Teaching Patients to Self-Care for Active, Recurrent Periodontal or Peri-Implant Pockets Guided by the TIME Wound-Healing Model: A Pilot Feasibility Study Based on Clinical and Microbiological Outcomes

Jaume Miranda-Rius,1– 3 Gerard Àlvarez,4 Vanessa Blanc,4 Rubén León,4 Albert Ramírez-Rámiz,1,3 Lluís Brunet-Llobet1– 3 1Department of Odontostomatology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; 2Department of Dentistry, Hospital Sant Joan de Déu (HSJD), University of Barcelona, Barcelona, Spain; 3Hospital Dentistry and Periodontal Medicine Research Group, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain; 4Department of Oral Microbiology, Dentaid Research Center, Cerdanyola del Vallès, Barcelona, SpainCorrespondence: Jaume Miranda-Rius, Section of Periodontology and Peri-implant Diseases, Department of Odontostomatology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain, Email jmiranda-rius@ub.eduBackground: The TIME therapeutic model is used for the management of chronic wounds: Tissue (non-viable); Infection/Inflammation; Moisture (imbalance); Edges (non-advancing). These four components will determine the persistence or the healing of any chronic ulcer on the skin’s surface and, by analogy, also those of the ulcerated epithelium at the subgingival level. We aimed to evaluate the clinical and microbiological changes recorded after implementation of this personalized subgingival model.Methods: Twelve patients with active periodontal or peri-implant pockets were recruited for a feasibility study. Patients were instructed to deeply clean these lesions subgingivally using an angulated interdental brush in a vertical position, twice per day for 15 days. On the first and last days, Löe & Silness gingival index and bleeding on probing (BoP) were recorded and samples were collected using the brush head for the quantitative PCR analysis of 8 bacterial species (commensal and pathogenic).Results: Severe gingival inflammation with profuse bleeding was present at baseline in ten patients. Eight of them complied and adhered with 100% of the treatment. Following self-treatment at home, ten patients exhibited normal or mildly inflamed gums. Seven patients no longer had bleeding, four had slight bleeding and only one moderate bleeding. Microbiologically, the total bacterial load significantly decreased from 7E07 to 9.39E06 cfu/head.Conclusion: This proposed conservative cost-effective subgingival model could significantly improve the inflammatory activity of certain recurrent periodontal or peri-implant pockets, stabilize them and thus minimize their progression. The preliminary findings reflected a reduction or absence of bleeding, a relative decrease in pathogenic species, and the restoration of a microbial community in symbiosis with the host.Keywords: periodontitis, peri-implantitis, chronic wound, dysbiosis, debridement, subgingival healing, ulcerated pocket epithelium, personalized periodontics, self-monitoring, patient empowerment, treatment compliance