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PubMed1992

The effect of stimulus duration using the Brookler-Grams closed-loop caloric irrigator.

Nystagmic responses to traditional 40-sec, 30 degrees C water calorics were recorded and compared to those obtained with the Brookler-Grams closed-loop irrigator using 30 degrees C, 40-, 50-, and 60-sec irrigations. Significant differences were noted between the responses to the water irrigator and the 40- and 50-sec closed-loop irrigations. The 60-sec closed-loop irrigation produced responses that were equivalent to the responses obtained with the water irrigation in slow component velocity, amplitude, frequency, latency, and duration. The 30 degrees C 60-sec closed-loop irrigation is an acceptable stimulus in electronystagmographic caloric testing.

Adolescent↗
PubMed2000

Experimental study of faecal continence and colostomy irrigation.

BACKGROUND: Colostomy irrigation is a useful method of achieving faecal continence in selected conditions, but remains largely underutilized because it is time consuming. This study investigated the effect of modifying irrigation technique (route, infusion regimen and pharmacological manipulation) on colonic emptying time in a porcine model. METHODS: An end-colostomy and caecostomy were fashioned in six pigs. Twenty markers were introduced into the caecum immediately before colonic irrigation. Irrigation route (antegrade or retrograde), infusion regimen (tap water, polyethylene glycol (PEG), 1.5 per cent glycine) and pharmacological agent (glyceryl trinitrate (GTN) 0.25 mg/kg, diltiazem 3.9 mg/kg, bisacodyl 0.25 mg/kg) were assigned to each animal at random. Colonic transit was assessed by quantifying cumulative expelled markers (CEM) and stool every hour for 12 h. RESULTS: Mean CEM at 6 h for bisacodyl, GTN and diltiazem were 18.17, 12.17 and zero respectively; all pairwise differences in means were significant (P < 0.001). The difference at 12 h between the two routes (P = 0.001) and three fluids (tap water 6.75, glycine 14.83, PEG 16.33; P < 0. 001) was significant, but not for PEG versus glycine and bisacodyl versus GTN. Cumulative output was significantly more with the antegrade than retrograde route using PEG, but the difference in mean cumulative output for bisacodyl and GTN at 12 h was not significant. CONCLUSION: Colonic emptying is more efficient with antegrade than retrograde irrigation. PEG and glycine enhance emptying similar to bisacodyl and GTN solution. These findings show promise for improved faecal continence by colostomy irrigation and may justify construction of a Malone conduit at the time of colostomy in selected patients who wish to irrigate. Presented in part to the British Society of Gastroenterology in Glasgow, UK, March 1999, and published in abstract form as Gut 1999; 44(Suppl 1): A135

Analysis of Variance↗
PubMed2002

Scintigraphic assessment of antegrade colonic irrigation through an appendicostomy or a neoappendicostomy.

BACKGROUND: The aim of this study was to evaluate large bowel transport following antegrade colonic irrigation with a new scintigraphic technique. METHODS: Ten patients (eight with severe constipation, two with faecal incontinence; median age 47 (range 41-66) years) treated with antegrade colonic irrigation took 111In-labelled polystyrene pellets to label the bowel contents. 99mTc-labelled diethylenetriamine penta-acetate was mixed with the irrigation fluid to map its distribution within the large bowel. Scintigraphy was performed before and after a standardized irrigation procedure. The large bowel was divided into four segments. Assuming ordered evacuation of the large bowel, the contribution of each colonic segment to total evacuation was expressed as a percentage of original segmental count. The segmental contributions were added to reach a total defaecation score (range 0-400). RESULTS: The median defaecation score was 350, corresponding to complete emptying of the rectosigmoid, descending colon, transverse colon, and half of the caecum and ascending colon. The retained irrigation fluid was located throughout the large bowel. Back-flow to the ileum was observed in four patients. CONCLUSION: This study used a new scintigraphic technique to assess large bowel transport following antegrade colonic irrigation. Antegrade colonic irrigation induces highly effective emptying even in patients with severe constipation.

Adolescent↗
PubMed2000

Cleaning effectiveness of root canal irrigation with electrochemically activated anolyte and catholyte solutions: a pilot study.

AIM: The aim of this study was to evaluate the potential of electrochemically activated (ECA) anolyte and catholyte solutions to clean root canals during conventional root canal preparation. METHODOLOGY: Twenty extracted single-rooted human mature permanent teeth were allocated randomly into four groups of five teeth. The pulp chambers were accessed and the canals prepared by hand with conventional stainless steel endodontic instruments using a double-flared technique. One or other of the following irrigants was used during preparation: distilled water, 3% NaOCl, anolyte neutral cathodic (ANC) (300 mg L-1 of active chlorine), and a combination of anolyte neutral cathodic (ANC) (300 mg L-1 of active chlorine) and catholyte. The teeth were split longitudinally and the canal walls examined for debris and smear layer by scanning electron microscopy. SEM photomicrographs were taken separately in the coronal, middle and apical parts of canal at magnification of x800 to evaluate the debridement of extracellular matrix and at a magnification of x2500 to evaluate the presence of smear layer. RESULTS: Irrigation with distilled water did not remove debris in the apical part of canals and left a continuous and firm smear layer overlying compressed low-mineralized predentine. All chemically active irrigants demonstrated improved cleaning potential compared to distilled water. The quality of loose debris elimination was similar for NaOCl and the anolyte ANC solution. The combination of anolyte ANC and catholyte resulted in improved cleaning, particularly in the apical third of canals. The evaluation of smear layer demonstrated that none of the irrigants were effective in its total removal; however, chemically active irrigants affected its surface and thickness. Compared to NaOCl, the ECA solutions left a thinner smear layer with a smoother and more even surface. NaOCl enhanced the opening of tubules predominantly in the coronal and middle thirds of canals, whereas combination of ANC and catholyte resulted in more numerous open dentine tubules throughout the whole length of canals. CONCLUSIONS: Irrigation with electrochemically activated solutions cleaned root canal walls and may be an alternative to NaOCl in conventional root canal treatment. Further investigation of ECA solutions for root canal irrigation is warranted.

Chlorine↗
PubMed2001

Radiofrequency catheter ablation using long coiled electrodes: impact of irrigation on lesion dimensions and incidence of coagulum formation.

Ablation catheters with multiple long coiled electrodes have been recently developed to induce continuous linear lesions for the treatment of atrial fibrillation. The efficacy and safety of ablation catheters with multiple long coiled electrodes has not been evaluated. The aim of the present in vivo study was to investigate the influence of saline irrigation on lesion dimensions and coagulum formation during RF current ablation using those ablation catheters. In 14 anesthetized sheep, the thigh muscle was prepared as a cradle and filled with heparinized blood (37 degrees C). The quadripolar coiled ablation catheter (electrode length 7 mm, electrode distance 2 mm) was placed parallel to the muscle with standardized 10-g contact pressure. RF current energy was delivered sequentially temperature-(70 degrees C) or power-controlled (10, 20, 30, or 40 W) with additional irrigation of the electrode (10 mL/min normal saline) for 90 seconds. Forty-two of 129 RF current lesions were induced by temperature-controlled and 87 by irrigated ablation. Except for three lesions following low energy irrigated application (10 W), all lesions were continuous. Significantly larger lesions following irrigated RF current applications were produced with a power output of 30 W (depth 0.74 +/- 0.13 cm, width 0.78 +/- 0.13 cm) and 40 W (depth 0.75 +/- 0.16 cm, width 0.92 +/- 0.28 cm) as compared to 20 W (depth 0.47 +/- 0.13 cm, width 0.82 +/- 0.22 cm). Coagulum formation adherent to the electrode was exclusively observed following 18 of 42 nonirrigated RF current ablations. In conclusion, irrigated coiled ablation electrodes induce continuous linear lesions with a power output of 20-40 W. The risk of coagulum formation at the coiled electrode can be avoided by irrigation.

Animals↗
PubMed2000

Bacteriological safety and cost-effectiveness of a nonrefluxing valve in the irrigation system during outpatient flexible cystoscopy.

OBJECTIVE: To critically evaluate the infection rate associated with the use of a nonrefluxing irrigation system for outpatient flexible cystoscopy, by comparing it with conventional irrigation systems, and to determine the costs and benefits of this system of irrigation delivery. PATIENTS AND METHODS: All patients undergoing flexible cystoscopy on scheduled outpatient lists were considered for inclusion in the study; 143 patients of 220 undergoing cystoscopy fulfilled the study criteria. The study group of patients underwent cystoscopy with a new single-use nonrefluxing valve inserted into the same irrigation delivery system that was used for the whole endoscopy session, and the control group had the complete irrigation system changed after each endoscopic examination. Midstream urine samples were taken for analysis before cystoscopy and again 3-4 days later. Infection was defined as a pure growth of >/= 105 organisms/mL, with associated pyuria defined as >/= 10 pus cells per high power microscopic field. RESULTS: Complete data were available on 133 patients, with a further nine being excluded from the statistical analysis because they had a pre-existing urinary tract infection, leaving 64 patients in the study and 69 in the control groups. The overall infection rate for flexible cystoscopy was 3.2%, with no significant difference between the study and control groups. Cost savings of > 35% can be expected using the nonrefluxing valve method of irrigation delivery. CONCLUSION: The nonrefluxing valve caused no detectable increase in patient morbidity from bacterial infection when compared with conventional irrigation systems for flexible cystoscopy, and can save considerable costs.

Aged↗
PubMed1982

An outbreak of amebiasis spread by colonic irrigation at a chiropractic clinic.

From June 1978 through December 1980, at least 36 cases of amebiasis occurred in persons who had had colonic-irrigation therapy at a chiropractic clinic in western Colorado. Of 10 persons who required colectomy, six did. Of 176 persons who had been to the clinic in the last four months of 1980, 80 had received other forms of treatment. Twenty-one per cent of the colonic-irrigation group had bloody diarrhea, as compared with 1 per cent of the non-irrigation group (P = 0.00013). Thirty-seven per cent of the colonic-irrigation group who submitted specimens had evidence of amebic infection on either stool examination or serum titer, as compared with 2.4 per cent in the non-irrigation group (P = 0.00012). Persons who were given colonic irrigation immediately after a person with bloody diarrhea received it were at the highest risk for the development of amebiasis. Tests of the colonic-irrigation machine after routine cleaning showed heavy contamination with fecal coliform bacteria. The severity of disease in this outbreak may have been related to the route of inoculation.

Adult↗
PubMed1999

Effects of irrigation fluid temperature on choroidal circulation during vitrectomy.

PURPOSE: To investigate the effects of irrigation temperature on choroidal circulation during vitrectomy. METHODS: After anesthetized albino rabbits underwent closed vitrectomy, choroidal blood flow was monitored while the vitreous cavity was irrigated with solutions (BSS plus) of various temperatures (6-42 degrees C). Irrigation pressure was maintained at 15 mmHg. A non-contact Doppler laser flowmeter was used to measure choroidal blood flow. Temperature change at the retina and mid-vitreous was also measured during irrigation. RESULTS: Choroidal blood flow showed a downward peak when perfused at 34 degrees C. As irrigation temperatures deviated above or below 34 degrees C, the blood flow increased. However, when irrigation temperature was below 16 degrees C, the blood flow decreased as the temperature declined. The temperature at the retina was maintained at a relatively constant level when irrigation was between 30 degrees C and 40 degrees C. CONCLUSION: The choroid acts as a thermostat to minimize intraocular temperature fluctuations by changing its blood flow.

Animals↗
PubMed1995

The effect of Biocell texturing and povidone-iodine irrigation on capsular contracture around saline-inflatable breast implants.

We performed a prospective, concurrently controlled, and blinded 4-year clinical study on 60 patient volunteers to determine the effects of two independent variables, McGhan's Biocell texturization and Betadine antibacterial irrigation, on the incidence of fibrous capsular contracture around saline-inflatable implants following retromammary augmentation. Each patient was randomly assigned both a textured and a smooth implant and both saline and Betadine irrigation so that each patient served as her own control. The textured devices irrigated with Betadine experienced an overall incidence of contracture of only 4 percent compared with 50 percent for the smooth devices irrigated with saline solution. The Betadine-irrigated devices in general had a lower incidence of contracture than the saline-irrigated devices, and the textured-surface devices in general had a lower incidence of contracture than the smooth devices. Antibacterial irrigation and surface texturization may work in a cumulative manner to reduce the early incidence of capsular contracture.

Adult↗
PubMed2004

A comparative study of three methods of nasal irrigation.

OBJECTIVE: To assess the effectiveness of three methods of nasal irrigation on distributing saline to the nasal cavity and paranasal sinuses. DESIGN: : A prospective, cross-over study. MATERIALS AND METHODS: Twelve subjects (9 patients with chronic sinusitis after functional endoscopic sinus surgery and 3 healthy controls) underwent nasal irrigation with normal saline containing Technetium 99m sulfur colloid. The distribution of radioactivity was assessed on each subject after three different irrigation techniques: metered nasal spray, nebulization with RinoFlow, and nasal douching while kneeling with the head on the floor. RESULTS: The nasal cavity was well irrigated by all three techniques. Compared with the other two methods, douching was significantly more effective in penetrating the maxillary sinus (P = .036) and frontal recess (P = .003). The sphenoid and frontal sinuses were poorly irrigated by all three techniques. CONCLUSION: Nasal douches are more effective in distributing irrigation solution to the maxillary sinus and frontal recess. This should be the method of choice for irrigating these areas.

Adult↗
PubMed1993

In vitro cleaning ability of root canal irrigants with and without endosonics.

A variety of methods have been used to evaluate the cleanliness of root canals after endodontic preparation and irrigation. Few irrigation agents other than sodium hypochlorite (NaOCl) have been tested in conjunction with endosonics. The purpose of this study was to examine the cleaning ability of water, NaOCl, Hibiscrub and a biological washing liquid when used as intracanal irrigants, with and without endosonics. Two methods of evaluation were employed to assess the root canal cleanliness after endodontic preparation. A total of 56 teeth, divided into eight groups, were prepared manually using the step-down technique. Each irrigating agent was used in two experimental groups, with and without endosonics. Two additional teeth which received neither instrumentation nor irrigation served as the controls. The teeth were split longitudinally and the state of cleanliness of the root canal was assessed by scoring the amount of stained organic debris and smear layer. It was demonstrated that the results of debris and smear layer scoring were significantly influenced by the type of irrigant and whether endosonics had been used. All agents exhibited similar cleaning ability when introduced manually. With endosonics, NaOCl yielded significantly less stainable debris (P < 0.05) than the other groups which showed no significant difference. The ability to remove the smear layer was enhanced, but at some distance short of the working length, by endosonics for all irrigants tested. None of the solutions tested was able to produce a canal wall that was free of smear layer.

Chi-Square Distribution↗
PubMed2005

The efficacy of ultrasonic irrigation to remove artificially placed dentine debris from human root canals prepared using instruments of varying taper.

AIM: To investigate the influence of the taper of root canals on the effectiveness of ultrasonic irrigation to remove artificially placed dentine debris. METHOD: Forty-four maxillary and mandibular canines were selected after bucco-lingual and mesio-distal radiographs indicated that their internal diameters were smaller than the diameters of a size 20, .06 taper System GT instrument (Dentsply Maillefer, Ballaigues, Switzerland). These canines were divided into three groups and prepared using either size 20, .06 taper System GT instruments, size 20, .08 taper or size 20, .10 taper System GT instruments. Each root was then split longitudinally through the canal, forming two halves. In one canal wall, a standard groove was cut 2-6 mm from the apex, to simulate un-instrumented canal extensions. Each groove was filled with dentine debris mixed with 2% NaOCl to simulate a situation when dentine debris accumulates in the un-instrumented canal extensions. Each canal was reassembled by joining the two halves of the teeth by means of wires and sticky wax. In each canal ultrasonic irrigation was performed with a size 15 K file using 2% NaOCl as an irrigant. Before and after irrigation, images of each half of the canal with a groove were taken using a microscope and a digital camera, after which they were scanned into a PC as TIFF images. The quantity of dentine debris in the groove was evaluated using a scoring system: the higher the score, the larger the amount of debris. The scores before and after irrigation were compared. The differences in percentage of score reduction between the three groups were analysed by means of one-way anova. RESULTS: After ultrasonic irrigation, the debris score reduced by 74, 81 and 93%, respectively, in the size 20, .06, 20, .08 and 20, .10 taper groups. However, the difference amongst groups was not statistically significant (P = 0.078). CONCLUSION: There was a tendency that ultrasonic irrigation was more effective in removing artificially placed dentine debris from simulated canal extensions from canals with greater tapers.

Analysis of Variance↗
PubMed2007

The evaluation of removal of calcium hydroxide paste from an artificial standardized groove in the apical root canal using different irrigation methodologies.

AIM: To evaluate the capacity to remove a calcium hydroxide (Ca(OH)2) paste from the root canal and to evaluate the efficacy of Ca(OH)2 removal during passive ultrasonic irrigation using either sodium hypochlorite (NaOCl) or water as an irrigant. METHODOLOGY: Sixteen mandibular premolars were used. Each root was prepared to the apical foramen using GT instruments of size 30, 0.06 taper. Each root was split longitudinally. In one half of the root, a groove was cut in the canal wall 2-6 mm from the apex which was then filled with a Ca(OH)2 paste. Subsequently the roots were reassembled. In group 1 (n = 16), the teeth were ultrasonically irrigated using 50 mL 2.0% NaOCl as the irrigant. Group 2 (n = 16) was treated in the same manner as group 1, but using 50 mL water in place of the NaOCl. In group 3 (n = 16), the teeth were irrigated by syringe injection of 50 mL 2.0% NaOCl. The quantity of remaining Ca(OH)2 in the groove was scored and the data analysed with Kruskal-Wallis and Mann-Whitney tests. RESULTS: The difference in remaining Ca(OH)2 between all groups was statistically significant (P < 0.001). Group 1 had significantly lower scores than group 2 (P < 0.001) and group 3 (P = 0.002), but there was no significant difference between groups 2 and 3 (P = 0.765). CONCLUSIONS: Passive ultrasonic irrigation with 2% NaOCl was more effective in removing Ca(OH)2 paste from artificial root canal grooves than syringe delivery of 2% NaOCl or water as irrigant.

Calcium Hydroxide↗
PubMed2006

Is using ethanol-glycine irrigating fluid monitoring and 'good surgical practice' enough to prevent harmful absorption during transurethral resection of the prostate?

OBJECTIVE: To evaluate the utility of using a tracer of 1% ethanol in 1.5% glycine for the early detection of irrigation fluid absorption during transurethral resection of the prostate (TURP). PATIENTS AND METHODS: In all, 126 men undergoing TURP were irrigated with a solution of 1% ethanol and 1.5% glycine; their expired air was tested for ethanol every 20 min, and again at the end of the procedure. Maximum absorption by the breath-ethanol reading was compared with the serum concentration of absorbed glycine (analysed by anion-exchange chromatography). RESULTS: Complete data on 120 men were assessed; 75% of the men absorbed irrigation fluid, with glycine levels above the normal range. The sodium levels tended to decrease with increasing glycine levels (Spearman's rank correlation coefficient, - 0.57; 120 men) and five men (4%) developed clinical features of the TUR syndrome. There was a weak correlation between breath-ethanol levels and serum glycine levels (Spearman's rank correlation coefficient, 0.54). The experience of the surgeon, the weight of the resected chips, and the operative duration were not significantly predictive of irrigation fluid absorption. CONCLUSIONS: A rising breath-ethanol level indicates irrigation fluid absorption. However, irrigating fluid absorption is unpredictable, supporting the case for alternative, potentially safer irrigants.

Aged↗
PubMedDate not supplied

The use of colonic irrigation to control fecal incontinence in dogs with colostomies.

OBJECTIVE: To determine if once-daily colonic irrigation results in fecal continence for a 24-hour period in dogs with colostomies and if colonic volume increased in response to the irrigation. STUDY DESIGN: A prospective controlled experimental study. ANIMALS: Four intact male and one intact female mixed breed dogs. MATERIALS: All dogs received left end-on paralumbar colostomies. Four dogs received once-daily colonic irrigation for 8 weeks, whereas the control dog did not. Daily fecal weights were recorded for the length of the study in all dogs. Barium enema studies and volumetric studies were used to determine colonic volumes. RESULTS: Daily fecal weights were significantly decreased in treatment dogs compared with the control dog. Colonic volume increased in irrigated dogs in response to daily irrigation over the 8 week period of the study. CONCLUSIONS: Colonic irrigation resulted in significantly decreased fecal production over a 24-hour period. Therefore management of dogs with colostomies would be more practical and cost effective. It did not result in complete fecal continence in this study. Further clinical studies are indicated to determine if longer periods of irrigation would result in complete continence.

Animals↗
PubMed2004

Cooled intramural needle catheter ablation creates deeper lesions than irrigated tip catheter ablation.

Endocardial radiofrequency ablation of the left ventricle does not create transmural lesions reliably even with active electrode cooling. The authors developed a prototype catheter with an internally cooled needle electrode that could be advanced an adjustable distance into the myocardium. Freshly excised hearts from eight male sheep were perfused and superfused using oxygenated ovine blood. Ablations were performed for 2 minutes using the prototype catheter and a conventional endocardial 5-mm irrigated tip ablation catheter at target temperatures of 80 degrees C and 50 degrees C, respectively. The prototype catheter needle was inserted 12 mm deep for all ablations. The maximal power and irrigation rate was 50 W, 20 mL/min for the irrigated tip catheter and 20 W, 10 mL/min for the intramural needle catheter. Intramural needle lesions were significantly deeper (13.5 +/- 2.3 vs 9.1 +/- 1.3 mm, P < 0.01) but less wide (8.7 +/- 1.5 vs 12.7 +/- 1.9 mm, P < 0.01) than irrigated tip lesions. Popping occurred during 12 (37%) of the 32 irrigated tip ablations. Popping did not occur during intramural needle ablation. The cooled intramural needle ablation catheter creates lesions that are significantly deeper than irrigated tip catheters with less tissue boiling. In contrast to irrigated tip ablation, electrode temperature monitoring can be used to determine if a lesion has been created during intramural needle ablation. The cooled intramural needle ablation lesions were of a clinically useful width, addressing one of the main recognized deficiencies of intramural needle ablation.

Animals↗
PubMed1981

Use of oral irrigators as vehicle for the application of antimicrobial agents in chemical plaque control.

The purpose of the present investigation was to study the topographical distribution of plaque formation using chlorhexidine digluconate (CH) as a mouthrinse and in oral irrigators during experimental gingivitis. Forty dental students (aged 22--26) with clean teeth and healthy gingivae abolished oral hygiene for a period of 3 weeks (Löe et al. 1965). During this period the participants were randomly assigned to one of five groups. Group A rinsed daily with 30 ml of a placebo and Group B with 30 ml 0.1% chlorhexidine digluconate. In Groups C and E a fractionated jet irrigator was used for the daily application of 600 ml placebo (C) or 0.05% CH (E); 600 ml of 0.05% CH was also used in a monojet irrigator (Group D). At the start, after 1, 2 and 3 weeks of no oral hygiene and 1 week following reinstituted oral hygiene, plaque was assessed using the Plaque Index (Silness & Löe 1964) and gingival health was scored according to the criteria of the Gingival Index (Löe & Silness 1963). The discoloration of the teeth was determined using a set of color photos. During the experiment all groups reached plaque levels that were significantly different from each other. The highest PlI were seen in the placebo rinsing group (A) following by placebo irrigation (C). Plaque was significantly reduced in the CH groups. However, rinsing group (A) followed by placebo irrigation (C). Plaque was significantly reduced in the CH groups. However, rinsing (B) formed significantly more plaque than using the oral irrigator (D, E). Group E showed the least amount of plaque. In addition, the interproximal PlI were equally low as the buccal and lingual. With CH (B, D, E), gingivitis did not develop except for some interproximals in Group B. A fractionated jet irrigator was more effective for the application of CH than rinsing.

Adult↗
PubMed1989

Effects of subgingival irrigation on A. actinomycetemcomitans.

The effects of repeated subgingival irrigation on Actinobacillus actinomycetemcomitans was examined. 24 periodontal pockets harboring A. actinomycetemcomitans in 3 juvenile and 4 adult periodontitis patients were studied. The protocol included bi-weekly subgingival irrigation with hydrogen peroxide of the periodontal sites until the micro-organism was no longer detected by selective culture, or for 6 months. A. actinomycetemcomitans was gradually suppressed to below detection following the irrigation regime and could no longer be detected in 46% of the sites at completion of the irrigation protocol. The sites were microbiologically re-examined 5 months after cessation of the irrigation regime. A. actinomycetemcomitans re-occurred in only 2 of the sites from which it had originally been suppressed below detection. The results indicate: (1) that the irrigation regime tested has some potential to suppress A. actinomycetemcomitans in periodontal pockets; (2) that the effect of the irrigation protocol generally lasted for 5 months; (3) that the reduction rate of A. actinomycetemcomitans to below detectable levels seems related to the initial number of cultivable bacteria from the periodontal pocket.

Actinobacillus↗