Holger Jentsch

To improve the clinical and microbiological outcomes of non-surgical mechanical periodontal therapy, the adjunctive use of antimicrobials has been utilized in treating moderate-to-severe periodontitis. In our study, the retrospective design included previously collected health-related patient data, obtained from the printed and digital charts of patients who received systemic or local antibiotic adjuncts to SI (subgingival instrumentation). A total of 34 patients (diagnosed with generalized Stage III/IV periodontitis) met the inclusion and exclusion criteria and were evaluated. The samples were tested for the following bacterial strains: Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Porphyromonas gingivalis (P. gingivalis), Prevotella intermedia (P. intermedia), Tanererella forsythia (T. forsythia), and Treponema denticola (T. denticola). The inter-group comparisons of the bacterial species did not show statistically significant differences between groups. The present study aimed to evaluate the clinical effects after SI and the adjunctive use of systemically administered (SA) AMX (amoxicillin) + MET (metronidazole) (administered for 7 days), with locally delivered (LDD) piperacillin + tazobactam in step 2 of periodontal therapy. Results: Overall, all parameters were improved in the groups, with a significant difference in inter-group comparison regarding the full-mouth bleeding score (FMBS) (p < 0.05) in favor of the SA group, and the p-value < 0.05 was considered to be statistically significant. Statistically significant PPD (probing pocket depth) reductions and CAL (clinical attachment level) gains were observed in both groups at the 3-month follow-up. In conclusion, within the limitations, the outcomes of this study suggest that SI, with adjunctive local or systemic antibiotic therapy, provided comparable clinical improvements. Systemic AMX + MET protocols were more efficacious with regard to the reduction in FMBS. Follow-up studies with larger patient numbers are needed to further investigate this effect.

Objectives: This randomized, placebo-controlled, double-masked clinical trial aimed to evaluate the clinical and microbiological efficacy of professional mechanical plaque removal (PMPR) with or without adjunctive application of piperacillin plus tazobactam gel in the treatment of peri-implant mucositis (PiM) for up to 6 months. Materials and Methods: The study included 31 patients with peri-implant mucositis (bleeding on probing (BoP) > 1 at at least one site at baseline, absence of peri-implant bone loss compared with a previous radiograph). After randomized assignment to test and control groups, patients received full-mouth supragingival scaling with or without piperacillin plus tazobactam gel. Clinical examination was performed at baseline and after 3 and 6 months, and a microbiological examination was performed at baseline and after 3 months. Results: After six months, both treatment modalities resulted in significant reductions and improvements in clinical parameters at the implant sites. Neither study group achieved a complete resolution of PiM (i.e., BoP ≤ 1 per implant). The number of implants with BoP decreased statistically significantly between subsequent time points (p < 0.001) in both the test and the control group. Significant BoP differences (p = 0.039) were observed between groups at 6 months (difference to baseline) following therapy. Conclusions: Within the limitations of the present study, the single use of a slow-release, locally applied antibiotic combination of piperacillin and tazobactam gel, adjunctive to PMPR, showed an improvement in clinical variable of implants diagnosed with PiM. The adjunctive treatment resulted in higher BoP reduction when compared to the control, but no significant differences were observed regarding the changes in other clinical and microbiological parameters.

Objectives: To verify the effect of adjunctive enamel matrix derivative (EMD) in subgingival reinstrumentation during supportive periodontal therapy. Method and materials: Using a split-mouth design, residual periodontal pockets with probing depth (PD) of 5 to 8 mm in 13 patients were treated by subgingival reinstrumentation with (test teeth) and without (control teeth) EMD. At baseline and after 6 and 12 months the clinical variables PD, clinical attachment level (CAL), and bleeding on probing (BOP) were recorded. At the same appointments gingival crevicular fluid (GCF) was collected to analyze for interleukin (IL)-1 beta, matrix metalloproteinase (MMP)-8, IL-10, and trans- forming growth factor (TGF)-beta. Results: Statistically significant improvements in PD, CAL, and BOP occurred in both groups. The reduction of PD was significantly higher in the test group than in the control group after 12 months (P =.005). The change of IL-1 beta within 12 months was significantly different between both groups (P =.019). No other significant differences were detected between both groups. Conclusion: The study suggests that subgingival reinstrumentation with adjunctive EMD could additionally reduce probing pocket depth and the need for periodontal surgery.

Purpose: The aim of this study was to verify how the prevalence of viridans-streptococci is changed by two appoint-ments of professional prophylaxis and after the subgingival instrumentation via scaling and root planing (SRP). Material and Methods: Samples of the subgingival biofilm were collected from 19 individuals with periodontitis re-ceiving two appointments of professional prophylaxis and SRP before and after the treatment procedures and the presence of viridans-streptococci was analysed by microbiological cultivation. Non-parametric statistical testing using Friedman/Wilcoxon tests and chi-square testing was used for statistical analysis. Results: No statistically significant changes over time were found for the mutans-group. The prevalence of Strepto-coccus mitis decreased after two appointments of professional prophylaxis (p = 0.013). The prevalence of S. mitis decreased again after SRP (p <0.001). The prevalence of Streptococcus anginosus decreased after two appoint-ments of professional prophylaxis (p = 0.002). After SRP five positive results for S. anginosus were detected (p = 0.026). For Streptococcus oralis and Streptococcus gordonii tendencies to statistical significance were found. The number of positive results for S. oralis increased after the first appointment of professional oral prophylaxis (p = 0.055). The number of positive results for S. gordonii increased after the first appointment of professional oral prophylaxis (p = 0.055). Conclusion: The step-wise periodontal therapy influences the prevalence of viridans-streptococci, especially S. mitis and S. anginosus. No tremendous increase of streptococci especially related to the carious process occurs in the subgingival biofilm. Clinical Relevance: The study reveals knowledge on changes of the composition of the subgingival biofilm due to different steps of periodontal therapy.

Background: This study was aimed to investigate if the adjunctive use of erythritol air-polishing powder applied with the nozzle-system during subgingival instrumentation (SI) has an effect on the outcome of non-surgical periodontal treatment in patients with moderate to severe periodontitis. Methods: Fourty-two individuals with periodontitis received nonsurgical periodontal therapy by SI without (controls, n = 21) and with adjunctive air-polishing using nozzle + erythritol powder (test, n = 21). They were analyzed for the clinical variables BOP (primary outcome at six months), probing depth (PD), attachment level, four selected microorganisms and two biomarkers at baseline, before SI as well as three and six months after SI. Statistical analysis included nonparametric tests for intra- and intergroup comparisons. Results: In both groups, the clinical variables PD, attachment level and BOP significantly improved three and six months after SI. The number of sites with PD ≥ 5 mm was significantly lower in the test group than in the control group after six months. At six months versus baseline, there were significant reductions of Tannerella forsythia and Treponema denticola counts as well as lower levels of MMP-8 in the test group. Conclusions: Subgingival instrumentation with adjunctive erythritol air-polishing powder does not reduce BOP. But it may add beneficial effects like reducing the probing depth measured as number of residual periodontal pocket with PD ≥ 5 mm when compared with subgingival instrumentation only. Clinical relevance: The adjunctive use of erythritol air-polishing powder applied with the nozzle-system during SI may improve the clinical outcome of SI and may reduce the need for periodontal surgery. Trial registration The study was retrospectively registered in the German register of clinical trials, DRKS00015239 on 6th August 2018, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL.

Background: This study was aimed to investigate if the adjunctive use of erythritol air-polishing powder applied with the nozzle-system during subgingival instrumentation (SI) has an effect on the outcome of non-surgical periodontal treatment in patients with moderate to severe periodontitis. Methods: Fourty-two individuals with periodontitis received nonsurgical periodontal therapy by SI without (controls, n=21) and with adjunctive air-polishing using nozzle + erythritol powder (test, n=21). They were analyzed for the clinical variables BOP (primary outcome at six month), probing depth (PD), attachment level (AL), four selected microorganisms and two biomarkers at baseline, before SI as well as three and six months after SI. Statistical analysis included nonparametric tests for intra- and intergroup comparisons. Results: In both groups, the clinical variables probing depth (PD), attachment level and BOP significantly improved three and six months after SI. The number of sites with PD ≥ 5mm was significantly lower in the test group than in the control group after six months. At six months vs. baseline, there were significant reductions of Tannerella forsythia and Treponema denticola counts as well as lower levels of MMP-8 in the test group. Conclusions: Subgingival instrumentation with adjunctive erythritol air-polishing powder does not reduce BOP. But it may add beneficial effects like reducing the probing depth measured as number of residual periodontal pocket with PD ≥ 5mm when compared with subgingival instrumentation only. Clinical relevance: The adjunctive use of erythritol air-polishing powder applied with the nozzle-system during SI may improve the clinical outcome of SI and may reduce the need for periodontal surgery. Trial registration: The study was retrospectively registered in the German register of clinical trials, DRKS00015239 on 6^th August 2018, https://www.drks.de/drks_web/navigate.do?navigationId =trial.HTML&TRIAL

Background: This study was aimed to investigate if professional oral prophylaxis before scaling and root planing (SRP) has an effect on the outcome of non‐surgical periodontal treatment in patients with chronic periodontitis.Methods: Fifty‐two individuals with chronic periodontitis receiving non‐surgical periodontal therapy by SRP with (test) and without (control) two appointments of professional tooth cleaning but with motivation and instruction were monitored for clinical variables, four selected microorganisms and two biomarkers at baseline, before SRP as well as 3 and 6 months after SRP. Statistical analysis included non‐parametric tests for intra‐ and intergroup comparisons.Results: Probing depth (PD), attachment level, bleeding on probing (BOP), and interproximal plaque index (API) were significantly improved in both groups 3 and 6 months after SRP. PD, BOP, API, and the number of sites with PD ≥5 mm were significantly lower in the test group than in the control group at the appointment immediately before SRP. Tannerella forsythia was significantly reduced in both groups at 3 and 6 months, Porphyromonas gingivalis only in the test group. Interleukin‐1β was significantly reduced in the control group 3 and 6 months after SRP, matrix metalloproteinase‐8 level decreased in the test group 3 months after SRP. There was no significant difference of any clinical and non‐clinical variable between both groups at 3 and 6 months after SRP.Conclusions: Professional tooth cleaning before the SRP does not improve the clinical results of the SRP. It has no obvious long‐lasting effects on major periodontopathogens in the subgingival biofilm as well as on biomarkers in the gingival crevicular fluid after SRP.

Objective: The aim of this study was to investigate the characteristics of bacteremia caused by professional mechanical plaque removal (PMPR) in two groups of patients with generalized moderate chronic periodontitis.Materials and Methods: Venous blood samples were taken at multiple time points for one hour following PMPR in fifty patients with generalized moderate chronic periodontitis. Subjects consisted of two groups, one group was receiving supportive periodontal therapy (SPT, n = 25) and the other group was receiving initial periodontal therapy (IPT, n = 25). Blood samples were processed and analyzed for cultivable microflora. Pertinent clinical parameters were recorded for each patient in both groups.Results: Bacteremia was detected in 10 of 25 SPT and 8 of 25 IPT patients (p = 0.796). In both groups, the prevalence of bacteremia was dependent on the time of blood sampling and varied in magnitude between 2 CFU/ml and 10⁶ CFU/ml. Sixteen different bacterial species were identified in both groups, mostly Actinomyces naeslundii (SPT n = 3, IPT n = 4) and Streptococcus spp. (SPT n = 6, IPT n = 2). In regression models, Grade II furcation involvement (p = 0.004) and Gingival Bleeding Index (p = 0.036) had affected the occurrence of bacteremia but in the SPT group only.Conclusion: Professional mechanical plaque removal was associated with bacteremia regardless of whether a patient was receiving SPT or IPT.

Introduction: Chronic Periodontitis (CP) and Rheumatoid Arthritis (RA) are both inflammatory diseases, characterised by severe inflammation of the associated tissues. Patients with RA have been reported to have poorer periodontal conditions such as more gingival bleeding, higher probing depth (PD) and Clinical Attachment Level (CAL) or missing teeth. However TNF-alpha blockers used in the treatment of RA seemed to positively influence the immune response of the periodontium. Aim: The aim of the present study was to verify if RA-patients under continuous medication with TNF-alpha blockers had better or worse periodontal health than non-RA-patients with periodontitis. Materials and Methods: The present case-controlled study included 13 patients with RA and 13 age and sex-matched non-RA periodontitis patients. In the RA-patients, RA-medication and duration of use were registered. In all patients Gingival Bleeding (GBI), Plaque Control Record (PCR), Bleeding on Probing (BOP), Probing Depth (PD), Clinical Attachment Level (CAL) and the number of teeth were recorded. For all patients the severity and extent of periodontitis was recorded respecting the classification system for periodontal diseases as well as serum level of C-Reactive Protein (CRP). Wilcoxon and Chi-square tests were performed for statistical analysis. Results: RA-patients had significantly less BOP (15.38% vs. 27.23%, p=0.045). RA-patients had a tendency to lower PD-values (2.54 mm vs. 3.15 mm, p=0.068) and fewer sites with PD >= 5 mm (6.00 vs. 17.46, p=0.099). Comparing severity and extent of periodontitis RA-patients had significantly better periodontal conditions (p=0.033). No significant influence of the duration of RA-medication was found. Conclusion: RA-patients treated with TNF-alpha blockers for more than 12 months have better periodontal health than non-RA-patients with periodontitis. These findings can be explained through the benefits of the TNF-alpha medication for host immune modulation.