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Objective: The beneficial effects of antiseptics in the treatment of periodontitis are still controversial. The goal of this randomized split-mouth study was to evaluate the clinical and microbiologic results of a unique subgingival irrigation of 10% povidone-iodine in addition to a full-mouth scaling and root planing for the treatment of chronic periodontitis. Method and Materials: Twenty patients with chronic periodontitis took part in this investigation. In each patient, four initially untreated pockets > 4 mm were randomly selected for one subgingival irrigation. After a one-session full-mouth treatment with scaling and root planing (SRP), two pockets of a split mouth received one unique irrigation with 10 mL 0.9% NaCl solution (control group, CG). Two pockets on the other side received 10 mL of povidone-iodine 10% (test group, PIG). Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), Plaque Index (PI), Gingival Index (GI), probing pocket depth (PPD), and clinical attachment level (CAL) parameters were assessed at baseline and after 1, 3, and 6 months (M). Bacterial samplings with sterile paper points were taken at M0 and after M1, M3, and M6. These samplings were separately cultured under aerobic and anaerobic conditions before CFU evaluation. Results: Pl, GI, PPD, and CAL were significantly improved in both groups after 6 months. The major difference was seen between M0 and M3 (P<.001). No significant differences were seen between the groups, except for deep pockets (> 6 mm) where a statistical difference was observed in favor of PIG after 6 months; in these subgroups the mean probing reduction was 2.68 ± 0.37 mm for CG versus 3.93 ±0.23 mm in PIG (P<.001). No significant differences were seen between CG and PIG regarding the microbiologic results after 6 months. Conclusion: One single irrigation of 10% povidone-iodine associated with full-mouth SRP would bring a small additional benefit in deep pockets. More studies are needed to yield additional results. [ABSTRACT FROM AUTHOR]

Aim This randomized controlled clinical trial evaluated the effects of an adjunctive single application of antimicrobial photodynamic therapy ( aPDT) in Surgical Periodontal Treatment ( ST) in patients with severe chronic periodontitis ( SCP). Material and Methods In a split-mouth design, 20 patients with SCP were treated with aPDT+ ST (Test Group, TG) or ST only (Control Group, CG). aPDT was applied in a single episode, using a diode laser and a phenothiazine photosensitizer. All patients were monitored until 90 days after surgical therapy. Levels of 40 subgingival species were measured by checkerboard DNA- DNA hybridization at baseline, 60 and 150 days. Clinical and microbiological parameters were evaluated. Results In deep periodontal pockets depth ( PPD ≥5 mm), Test Group presented a significantly higher decrease in PPD than Control Group at 90 days after surgical therapy ( p < .05). Test Group also demonstrated significantly less periodontal pathogens of red complex ( Treponema denticola) ( p < .05). Conclusion A single episode of aPDT used in adjunct to open flap debridement of the root surface in the surgical treatment of SCP: i) significantly improved clinical periodontal parameters; ii) eliminates periodontal pathogens of the red complex more effectively ( NCT02734784). [ABSTRACT FROM AUTHOR]

Aim A randomized controlled clinical trial was designed to evaluate the efficacy of the photodynamic therapy ( PDT) in the treatment of residual pockets of chronic periodontitis patients. Material and Methods Thirty-four patients with at least four residual periodontal pockets undergoing maintenance care were included and randomly assigned to test group ( PDT, n = 18) or control group (sham procedure, n = 16). The intervention was performed at baseline, 3, 6 and 12 months. Clinical parameters such as pocket probing depth ( PPD), clinical attachment level ( CAL), bleeding on probing (BoP) and plaque index ( PI) were measured before intervention and after 3, 6 and 12 months. Subgingival samples were obtained at baseline, and after 7 days, 3, 6 and 12 months to quantify Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia by real-time polimerase chain reaction ( PCR). Results All clinical variables showed significant improvement during the study, but there was no significant difference between test and control groups. The microbiological analyses showed no differences between groups at any time during the study. Conclusion Within the limits of this clinical trial and considering the laser and photosensitizer protocol used, PDT failed to demonstrate additional clinical and bacteriological benefits in residual pockets treatment. [ABSTRACT FROM AUTHOR]

Background: The purpose of the present investigation is to compare the presence and number of periodontal pathogens in the subgingival microbiota of smokers versus never-smokers with chronic periodontitis and matched probing depths (PDs) using real-time polymerase chain reaction (RT-PCR). Methods: Forty current smokers and 40 never-smokers, matched for age, sex, and mean PD of sampling site, were included in this investigation. A full-mouth periodontal examination was performed, and a pooled subgingival plaque sample was collected from the deepest site in each quadrant of each participant. To confirm smoking status, expired carbon monoxide (CO) concentrations were measured with a CO monitor. The presence and quantification of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were determined using RT-PCR. Results: Smokers had greater overall mean PD (P = 0.001) and attachment loss (P = 0.006) and fewer bleeding on probing sites (P = 0.001). An association was observed between smoking status and the presence of A. actinomycetemcomitans (P<0.001). The counts of A. actinomycetemcomitans (P<0.001), P. gingivalis (P= 0.042), and T. forsythia (P<0.001) were significantly higher in smokers. Conclusions: Smokers showed significantly greater amounts of P. gingivalis, A. actinomycetemcomitans, and T. forsythia than never-smokers. There was a significant association between smoking and the presence of A. actinomycetemcomitans. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to determine in a randomized trial the impact on treatment outcome after 12 months of different subgingival irrigation solutions during scaling and root planing (SRP). Methods: Fifty-one adult volunteers with generalized chronic periodontitis were treated by full-mouth SRP using 0.9% sodium chloride, 0.12% chlorhexidine digluconate, or 7.5% povidoneiodine for subgingival irrigation during SRP. Before SRP and after 3 and 12 months, probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded. Sub-gingival plaque samples were analyzed for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. Results: PD, CAL, and BOP were significantly improved in all groups after 12 months (P<0.001 to P = 0.044). No significant differences were seen among the groups for all sites and sites with 4 to 6 mm PD at baseline. The povidone-iodine group had the highest clinical improvements. The counts of A.actinomycetemcomitans and P.gingivalis were significantly reduced after 12 months (P= 0.045 and P = 0.002) using povidone-iodine. Significant differences between the groups were seen after 3 months for A. actinomycetemcomitans and P. gingivalis, and after 12 months for T. forsythia. Conclusions: No differences were seen among the groups in the clinical results after 12 months. Regarding the microbiologic results, a slight benefit seemed to derive from the use of povidone- iodine. [ABSTRACT FROM AUTHOR]

Fernandez y Mostajo M, Zaura E, Crielaard W, Beertsen W. Does routine analysis of subgingival microbiota in periodontitis contribute to patient benefit? 
 Eur J Oral Sci 2011; 119: 259–264. © 2011 Eur J Oral Sci In clinical periodontology it is common practice to sample subgingival plaque from periodontitis patients and to search for the presence of alleged periodontal pathogens using routine laboratory techniques such as culture, DNA–DNA hybridization or real‐time PCR. Usually, special attention is given to the recognition of 'red complex' microorganisms and to Aggregatibacter actinomycetemcomitans. Recently, molecular open‐ended techniques have been introduced which are distinct from the more 'classical' approaches in that they do not preselect for certain species. In this study, we investigated to what extent the outcome of these techniques has changed our insight into the composition of the subgingival microbiota and whether this has consequences on clinical decision making. The open‐ended approaches showed that the composition of subgingival plaque is much more complex than previously thought. Next to the 'classical' putative periodontal pathogens, several non‐culturable and fastidious species are now recognized as being associated with periodontitis, thus enlarging the group of suspected periodontal pathogens. We conclude that routine analyses of subgingival plaque in the clinic are not necessarily of benefit to the patient. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to compare the results of microbiological RNA-probe analysis after subgingival plaque sampling applying two different strategies. Methods: in 220 patients, clinical examinations were obtained prior to commencement of therapy for aggressive or generalized severe chronic periodontitis (n = 113), after combined mechanical and antibiotic anti-infective periodontal therapy (n = 43), or because of periodontal pockets despite adequate therapy (n = 64). Subgingival plaque samples were obtained from the three pockets with the deepest probing depths. Two sterile paper points were inserted simultaneously into the periodontal pockets. One paper point from each pocket was put into a separate transport vial; the second paper point was pooled (multiple site test [MT3]) with paper points from each of the two other sampling sites from the respective patient into a transport vial. The content of each vial was analyzed separately for Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Porphyromonas gingivalis, and Treponema denticola (Td) with a commercially available RNA-probe test. Results: For all tested pathogens, log-transformed numbers of bacteria were higher in pooled samples compared to the mean values for the separate samples (P≤0.01). However, for Td only, statistically significant differences in frequency were seen between the separate samples and MT3. These findings were observed over all samples as well as after evaluation of subgroups separately. Conclusions: Pooling of plaque samples increased the bacterial counts per analysis compared to separate samples and thus may increase the probability of detecting existing pathogens. However, this observation only was statistically significant for the frequency of Td. [ABSTRACT FROM AUTHOR]