Dental Tribune United Kingdom Edition

September 10-16, 201216 Perio Tribune United Kingdom Edition A s part of this year’s Euro- perio in Vienna, Heraeus held two symposia on the latest developments in the treatment of periodontitis. The question investigated by the first session on Friday morning was how local antibiotics can assist in the treatment of peri- odontitis. Following a brief introduction from Professor Niklaus P. Lang from the Uni- versity of Hong Kong, China, Professor Maurizio S. Tonetti, Executive Director of the Eu- ropean Research Group on Periodontology (ERGOPerio), Italy, opened the first Heraeus symposium with his presenta- tion on current understand- ing of periodontitis and how it changes treatment. He began by immediately emphasising that periodontitis has become a serious health problem in Europe. In addition to the role played by biofilm in trigger- ing development, individual susceptibility to periodontal disease is also an increasingly important factor. This is influ- enced by genetic predisposi- tion and environmental risk factors, and determines the intensity and clinical presen- tation of the periodontal in- flammatory process. Periodontitis is also proven to have various effects on the body as a whole. In addition to providing systematic peri- odontal therapy with regular follow-up for the rest of the pa- tient’s life, it is therefore also important to limit additional risk factors. With professional preventative measures geared towards the patient’s individu- al symptoms, further progres- sion of the condition can be prevented in the long-term. Professor Tonetti conclud- ed with an outlook on possi- ble future therapies. In a dog (beagle) model of replace- ment therapy, “friendly” bac- teria such as streptococcus sanguinis, streptococcus sali- varius and streptococcus mitis appear to have a positive im- pact on inflammatory response when applied sub-gingivally in addition to scaling & root plan- ing (SRP). This is demonstrated in X-ray images by increased bone density and bone level (Nackaerts et al., 2008). Anoth- er treatment approach looks at the effect of micronutrients as a food supplement. Here, daily intake indicates a reduction in probing pocket depths (Chap- ple ILC et al., 2012). Further clinical studies are required in order to verify the clinical sig- nificance. Professor Lang concen- trated his presentation on the management of deep pockets. Currently considered equiva- lent to a probing pocket depth of ≥ 6 mm, this correlates with a significantly increased risk of tooth loss. This is also the level at which the composition of biofilm and its pathogenicity changes. The local administra- tion of adjunctive antibiotics requires the application of a significantly higher concentra- tion of active ingredients in or- der to kill the periodontal path- ogenic bacteria. In addition, the delivered substance must remain at the active site for a sufficient length of time in or- der to ensure continued release of the active ingredient. A recently completed study by the ERGOPerio group (Tonetti et al., 2012) investi- gated the therapeutic effect of once-off, topical, adjunctive ad- ministration of a slow-release doxycycline gel (SRD) in pa- tients with persistent/recurring periodontitis during supportive periodontal therapy (SPT). Fol- lowing supra-gingival debride- ment and sub-gingival treat- ment using ultrasonic/sonic instrumentation, the SRD was applied in all the residual pock- ets ≥ 4 mm in the test group. The result of this study supports the concept of additional local an- tibiotic administration, particu- larly SRD. In the treatment of persistent/recurring periodon- titis during SPT, this has been shown to have a positive thera- peutic effect on inflammatory response as well as in the case of deep pockets (≥ 5 mm). Lo- cal antibiosis also seems to be the most effective approach for treating peri-implantitis due to the high concentration of active ingredients. The micro- biological flora is for the most part comparable with perio- dontitis, although peri-implant lesions may also be affected by staphylococcus aureus (typical pyogenic organism). The dis- charge of pus when probing a pocket is a clinical indication of infection in the diagnosis of peri-implantitis. The greatest challenge here is the removal of biofilm, a procedure that is considerably more difficult in the case of implant surfac- es than in the case of natural dentition. Currently there is no standard, evidence-based ap- proach to therapy: local anti- biotics may provide an answer for the future, however, this must first be borne out by a study. Nevertheless, Professor Lang summarises as follows: “Nothing excuses the patient from cleaning his teeth every day”. Dr. Waleed S.W. Shalaby, Chief Science Officer at Poly- Med Inc., USA, continued in the same vein as Professor Lang, and presented the latest biomaterials for oral and peri- odontal applications. He pro- vided detailed information on the critical aspect of the slow release of active ingredients in local antibiosis. According to Dr. Shalaby, “The development of Ligosan Slow Release for non-surgical therapy of periodontitis is a good example of functional technological innovation”. Its main feature is its biodegrad- able carrier substance com- prised of hydrophobic and hy- drophilic parts, which ensure that the initially fluid consist- ency enables penetration into the deep areas of the periodon- tal pocket that are difficult to reach. Liquid environments increase the viscosity, creating a gel consistency that ensures that the carrier substance re- mains at the active site. This ef- Insights into the latest therapy options for periodontitis A look at Europerio7 in Vienna Prof Peter Eickholz Heraeus’ stand at Europerio Delegates at the event Prof Niklaus Lang ‘In addition to the role played by biofilm in triggering development, individual sus- ceptibility to periodontal disease is also an increasingly important factor’