![Page 1: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/1.jpg)
DrFranckChaubron(PhD)CEOIns5tutClinident
![Page 2: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/2.jpg)
Microbiological test systems in periodontology and implantology
Dr. Franck Chaubron
Institut Clinident France
![Page 3: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/3.jpg)
FranckCHAUBRON(PhD),CellularandMolecularBiologistUniversitéBlaisePascal(Fr)-Dundee(UK)CEOofInsGtutClinident(www.insGtut-clinident.com)FranceCEOofInsGtutClinidentBiopharmaSwiss(www.clinidentstemcell.com)SwitzerlandCEOofBlueDNAcompanion(www.bluednacompanion.com)FranceDirectorofBusinessDvpMedXcellS.A(www.medxcell.ch)SwitzerlandPreviousPosiGonManagerandGeneralDirectorofGENOLIFESA(1996–2004)BusinessDeveloperManagerofCAMBREX-LONZA(US-Europe-Japan(2004-December2008)Experiences DentalMedicineandBiology(periodontaldisease,dentalpulpcellbiology,oralcancer)ManagingDirectorofHumanCell&TissueBiobankMicrobiologyMedicaldiagnosGcsGenotyping
CVFranckCHAUBRON
![Page 4: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/4.jpg)
Ourtestpor`oliofororaldiagnosGcsiscurrentlyusedforthefollowingapplicaGons:
• Periodontaldisease-diagnosis,risk,treatmentdecision
• Implantology-therapycontrolandimplantmonitoring
• Cariesdisease-fromsaliva;riskevaluaGon,maintenance• OralCancer-earlyscreeningfromsalivasample(*2internaGonalpatents)
Technologies:
-MolecularBiology-DNA,RNAquanGtaGverealGme
-Vola5leOrganicCompoundsanalysis-VOCMassSpectrometry
-PointofCare–instrument,realGmePCR
,
INSTITUTCLINIDENTac5vi5es
![Page 5: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/5.jpg)
5 . 0 0 1 0 . 0 0 1 5 . 0 0 2 0 . 0 0 2 5 . 0 0 3 0 . 0 0 3 5 . 0 0 4 0 . 0 0 4 5 . 0 0 5 0 . 0 0 5 5 . 0 0
2 0 0 0 0
4 0 0 0 0
6 0 0 0 0
8 0 0 0 0
1 0 0 0 0 0
1 2 0 0 0 0
1 4 0 0 0 0
1 6 0 0 0 0
1 8 0 0 0 0
2 0 0 0 0 0
2 2 0 0 0 0
2 4 0 0 0 0
2 6 0 0 0 0
2 8 0 0 0 0
3 0 0 0 0 0
T i m e - - >
A b u n d a n c e
T I C : O C 1 0 0 8 A . D -VOCidenGficaGoninsaliva
-DataBases
- StaGsGc
- DNA&RNA- BacterialDNA
- Y&MDNA
- Virus
MetaboliteBiomarkersanalysis
RealTimePCRDNA/RNABiomarkersanalysis
INSTITUTCLINIDENTDIAGNOSIS/TESTSTECHNOLOGIES
![Page 6: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/6.jpg)
OralTestproductporOolio
RealTimePCRtestbasedonDNAextrac5onandMulGparametricquanGficaGonofDNAbiomarkersandMassMectrometryVOCidenGficaGonTheproposedbiomarkersfororalanddentalapplicaGons• Bacteria:Aggrega&bacterac&nomycetemcomitans,Porphyromonasgingivalis,Tannerellaforsythensis,Treponemaden&cola,Prevotellaintermedia,Peptostreptococcusmicros,Fusobacteriumnucleatum,Campylobacterrectus,Eikenellacorrodens,Candidaalbicans,Streptococcusspp.,Streptococcusmutans,Streptococcussobrinus,Lactobacillusspp.,Enterococcusspp.,Ac&nomycesviscosus,Capnocytophagaspu&gena,Capnocytophagaochracea,Enterococcusspp.,Enterococcusfaecalis,Ac&nomycesodontoly&cus,Veillonellaparvula,Prevotellanigrescens,Campylobactergracilis,Campylobacterconcisus,Streptococcusmi&s,Streptococcussp.• CandidaAlbicans• TotalOralBacteriaCount• Virus:HPV,Herpes,EBV...• SalivaVOCiden5fica5oninsaliva• DentalClinicenvironmentmonitoring:LegionallePneumophila,Speudomonasaeruginosaindentalunitwater,E.coli,Candida,MRSA
![Page 7: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/7.jpg)
Oral Bacterial Etiology
-1970:
Plaque induce periodontitis
1980-1990:
Infection by Anaerobic bacteria
![Page 8: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/8.jpg)
Fusiformis
Steptococci
Spirochetes
Amoeba
FusospirochetalinfecGon
Spirochetes
A.viscosus
A.a.
P.g.
T.f.
1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990
Oral Bacterial Strain History
![Page 9: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/9.jpg)
1year 3years 5years
Periodontaldisease
Mucosi5s Peri-implan55s
Peri-implan55s:InflammatorylesionsthatmayaffectthePeri-ImplantmucosaandmayresultinlossofthesupporGngbonefollowedbydentalimplantfailure
Boneloss Implant Boneloss
From periodontitis to Peri-implantitis
![Page 10: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/10.jpg)
Peri-implantitis Same pathogenic strains as Periodontal disease
Bacterial concentration effect in Peri-implantitis
G.Tabanella, H.Nowzari, J; Slots Clinical Implant Dentistery and Related Research, 11(1), 2009
HigherquanGtyand%
![Page 11: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/11.jpg)
• 28-56%ofpaGentshaveperi-implanGGsatoneormoreimplants.• (Zitzmann&Berglunch,2008)
Prevalenceofboneloss
• 16%ofpaGents/6.6%oftheimplantshave≥1.8mmbonelossaqer1yearof
implantaGon.(Roos-Jansakeretal.,2006a)
• 28%ofpaGentshaveprogressivebonelossover5yearsof
post-implantaGon.(Franssonetal.,2005)
Prevalence of Peri-implantitis
![Page 12: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/12.jpg)
Haffajee1994
Bonelostin2monthsQuanGtyCFU
Aa Pg
105 3.2mm 2.2mm
106 4.3mm 4.1mm
Bone lost depend of the bacterial identity & quantity in CFU (colony forming unit)
![Page 13: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/13.jpg)
A: Microscopic identification B: Microbiological cultures
Microbiological tests for bacterial identification
C: Nucleic acid probes (PCR)
![Page 14: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/14.jpg)
A: Microscopic Identification Dark field microscopy
E.Cowen,Miscape,1999
![Page 15: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/15.jpg)
B: Microbiological cultures & Identification
RobertKoch,N.Doanetal,JournalofClinicalMicrobiology,1999.
![Page 16: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/16.jpg)
A: GoldstandardmethodB: AllculGvableorganismcanbeidenGfiedC: PhenotypicIdenGficaGonD: AnGbiogram
Bacterial cultures
A:LowleveldetecGonandO2sensiGvityB:NonculGvableorganisms?C:VariaGonbetweenanaerobicculturesystemD:ShortGmeoftransportaGon(24-48h)E:Highcost(labour)F:Prolongedperiodbeforeresults(2weeks)
![Page 17: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/17.jpg)
C: Nucleic acid probes
DNAextractedfromsamplesarehybridizedwithDNAprobes.AqerDNAextracGon,DNAtargetsaredetectedwithdifferentmethods(directhybridizaGon,PCR,realGmePCR).
![Page 18: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/18.jpg)
Classifica5onofNucleicacidprobetechniques
1)DNAprobe: ExtracGon+hybridizaGon(lowsensiGvity)2)PCR: ExtracGon+specificgeneamplificaGon+
hybridizaGon(noquanGficaGon)3)RT-PCR: RealTimePCR:specificityandquanGficaGonofDNA
extractedfrombacteria
![Page 19: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/19.jpg)
Synthe5coligonucleo5desDNAsequences(primers/probes)
OurGenomicTarget:rRNA16ssequences
Theribosomeiscomposedoftwosubunits.The30SsubunitisthesiteoftranslaGoniniGaGon.16Shasgotuniversal,consensusandspecificsequencesOneofthemostimportantDNAsequencesdatabaseforbacteria
hvp://www.hybridmedicalanimaGon.com
![Page 20: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/20.jpg)
16SDNAcodingforrRNA16scontainhighlyconservedregionsandextremeheterogeneouspartsthatmakeitidealfordisGncGonbetweenspecies.
rRNA16SsequencesB:rRNA16s
![Page 21: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/21.jpg)
Real Time PCR method DNA from each pathogen are amplified. The control of the cycle number allow to quantify initial bacterial number.
100 000 fg 10 000 fg 1000 fg 100 fg 10 fg
Fluo
resc
ence
inte
nsity
Ct
![Page 22: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/22.jpg)
RealTimePCRwith16SNucleicacidØ easycollecGonandtransport(nosurvival
ofthebacterianecessary)Ø fastanalysisvscultures(severalhours)Ø highsensiGvity(LOD103)beverthan
culturemethodsØ highspecificityØ OKnonculGvablespeciesØ LimitedmutaGonof16Sanaerobicstrain
NoevaluaGonofanGbioGcsensiGvityNoevaluaGonofvirulence
Evalua&onofan&bio&cresistancecouldbedonewithspecificprobes
![Page 23: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/23.jpg)
Institut Clinident test : Perio-Analysis Real Time PCR for Peri-implantitis prevention
• DNAExtracGonfromthepaperpoints• DNAamplificaGonwithDNAprobesandprimers
– QuanGficaGonpermicrobialtarget– TotalOralCount %foreachtarget/TotalOralCount
![Page 24: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/24.jpg)
Perio-analyse®isaRealTimePCRtestbasedonmicrobialDNAextrac5onandMulGparametricquanGficaGonofDNAbacterialspecificsequencesfromGingivalCrevicularFluidorPerio-implantSulcusFluid.
Theproposedtestismeasuring9bacteria+CandidaAlbicans+TotalOralCount:§Aggrega&bacterac&nomycet-emcomitans§Porphyrom-onasgingi-valis§Tannerellaforsythensis§Treponemaden&cola§Prevotellaintermedia§Peptostreptococcusmicros§Fusobacteriumnucleatum§ Campylobacterrectus§ Eikenellacorrodens§ CandidaAlbicans+TotalOralBacteriaCount
A service provided by Institut Clinident
![Page 25: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/25.jpg)
1.prélèvement 2.insertion dans tube 3.formulaire
4. envoi postal
Prescription form and instructions
![Page 26: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/26.jpg)
Method
DNA extraction from paper point
PCR ADNr 16S
Quantification by Real time PCR
![Page 27: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/27.jpg)
• MucosiGs≈GingiviGs• Peri-implanGGs≈Periodontaldisease
Samebacteriaµflora(Mombelli2002,Quirynen2002,Renvert2006,Mavout2009,Pye2009,Heydenrijk2002)
SocranskyclassificaGon
*Tannerellaforsythia=previouslyTannerellaforsythensis**Parvimonasmicra=previouslyPeptostreptococcusmicros
TannerellaForsythia(Tf)*
Parvimonas Micra (Pm)**
Increaseofthe
patho
genicit,
Microflora to be tested
Foundinto7.1%to19.6%ofpaGenthavingchronicperiodontaldisease(Sardietal,ArchOralBiol2011;56(10):1098-105.
![Page 28: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/28.jpg)
• AacouldbealonewithhighquanGtyinagressiveperiodontaldisease• Aacannotbetreatedonlymechanically(intra-cellularbacteria)• Boneand5ssuedestruc5oneveninlowquan5ty• SpecificanGbioGctreatment(Tetracycline)associatedwithmechanicaltreatment
(newquinoloneisalsoefficient).Metronidazoleisnotefficient.
• OsteoplastycouldberecommendedfortotaleliminaGon(intra-cellular)• Synthesisofendotoxinsabletodamageleucocytes&monocytes• Presentinendocarditesandpneumonia
![Page 29: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/29.jpg)
PorphyromonasgingivalisBone destruction . Destruction of the immunoglobulins and collagen tissue Active in limited quantity (105 CFU par sample)
TannerellaForsythia(Tf)*
Limited action if low quatity Destruction of proteins (proteolytic activities)
Treponemaden3cola
Eliminated by a mecanical treatment Destruction of proteins (proteolytic activities) Need to ba associated with other pathogens (red complex, orange complex…) to grow in vivo
Tannerellaforsythia RedcomplexAggressivebacteria
![Page 30: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/30.jpg)
Prevotellaintermedia
Very well known resistance of Pi to Ampicillin Most of P. intermedia strains are know to be resistant to titanium bactericide effect (implant material or surface treatment)
ParvimonasmicraSynergies with other bacteria for bone and tissue destruction .
Always present . High quantity if GUN and Peri-implantitis Associated with stress
Parvimonas Micra (Pm)**
Fusobacteriumnucleatum
Virulent factor are not know
Campylobacterrectus
Commensal bacteria Cytotoxic effect on epithelial cells (high concentration)
Eikenellacorrodens
Synergywithotherbacteria
![Page 31: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/31.jpg)
• C.albicansiscommensalandaconsGtuentofthenormalfloracomprisingmicroorganismsthatliveinthehumanmouth
• Candidaalbicanscancolonizesulcusandberesponsibleforperiodontaldisease• CandidaalbicanscannotbetreatedwithanGbioGcs(notabacteria)• C.albicansiscapableofcolonizingtheperiodontalpocketsinpaGentswithchronic
periodonGGsandpaGentswithaggressiveperiodonGGs.• AnGbioGctreatmentcouldfacilitedevelopmentofCandidaalbicans• LocalanGfungalscouldberecommendedforeliminaGon• PrecisequanGficaGonofCandidaalbicansisnotpossible
![Page 32: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/32.jpg)
Complex PathogensPeriodon55s Chronic
gingivi-5s
Chronic RapidlyProgres-sive
Juvenile Pre-pubertal
Peri-coronary
Necro5zingulcera5ve
Aggrega5bacterac5nomycetemcomitans(Aa)
RedComplex
Porphyromonasgingivalis(Pg)
Tannerellaforsythensis(Tf)
Treponemaden5cola(Td)
OrangeComplex
Prevotellaintermedia(Pi)
Peptostreptococcusmicros(Pm)
Fusobacteriumnucleatum(Fn)
Orangecomplexassociated
Campylobacterrectus(Cr)
Greencomplex
Eikenellacorrodens(Ec)
CandidaAlbicans(Ca)
BasedontheSocransky’sdefini5on
Pathogenicity
NEW
Pathogenicity
![Page 33: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/33.jpg)
Result presentation
Microbiologicalresults<Numericdata> <Graphicdata> +
Bacteria Pathogenicload
Pathogenic threshold Status
Total Count 3,6E+09Aggregatibacter actinomycetemcomitans 7,6E+05 1,0E+03 +++
Porphyromonas gingivalis 5,8E+07 1,0E+05 +++Tannerella forsythensis 1,1E+05 1,0E+05 ++Treponema denticola 0,0E+00 1,0E+05 +Prevotella intermedia 1,4E+06 1,0E+05 +++
Peptostreptococcus micros 1,0E+06 1,0E+06 ++Fusobacterium nucleatum 1,7E+07 1,0E+07 ++
Campylobacter rectus 1,8E+05 1,0E+06 +Eikenella corrodens 4,1E+06 1,0E+07 -Candida albicans 1,9E+08
Periodontalpocketflora NotbalancedSymptom Aggressive/activeperiodontaldisease
Pathogenreduction Withaprotocoltodisruptbiofilm(surgicalplastysuggested)Homecare Withlocalantimicrobials
Doxycycline+MetronidazoleReduceCandidaalbicanswithoralantifungaltherapy
Reassessment Comparepre-andpost-treatment(12weekspostantibiotictreatment)
Implantplacement NotrecommendedVeryhighriskforPeri-implantsHighriskforrapidbonelosswithouttreatment
*SuggestedantibiotherapyoptionisatClinician'sdirection.(subjecttoallergy,druginteraction,medicalconsideration)
Possiblecomplications
Clinicalinterpretation
Therapeuticrecommendation
Reassessmentrecommendation
Riskassessment
Antibiotictherapy
Type4-6 Type5
1
10
100
1000
10000
100000
1000000
10000000
100000000
1E+09
1E+10
Aa Pg Tf Td Pi Pm Fn Cr Ec Ca
• Stepbystep• Iden5fica5on• Quan5fica5on
• Clearerimagewithbacteriagroupcolorcoding• Easiertounderstand/interpret• Supportfortreatmentdecisions
![Page 34: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/34.jpg)
PaGentDiagnosis(Saliva)
TreatmentdecisionAnGbioGcchoice
Monitoring(3monthsand12months)
TissuecontrolbeforeplacingtheImplant(T-14days)
PreventPeri-implanGGsandimplantfailure(3monthsand12months)
AnnualMonitoringcontrol
When?
![Page 35: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/35.jpg)
Rational treatment plan
Firstvisit
PeriodontalDiagnostic
Treatment
TreatmentEvaluation
Followup Surgery
Implantinstallation Evaluation
Evaluation
Peri-implantitis treatment
Followup
Perio-Analyse:SoproCare:
Perio-AnalyseSaliva
Sulcus
![Page 36: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/36.jpg)
Testedmatrices Results Recommenda&ons
saliva presenceofpathogenicbacteriawithoutAaand/orPg
-controlalldentalpocket,depth,radicularsurfacing -sub-gingivalscaling -hygieneprotocol
saliva presenceofAaand/orPg -controlalldentalpocketdepths,andusePerio-Analyseforeachdentalpocketwithmorethan4mm -followdentalpocketPerio-AnalyserecommendaGonswiththenewresults
dentalpocket presenceofpathogenicbacteriaunderthethreshold
-radicularsurfacing -sub-gingivalscaling -hygieneprotocol -noneedforanGbioGcs
dentalpocket presenceofAaoverthethresholdassociatedornotwithotherpathogenicbacteriaoverthethreshold
-radicularsurfacing -sub-gingivalscaling -hygieneprotocol -possiblebonesurgerywith/withoutflap -tetracyclinecouldberecommended
ThepossiblesituaGonsarepresentedschemaGcallywithinmicrobiologicalcomplexespresenceorabsenceintosalivaorpocket.
![Page 37: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/37.jpg)
• Allmedicalactsarecondi5onedbyitsmedicalvalueandeconomicalsustainability
Economicalvalue Medicalvalue
- Peri-implanGGsriskevaluaGon ++++ +++- TreatmentdecisionforPeri-implanGGsdisease +++ +++- Treatmentdecisionforperiodontaldisease - ++- PeriodontalriskevaluaGon + ++
- RightGmetoplacetheimplant - +++- Implantsurfacestrategy ++ ++++- tesGngatannualvisit +++ ++++- Medicolegalresponsibility ++++ ++- Medicalinsurances +++ +
Medical and Economical value
Rational of Periimplantitis Diagnostic
![Page 38: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/38.jpg)
BenefitsperceivedbyPeriodon5st
• Cleardiagnosis/infecGouscauseevaluaGonbeforetreatment/surgeryandanGbioGcdecision
• NewtoolsforclearcommunicaGonwithpaGents• realmonitoringoftheperiodontalsituaGon• treatmentefficiency• biologicaljusGficaGonforlongtreatmentperiod
• ReducGonoftheriskfortreatmentfailureorsecondinfecGon
• MoGvaGonofthepaGent
![Page 39: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/39.jpg)
Benefitsperceivedbyden5stsusingimplants
• RiskevaluaGonbeforeplacingtheimplant• LimitresponsibilityincaseofimplantfailureifthepaGentwouldliketoproceedwithimplantplacementwithoutefficienttreatmentorina“poorcondiGon”
• ReducGonofrisk&earlydiagnosistopreventperi-implanGGs
• MoGvaGonofthepaGentforbeverhygieneandimplantcleaningprotocol(reducebacteria=saveimplant)
![Page 40: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/40.jpg)
Benefitsperceivedbypa5ent
• TheywillunderstandthepathologycausedbybacterialinfecGonandwillimprovedentalmaintenance
• MoGvaGonofthepaGent• Theywillpreserveinvestmentandreduce“possible“infecGousrisk
• GoodappreciaGonfortheknowledgeofthedenGst
![Page 41: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/41.jpg)
ECONOMICALVALUEFORTHEDENTISTS
ECONOMICALVALUEFORTHEPATIENT
PREVENTPERI-IMPLANTITIS SAVEATOOTHANDBONE
MEDICALVALUEFORTHEDENTISTS
AnnualMonitoringthesurfaceoftheperi-implanttoreducefinancialriskofimplantfailureduringanacceptableperiodofGme
BeverDiagnosis=Bevertreatment
Fasterthetreatment
DonotcompromisethechanceforsuccessfulboneregeneraGon
Monitoringthesurfaceoftheperi-implantbever
protecGonofmedicolegalresponsibilityforthedenGsts(&couldsave
money)
Values for the dentist and patient
![Page 42: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/42.jpg)
PersonalizedtreatmentHighersuccessofmypracGce(Perio&implantology)ExternalopinionviatheanalyGcalreportBiologicalsupportHightechposiGonofmypracGceandbevervisibilityofmyClinicSecuretheprognosisforPeriodontaltreatmentReducePeri-implanGGsrisk–improvecuraGvetreatment
Whatistheinterestformypa5ent?
WhatismyinterestasaDen5st?
FAQ
![Page 43: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/43.jpg)
WhynotonlycollecGngthesaliva?- becausethepresenceofperiodontalbacteriaintothesalivaisariskfactor,butnotadiagnosGc.OnlypresenceofnonequilibredmicroflorainthesulcuscouldbeconsideredasadiagnosGctoolandshouldbetreated.
- HowcanIusePerio-analyseinmypraGce- FornewpaGent- PaGentwithperiodontaldiseasetobetreated- PaGentatrisk,goingtohavedentalimplantaqerperiodontaldisease- PaGentatriskhavingdentalimplant(annualcontrol)- PaGentwithdentalimplanthavingmucosiGsorperi-implanGGs- PaGentatgeneGcrisk(InterleukinmutaGon)- DiabeGcpaGent- PregnantpaGenthavingperiodontaldiseaserisk
- Whatbacteriaareathightriskforrapidbonelost?- AaandPg
- WhyAbisassociatedwithsurgery/mecanicaltreatment- Aaisintracellularbacteria.CertainbacterialikeAaandPgarenotstrictanaerobicandcouldsurviveinpresenceofoxygenaqersurgery
FAQ
![Page 44: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/44.jpg)
WhyCandidaalbicanscouldbeatrisk?- becauseinpresenceofanGbioGcandaqerbacteriareducGonandlimitedcompeGGon,Cacangrowandfullycolonizethesulcus.
- Whataretheunitsusedforbacteriaload- 10000=104=E+04=10000bacteriainthetestedsulcus
- WhatisPCR- PCRisamplificaGonofspecificzoneofDNA- Eachamplifiedzoneisspecificfromabacteriaspecies
- HowlongisthePCRprocess- DNAextracGon2hours- PCRpreparaGon1hour- PCRrunGme2hour(about10paGentsperrun)
- WhenshouldItestforthesecondGme- 3monthsaqerthefirstsamplingandanGbioGcuse
- AnGbioGcrecommendaGon- Aaaloneorwithredcomplex=Tetracycline- Redcomplex>thethreshold=Penicillin- Redcomplex+Pi>thethresholdorPialone=Metronidazole
FAQ
![Page 45: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/45.jpg)
- MayIuseprobioGc?- yesaqerPeriotreatment,probioGcwillassureamicrobialcompeGGonandreducetheriskfornewinfecGon.ProbioGcsarenoteffecGveasacuraGvesoluGon.
-HowmanypaperpointshouldIused?- minimum2persite.10paperpointsforapoolsample
- HowlongisstableDNAonpaperpointatroomtemperature- >2weeks
- HowmanysamplescanberunperdaybyClinident- about150/day- Labisclosed2weeksperyear(1weekinAugustand1weekendofDecember
- WhataretheDNAtargetandDNAstandardofthePCRdevelopedbyClinident- Ribosomal16SDNAsequences- QualibratedDNAfromDSMZ(Germany)andInsGtutPasteur(France)
FAQ
![Page 46: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/46.jpg)
AixenProvenceintheSouthofFrance
Loca5onofthelaboratory
![Page 47: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/47.jpg)
![Page 48: Dr Franck Chaubron (PhD) CEO Instut Clinident · 2017-06-11 · presentation Microbiological results + Bacteria Pathogenic load Pathogenic](https://reader030.vdocument.in/reader030/viewer/2022041021/5ed176bce6905b5b670884ba/html5/thumbnails/48.jpg)
Thank you