Objectives
To evaluate through computer software analysis, the efficacy of the use of a plaque disclosing agent as a visual guide for biofilm removal during professional mechanical plaque removal in ...terms of post‐treatment residual plaque area (RPA).
Methods
Thirty‐two healthy patients were selected and randomized in two groups to receive a session of professional mechanical plaque removal with air‐polishing followed by ultrasonic instrumentation with (Guided Biofilm therapy—GBT) or without (Control) the preliminary application of a plaque disclosing agent as visual guide. The residual plaque area (RPA) was evaluated through re‐application of the disclosing agent and computer software analysis, considering the overall tooth surface and the gingival and coronal portions separately.
Results
A statistically and clinically significant difference between treatments is observed, with GBT achieving an RPA of 6.1% (4.1‐9.1) vs 12.0% (8.2‐17.3) of the Control on the Gingival surface and of 3.5% (2.3‐5.2) vs 9.0% (6‐13.1) on the Coronal, with a proportional reduction going from 49.2% (P‐value = .018) on the former surface to more than 60% (P‐value = .002) on the latter.
Conclusion
The application of a plaque disclosing agent to guide plaque removal seems to lead to better biofilm removal.
Marongiu et al descibe the study which aims to characterize bilateral lung injury owing to unilateral ligation of the pulmonary artery in healthy swine undergoing controlled mechanical ventilation ...and its prevention by 5% CO2 inhalation and to investigate relevant pathophysiological mechanisms. Sixteen healthy pigs were allocated to surgical ligation of the left pulmonary artery (ligation group), seven to surgical ligation of the left pulmonary artery and inhalation of 5% CO2 (ligation-FiCO2 5%), and six to no intervention (no ligation). Then, all animals received mechanical ventilation with Vt 10 ml/kg, positive end-expiratory pressure 5 cm H2O, respiratory rate 25 breaths/min, and FiO2 50% for 48 hours or until development of severe lung injury. Mechanical ventilation induces bilateral lung injury within 48 hours in healthy pigs undergoing left pulmonary artery ligation. Inhalation of 5% CO2 prevents injury, likely through decreased stress to the right lung and antiinflammatory effects.
Objectives
To evaluate the clinical efficacy in the short‐term resolution of gingivitis of a novel protocol involving full‐mouth erythritol powder air polishing followed by ultrasonic calculus ...removal.
Methods
Forty‐one healthy patients completed the study. Following a split‐mouth design, quadrants 1–4 and 2–3 were randomly allocated to receive air polishing followed by ultrasonic calculus removal (A+US) or traditional full‐mouth ultrasonic debridement followed by polishing with a rubber cup and prophylactic paste (US+P). Bleeding on probing (BoP) and plaque index (PI) were collected at baseline and 2 and 4 weeks. Moreover, the residual plaque area (RPA), treatment time and patient comfort/satisfaction were evaluated at the end of the treatment.
Results
Both treatments showed a significant reduction in BoP and PI. At 4 weeks, A+US seems to reach a statistically significant lower BoP (8.7% 6.9; 10.9 vs. 11.6%9.3; 14.4, p < 0.0001) and PI (10.7% 8.9; 13.0 vs. 12.3% 10.2; 14.9, p = 0.033). Moreover, A+US treatment time lasted on average 9.2% less than US+P (p < 0.0001) and was the preferred treatment for a significantly higher number of patients (73.2% vs. 17.1%, p = 0.0001).
Conclusion
The A+US protocol is suitable for the short‐term resolution of plaque‐induced gingivitis.
Objectives
To date, scarce evidence exists around the application of subgingival air-polishing during treatment of severe periodontitis. The aim of this study was to evaluate the effect on the ...health-related and periodontitis-related subgingival microbiome of air-polishing during non-surgical treatment of deep bleeding pockets in stage III–IV periodontitis patients.
Materials and methods
Forty patients with stage III–IV periodontitis were selected, and pockets with probing depth (PD) 5–9 mm and bleeding on probing were selected as experimental sites. All patients underwent a full-mouth session of erythritol powder supragingival air-polishing and ultrasonic instrumentation. Test group received additional subgingival air-polishing at experimental sites. Subgingival microbial samples were taken from the maxillary experimental site showing the deepest PD at baseline. Primary outcome of the first part of the present study was the 3-month change in the number of experimental sites. Additional analysis of periodontal pathogens and other sub-gingival plaque bacteria sampled at one experimental site at baseline and 3 months following treatment was performed through a real-time quantitative PCR microarray.
Results
In the test group, a statistical increase of some health-related species was observed (
Abiotropha defectiva, Capnocytophaga sputigena, and Lautropia mirabilis
), together with the decrease of pathogens such as of
Actinomyces israelii
,
Catonella morbi
,
Filifactor alocis
,
Porphyromonas endodontalis
,
Sele-nomonas sputigena
,
Tannerella forsythia
,
Treponema denticola
, and
Treponema socranskii
. In the control group, statistical significance was found only in the decrease of
Filifactor alocis
,
Tannerella forsythia
, and
Treponema socranskii
.
Conclusions
The addition of erythritol-chlorhexidine powder seems to cause a shift of the periodontal micro-biome toward a more eubiotic condition compared to a conventional treatment. The study was registered on Clinical Trials.gov (NCT04264624).
Clinical relevance
Subgingival air-polishing could help re-establishing a eubiotic microbioma in deep bleeding periodontal pockets after initial non-surgical treatment.
Extracorporeal carbon dioxide removal is used to treat patients suffering from acute respiratory failure. However, the procedure is hampered by the high blood flow required to achieve a significant ...CO2 clearance. We aimed to develop an ultralow blood flow device to effectively remove CO2 combined with continuous renal replacement therapy (CRRT).
Preclinical, proof-of-concept study.
An extracorporeal circuit where 200 mL/min of blood flowed through a hemofilter connected to a closed-loop dialysate circuit. An ion-exchange resin acidified the dialysate upstream, a membrane lung to increase Pco2 and promote CO2 removal.
Six, 38.7 ± 2.0-kg female pigs.
Different levels of acidification were tested (from 0 to 5 mEq/min). Two l/hr of postdilution CRRT were performed continuously. The respiratory rate was modified at each step to maintain arterial Pco2 at 50 mm Hg.
Increasing acidification enhanced CO2 removal efficiency of the membrane lung from 30 ± 5 (0 mEq/min) up to 145 ± 8 mL/min (5 mEq/min), with a 483% increase, representing the 73% ± 7% of the total body CO2 production. Minute ventilation decreased accordingly from 6.5 ± 0.7 to 1.7 ± 0.5 L/min. No major side effects occurred, except for transient tachycardia episodes. As expected from the alveolar gas equation, the natural lung Pao2 dropped at increasing acidification steps, given the high dissociation between the oxygenation and CO2 removal capability of the device, thus Pao2 decreased.
This new extracorporeal ion-exchange resin-based multiple-organ support device proved extremely high efficiency in CO2 removal and continuous renal support in a preclinical setting. Further studies are required before clinical implementation.
Unilateral ligation of the pulmonary artery may induce lung injury through multiple mechanisms, which might be dampened by inhaled CO
.
This study aims to characterize bilateral lung injury owing to ...unilateral ligation of the pulmonary artery in healthy swine undergoing controlled mechanical ventilation and its prevention by 5% CO
inhalation and to investigate relevant pathophysiological mechanisms.
Sixteen healthy pigs were allocated to surgical ligation of the left pulmonary artery (ligation group), seven to surgical ligation of the left pulmonary artery and inhalation of 5% CO
(ligation + Fi
5%), and six to no intervention (no ligation). Then, all animals received mechanical ventilation with Vt 10 ml/kg, positive end-expiratory pressure 5 cm H
O, respiratory rate 25 breaths/min, and Fi
50% (±Fi
5%) for 48 hours or until development of severe lung injury.
Histological, physiological, and quantitative computed tomography scan data were compared between groups to characterize lung injury. Electrical impedance tomography and immunohistochemistry analysis were performed in a subset of animals to explore mechanisms of injury. Animals from the ligation group developed bilateral lung injury as assessed by significantly higher histological score, larger increase in lung weight, poorer oxygenation, and worse respiratory mechanics compared with the ligation + Fi
5% group. In the ligation group, the right lung received a larger fraction of Vt and inflammation was more represented, whereas CO
dampened both processes.
Mechanical ventilation induces bilateral lung injury within 48 hours in healthy pigs undergoing left pulmonary artery ligation. Inhalation of 5% CO
prevents injury, likely through decreased stress to the right lung and antiinflammatory effects.
Aim
The aim of this study was to compare the efficacy of two brushing methods (manual vs. sonic) in terms of plaque control after a session of professional mechanical plaque removal (PMPR).
Methods
...Subjects with gingivitis underwent a session of PMPR and were randomly assigned to sonic (SB) or manual brushing (MB). Oral hygiene instructions were provided at baseline (BL), 2 (T0a), 4 (T0b) and 6 weeks (T1) and 6 months (T2). Plaque Index (PI), Gingival Index (GI) and bleeding on probing (BoP) were measured at BL, T1 and T2. The proportion of sites with PI, GI and BoP was modelled at site level using a negative binomial regression fitted via generalized linear mixed model accounting for intra‐patient correlation.
Results
Thirty‐two subjects were selected, 16 assigned to each group and 31 completed the study. PI, BoP and GI were comparable at BL. At T1, PI was successfully maintained at 6.21% for SB and 22.81% for MB, while at T2 reached 11.34% for SB and 28% for MB, favouring the SB group (p < 0.001). GI and BoP were significantly lower in the SB group at T1, with a BoP reduction for SB about 3 times higher than MB (p < 0.001). These parameters then levelled at T2 between the groups, with BOP reaching 0.14% versus 0.05% (p = 0.356) and GI 1.75% versus 3.52% (p = 0.020).
Conclusion
Sonic brushing seemed to maintain a lower PI score compared to a manual brush at 6 months. BoP and GI resulted comparable.
Acidemia is a severe condition among critically ill patients. Despite lack of evidence, sodium bicarbonate is frequently used to correct pH; however, its administration is burdened by several side ...effects. We hypothesized that the reduction of plasma chloride concentration could be an alternative strategy to correct acidemia.
To evaluate feasibility, safety, and effectiveness of a novel strategy to correct acidemia through extracorporeal chloride removal by electrodialysis.
Ten swine (six treated and four control animals) were sedated, mechanically ventilated and connected to an extracorporeal electrodialysis device capable of selectively removing chloride. In random order, an arterial pH of 7.15 was induced either through reduction of ventilation (respiratory acidosis) or through lactic acid infusion (metabolic acidosis). Acidosis was subsequently sustained for 12-14 hours. In treatment pigs, soon after reaching target acidemia, electrodialysis was started to restore pH.
During respiratory acidosis, electrodialysis reduced plasma chloride concentration by 26 ± 5 mEq/L within 6 hours (final pH = 7.36 ± 0.04). Control animals exhibited incomplete and slower compensatory response to respiratory acidosis (final pH = 7.29 ± 0.03;
< 0.001). During metabolic acidosis, electrodialysis reduced plasma chloride concentration by 15 ± 3 mEq/L within 4 hours (final pH = 7.34 ± 0.07). No effective compensatory response occurred in control animals (final pH = 7.11 ± 0.08;
< 0.001). No complications occurred.
We described the first
application of an extracorporeal system targeted to correct severe acidemia by lowering plasma chloride concentration. Extracorporeal chloride removal by electrodialysis proved to be feasible, safe, and effective. Further studies are warranted to assess its performance in the presence of impaired respiratory and renal functions.
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