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Periodontal disease is one of the most common and most costly problems for the public health system and reduces the quality of life of those who suffer from it. It can be caused by a combination of factors including lifestyle, genetic susceptibility and the oral microbiological profile of the individual.
The microbial infection of the periodontal tissues by specific pathogenic bacteria is the main aetiological factor of the disease which triggers a chronic inflammatory response, responsible for bone and tissue damage. In addition, periodontal bacteria can also spread into the bloodstream, increasing the risk of developing significant associated diseases such as diabetes, infertility, respiratory and cardiovascular disorders, and osteoporosis.
Periodontal disease is traditionally considered a chronic disease which can, in some cases, result in the extraction of compromised teeth, scaling, root planning and the need for antibiotics.
In this regard it is important to point out that periodontal bacteria are able to colonize all types of niches found in the oral cavity, even those that are non-vascularised and therefore cannot be reached by systemic antibiotics that only produce a reduction in the periodontal bioburden. In this way the residual pathogenic bacteria located in the oral cavity can easily re-colonise the periodontal tissues, causing a recurrence of the disease.
The identification of an effective periodontal treatment that maximises the elimination of the bacteria – PERIOBLAST™ – is therefore crucial and is what founder of IMI Clinic, Dr. Francesco Martelli, has been developing for over 30 years, first through the founding of the Institute of Research and Training in Microdentistry, and later by setting up EDN clinics in Italy.
Our research team has focussed his efforts on finding an effective therapeutic solution to periodontal disease. Traditional surgical treatment has always had varying effects on patients: some heal only partially, others get worse, but none ever heal completely and in general, patients remain at risk of relapse.
Researchers carried out an in-depth investigation of the nature of the inflammation and the patients’ immune response to provide a greater understanding of the biological determinants of the disease, allowing the development of increasingly more effective treatment, also in cases of particularly aggressive periodontitis, considered incurable until now.
Perioblast™: using the surgical microscope and laser to treat periodontal disease
Perioblast™ is the unique and exclusive treatment for periodontal disease developed by researchers at IMI Clinic. The combination of the surgical microscope and laser is a minimally-invasive approach to treating the condition with minimised pain and discomfort to the patient. The anti-microbial properties from the thermal effect, combined with the capacity to promote fibroblast and osteoblast activity make the laser an effective alternative to traditional surgical therapy for patients in terms of pain reduction, minor invasiveness and enhanced microbial decontamination. We aim to transfer the results of our research into daily clinical practice in order to provide our patients with more effective and less invasive treatments.
An important retrospective study has been conducted, in order to verify the effectiveness of the laser-assisted and biologically-guided periodontal protocol used at our clinics. Patients who come to IMI Clinic undergo a microbiological test to evaluate how much and what kind of bacteria is in the mouth, not only during the first appointment, but also afterwards at follow-up appointments.
Therefore the study was conducted on a dataset consisting of clinical data (bleeding, pocket depth and suppuration), as well as the results of the microbiological tests on approximately 3,000 patients and 14,000 periodontal pockets. The statistical analysis demonstrated in an incontrovertible manner the effectiveness of the IMI periodontal protocol in relation to all the clinical and bacteriological parameters considered, with improvements that remain stable for up to 24 months, even in cases of aggressive periodontal disease. Right from the first post-therapy follow-up, patients showed a shift in the microbial composition of the pockets to the benefit of less pathogenic species, and a significant reduction in the bioburden responsible for the disease. The disappearance of suppuration was also observed and a considerable reduction of the bleeding.
The results of this study conducted on such a high number of patients clearly show for the first time the long-term effectiveness of the laser-assisted EDN protocol in the treatment of periodontal disease.
IMI understand the crucial links between periodontitis and systemic diseases, funding and leading research in this field. It is hoped that by sequencing the microbes present in periodontisis, as well as studying the in-vitro immune response, that the relevant correlations can be discovered.
This cutting-edge research will study the entire bacterial DNA found at the level of the sub-gingival plaque in order to be able to trace back to the microbial species that the bacteria originates from.
By monitoring periodontal patients before and after the application of the therapeutic protocol – unique to IMI – and comparing with patients who do not show the onset of periodontitis, the study will identify the microbial species present and the onset of important systemic diseases (especially those affecting the cardiovascular apparatus). In essence an important ‘alarm bell’ for the patient’s systemic health conditions.
The study of the in-vitro immune response foresees the creation of cultures of monocytes (white blood cells) isolated from blood samples of periodontal patients. After inflammatory stimuli and/or infections, the monocytes in our body are able to migrate from the blood vessels to the tissues hosting the infection where they differentiate into macrophages (white blood cells specialised in the elimination of pathogenic microorganisms).
The scientific project foresees the in-vitro reproduction of what really happens inside our body during a bacterial infection like periodontitis. To this end, the cellular differentiation of the monocytes into macrophages is induced and stimulation is carried out with bacterial antigens (simulation of an infection) in order to trigger the production of interleukins and other key mediators of the inflammatory response and evaluate their quantity.
Since the immune response is determined at the genetic level, the purpose of the study was to assess the effective existence of a correlation between the patient’s genotype and the quality of his/her inflammatory response.
The results obtained will be able to provide important insights into the most significant and representative genetic polymorphisms that can be used to assess the individual susceptibility of a patient to the progression of periodontal disease, and make it possible to establish a personalised treatment and follow-up plan.
From time to time, IMI Clinic may organize professional training and refresher courses for the dentists of the affiliated clinics. These training sessions range from theoretical teaching to live lessons on patients with closed-circuit video-recordings and the possibility of live interaction with patients
Every year, there are international meetings especially designed for the affiliated dentists. These meeting serve the purpose of promoting comparisons and discussions, addressing clinical issues, and sharing management problems. This means best practice can be shared among colleagues from across Italy and internationally.
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