[Tissue engineering and stem cells in periodontal regeneration]

Reconstructive treatments in dentistry aimed at achieving complete regeneration of destroyed structures both in soft and hard tissues. To date, this goal has been tried to accomplish using various bone grafts, growth factors, and barrier membranes. Stem cells are the most fascinating area of biology today and have been used clinically in the field of medicine to treat many incurable diseases. The English literature indexed in in the MEDLINE/PubMed database was systematically searched and original papers were critically reviewed on this subject, until the second quarter of 2011. Additional papers were obtained by manual searching reference lists of previously published review papers. More than fifty years ago, the first allogenic hematopoietic stem cell was transplanted in patients. However, the promise of other stem cell populations for tissue replacement and repair remains unachieved. When considering cell-based interventions for tissue regeneration, the factors influencing therapeutic success and safety are more complicated than for traditional treatments. So, it is important for dentists to have a brief understanding about the principles and clinical applications of stem cells in tissue engineering field. This article reviews the most recent published data to regenerate dental and periodontal tissues based on scientific principles and provides fundamental information to readers about the different aspects involved in tissue engineering. Ideal combination of cells, scaffolds, and growth factors for tissue engineering may be extended over future years. The findings collected in this literature review show that we are now at a stage in which engineering a complex tissue, such as the periodontium, is no longer an unachievable goal and the next decade will certainly be an exciting time for dental and periodontal research

[ clinical comparison of free gingival graft harvested from palate versus attached gingival]

Despite doubts about the necessity of the presence of keratinized gingival tissue around teeth, increasing its width is still of special importance in particular situations. Among currently used procedures, free gingival autograft is more common. The aim of this study was to clinically compare the free gingival graft taken from palate[FGGP] versus free gingival graft taken from attached gingival [FGGA] following a healing period of one, two and three month that will determine and introduce the superior procedure to be used in practice. The present study was a controlled, split mouth clinical trial which 10 pairs of lower anterior and premolar teeth requiring gingival augmentation were exposed to surgery using [FGGP] and [FGGA]. Statistical data analysis was done using SPSS software. Chi- square [X[2]] test was used for comparison of color matching between two groups. Nonparametric Mann- Whitney test was used for comparison of mean keratinized gingival width and dimensional changes of graft between two groups. This study demonstrated that the increased amount of keratinized gingival width three months following the surgery, was significant for both groups but there were no statistically significant differences between two groups. [P>0/05]. With regard to the color matching with adjacent tissue, the results of [FGGA] was superior to [FGGP] [P<0.05]. The amount of dimensional changes in the [FGGP] was more than [FGGA][P<0.05]. Both procedures had the ability to increase the keratinized gingival width, however [FGGA]had lower dimensional changes. In addition, [FGGA] had better color matching and esthetic

Diagnostic value of bone sounding technique for estimation of level in periodontal defects

Alveolar bone level measurement in periodontal disease is very important because it may affect planning of forthcoming surgery, treatment response and prognosis. Surgical approach is the most accurate procedure for obtaining this measurement. Nowadays, transgingival probing as a non-invasive and accurate method has been claimed to be a proper substitution for surgical measurement and direct visualization. This study aimed at evaluation of diagnostic value of bone sounding technique in estimation of bone level in I, II and III-wall periodontal defects. Ninety vertical defects in 37 individuals with chronic periodontitis having one, two or three-wall defects were assessed. Bone levels were measured by UNC-15 probe. The resulted values were compared with the values obtained during surgery. Collected data were analyzed using Paired samples T test and Pearson's correlation coefficient. High and significant correlation was found between the results of transgingival probing and surgery methods [0.97, 0.94 and 0.95 in one, two, and three-wall defects respectively [p < 0.001]]. The mean bone levels measured by transgingival probing were 0.21, 0.53 and 0.19 mm less than their assigned values in surgery and there was no significant difference between one and three- wall defects [p < 0.001]. The findings of this study indicated a high correlation between the two procedures, bone sounding and surgery, in detection of bone level. Due to the negligible difference, it seems that trans gingival probing could be considered as a feasible replacement for invasive surgical approach in detection of alveolar bone level

clinical detection of helicobacter pylori in dental plaque using polymerase chain reaction

Helicobacter pylori [H.pylori] are considered to be a pathogen responsible for gastritis and peptic ulcers as well as a risk factor of gastric cancer. Recently, H.pylori has been detected in dental plaques, hence oral cavity has drawn attention to be the second site for H.pylori. However, it is not yet clear whether the oral cavity acts as a reservoir for this bacterium. The aim of this study was to clarify whether the oral cavity is the reservoir for H.pylori, and to find out any relationship between gastritis and dental plaque the infection. In this study, PCR was used for detection of Helicobacter pylori as a noninvasive method with higher sensitivity and specificity. Samples of the supragingival and sub gingival dental plaque were collected from 67 patients [44 with periodontitis, and 23 suffered from both gastritis and periodontitis]. Using sequences of different H. pylori genes, four pairs of oligonucleotide primers were designed to optimize a sensitive and specific protocol for diagnosis and detection of H.pylori. The data were analyzed using Chi Square and Fisher statistical tests. The level of significance was considered at p

[ clinical comparison of Azithromycin versus Doxycycline in non-surgical periodontal treatment of smokers]

Weaker immune system in smokers reduces the favorable response of these patients to both surgical and non-surgical periodontal treatments in comparison with non smokers and ex-smokers. The aim of the present study was to compare the healing of periodontal tissues following phase 1 therapy alone, or along with taking Azithromycin or Doxycycline in smokers with chronic periodontitis. In this investigation a total of 45 male smokers with chronic periodontitis were randomly assigned into 3 groups, each containing 15 patients. All patients were initially examined by measuring the periodontal indices, such as Bleeding On Probing [BOP], Clinical Attachment Level [CAL], and Probing Depth [PD]. The control. group received phase 1 therapy only. While the second and third groups received Doxycycline and Azithromycin respectively along with phase 1 therapy. The periodontal indices were measured and recorded again after six months. The results showed that, there was a significant difference between all recorded parameters before and after the treatment [P<0.05]. However, there was no statistically significant difference between Doxycycline and Azithromycin groups regarding PD index [P >0.05], but groups receiving antibiotics showed statistically significant reduction in PD compared to control group [P<0.05]. The best result for CAL was obtained in Azithromycin group when compared with Doxycycline and control groups. Also, a statistically significant difference was detected between the two antibiotic groups [P<0.05]. Furthermore. Doxycycline group showed a statistically significant reduction in CAL in comparison with the control group [P<0.05]. Regarding BOP index no statistical significant difference was seen between the results of the 3 groups under investigation [P>0.05]. Azithromycin and Doxycycline consumption along with phase 1 therapy may improve the clinical periodontal indices in comparisons with phase 1 therapy alone

[Evaluation of clinical efficacy of two low-dose doxycycline regimen in patients with chronic periodontitis]

Statement of Problems: Incomplete therapy of periodontal diseases treated with scalling and root planning [SRP] has been resulted in improvement of host- modulated therapy [HMT] as a new method

Purpose: Introducing an adjunctive therapy in addition to SRP in managing of destructive periodontal therapy was the main purpose of this study

Materials and Methods: Fifteen patients suffered from chronic periodontitis were randomly assigned to test and control groups. Treatment consisted of: SRP+ placebo [control group], SRP+ low dose doxycycline [LDD] twice daily for six months [continous LDD], and SRP+LDD twice daily for first and third two months after completion of phase I [cyclic LDD]. Gingival indices including: probing depth [PD], clinical attachment level [CAL], modified gingival index [MGI], and O'leary plaque index were measured and recorded at baseline and at one and six months after the completion of therapy. The data were analyzed using one-way ANOVA and Kruskal-Wallis tests

Results: Probing depth reduction in both of LDD groups were significantly greater than control group [p<0.01]. However, this reduction happened between baseline and follow-up oppointments. In other word, the differences between the 1-and 6-month evaluation were not significant [p=0.25]. Continous LDD regimen showed an additional PD reduction [from 5.40 to 2.06mm] for pockets greater than 5mm in comparison to the other groups

Conclusion: Within the limitation of this study, the results showed that adjunctive continous and cyclic regimen of low-dose doxycycline can improve the clinical efficacy of conventional therapy, even in patients with less than favorable plaque control

[Evaluation of alteration in mucogingival junction location following use of connective tissue graft and coronally advanced flap]

One of the most successful procedures in root coverage is free connective tissue graft combined with coronally advanced flap. The assessment of mucogingival junction [MGJ] changes during healing period is of great importance. The aim was to assess the positional changes of MGJ following use of connective tissue graft in combination with coronally advanced flap in 3- 6- and 12- month intervals. In this cross sectional and interventional study, 19 cases of gingival recession in 10 patients with Miller class I and II defects >/= 4 mm were treated with connective tissue graft and coronally advanced flap. After phase I therapy, an acrylic stent was made. Clinical parameters monitored in this study included clinical attachment level [CAL], mucogingival junction [MGJ], keratinized gingival [KG] width and attached gingival [AG] width. Each parameters were measured at baseline, and 3- 6- and 12- month intervals. For comparison, statistical analysis was performed using Paired-T test at p < 0.05.The mean distance from MGJ to acrylic stent at baseline was 5.94 +/- 0.88 mm which during surgery, was moved coronally by 4.39 +/- 0.65 mm. Distance from MGJ to CEJ immediately after surgery was 1.55 +/- 0.58 mm. This distance during healing periods at 3, 6, and 12 months changed to 3.13 +/- 0.87, 3.34 +/- 0.66, and 3.65 +/- 0.64 mm, respectively indicating a gradual regression of MGJ to presurgical position. Keratinized gingival width had remarkable changes in 3-, 6- and 12 month intervals in comparison to the baseline. Mean presurgical width of keratinized gingiva was 1.55 +/- 0.76 mm which increased to 3.44 +/- 0.49 mm [p <0.05]. Mean presurgical attached gingival was 0.36 +/- 0.62 mm and 12 months after surgery it was increased to 2.18 +/- 0.50 mm 12 month after surgery [p <0.05]. Presurgical clinical attachment level was 5.81 +/- 0.88 mm which was decreased to 1.55 +/- 0.57 mm, 12 month after surgery.Based on the findings, it seems that mucogingival junction has a gradual tendency to moved back to its presurgical position after use of free connective tissue graft with coronally advanced flap technique

Clinical comparison between potassium nitrate and strontium chloride in decreasing hypersensitivity following resective periodontal surgery

Dentin hypersensitivity is a transient toothache with multiple external stimuli that has high prevalence in adults [about one out of every seven patients]. The aim of this study is clinical comparison of the role of potassium nitrate and strontium chloride in decreasing hypersensitivity following periodontal resective surgery. Fifty one patients with tooth hypersensitivity following resective periodontal surgery participated in this study. Patients were randomly divided into 3 groups, group I: patients using Sensodyne toothpaste containing potassium nitrate, II: patients using Sensodyne toothpaste containing strontium chloride and group III: as control. The patients used the dentifrices for 14 days. The severity of hypersensitivity was recorded in specific questionnaires designed for this study and verified by visual Analogue Scale [VAS]. Furthermore, the severity of hypersensitivity of different teeth and the different irritants producing hypersensitivity according to gender and age were recorded. Collected data was statistically analyzed using exact Fisher and Chi-square tests. Out of 51 participants in the study there were 30 females and 21 males. No statistically significant differences were found between group I and group II [P>0.05], but there were significant differences in hypersensitivity reduction between group III with group I and II [P<0.05]. Cold was the most common irritant in this study 96.2% and after that, heat with 33.3% of cases. The most common involved teeth were m and ibular lateral and central incisors respectively. According to the high rate of tooth hypersensitivity following resective periodontal surgery, the use of desensitizing agents such as potassium nitrate and strontium chloride along with good oral hygiene are recommended

[Effect of cigarette smoking quantity on periodontal tissue response to phase I therapy]

Although bacterial plaque is the primary ethiologic factor in the initiation of chronic periodontitis, there is some predisposing factors such as smoking which may aggravates disease process and its roll appears to be considered more important recently. The purpose of the present study was the evaluation of the effect of the quantity of cigarette smoking on periodontal tissue response following phase I therapy. Thirty patients [26 male and 4 female] with mean age of 48 +/- 11 years participated in this interventional and cross-sectional study. All patients suffered from generalized moderate chronic periodontitis. The patients were divided into three equal groups of 10 [heavy smokers, light smokers and non smokers], according to the number of cigarette consumption. The smoker groups had a history of cigarette consumption at least for the past two years. Clinical probing depth, clinical attachment level and bleeding on probing were evaluated for the patients at baseline and eight weeks following completion of phase I therapy. The results were analyzed using Wilcoxon rank and Kruskal- Wallis tests. No statistically significant differences were found in the evaluated variables between the groups except for BOP at baseline. All parameters decreased significantly eight weeks after completion of phase I therapy, but in comparison between three groups, only differences of CPD reduction and CAL gained between heavy and non-smokers were statistically significant. The present study indicated that heavy cigarette smoking have a negative effect on periodontal tissue response to phase I therapy. This effect depends on the number of daily smoked cigarettes and is increased with more than 20 cigarettes smoking per day

evaluation of prevalence and severity of gingival recession in anterior and premolar teeth in referring patients to Tabriz dental faculty during 2004-2005

Gingival recession can cause several complications such as esthetics, root caries and plaque control that treatment of each necessitate time and cost from the patient. Regarding the importance of gingival recession, this study was undertaken in order to evaluate prevalence and severity of this clinical entity in anterior and premolar teeth. This study was performed on 246 patients between 10-70 years old who referred to Tabriz Dental Faculty. All measurements of recession depth and width were done with periodontal probe and under sufficient illumination. Furthermore the type of gingival recessions was evaluated based on Miller's classification. Some measurements were done twice randomly in order to examine intra-observer agreement of data. Statistical analysis was accomplished using Kappa, chi-square and T. Test. Our findings showed that 45.9% of patients had gingival recession. The trend of recession was upward between 10-30 [22.3%] to 50-70 years of age [100%]. Prevalence of recession in males was significantly higher than females [P<0.05]. The most prevalent recession sites were detected in lingual surface of lower right lateral [37.4%], lower left lateral [37%], buccal surface of lower left central [20.7%], lower right central [20.3%], respectively. Class I Miller was the most common type of recession. Considering the high prevalence of this clinical entity, implementation of oral hygeine instructions and conducting analytical and experimental researches would be a neccessity

[ clinical assessment of the effects of smoking on periodontal tissues in referring patients to Tabriz dental faculty during 2005-2006]

Many risk factors cause progression of peridontitis. Smoking is one of these factors and due to increasing rate of smokers, there is need to study more about the effect of smoking on periodontal indicators. The aim of this study was clinical evaluation of smoking effects on periodontal tissues in referring patients to oral medicine and periodontics department in Tabriz dental faculty. This study was an analytical, cross-sectional study. Sample size consisted of one hundred patients with chronic periodontitis. Of these patients, 50 smoker patients [34 Heavy smokers and 16 Light smokers] entered into case group and 50 non-smoker patients entered into control group. After ensuring age matching between smokers and non-smokers, periodontal measurements such as clinical probing depth [CPD], gingival recession [GR], clinical attachment level [CAL], tooth mobility [TM] and bleeding on Probing [BOP] were obtained and recorded in special questionnaires. Data analysis was performed by SPSS soft ware and Tukey and Pearson tests. Clinical probing depth, gingival recession, clinical attachment loss and tooth mobility increased significantly in Heavy smokers compared with non-smokers and Light smokers [p<0.05], while no statistically significant differences were found between non- smoker and light smoker groups. Considering bleeding on probing, there was declining trend in BOP in Heavy smokers compared with non-smokers and Light smokers [p=0.00]. There was not significant differences upon the effect of cigarette consumption [based on pack years] in the mentioned indices [p>0.05] between the two groups. Based on the results of this study which showed an increasing rate of intensity in periodontal indicators in smokers group compared with non-smoker, specific programs to increase public awareness on the effect of smoking should be recommended

[Reproducibitity of keratinized gingival width assessment with three methods of mucogingival junction determination]

Although the need for "adequate" amount of keratinized tissue [KT] for periodontal health is questionable, the mucogingival junction [MGJ] often serves as a measurement landmark in periodontal evaluations. Limited information is available on the reproducibility of KT width [KTW] assessment. The purpose of this study was to assess reproducibility of 3 different methods to identify MGJ location. In this test evaluation study, fourteen patients contributed with 40 teeth. At the midbuccal aspect of each tooth, KTW was assessed by 2 independent examiners after MGJ identification by the visual [VM], functional [FM], and visual with histochemical staining [HM] method. Data analysis was based on intra-class correlation coefficients [ICC] and paired t test. The results of this study exhibits no significant differences in keratinized tissue width assessment in visual and histochemical methods, but a significant difference in functional method is found. Intra- and inter-examiner reproducibility has been shown to be substantially consistent when different methods of mucogingival junction determination are used to measure in order to determining corono apical dimension of the gingival. Finally the results of this study indicate that all three methods for detecting MGJ location are accurate and reproducible, but if we need more accuracy and reproducibility, the histochemical method is recommended

Clinical comparison of the prevalence and type of the periodontal diseases in leukemic patients hospitalized in Tabriz through 2004-2005

Periodontal diseases are common in leukemic patients and in most cases one of the primary diagnostic signs. The aim of this study was clinical comparison of the prevalence and type of the periodontal diseases in leukemic patients in Tabriz hospitals. In this descriptive - analytic study, 70 hospitalized leukemic patients were clinically examined in the city of Tabriz in 2004-2005. The data were collected in a questionnaire designed for this study and were analyzed using chi-square test through SPSS software. There was a significant relationship between leukemia and periodontal diseases either in general or classified into periodontitis and gingivitis [p<0.05]. Although, there was a significant relationship between different types of leukemia and age [p<0.05], sex comparison of patients with different types of leukemia, didn't show a significant relationship. In general evaluation of periodontal disease, there was a significant relationship between periodontal disease and type of leukemia in males [P=0.013], but there was not such a relationship in female patients. In general evaluation of peridontal diseases with different types of leukemia in different age groups in male and female patients, there was a significant relationship [P= 0.00] while. comparing periodontal diseases with the type of leukemia in different age groups, there was a significant relationship only between absence of periodontal disease and the type of leukemia [P=0.00]. With attention to the factors that increase the prevalence of periodontal diseases in leukemic patients, developing prophylactic and appropriate therapeutic strategies are recommended

[Guided tissue regeneration through growth factors in periodontal treatments]

Aim and Background: periodontal regeneration is one of periodontal treatments goals that a lot of studies have been conducted on it. Guided tissue regeneration technique [GTR], through the inhibition of epithelial cells and gingival connective tissue immigration, cause PDL fibroblasts proliferation at lesion site and also lead to cementum, bone and PDL reconstruction. Despite successful achievements of this technique in human and animal studies, its application in severe lesions such as furcation involvement grade 111 has not been satisfactory. To promote the level of' treatment success, the application of growth factors as agents for the progression of cells proliferation and immigration and the production of extracellular substance has been suggested. The goal of this article was to review these different factors and conducted researches to present a panorama of modern periodontics

Materials and Methods: articles on growth factors application in periodontal lesions regeneration, up to 2003, were collected from Medline and other medical information banks. More over, a lot of specific cases were studied in dentistry journals

Results: it is concluded that the application of different types of growth factors alone or in combination with each other either allogene or autogene, is able to hasten and motivate periodontal lesions regeneration including: intrabony defects and furcation involvements to more advanced cases such as peri implant bone reconstruction. However, their precise application requires more studies

Conclusion: high-level capability of growth factors in the promotion of periodontal treatments consequences has prouided a favourable background for purposeful researches. So as a promising future in periodontal regenerative methods should be expected

[Clinical comparison between free gingival graft [with citric acid] subepithelial connective tissue graft in denuded roots coverage]

Background and aim: gingival recession is a relatively prevalent gingival disorder, which increases with age. The purpose of this study was to compare free gingival graft technique [with citric acid] with subepithelial connective tissue graft in the coverage of denuded root surfaces of CII and CIII Miller

Materials and Methods: ten systemically healthy patients with at least two bilateral recession defects of cII and cIII Miller participated in this study. After oral hygiene instruction and reaching plaque index below 20% and gingival bleeding index below l0 %, patients entered surgical phase. For each patient, the recession was treated using free gingival graft with citric acid on one side [group A] and with subepithelial connective tissue [group B] on the other side randomly. Recession width [RW], recession depth [RD], the width of keratinized tissue [KT], probing depth and probing attachment level were measured before and three months after surgery. The results were statistically analyzed by Mann-Whitney test

Results: keratinized tissue increased significantly after both surgical treatments, however, no significant difference was found between the groups. Furthermore, decrease in RD and RW with subepithelial connective tissue graft technique was significantly more than that with free gingival graft

Conclusion: in agreement with the results of other studies, the present study shows subepithelial connective tissue graft as a more efficient technique for root coverage, as compared with free gingival graft