Rule Number One: “Know thine enemy” – Sun Tzu, The Art of War

Welcome to ‘Microbe Manager’ Integral Dental’s blog. We invite practitioners to share their thoughts on new technologies and methodologies for patient care. If you have a topic or a question, please don’t hesitate to reach out at contact@integraldental.bio – we love to hear from you!

In our first post of Microbe Manager we’ll discuss the power of Next Generation sequencing for your practice. If you’re not familiar with that concept, no worries, we’ll talk you through it.

These thoughts come from Dr. Peter Joseph, our periodontist Clinical Advisor who specializes in working with startup companies like ours.

Rule Number One: “Know thine enemy” – Sun Tzu, The Art of War

If you’re reading this you most likely know a lot about dental implants, their benefits to your patients and your practice, and that peri-implant disease is the number one risk to their long-term success. I won’t spend your time telling you all that – I want to focus on the power of early diagnosis and understanding the microbial composition of the disease.

Most of us rely on our years of training and experience when diagnosing peri-implant disease – which is why we trained for so long. Some of us may use cultures to deeply understand the microbiology at work. And all of us are using our best judgment to make the right diagnosis and intervention decisions for our patients. In my experience, if I find a tool that helps me do what I do even better, it’s a no brainer for me to integrate it into my practice.

Here's where OraclePI adds value to me:

1. Confidence in intervening at the peri-implant mucositis stage. With a diagnostic tool I can not only feel confident in recommending earlier interventions, but I have data to show my patients and support their decision making as well. As you know, earlier interventions in peri-implant disease are less invasive and more effective. If I could stop peri-implant disease at the peri-implant mucositis stage every time – I would.
2. Deep understanding of the microbes we’re up against. Unlike cultures, which focus on a small subset of the microbes causing the infection, Next Generation Sequencing allows us to understand not only the entire list of microbes present at the infection site but also their relative abundance to one another. This is a huge step forward in managing infections and tailoring care plans to specific patient needs.

There have been some solid papers written on this subject. One that caught my attention was published in J Clin Periodontol in 2017 and was written by some of the world experts in this space: “Exploring the microbiome of healthy and diseased peri-implant sites using Illumina Sequencing.” I’ve attached the full free version below, but here are some of the key points: 

Importance of peri-implant disease

Peri-implant diseases represent a significant challenge in dental medicine, being the foremost cause of dental implant failures. These conditions, which range from mild inflammation to severe infection around dental implants, can lead to implant loss if not properly managed. The traditional approach to diagnosing and treating these infections often involves clinical assessments or culture-based methods to identify pathogens. However, this method falls short in accuracy, speed, and comprehensiveness, especially when compared to the capabilities of next-generation sequencing (NGS). A landmark study published in the Journal of Clinical Periodontology in December 2017 sheds light on how NGS, specifically Illumina Sequencing, can provide a deeper understanding of the microbiome associated with healthy and diseased peri-implant sites, heralding a new era in the treatment and management of peri-implant diseases.

Understanding the Microbiome through Next-Generation Sequencing

NGS technology, such as Illumina Sequencing, allows for the rapid sequencing of the DNA from all organisms present in a sample. This is a game-changer for peri-implant disease management for several reasons. First, it offers a comprehensive overview of the microbial landscape, identifying not only the usual suspects but also rare or previously undetectable pathogens. The study discussed here explored the microbial diversity in healthy vs. diseased peri-implant sites, revealing significant differences in the microbial communities. Such detailed microbial profiling is crucial because it can guide more targeted and effective treatment strategies.

Personalized Treatment Strategies

Armed with detailed information about the specific microbes causing an infection, dental practitioners can tailor their treatment approaches to the individual patient. This is a significant step forward from the one-size-fits-all approach of prescribing broad-spectrum antibiotics, which can sometimes be ineffective against specific pathogens and contribute to antibiotic resistance. The study highlights the potential for NGS to enable personalized medicine in dentistry, ensuring that interventions are as effective as possible.

Earlier Interventions

One of the key advantages of using NGS in diagnosing peri-implant diseases is the possibility of earlier intervention. The technology's sensitivity allows for the detection of pathogens at much lower levels than traditional methods, potentially identifying infections before they cause significant damage. Early intervention is often less invasive and more effective, preserving the implant and surrounding tissues. This proactive approach can significantly reduce the overall burden of peri-implant diseases and improve patient outcomes.

A Future of Less Invasive Management

The findings from the study underscore the importance of understanding the microbiome in peri-implant diseases. With NGS, dental professionals can move away from reactive, often invasive interventions, towards more preventative and less invasive strategies. By accurately identifying the microbial cause of infection early, it's possible to use targeted antimicrobials or even microbiome-modulating interventions to manage the disease, reducing the need for surgical interventions.

Conclusion

The advent of next-generation sequencing, exemplified by the insights from the 2017 study in the Journal of Clinical Periodontology, represents a paradigm shift in the management of peri-implant diseases. By providing a detailed understanding of the microbiome associated with these conditions, NGS enables personalized, effective, and less invasive treatment strategies. As we continue to explore the microbial world with these advanced technologies, the future of dental implant care looks brighter, promising better outcomes for patients suffering from peri-implant diseases.

Interested in learning more?

If you're interested in reading more on the topic, here is an article from the Madrid paper:

Exploring the microbiome of healthy and diseased peri-implant sites using Illumina Sequencing.