Andreas Braun

Background: Porphyromonas gingivalis is a Gram-negative, anaerobic keystone pathogen strongly implicated in the pathogenesis of periodontitis. Its pathogenicity is mediated through virulence factors, such as lipopolysaccharides (PG-LPS), which have been reported to display conflicting results regarding structural composition and immunogenicity. Objectives: This scoping review investigates how PG-LPS modulates host immunity and contributes to advanced periodontitis, with emphasis on its structural composition, divergent immunogenic properties, and the possible regulatory factors underlying these observations. Furthermore, PG-LPS interactions with periodontal tissues and associations with outer membrane vesicles (OMV) are examined. Materials and Methods: A structured literature search was conducted in PubMed following the PRISMA-ScR guidelines and PCC frameworks. Results: Structural heterogeneity, especially within the lipid A moiety of PG-LPS, accounts for previously inconsistent findings regarding its immunogenicity. Minor alterations in lipid A composition through enzymatic dephosphorylation or deacylation profoundly affect Toll-like receptor (TLR) engagement, antimicrobial resistance, and cytokine induction, and contribute to the biogenesis of OMVs. Environmental factors such as hemin availability and temperature influence enzymatic activity, resulting in lipid A isoforms that act as TLR4 agonists, antagonists, or remain immunologically inert. This structural plasticity mediates dynamic immune modulation that fosters polymicrobial dysbiosis and perpetuates non-resolving inflammation, leading to progressive tissue destruction, while concurrently contributing to the systemic inflammatory burden. Conclusions: Lipid A heterogeneity represents a central adaptive strategy potentially linking environmental cues and the bioenergetic status of P. gingivalis to immunomodulative properties. Verification of in vivo lipid A structural shifts in clinical isolates could inform novel therapeutic approaches targeting P. gingivalis-mediated inflammation.

Background: Autologous platelet concentrates (PRP, PRF, i-PRF) represent blood-derived biomaterials that have been reported to exhibit antimicrobial activity against oral microorganisms in vitro. In diffusion-based assays, visualization of inhibitory effects depends not only on bacterial growth but also on matrix-dependent diffusion behavior within the surrounding culture medium, particularly those complex media used for fastidious anaerobic species. However, it remains unclear whether commonly used agar media provide comparable assay environments for evaluating APC-derived antimicrobial effects. This feasibility study therefore investigated whether PRP, PRF and i-PRF generate measurable inhibition zones on different agar matrices and whether medium selection influences inhibition detectability and measurable zone expression in diffusion-based assays. Methods: Inhibitory effects of PRP, PRF and i-PRF against Porphyromonas gingivalis and Prevotella intermedia were tested on Brucella blood agar (BBA), Mueller–Hinton blood agar and Tryptic Soy Agar supplemented with blood (TSASB). Only measurable inhibition zones were included in quantitative analyses, while detectability outcomes were assessed separately. Results: BBA produced significantly larger measurable inhibition zones for P. gingivalis compared with TSASB ( p = 0.0006; Cliff’s δ = 0.92). For P. intermedia , BBA and MHB showed comparable inhibition patterns ( p = 0.77), whereas TSASB yielded no measurable inhibition zones. Inhibition effects were detectable for all investigated platelet preparations. Exploratory comparisons between PRP, PRF and i-PRF across culture media did not reveal statistically significant differences under the present experimental conditions. Conclusion: Agar composition represents an active experimental matrix in diffusion assays and critically shapes inhibition zone expression, particularly for strict anaerobic periodontal pathogens. Culture medium selection therefore constitutes a key methodological variable in antimicrobial evaluation of APCs, and negative findings in diffusion assays should be interpreted cautiously within the context of the underlying assay environment.

Background/Objectives: Accurate assessment of periodontal parameters such as bleeding on probing (BoP) and tooth mobility is essential for diagnosis and treatment planning. In contrast to metric measures, these findings represent more subjective clinical parameters, potentially increasing examiner-related variability, particularly among less experienced examiners. This study evaluated agreement patterns between student recordings and educator verification recordings and assessed the influence of educational level and anatomical factors. Methods: BoP and tooth mobility data recorded by undergraduate dental students (ICC1, ICC4, state examination) and verified by licensed dental educators were retrospectively analyzed, comprising 6504 BoP sites and 1084 mobility recordings. Agreement and directional disagreement (under-/over-rating) were analyzed. Statistical analyses evaluated the effects of training stage, anatomical site, and periodontal severity. Associations with probing depth deviations and patient age were also examined. Results: Overall agreement was high for both parameters (BoP: 86%; mobility: 91%). Nevertheless, statistically significant differences were observed across educational levels (global Chi² tests p < 0.001). ICC1 students predominantly underestimated findings, whereas ICC4 students more frequently overestimated them; results stabilized in the state examination. Anatomical location significantly influenced disagreement patterns, with anterior and distal sites showing higher variability. BoP deviations were significantly associated with probing depth inaccuracies (r = 0.6; p < 0.001) and patient age (r = 0.187; p < 0.05). Conclusions: Within the limitations of this retrospective study, student recording accuracy for subjective periodontal parameters appears to be influenced by training stage and anatomical site. These findings may highlight the importance of structured calibration and targeted training strategies to improve diagnostic reliability in undergraduate periodontal education.

Background/Objectives: Oral infections are caused by a wide spectrum of bacterial and fungal species and remain clinically challenging, particularly against the background of increasing antimicrobial resistance and efforts to reduce antibiotic use in dentistry. Platelet concentrates are widely applied in periodontal and oral surgery due to their regenerative and immunomodulatory properties, and accumulating evidence suggests additional antimicrobial effects. This study evaluated the antimicrobial activity of platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and injectable PRF (i-PRF) against clinically relevant oral microorganisms. Methods: PRP, PRF, and i-PRF were prepared from venous blood of five healthy donors and evaluated using diffusion-dependent, qualitative-semiquantitative agar diffusion assays against Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Staphylococcus aureus, Streptococcus mutans, Streptococcus mitis, Enterococcus faecalis, and Candida albicans, with inhibition zones assessed after species-specific incubation times. Chlorhexidine (2%) and amoxicillin served as positive controls and NaCl (0.9%) as negative control. Inhibition zones were digitally quantified and analyzed using non-parametric statistics (Kruskal–Wallis, Friedmann) due to skewed distributions and frequent zero values. Results: All platelet concentrates demonstrated microorganism-dependent inhibition zones in vitro. Overall, i-PRF demonstrated the strongest inhibitory effect across all pathogens (p < 0.001). Significant differences were detected for E. faecalis and C. albicans, where i-PRF produced markedly larger inhibition zones compared to PRP and PRF. Descriptively, anaerobic periodontal pathogens and S. aureus tended to be more susceptible, while streptococci and C. albicans demonstrated lower inhibition. Conclusions: These findings support a potential adjunctive antimicrobial role of platelet-derived preparations in dental infection management but should be interpreted with caution, as agar diffusion results do not necessarily reflect clinical performance.

Background: Digital transformation in healthcare has advanced rapidly in hospitals and primary care, while long-term care facilities have often lagged behind. In nursing homes, nurses play a central role in coordinating care and accessing medical expertise, yet digital tools to support these tasks remain inconsistently implemented. The CareConnect study, funded under the German Model Program for Telecare (§ 125a SGB XI), aimed to develop and implement a multiprofessional telecare system tailored to nursing home care. Objective: This implementation study examined the feasibility, acceptability, and early adoption of a multiprofessional telecare system in nursing homes, focusing on implementation processes, contextual influences, and facilitators and barriers to integration into routine nursing workflows. Methods: A participatory implementation design was employed over 15 months (June 2024–August 2025), involving a university hospital, two nursing homes (NHs), and four medical practices in an urban region in Germany. The telecare intervention consisted of scheduled video-based teleconsultations and interdisciplinary case discussions supported by diagnostic devices (e.g., otoscopes, dermatoscopes, ECGs). The implementation strategy followed the Standards for Reporting Implementation Studies (StaRI) and was informed by the Consolidated Framework for Implementation Research (CFIR). Data sources included telecare documentation, nurse surveys, researcher observations, and structured feedback discussions. Quantitative and qualitative data were analyzed descriptively and triangulated to assess implementation outcomes and mechanisms. Results: A total of 152 documented telecare contacts were conducted with 69 participating residents. Most interactions occurred with general practitioners (48.7%) and dermatologists (23%). Across all contacts, in 79% of cases, there was no need for an in-person visit or transportation. Physicians rated most cases as suitable for digital management, as indicated by a mean of 4.09 (SD = 1.00) on a 5-point Likert scale. Nurses reported improved communication, time savings, and enhanced technical and diagnostic skills. Key challenges included delayed technical integration, interoperability issues, and varying interpretations of data protection requirements across facilities. Conclusions: This pilot study suggests that telecare can be feasibly introduced and accepted in nursing home settings when implemented through context-sensitive, participatory strategies. Implementation science approaches are essential for understanding how telecare can be sustainably embedded into routine nursing home practice.

Background: Precise periodontal diagnosis is taught and routinely performed during dental school training. The aims of this study were to determine to what extent the measurement values obtained by students during their clinical training years correspond to those of licensed dentists; to assess the distribution of divergent results relative to measurement positions; and to identify sources of error. The study also investigated whether fewer errors are made in accessible areas such as the anterior teeth and vestibular areas in comparison with inaccessible areas. Finally, it investigated the influence of students’ level of experience on measurement accuracy. Materials and methods: Data for probing depths in 6858 measurements made by students in comparison with dentists were documented and analyzed statistically. The influence of periodontal pocket depths on measurement accuracy was examined, and it was investigated whether the location of pockets (vestibular/oral, anterior/posterior, quadrant, mesial/medial/distal) influenced measurement divergences. Results: There were significant differences ( P < 0.001) between the students’ and dentists’ measurements, which were in agreement in 63% of cases. Differences of 1 mm were observed in 80% of cases, 2 mm in 15.3%, and 3, 4, or 5 mm in fewer than 5%. Measurement differences in the last clinical course were significantly the largest ( P < 0.01). Accuracy in medial measurement points was significantly better ( P < 0.001). Differences in measurement accuracy in the anterior and posterior teeth, as well as on the vestibular and oral surfaces, only became apparent after analysis of subgroups for healthy, mild, and severe cases. Patients with severe cases had significantly smaller measurement differences in both the oral and vestibular areas ( P < 0.02). Healthy patients had significantly better measurement values in the posterior region ( P = 0.02), and patients with mild conditions had significantly better values in the anterior region ( P = 0.03). Conclusions: The results of this retrospective examination show that students already achieve a comparatively high level of measurement accuracy, but that differences occur, particularly in the approximal region. Targeted practical training and structured feedback systems could help further improve diagnostic precision, which is particularly important when there is a recall system with changing practitioners.

Background/Objectives: Important goals of endodontic treatment procedures are to effectively eliminate microorganisms from the root canal system and prevent reinfection. Despite advances in techniques, these goals continue to be difficult to achieve due to the complex anatomy of the root canal system and bacterial invasion into the dentinal tubules of the surrounding root dentin. This pilot study aimed to refine a confocal laser scanning microscopy (CLSM) model with LIVE/DEAD staining to quantitatively assess the depth of effective disinfection by endodontic disinfection measures. Methods: Thirty caries-free human teeth underwent standardized chemo-mechanical root canal preparation and were inoculated with Enterococcus faecalis. Following treatment, CLSM-guided imaging with LIVE/DEAD staining allowed for differentiation between vital and dead bacteria and quantification of the depth of effective disinfection. Results: An average depth of bacterial eradication of 450 µm for conventional and 520 µm for sonically activated irrigation (EDDY) could be observed with significant differences (p < 0.05) in the coronal and medial positions. Conclusions: The results indicated that sonically activated irrigation (EDDY) provided a more homogeneous (omnidirectional) irrigation pattern compared to conventional irrigation. The study highlights the importance of effective disinfection strategies in endodontics, emphasizing the need for further research on the depth of effective disinfection of endodontic disinfection measures and the optimization of disinfection protocols.

Background: Digital transformation in healthcare has progressed rapidly in hospitals and primary care, while long-term care facilities have often been left behind. The CareConnect project, funded under the German Model Program for Telecare (§ 125a SGB XI), aimed to implement and evaluate a comprehensive telecare system in two nursing homes in Germany, to improve collaboration across sectors, enhance communication between professionals, and strengthen nurses’ digital competencies. Objective: This implementation study examined the feasibility, acceptability, and early adoption of a multiprofessional telecare system in nursing homes, identifying key facilitators, barriers, and perceived effects on interprofessional collaboration and care delivery. Methods: A participatory implementation design was employed over 15 months (June 2024–August 2025), involving a university hospital, two nursing homes (NHs), and four medical practices in an urban region. The intervention consisted of teleconsultations and interdisciplinary case discussions utilizing a certified video platform, combined with diagnostic devices (e.g., otoscopes, dermatoscopes, ECGs). Implementation data included quantitative usage statistics, researcher observations, and user feedback collected during the rollout phase. Data were analyzed descriptively to assess usage patterns, case characteristics, and implementation experiences. Results: A total of 152 documented telecare contacts were conducted with 69 participating residents. Most interactions occurred with general practitioners (48.7%) and dermatologists (23%). Across all contacts, in 79% of cases, there was no need for an in-person visit or transportation. Physicians rated most cases as suitable for digital management, as indicated by a mean of 4.09 (SD = 1.00) on a 5-point Likert scale. Nurses reported improved communication, time savings, and enhanced technical and diagnostic skills. Key challenges included delayed technical integration, interoperability issues, and varying interpretations of data protection requirements across facilities. Conclusions: The CareConnect pilot demonstrates that telecare can effectively improve access to specialized care and strengthen interprofessional collaboration in nursing homes. A participatory, user-centered approach proved crucial for acceptance and sustainability. Future scale-up requires stable technical infrastructures, clear reimbursement pathways, and harmonized legal frameworks.

Objectives: This review examines the efficacy of each laser type in the field of periodontal surgery and analyzes published articles that focus on the use of lasers in periodontal surgery. Methods: Automatic and manual searches were made in 3 separate databases (PubMed, Embase, and Cochrane) with the aim of finding all published articles of the last 15 years up until December 2023 that describe the clinical manipulation of diode, erbium:yttrium-aluminum-garnet (Er:YAG), erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG), neodymium yttrium-aluminum-garnet (Nd:YAG), and carbon dioxide (CO₂) lasers for periodontal surgical procedures in humans. Results: A total of 18 studies were selected for inclusion, all of which compared the usage of a laser type to conventional periodontal surgical techniques with their main follow-ups being in 3, 6, or 9 months. Conclusions: There are a variety of laser types, each with different settings and wavelengths, that can be applied to the established aspects of resective and regenerative periodontal surgeries. A significant majority of the publications, 10 of the 12 studies, that include diode lasers as an adjunctive show an improvement in clinical results compared to traditional surgical techniques alone, while 2 articles studied the Er:YAG laser and 1 article studied the Er,Cr:YSGG laser, with all 3 of them failing to completely test their therapeutic capabilities and indicating similar results to conventional surgery. The Nd:YAG laser was featured in 3 studies, with 1 study showing superior results for the laser group, another study showing the negative influence of the laser, and the 3rd study being inconclusive. The CO₂ laser was used in 1 study and showed better clinical results for the laser group. Diode lasers have been proven to produce additional therapeutic results, but there is a need for further investigation of erbium family lasers along with the Nd:YAG and CO₂ lasers, as the current provided literature contradicts their potential healing capabilities.