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Hyoid Suspensions Together with UPPP to treat Obstructive Sleep Apnea.
In reality, most microorganisms are not free floating. They exist in biofilms, a community of many of them from the same species or from other genera and attached to surfaces.Microorganisms undergo a transition from free-floating, planktonic microorganisms to a sessile, surface-attached one. Contact with a surface induces changes in gene expression, and a strong attachment of microcolonies occurs only after a few hours. The maturation of a biofilm is associated with matrix formation. The matrix is of importance as it provides stability and protects against environmental insults, it consists of polysaccharides, water, lipids, proteins, and extracellular DNA. Biofilms can be found everywhere - in the environment, in water systems - and they play an important role in medicine and dentistry. In medicine, infections of chronic wounds, of the respiratory tract in cystic fibrosis infections, or when linked with incorporated biomaterial are mostly biofilm associated. In the oral cavity, the most prevalent oral diseases, dental caries, and periodontitis are multi-species biofilm-associated diseases. Although not acting alone, key pathogens drive the development of the microbial shift. Microorganisms metabolize sugar and create an acidic environment where aciduric bacteria (including mutans streptococci) become dominant, which leads to the demineralization of enamel and dentine. Porphyromonas gingivaliscauses biofilm dysbiosis in the development of periodontal disease. Biofilm-associated infections are extremely difficult to treat. The matrix serves as a barrier to antimicrobial agents and there are subpopulations of dormant bacteria resistant to antimicrobials requiring metabolically active cells. Approaches to treat biofilm-associated infections include the modification of the biofilm composition, inhibitors of quorum-sensing molecules, or interfering with matrix constituents.The goal of modern periodontal therapy, both during the initial stages and during maintenance, is to create biologically acceptable tooth surfaces through sub- and supragingival cleaning, which enables binding of the connective tissue to the greatest extent possible. In past centuries, the focus of periodontal treatment was on the removal of the supposed cause of periodontal disease, the supra- and supragingival calculus and "infected" root cementum. The findings on the importance of biofilm (plaque) and the endogenous responses to biofilm metabolism have shifted the therapeutic focus to elimination of the biofilm. The importance of avoiding injury to the hard and soft dental tissue is nowadays of upmost importance. For classical scaling and root planing to remove mineralized deposits and "infected" cementum, only hand instruments were available in the past. The regular, long-term use of these tools is associated with changes in the hard and soft tooth tissues, and with pain and sensitivity experienced by the patient during and after treatment. Modern root-surface debridement primarily uses ultrasound systems to remove hard mineralized deposits. Guanidine inhibitor For biofilm management, air polishing devices with low-abrasive powders are increasingly gaining acceptance. With this new technology, biofilm management can now be performed much more effectively and efficiently, using materials more sparingly; this also causes less pain and discomfort for patients during and after treatment, and less fatigue for practitioners. The modern systems allow gentle, optimal biofilm management, whereas the traditional hand instruments (curettes, scalers) and classic rotating instruments used for polishing do not. Current knowledge suggests that these instruments are not best suited for biofilm management.The present narrative review provides a summary of the temporal and spatial reactions of the oral microbiome to the placement of a dental implant into the oral cavity, depicting the most important interactions between the oral microbiota and the host response involved in the development of peri-implant infections in humans (i.e., peri-implant mucositis and peri-implantitis). Starting with the formation of a pellicle to acute and rampant peri-implant inflammation, a number of steps, including biofilm formation, aggressive bacterial invasion, and host defense mechanisms, are involved. Better understanding of the factors related to the host response and changes in the composition of microbiota has led to the development of novel treatment modalities. Finally, a short outlook into the future is provided.During the last decade, photodynamic therapy (PDT) has been extensively investigated for the treatment of periodontal and peri-implant infections. Nonetheless, contradicting clinical and microbiological outcomes and only results on a short-term basis have been reported so far, thus making it difficult to conclude on clinically relevant recommendations for the use of PDT. Therefore, the aim of this narrative review is to provide an overview of the current evidence from randomized controlled clinical trials (RCTs) evaluating the potential clinical and/or microbiological benefit for the use of PDT in non-surgical periodontal and peri-implant therapy, and to draw clinically relevant conclusions on the use of PDT in periodontal practice. Based on the available evidence from RCTs and recent meta-analyses, we can conclude the following in patients with mild to moderate periodontitis, the combination of scaling and root planing (SRP) and PDT may result in significantly higher clinical improvements (bleeding on probing and probing depth reduction, clinical attachment gain) compared to SRP alone in the non-surgical treatment of periodontitis; in patients with stage III and IV grade C periodontitis (previously known as AgP) the use of PDT provides clinical improvements, although PDT cannot so far be recommended as a replacement for systemic antibiotics (i.e., amoxicillin and metronidazole); PDT may be indicated as a valuable tool for treating moderate residual periodontal pockets during maintenance therapy; limited evidence on the use of PDT in medically compromised patients (i.e., diabetes mellitus, oral lichen planus) indicates that PDT may represent a possible alternative to other more invasive medication/treatment procedures; limited evidence suggests that PDT may represent a valuable tool in attaining inflammation reduction on a short-term basis in peri-implant diseases (i.e., peri-implantitis, peri-implant mucositis).
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