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      Impact of the Daily Use of a Microcrystal Hydroxyapatite Dentifrice on De Novo Plaque Formation and Clinical/Microbiological Parameters of Periodontal Health. A Randomized Trial

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          Abstract

          Aim

          This 12-week prospective, randomized, double-blind, two-center trial evaluated the impact of a microcrystalline zinc hydroxyapatite (mHA) dentifrice on plaque formation rate (PFR) in chronic periodontitis patients. We hypothesized that mHA precipitates cause delayed plaque development when compared to a fluoridated control (AmF/SnF 2), and therefore would improve periodontal health.

          Material & Methods

          At baseline and after 4 and 12 weeks, PFR and other clinical and microbiological parameters were recorded. Seventy periodontitis patients received a mHA or AmF/SnF 2 dentifrice as daily oral care without hygiene instructions. Four weeks after baseline, participants received full mouth debridement and continued using the dentifrices for another 8 weeks.

          Results

          Primary outcome PFR did not change statistically significantly from baseline to weeks 4 and 12, neither in mHA (n = 33; 51.7±17.2% vs. 48.5±16.65% vs. 48.4±19.9%) nor in AmF/SnF 2-group (n = 34; 52.3±17.5% vs. 52.5±21.3% vs. 46.1±21.8%). Secondary clinical parameters such as plaque control record, gingival index, bleeding on probing, and pocket probing depth improved, but between-group differences were not statistically significant. Microbiological analyses showed similar slight decreases in colony-forming units in both groups.

          Conclusion

          In patients with mild-to-moderate periodontitis, periodontal therapy and use of a mHA-or AmF/SnF 2 dentifrice without instructions induced comparable improvements in periodontal health but did not significantly reduce the PFR.

          Trial Registration

          ClincalTrials.gov NCT02697539

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          Most cited references19

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          Statistical methods for assessing agreement between two methods of clinical measurement.

          In clinical measurement comparison of a new measurement technique with an established one is often needed to see whether they agree sufficiently for the new to replace the old. Such investigations are often analysed inappropriately, notably by using correlation coefficients. The use of correlation is misleading. An alternative approach, based on graphical techniques and simple calculations, is described, together with the relation between this analysis and the assessment of repeatability.
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            Absence of bleeding on probing. An indicator of periodontal stability.

            Following active periodontal therapy, 41 patients were incorporated in a maintenance program for 2 1/2 years with recall intervals varying between 2-6 months. At the beginning of each maintenance visit, the periodontal tissues were evaluated using "bleeding on probing" (BOP). Reinstrumentation was only performed at sites which bled on probing. However, supragingival plaque and calculus was always removed. Pocket probing depths and probing attachment levels were recorded after active treatment and at the conclusion of the study. Progression of periodontal disease was defined by an observed loss of probing attachment of greater than or equal to 2 mm. The reliability of the BOP test as a predictor was evaluated by calculating sensitivity, specificity, accuracy, and positive and negative predictive values. While only a 29% sensitivity was calculated for frequent bleeding, the specificity was 88%. The fact that the positive predictive value for disease progression was only 6% and the negative predictive value was 98% renders continuous absence of BOP a reliable predictor for the maintenance of periodontal health.
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              Periodontitis.

              The purpose of this review was to assess the scientific and clinical bases for the proposed classification of periodontitis. The clinical and histopathological signs and the etiology of periodontitis were described. Cross-sectional studies were analyzed to determine when onset of periodontitis most frequently occurs in adults. In addition, the progression rates of periodontitis have been assessed from longitudinal studies. No clinical, histopathological, or microbiological features could be identified that would characterize different disease entities of chronic periodontitis. The prevalence, extent, and severity of periodontitis were found to increase continually with higher age and there was no age when onset of disease would most likely occur. The rate of periodontitis progression varies largely between patients and there is no natural threshold for distinguishing various rates of disease progression. The incidence of periodontitis unresponsive to treatment depends on pretreatment progression rate, extent and severity of disease, tooth type, smoking, high levels of putative periodontal pathogens, a deficient immune response, and the type of therapy provided. There is no scientific basis for the classification "adult periodontitis" and "refractory adult periodontitis." Extensive clinical examinations are required for the diagnosis of "rapidly progressive adult periodontitis." It appears unrealistic that these examinations can be performed routinely in clinical practice. Therefore, the classification proposed by the Organizing Committee to define adult, rapidly progressive, and refractory periodontitis as specific disease entities was replaced with a simplified classification of periodontitis based on the scientific data available.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                28 July 2016
                2016
                : 11
                : 7
                : e0160142
                Affiliations
                [1 ]Department of Periodontology, University Hospital Muenster, Muenster, Germany
                [2 ]Department of Periodontology, University Hospital Wuerzburg, Wuerzburg, Germany
                [3 ]Society for Biometry and Psychometry, Bielefeld, Germany
                [4 ]Private Practice, Wuerzburg, Germany
                The Ohio State University, UNITED STATES
                Author notes

                Competing Interests: All study affairs have been exclusively funded by Dr. Kurt Wolff GmbH & CO. KG, Johanneswerkstr. 34 – 36, 33611 Bielefeld, Germany. There are no patents, products in development, or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

                Conceived and designed the experiments: BE IH US YJ-S GP. Performed the experiments: IH YJ-S. Analyzed the data: TWM. Contributed reagents/materials/analysis tools: MG KP. Wrote the paper: IH YJ-S US BE GP. Managed the trial: IH YJ-S MG. Performed the microbiological analyses: KP.

                Article
                PONE-D-16-07235
                10.1371/journal.pone.0160142
                4965058
                27467683
                23a1ee36-87fd-42e3-a27b-6d28b70517fa
                © 2016 Harks et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 7 March 2016
                : 14 July 2016
                Page count
                Figures: 3, Tables: 4, Pages: 14
                Funding
                The authors declare that all study affairs have been exclusively funded by Dr. Kurt Wolff GmbH & CO. KG, Johanneswerkstr. 34 – 36, 33611 Bielefeld, Germany. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Oral Medicine
                Biology and Life Sciences
                Physiology
                Digestive Physiology
                Dentition
                Medicine and Health Sciences
                Physiology
                Digestive Physiology
                Dentition
                Biology and Life Sciences
                Anatomy
                Digestive System
                Teeth
                Medicine and Health Sciences
                Anatomy
                Digestive System
                Teeth
                Biology and Life Sciences
                Anatomy
                Head
                Jaw
                Teeth
                Medicine and Health Sciences
                Anatomy
                Head
                Jaw
                Teeth
                Medicine and Health Sciences
                Oral Medicine
                Oral Diseases
                Periodontal Diseases
                Periodontitis
                Physical Sciences
                Chemistry
                Chemical Compounds
                Fluorides
                Biology and Life Sciences
                Organisms
                Bacteria
                Anaerobic Bacteria
                Medicine and Health Sciences
                Oral Medicine
                Oral Health
                Medicine and Health Sciences
                Infectious Diseases
                Bacterial Diseases
                Caries
                Custom metadata
                All relevant data are within the paper files.

                Uncategorized
                Uncategorized

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