiovascular disease (CVD). Some payers in the U.S. have started covering nonsurgical periodontal treatment for those with chronic conditions, such as diabetes. We sought to identify the cost-effectiveness of expanding periodontal treatment coverage among patients with T2D. RESEARCH DESIGN AND METHODS:A cost-effectiveness analysis was conducted to estimate lifetime costs and health gains using a stochastic microsimulation model of oral health conditions, T2D, T2D-related microvascular diseases, and CVD of the U.S. POPULATION:Model parameters were obtained from the nationally representative National Health and Nutrition Examination Survey (NHANES) (2009-2014) and randomized trials of periodontal treatment among patients with T2D. RESULTS:Expanding periodontal treatment coverage among patients with T2D and periodontitis would be expected to avert tooth loss by 34.1% (95% CI -39.9, -26.5) and microvascular diseases by 20.5% (95% CI -31.2, -9.1), 17.7% (95% CI -32.7, -4.7), and 18.4% (95% CI -34.5, -3.5) for nephropathy, neuropathy, and retinopathy, respectively. Providing periodontal treatment to the target population would be cost saving from a health care perspective at a total net savings of $5,904 (95% CI -6,039, -5,769) with an estimated gain of 0.6 quality-adjusted life years per capita (95% CI 0.5, 0.6). CONCLUSIONS:Providing nonsurgical periodontal treatment to patients with T2D and periodontitis would be expected to significantly reduce tooth loss and T2D-related microvascular diseases via improved glycemic control. Encouraging patients with T2D and poor oral health conditions to receive periodontal treatment would improve health outcomes and still be cost saving or cost-effective. 10.2337/dc19-1201
    Amoxicillin Plus Metronidazole Therapy for Patients with Periodontitis and Type 2 Diabetes: A 2-year Randomized Controlled Trial. Tamashiro N S,Duarte P M,Miranda T S,Maciel S S,Figueiredo L C,Faveri M,Feres M Journal of dental research The aim of this study was to assess the changes occurring in subgingival biofilm composition and in the periodontal clinical parameters of subjects with periodontitis and type 2 diabetes mellitus (DM) treated by means of scaling and root planing (SRP) only or combined with systemic metronidazole (MTZ) and amoxicillin (AMX). Fifty-eight subjects were randomly assigned to receive SRP only (n = 29) or with MTZ (400 mg/thrice a day [TID]) and AMX (500 mg/TID) (n = 29) for 14 d. Six subgingival plaque samples/subject were analyzed by checkerboard DNA-DNA hybridization for 40 bacterial species at baseline and 3 mo, 1 y, and 2 y posttherapy. At 2 y posttherapy, the antibiotic-treated group harbored lower mean proportions (5.5%) of red complex pathogens than the control group (12.1%) (P < 0.05). The proportions of the Actinomyces species remained stable in the antibiotic group but showed a statistically significant reduction in the control group from 1 to 2 y in subjects achieving a low risk clinical profile for future disease progression (i.e., ≤4 sites with probing depth [PD] ≥5 mm). The test group also had a lower mean number of sites with PD ≥5 mm (3.5 ± 3.4) and a higher percentage of subjects reaching the low risk clinical profile (76%) than the control group (14.7 ± 13.1 and 22%, respectively) (P < 0.05) at 2 y posttreatment. MTZ + AMX intake was the only significant predictor of subjects achieving the low risk at 2 y (odds ratio, 20.9; P = 0.0000). In conclusion, the results of this study showed that the adjunctive use of MTZ + AMX improves the microbiological and clinical outcomes of SRP in the treatment of subjects with generalized chronic periodontitis and type 2 DM up to 2 y (ClinicalTrials.gov NCT02135952). 10.1177/0022034516639274
    Quantification of TNF- in Patients with Periodontitis and Type 2 Diabetes. Martínez-Aguilar Víctor M,Carrillo-Ávila Bertha A,Sauri-Esquivel Eduardo A,Guzmán-Marín Eugenia,Jiménez-Coello Matilde,Escobar-García Diana María,Pozos-Guillén Amaury BioMed research international Objective:The present study aimed to compare variations in quantified tumor necrosis factor-alpha (TNF-) levels in patients with periodontitis stage 2 grade B (POD2B) and/or type 2 diabetes (T2D) and to identify any relationships between this cytokine and these diseases. Methods:Levels of the cytokine TNF- in gingival crevicular fluid in patients with POD2B and/or T2D were evaluated. A total of 160 subjects were distributed into four groups: those with POD2B (n=44); those with T2D (n=37); those with POD2B/T2D (n=40); and healthy subjects (n=39). Glycosylated hemoglobin (HbA1c) and blood glucose (BG) levels were quantified in each subject. Data were collected on body mass index (BMI), loss of insertion (LI), and probe depth (PD). Gingival crevicular fluid samples were collected from the most acutely affected periodontal pocket and gingival sulcus in each subject, and TNF- was quantified by multiplex analysis. Results:Kruskal Wallis tests was used to identify differences in TNF- levels, LI, PD, BMI, BG, and HbA1c by group. Differences (p<0.001) were found for LI, PD, BG, and HbA1c. A Spearman test was used to calculate possible correlations between TNF- levels and LI or PD identified a weak but significant negative correlation of TNF- with LI (Rho=-0199; p=0.012), and a moderately positive correlation of LI with PD (Rho=0.509; p < 0.001). Conclusions:No variation was found between TNF- levels and the presence of POD2B, POD2B/T2D, or T2D, suggesting the absence of any direct relationship between progression of these diseases and TNF- levels. However, a correlation was present between low TNF- concentrations and greater LI. 10.1155/2019/7984891
    The effect of photobiomodulation therapy on nonsurgical periodontal treatment in patients with type 2 diabetes mellitus: a randomized controlled, single-blind, split-mouth clinical trial. Özberk Seda Sevinç,Gündoğar Hasan,Özkaya Mesut,Taner İbrahim Levent,Erciyas Kamile Lasers in medical science Photobiomodulation therapy (PBMT) is a method currently used in the treatment of hard and soft tissue injuries due to its accelerating and enhancing effects on healing. In this study, we aimed to evaluate the possible additional benefits of applying PBMT with nonsurgical periodontal treatment in type 2 diabetes mellitus (DM) patients with chronic periodontitis (CP). Twenty-two type 2 DM patients with CP were enrolled in this clinical split-mouth study. Probing pocket depth (PPD), gingival index (GI), plaque index (PI), and clinical attachment level (CAL) were measured by intracaliber clinician (H.G.) at baseline and at 1 m, 3 m, and 6 m after treatment. Gingival crevicular fluid (GCF) samples were collected at baseline and at 1 week and 1 m, 3 m, and 6 m after treatment. According to split-mouth design, one randomly selected quadrant was treated with PBMT + nonsurgical periodontal treatment (NSPT) and the other quadrant was treated only non-surgical periodontal treatment. PBMT was applied the test quadrant on NSPT day and first, third, and seventh day after treatment at an energy density of 7.64 J/cm. Repeated measures analysis of variance test was used for the intragroup comparison and a "paired t test" in the intergroup comparison of the clinical and laboratory findings. Comparing the test and control quadrant after treatment, the test quadrant showed significant decrease in PPD at 1 month, 3 months, and 6 months; in GI at 3 months and 6 months; in CAL at month 6; in GCF at 1 week, 1 month, 3 months, and 6 months; and in IL-1β data at 3 months in comparison to the control quadrant. In contrast, there was no statistically significant difference in PI data at all times. Within the limitation of this study, adjunct use of PBMT on NSPT in patient with DM may positively affect the clinical and biochemical parameters. 10.1007/s10103-019-02897-z
    Effect of two periodontal treatment modalities in patients with uncontrolled type 2 diabetes mellitus: A randomized clinical trial. Quintero Antonio J,Chaparro Alejandra,Quirynen Marc,Ramirez Valeria,Prieto Diego,Morales Helia,Prada Pamela,Hernández Macarena,Sanz Antonio Journal of clinical periodontology AIM:To evaluate the impact of two non-surgical periodontal treatment modalities on metabolic and periodontal clinical parameters in subjects with type 2 diabetes mellitus (T2DM) and poor glycaemic control and chronic periodontitis. MATERIAL AND METHODS:A randomized controlled clinical trial was conducted. Ninety-three T2DM subjects with glycosylated haemoglobin (HbA1c) > 7% were randomly assigned to one of two groups receiving scaling with root planing in multiple sessions quadrant-by-quadrant (Q by Q) or within 24 hr (one stage). Periodontal parameters, HbA1c, glycaemia blood levels (FPG) and C-reactive protein (CRP) values were assessed at baseline and at 3 and 6 months post-therapy. RESULTS:At 6 months, HbA1c had decreased by 0.48% in the Q by Q group and by 0.18% in the one-stage group (p = 0.455). After therapy, subjects with an initial HbA1c < 9% showed an increase of 0.31% (p = 0.145), compared with a decrease of 0.88% (p = 0.006) in those with an initial HbA1c ≥ 9%. Periodontal parameters improved significantly (p < 0.0001) post-therapy, with similar results for both treatment modalities. CONCLUSION:Periodontal therapy had the greatest impact on HbA1c reduction on patients with an HbA1c > 9% regardless of treatment modality. Both modalities resulted in significant improvements in periodontal parameters. 10.1111/jcpe.12991
    Efficacy of adjunctive photodynamic therapy on the clinical periodontal, HbA1c and advanced glycation end product levels among mild to moderate chronic periodontal disease patients with type 2 diabetes mellitus: A randomized controlled clinical trial. Mirza Sana,Khan Aftab Ahmed,Al-Kheraif Abdulaziz Abdullah,Khan Sultan Zeb,Shafqat Syed Saad Photodiagnosis and photodynamic therapy AIMS:To evaluate the clinical periodontal, serum glycated haemoglobin (HbA1c) and levels of advanced glycation end-products (AGEs) in the gingival crevicular fluid (GCF) among patients with periodontitis and type 2 diabetes mellitus (DM) after photodynamic therapy (PDT) as an adjunct to full-mouth disinfection (FMD). MATERIALS AND METHODS:Thirty type 2 DM patients with mild to moderate periodontitis were divided into two main groups: Group-A receiving adjunctive PDT with FMD and Group-B receiving FMD alone. Full-mouth plaque index (PI), bleeding on probing (BOP), probing depth (PD), attachment level (AL) were recorded. Serum HbA1c was assessed among all participants using a HbA1c analyser kit. Levels of AGEs in GCF were determined using enzyme-linked immunosorbent assay. Clinical periodontal and metabolic parameters were assessed at baseline, 3 months and 6 months. Differences were compared using the Friedman test within the groups for different time points. Kruskal-Wallis test with Bonferroni correction test was applied for intragroup and multiple comparisons, respectively. RESULTS:All the clinical periodontal parameters showed significant reduction from baseline to 3 months (P < 0.05) and 6 months follow-up in both the groups (P < 0.01). Only PD showed statistically significant difference from baseline to 3 months in Group-A (P < 0.01). Mean percentage of HbA1c remained constant throughout the study period in both the groups. Mean level of AGEs significantly reduced in both the groups at all time-points. Mean AGEs level reduced slightly higher in Group-A compared to Group-B at 3 months follow-up. However, this difference was not statistically significant (P > 0.05). CONCLUSION:No additional benefit was seen in the improvement of clinical periodontal parameters and systemic (HbA1c levels) outcomes with PDT except that a minor reduction in the levels of AGEs in the GCF was observed with PDT in the short term. 10.1016/j.pdpdt.2019.08.003
    The effects of ginger supplementation on inflammatory, antioxidant, and periodontal parameters in type 2 diabetes mellitus patients with chronic periodontitis under non-surgical periodontal therapy. A double-blind, placebo-controlled trial. Zare Javid Ahmad,Bazyar Hadi,Gholinezhad Hasan,Rahimlou Mehran,Rashidi Homeira,Salehi Parvin,Haghighi-Zadeh Mohammad Hosein Diabetes, metabolic syndrome and obesity : targets and therapy Background:The aim of this study was to evaluate the effects of ginger supplementation on inflammatory, antioxidant, and periodontal parameters in type 2 diabetes mellitus (T2DM) patients with chronic periodontitis (CP) under non-surgical periodontal therapy (NSPT). Material and methods:In this double-blind clinical trial study, 46 T2DM patients with CP were randomly allocated to intervention and control groups and received either 4 tablets 500 mg (2 g) ginger or placebo twice a day for 8 weeks. All patients were treated with NSPT during the intervention period. Serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), hs-C-reactive protein (hs-CRP), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), periodontal indices including clinical attachment loss (CAL), bleeding on probing (BOP), pocket depth (PD), and plaque index were evaluated in all subjects pre- and post-intervention. Results:Following 8 weeks of ginger treatment with NSPT, significant reductions were observed in the mean levels of IL-6 (=0.001), hs-CRP (=0.03), TNF-α (=0.007), CAL, and PD (<0.001) in the intervention group. The mean serum levels of SOD and GPx were significantly increased in the intervention group after the intervention (=0.001 and 0.002, respectively). At the end of the study, the mean changes of GPx were significantly higher in the intervention group compared with the control group (=0.04). Also, after the administration of the ginger with NSPT, significant decrease occurred in the mean change of IL-6 (=0.009), hs-CRP (=0.049), TNF-α (=0.049), CAL (=0.003), and PD (=0.04) compared with the control group. Conclusion:It is recommended that ginger supplementation along with NSPT may be effective in the improvement of inflammation, oxidative, and periodontal status in T2DM with CP. 10.2147/DMSO.S214333
    Effect of photodynamic therapy as an adjuvant to non-surgical periodontal therapy: Periodontal and metabolic evaluation in patients with type 2 diabetes mellitus. Barbosa Flávia Isabela,Araújo Patrícia Valente,Machado Lucas José Campos,Magalhães Cláudia Silami,Guimarães Milena Maria Moreira,Moreira Allyson Nogueira Photodiagnosis and photodynamic therapy BACKGROUND:This pilot study aimed to evaluate the effect of antimicrobial photodynamic therapy (aPDT) as an adjuvant to non-surgical periodontal therapy (NSPT) on periodontal status and glycemic control in patients with type 2 diabetes mellitus and generalized chronic periodontitis. METHODS:Twelve patients were evaluated at five time points: during the preparation of the patient (T0), during the treatment phase (T1) and after 30 (T2), 90 (T3) and 180 (T4) days. The patients had a mean age of 52.2 years and a 9.58-year history of diabetes, on average, and were divided into two randomized treatment groups: 6 patients received NSPT combined with aPDT (G1) and 6 patients received only NSPT (G2). The aPDT was applied associating the photosensitizing agent methylene blue (10 mg/ ml) with a red laser (660 nm-40 mW). The total time of exposure was 2 min per tooth. RESULTS:Whitin the limitation of this study, the results showed that the plaque index reduced significantly only in the control group (p = 0.02) at T2 (30 days). For bleeding on probing, both groups showed a significant reduction between T1 and T2, with no difference between groups G1 and G2. Regarding the probing depth, there were no differences between groups, but the parameters decreased over time when compared to T1. The glycated haemoglobin and fructosamine levels did not significantly differ between or within the groups at any time point. CONCLUSION:When NSPT was combined with aPDT, no additional benefits were observed for the periodontal and metabolic clinical parameters. 10.1016/j.pdpdt.2018.04.013
    The combined and individual impact of diabetes and smoking on key subgingival periodontal pathogens in patients with chronic periodontitis. Joaquim C R,Miranda T S,Marins L M,Silva H D P,Feres M,Figueiredo L C,Duarte P M Journal of periodontal research BACKGROUND AND OBJECTIVE:Comprehension of the similarities and differences in the composition of the subgingival microbiota of patients with diabetes mellitus (DM), smokers or smokers with DM is an important step in developing therapies specific for these groups at risk for periodontitis. Therefore, the aim of this study was to compare the combined and individual effects of DM and smoking on the levels and prevalence of key subgingival periodontal pathogens in patients with chronic periodontitis. MATERIAL AND METHODS:One hundred patients with generalized chronic periodontitis were allocated into one of the following groups: DM (n = 25, non-smokers with type 2 DM); S (n = 25, non-diabetic smokers); SDM (n = 25, smokers with type 2 DM); and control (n = 25, non-diabetic non-smokers). Two subgingival biofilm samples from healthy sites (probing depth and clinical attachment level ≤3 mm and no bleeding) and 2 from diseased sites (probing depth and clinical attachment level ≥5 mm and bleeding on probing) were analyzed by quantitative polymerase chain reaction for Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Eubacterium nodatum, Parvimonas micra, Fusobacterium nucleatum ssp. and Prevotella intermedia. RESULTS:There were no differences among groups in the mean counts of the bacterial species studied, considering all sampled sites (healthy plus diseased sites). There were also no differences among groups regarding the prevalence of any bacteria species in healthy and diseased sites (P > .05). The mean P. micra count was significantly higher in the healthy sites of both smoking groups, than in those of the control group (P < .05). CONCLUSION:The subgingival levels and prevalence of the bacterial species studied are not significantly different in subjects with chronic periodontitis presenting DM, smokers or smokers with DM. In addition, DM and smoking, jointly and individually, do not considerably affect the subgingival levels of target periodontal pathogens in patients with chronic periodontitis. 10.1111/jre.12516
    Propolis Improves Periodontal Status and Glycemic Control in Patients With Type 2 Diabetes Mellitus and Chronic Periodontitis: A Randomized Clinical Trial. El-Sharkawy Hesham M,Anees Mohamed M,Van Dyke Thomas E Journal of periodontology BACKGROUND:Propolis is a natural resin made by bees from various plant sources and exerts antimicrobial, anti-inflammatory, immunomodulatory, antioxidant, and antidiabetic properties. The purpose of this study is to assess adjunctive benefit of propolis supplementation in individuals with chronic periodontitis (CP) and type 2 diabetes mellitus (DMt2) receiving scaling and root planing (SRP). METHODS:A 6-month masked, randomized clinical trial comparing SRP with placebo (placebo + SRP group, n = 26) or SRP combined with a 6-month regimen of 400 mg oral propolis once daily (propolis + SRP group, n = 24) was performed in patients with long-standing DMt2 and CP. Treatment outcomes included changes in hemoglobin (Hb) A1c (primary outcome), fasting plasma glucose (FPG), serum N-(carboxymethyl) lysine (CML), and periodontal parameters (secondary outcomes). RESULTS:After 3 and 6 months, average HbA1c levels in the propolis group decreased significantly by 0.82% and 0.96% units, respectively (P <0.01); however, there were no significant differences in the placebo group. Likewise, FPG and CML levels were significantly reduced in the propolis group, but not in the placebo group. After therapy, periodontal parameters of CP were significantly improved in both groups. The propolis group showed significantly greater probing depth reduction and clinical attachment level gain than the control group after 3 and 6 months. CONCLUSION:A 6-month regimen of 400 mg propolis once daily is a potentially viable adjunct to SRP that significantly reduces levels of HbA1c, FPG, and CML, and improves periodontal therapy outcome in people with DMt2 and CP. 10.1902/jop.2016.150694
    Systemic effects of periodontitis treatment in patients with type 2 diabetes: a 12 month, single-centre, investigator-masked, randomised trial. D'Aiuto Francesco,Gkranias Nikolaos,Bhowruth Devina,Khan Tauseef,Orlandi Marco,Suvan Jean,Masi Stefano,Tsakos Georgios,Hurel Steve,Hingorani Aroon D,Donos Nikos,Deanfield John E, The lancet. Diabetes & endocrinology BACKGROUND:Chronic inflammation is believed to be a major mechanism underlying the pathophysiology of type 2 diabetes. Periodontitis is a cause of systemic inflammation. We aimed to assess the effects of periodontal treatment on glycaemic control in people with type 2 diabetes. METHODS:In this 12 month, single-centre, parallel-group, investigator-masked, randomised trial, we recruited patients with type 2 diabetes, moderate-to-severe periodontitis, and at least 15 teeth from four local hospitals and 15 medical or dental practices in the UK. We randomly assigned patients (1:1) using a computer-generated table to receive intensive periodontal treatment (IPT; whole mouth subgingival scaling, surgical periodontal therapy [if the participants showed good oral hygiene practice; otherwise dental cleaning again], and supportive periodontal therapy every 3 months until completion of the study) or control periodontal treatment (CPT; supra-gingival scaling and polishing at the same timepoints as in the IPT group). Treatment allocation included a process of minimisation in terms of diabetes onset, smoking status, sex, and periodontitis severity. Allocation to treatment was concealed in an opaque envelope and revealed to the clinician on the day of first treatment. With the exception of dental staff who performed the treatment and clinical examinations, all study investigators were masked to group allocation. The primary outcome was between-group difference in HbA at 12 months in the intention-to-treat population. This study is registered with the ISRCTN registry, number ISRCTN83229304. FINDINGS:Between Oct 1, 2008, and Oct 31, 2012, we randomly assigned 264 patients to IPT (n=133) or CPT (n=131), all of whom were included in the intention-to-treat population. At baseline, mean HbA was 8·1% (SD 1·7) in both groups. After 12 months, unadjusted mean HbA was 8·3% (SE 0·2) in the CPT group and 7·8% (0·2) in the IPT group; with adjustment for baseline HbA, age, sex, ethnicity, smoking status, duration of diabetes, and BMI, HbA was 0·6% (95% CI 0·3-0·9; p<0·0001) lower in the IPT group than in the CPT group. At least one adverse event was reported in 30 (23%) of 133 patients in the IPT group and 23 (18%) of 131 patients in the CPT group. Serious adverse events were reported in 11 (8%) patients in the IPT group, including one (1%) death, and 11 (8%) patients in the CPT group, including three (2%) deaths. INTERPRETATION:Compared with CPT, IPT reduced HbA in patients with type 2 diabetes and moderate-to-severe periodontitis after 12 months. These results suggest that routine oral health assessment and treatment of periodontitis could be important for effective management of type 2 diabetes. FUNDING:Diabetes UK and UK National Institute for Health Research. 10.1016/S2213-8587(18)30038-X
    Periodontitis and incident type 2 diabetes: a prospective cohort study. Winning Lewis,Patterson Christopher C,Neville Charlotte E,Kee Frank,Linden Gerard J Journal of clinical periodontology OBJECTIVES:The aim of this study was to investigate periodontitis as a risk factor for incident type 2 diabetes mellitus (T2DM) in a group of men aged 58-72 years. METHODS:One thousand three hundred and thirty-one dentate, diabetes-free men in Northern Ireland underwent a detailed periodontal examination during 2001-2003. Follow-up was by bi-annual questionnaire and for those reporting diabetes their general medical practitioner was contacted to validate diabetes type, treatment and diagnosis date. Cox's proportional hazard models were used to estimate the effect of periodontitis on incident diabetes. Multivariable analysis included adjustment for various known confounders. RESULTS:The mean age of the men was 63.7 (SD 3.0) years. There were 80 cases (6.0%) of incident T2DM. Follow-up was for a median period of 7.8 years (IQR 6.7-8.3). After adjusting for confounding variables, the hazard ratio (HR) for incident T2DM in men with moderate/severe periodontitis versus those with no/mild periodontitis was 1.69 (95% CI 1.06-2.69), p = 0.03. CONCLUSION:There was evidence in this homogenous group of dentate men, that those with moderate to severe periodontitis had a significantly increased risk of incident T2DM. 10.1111/jcpe.12691
    A comparative clinical, microbiological and glycemic analysis of photodynamic therapy and Lactobacillus reuteri in the treatment of chronic periodontitis in type-2 diabetes mellitus patients. Elsadek Mohamed Farouk,Ahmed Badreldin Mohamed,Alkhawtani Daniyah Mohammed,Zia Siddiqui Adel Photodiagnosis and photodynamic therapy BACKGROUND:Evidence indicates that patients with type 2 diabetes mellitus (DM) exhibit impaired wound healing and are at higher risk for periodontal disease. In DM patients, adjunctive periodontal treatment provides small but statistically significant benefits in terms of reductions in clinical periodontal parameters. This study incorporates antimicrobial and immune modulatory treatment approach specifically targeted at these patients. PURPOSE:To evaluate and compare the clinical periodontal, microbiological and HbA1c levels with the use of photodynamic therapy (PDT) and probiotic therapy (PT) as adjunct to root surface debridement (RSD) in the treatment of periodontitis in DM. MATERIALS AND METHODS:Demographic data was collected using a questionnaire. Treatment-wise, chronic periodontitis with 2DM patients were subdivided into: (i) Group-A: Patients that underwent RSD with adjunct PDT; (ii) Group-B: Patients that underwent RSD with adjunct PT and; (iii) Group-C: RSD alone. In all groups, probing depth (PD), plaque scores (PS), bleeding on probing (BOP) and clinical attachment level (CAL) gain were measured at baseline and 3 months. Microbiological data consisted the assessment of detection percentage of Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola. RESULTS:A total of 58 patients completed the trial. All clinical and microbiological parameters showed statistically significant reduction from baseline to 3 months in all groups (p < 0.05). On inter-group comparison, the proportion of PD with ≥4 mm and ≥5 mm showed statistically significant reduction for Group-A compared to Group-B and Group-C (p < 0.01). Only Group-A showed statistically significant reduction in percentage of HbA1c levels from baseline to 3 months (p < 0.05). Groups A and B showed significantly higher reductions for all the three bacteria compared to Group-C (p < 0.05). However, this reduction was comparable between Groups-A and B, respectively (p > 0.05). CONCLUSION:PDT showed additional benefit in deep periodontal pockets and slightly modest reduction in HbA1c levels in DM patients. Further clinical trials are required with large sample size and longer follow up duration to ascertain the findings of the present clinical study. 10.1016/j.pdpdt.2019.101629
    Does diabetes increase the risk of periodontitis? A systematic review and meta-regression analysis of longitudinal prospective studies. Nascimento Gustavo G,Leite Fábio R M,Vestergaard Peter,Scheutz Flemming,López Rodrigo Acta diabetologica AIM:Even though the association between diabetes and periodontitis is taken for granted, results on this association are conflicting within the literature. This systematic review assessed whether poorly controlled diabetes was associated with periodontitis onset or progression. METHODS:Electronic searches were performed in PubMed, Scopus and Embase databases. Hand search was carried out in the reference list of all articles included. Gray literature was investigated with a Google Scholar search. Prospective longitudinal studies on the association between diabetes and periodontitis were considered for this review. Studies should have presented at least two measurements of periodontal conditions over time. Data on study design, crude and adjusted estimates were collected. We used meta-analysis to estimate the pooled effect of hyperglycemia in people with diabetes on periodontitis onset or progression. Meta-regression and subgroup analyses were employed to investigate potential sources of heterogeneity between studies. RESULTS:Thirteen studies matched the inclusion criteria, comprising 49,262 individuals, including 3197 diagnosed with diabetes. Meta-analyses of adjusted estimates showed that diabetes increased the risk of incidence or progression of periodontitis by 86% (RR 1.86 [95% CI 1.3-2.8]). However, there is scarce information on the association between diabetes and periodontal destruction. CONCLUSIONS:This study provides evidence that diabetes is associated with increased risk of periodontitis onset and progression in adults. Upcoming prospective longitudinal studies ought to overcome methodological caveats identified in this review. 10.1007/s00592-018-1120-4
    Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology. Sanz Mariano,Ceriello Antonio,Buysschaert Martin,Chapple Iain,Demmer Ryan T,Graziani Filippo,Herrera David,Jepsen Søren,Lione Luca,Madianos Phoebus,Mathur Manu,Montanya Eduard,Shapira Lior,Tonetti Maurizio,Vegh Daniel Journal of clinical periodontology BACKGROUND:Diabetes and periodontitis are chronic non-communicable diseases independently associated with mortality and have a bidirectional relationship. AIMS:To update the evidence for their epidemiological and mechanistic associations and re-examine the impact of effective periodontal therapy upon metabolic control (glycated haemoglobin, HbA1C). EPIDEMIOLOGY:There is strong evidence that people with periodontitis have elevated risk for dysglycaemia and insulin resistance. Cohort studies among people with diabetes demonstrate significantly higher HbA1C levels in patients with periodontitis (versus periodontally healthy patients), but there are insufficient data among people with type 1 diabetes. Periodontitis is also associated with an increased risk of incident type 2 diabetes. MECHANISMS:Mechanistic links between periodontitis and diabetes involve elevations in interleukin (IL)-1-β, tumour necrosis factor-α, IL-6, receptor activator of nuclear factor-kappa B ligand/osteoprotegerin ratio, oxidative stress and Toll-like receptor (TLR) 2/4 expression. INTERVENTIONS:Periodontal therapy is safe and effective in people with diabetes, and it is associated with reductions in HbA1C of 0.27-0.48% after 3 months, although studies involving longer-term follow-up are inconclusive. CONCLUSIONS:The European Federation of Periodontology (EFP) and the International Diabetes Federation (IDF) report consensus guidelines for physicians, oral healthcare professionals and patients to improve early diagnosis, prevention and comanagement of diabetes and periodontitis. 10.1111/jcpe.12808
    Effect of non-surgical periodontal therapy on insulin resistance in patients with type II diabetes mellitus and chronic periodontitis, as assessed by C-peptide and the Homeostasis Assessment Index. Mammen Jerry,Vadakkekuttical Rosamma Joseph,George Joseraj Manaloor,Kaziyarakath Jaishid Ahadal,Radhakrishnan Chandni Journal of investigative and clinical dentistry AIM:A bidirectional relationship exists between diabetes and periodontitis. In the present clinical trial, we evaluated the effects of non-surgical periodontal therapy (NSPT) on insulin resistance in patients with type II diabetes mellitus (DM) and chronic periodontitis. METHODS:Forty chronic periodontitis patients with type II DM were selected and equally allocated to case and control groups. All patients were assessed for periodontal parameters and systemic parameters. The case group received NSPT, and both groups were re-evaluated after 3 months. RESULTS:All periodontal parameters were found to be significantly improved in the case group compared to the control group 3 months after NSPT. The mean differences in systemic parameters, such as fasting serum C-peptide, Homeostasis Assessment (HOMA) Index-insulin resistance, and HOMA-insulin sensitivity, from baseline to 3 months for the case group were 0.544 ± 0.73, 0.54 ± 0.63, and -25.44 ± 36.81, respectively; for the control group, they were significant at -1.66 ± 1.89, -1.48 ± 1.86, and 31.42 ± 38.82 respectively (P < 0.05). There was a significant decrease in fasting blood glucose and glycosylated hemoglobin A1c from baseline to 3 months in the case group (P < 0.05). CONCLUSION:The present study showed that periodontal inflammation could affect glycemic control and insulin resistance. Effective periodontal therapy reduced insulin resistance and improved periodontal health status and insulin sensitivity in patients with type II DM and chronic periodontitis. 10.1111/jicd.12221
    Does periodontitis affect diabetes incidence and haemoglobin A1c change? An 11-year follow-up study. Kebede T G,Pink C,Rathmann W,Kowall B,Völzke H,Petersmann A,Meisel P,Dietrich T,Kocher T,Holtfreter B Diabetes & metabolism AIM:As periodontitis may contribute to the pathogenesis of diabetes, the effects of periodontitis on diabetes incidence and HbA1c change was quantified in a prospective cohort. METHODS:Data from an 11-year follow-up of the Study of Health in Pomerania were analyzed to evaluate the effects of periodontitis on incident diabetes and long-term HbA1c changes in 2047 subjects aged 20-81years. Diabetes was based on self-reported physician diagnoses, antidiabetic medication use, or HbA1c≥6.5% or non-fasting blood glucose levels ≥11.1mmol/L. To assess periodontal status, periodontal pockets were probed, and their depth and clinical attachment levels measured. For both measures, means and percentages of sites≥3mm were calculated. In addition, all probing depths≥4mm were summed (cumulative probing depth). Modified Poisson and multivariable linear models were applied, adjusted for age, gender, highest level of general education, marital status, waist circumference, physical activity, smoking status and follow-up time. RESULTS:Over a mean follow-up period of 11.1years, 207 subjects developed diabetes. Baseline mean clinical attachment levels (CAL) and probing depths (PPD) were not significantly associated with either diabetes incidence [mean CALs, fourth quartile, incidence rate ratio=0.819, 95% confidence interval (CI): 0.489-1.370; P=0.446] or long-term changes in HbA1c (mean CAL, fourth quartile, β=-0.086, 95% CI: -0.187, -0.016; P=0.098). Sensitivity analyses using alternative exposure definitions confirmed these results. CONCLUSION:Contrary to the currently available literature, no convincing evidence was found of any potential association between periodontitis and diabetes incidence or HbA1c change. 10.1016/j.diabet.2017.11.003
    A systematic review and meta-analysis of epidemiologic observational evidence on the effect of periodontitis on diabetes An update of the EFP-AAP review. Graziani Filippo,Gennai Stefano,Solini Anna,Petrini Morena Journal of clinical periodontology AIM:To update the available evidence on the impact of periodontitis on diabetes control, incidence and complications. METHODS:Observational studies on the effect of periodontitis on diabetes, published after 2012, were identified through electronic databases and hand-searched journals. Findings were summarized by evidence tables, using PRISMA statement. Quality of the included studies was evaluated through the Newcastle Ottawa scale. RESULTS:Healthy individuals with periodontitis exhibit a poor glycaemic control and a higher risk of developing diabetes. Individuals affected by diabetes show a deterioration of glycaemic control if also affected by periodontitis and significantly higher prevalence of diabetes-related complications. Limited evidence is available on gestational diabetes and type 1 diabetes. CONCLUSIONS:Periodontitis has a significant impact on diabetes control, incidence and complications. Nevertheless, the heterogeneity and quality of the included publications suggest that caution should be exercised when interpreting the data and that there remains an important need for additional evidence. 10.1111/jcpe.12837