Determination of the stage and grade of periodontitis according to the current classification of periodontal and peri-implant diseases and conditions (2018) using machine learning algorithms.

PURPOSE: The current Classification of Periodontal and Peri-Implant Diseases and Conditions, published and disseminated in 2018, involves some difficulties and causes diagnostic conflicts due to its criteria, especially for inexperienced clinicians. The aim of this study was to design a decision system based on machine learning algorithms by using clinical measurements and radiographic images in order to determine and facilitate the staging and grading of periodontitis. METHODS: In the first part of this study, machine learning models were created using the Python programming language based on clinical data from 144 individuals who presented to the Department of Periodontology, Faculty of Dentistry, Süleyman Demirel University. In the second part, panoramic radiographic images were processed and classification was carried out with deep learning algorithms. RESULTS: Using clinical data, the accuracy of staging with the tree algorithm reached 97.2%, while the random forest and k-nearest neighbor algorithms reached 98.6% accuracy. The best staging accuracy for processing panoramic radiographic images was provided by a hybrid network model algorithm combining the proposed ResNet50 architecture and the support vector machine algorithm. For this, the images were preprocessed, and high success was obtained, with a classification accuracy of 88.2% for staging. However, in general, it was observed that the radiographic images provided a low level of success, in terms of accuracy, for modeling the grading of periodontitis. CONCLUSIONS: The machine learning-based decision system presented herein can facilitate periodontal diagnoses despite its current limitations. Further studies are planned to optimize the algorithm and improve the results.

Evaluation of RANK, RANKL and OPG Levels in Gingival Crevicular Fluid After Surgically Assisted Rapid Maxillary Expansion.

Objectives: Maxillary transverse deficiency is one of the most common skeletal problems. Patients who have completed skeletal maturity, maxillary transverse deficiency can be treated with surgically assisted rapid maxillary expansion. Orthodontic forces affect the cells in the periodontium to form biologically active substances responsible for remodeling. These substances can be detected in the content of the gingival crevicular fluid (GCF). This study aimed to investigate changes in RANK, RANKL and OPG in the gingival crevicular fluid after surgically assisted rapid maxillary expansion. Materials and Methods: A total of 16 patients with a maxillary transverse deficiency were included in the study. Gingival crevicular fluid samples were collected from the mesiobuccal regions of the upper left central, lateral incisors, first and second premolar teeth before the operation (T0), after activation period (T1) and at the 4th month (T2) after the retention period. Changes in RANK, RANKL and OPG levels of gingival crevicular fluid samples were investigated. Results: RANK and RANKL amounts were found to be significantly increased in the first and second premolar teeth after expansion, and OPG amounts were significantly decreased in central incisor and first premolar teeth. RANKL was also significantly higher in the first premolar teeth than in the second premolar after retention. Conclusion: According to the results of the study, RANK, RANKL and OPG levels are changed in the gingival crevicular fluid after surgically assisted rapid maxillary expansion. Clinical Relevance: Using tooth-borne appliances for SARME operations alters the biological content of the GCF. For avoiding these interactions, bone-borne appliances may be used for SARME procedures.

The gingival crevicular fluid levels of interleukin-11 and interleukin-17 in patients with aggressive periodontitis.

BACKGROUND: The balance (ratio) of anti-inflammatory and proinflammatory cytokines is thought to play an important role in the pathogenesis of chronic periodontitis. Moreover, the imbalance of anti-inflammatory/proinflammatory cytokines may modulate disease progression in aggressive periodontitis (AgP). This study aims to investigate the levels of interleukin (IL)-11 and IL-17 and their ratio in gingival crevicular fluid (GCF) in patients with AgP. METHODS: This study included 20 patients with generalized AgP (GAgP) and 18 healthy controls (HC). For each patient, the values of clinical parameters, such as gingival index, plaque index, probing depth, and clinical attachment level, were recorded. Levels of IL-11 and IL-17 in GCF samples were evaluated using enzyme-linked immunosorbent assay. The values of clinical parameters, cytokine levels, and the ratios of cytokines were evaluated. RESULTS: The values of all the clinical parameters were significantly higher in the GAgP group than in the HC group (P < 0.001). The total amount and concentration of IL-11 and the concentration of the IL-17 and IL-11/IL-17 ratio were significantly lower in the GAgP group than in the HC group (P < 0.001). The total amount of IL-17 was not significantly different between the groups (P = 0.317). CONCLUSIONS: The IL-11/IL-17 ratio was decreased in the GAgP group because of the decreased IL-11 levels. The IL-11/IL-17 axis and the link between IL-17 and neutrophil function disorders in AgP should be investigated to clarify the role of the IL-11/IL-17 axis and its balance and imbalance in the pathogenesis of AgP.

The gingiva contains leptin and leptin receptor in health and disease.

The presence of leptin (OB) and soluble OB receptor (s-OB-R) in gingival tissue extract and gingival crevicular fluid has led the studies investigating the relationship between OB and periodontal diseases. This study aims to investigate the levels of OB and s-OB-R in serum and their presence in gingiva of healthy controls (HC), gingivitis (G), aggressive periodontitis (AP), and chronic periodontitis (CP) patients; and whether correlations exist between clinical and serum parameters, OB and s-OB-R. Seventy-seven subjects [HC (n = 20), G (n = 20), CP (n = 21), and AP (n = 16)] were included in this study. After the clinical periodontal parameter recordings and venous blood sampling, gingival tissues obtained. Serum parameters' levels determined with enzyme linked immune sorbent assay; and OB and OB-R in gingiva immunohistochemically. No significant differences were observed regarding the serum parameters [high sensitivity C-reactive protein (hs-CRP), lipids, OB, and s-OB-R] when the groups were compared (P > 0.0125). The serum OB has positive correlations with hs-CRP in the G group (P < 0.05), and s-OB-R has presented significant negative correlations with BOP in HC group (P < 0.05), with hs-CRP in G (P < 0.05) and AP groups (P < 0.05). The positive correlations were observed between the serum OB and HDL and body mass index in the CP group (P < 0.05). In all of the tissue samples of all groups, there was positive OB and OB-R immunoreactivity in the gingival epithelium. The gingival tissues contain both OB and OB-R. The serum levels of OB and s-OB-R do not vary between patients and with different periodontal conditions.

Serum lipoprotein-associated phospholipase A2 and C-reactive protein levels in association with periodontal disease and hyperlipidemia.

BACKGROUND: The aim of this study is to evaluate the levels of serum lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) and high-sensitivity C-reactive protein (hsCRP) in association with periodontal disease and hyperlipidemia. METHODS: A total of 123 subjects with hyperlipidemia and 68 systemically healthy controls were included in the study. Subjects with hyperlipidemia were divided into two groups: the suggested-diet (HD) and prescribed-statin (HS) groups and then into three subgroups: the healthy (HDh and HSh), gingivitis (HDg and HSg), and periodontitis (HDp and HSp) groups. Periodontal parameters were recorded and included the plaque index, gingival index (GI), probing depth (PD), clinical attachment level (CAL), and percentage of sites with bleeding on probing (BOP). Fasting venous blood samples were obtained, and serum lipid, Lp-PLA(2), and hsCRP levels were evaluated. RESULTS: Median values for the GI, PD, BOP(%), and CAL in the HSg group were statistically significantly higher than those in the HDg and systemically healthy with gingivitis (Cg) groups. The HSp group had higher percentages of BOP compared to those of the chronic periodontitis and HDp groups. The HDg group had higher serum Lp-PLA(2) and hsCRP levels compared to those of the Cg and HSg groups. The ratio of total cholesterol to high-density lipoprotein cholesterol (TC/HDL) was significantly associated with the GI, PD, and BOP(%) in both groups with hyperlipidemia. Serum Lp-PLA(2) and hsCRP levels were significantly correlated with TC/HDL, the GI, PD, and BOP(%) in the HD group. CONCLUSIONS: Serum Lp-PLA(2) and hsCRP levels may play an important role in the association between periodontal disease and hyperlipidemia, and the control of these mediators may affect the inflammatory control of patients with hyperlipidemia and periodontal disease.

Pro-inflammatory cytokine levels in association between periodontal disease and hyperlipidaemia.

AIM: The aim of this study was to evaluate serum and gingival crevicular fluid (GCF) pro-inflammatory cytokine levels in association between periodontal disease and hyperlipidaemia. MATERIAL AND METHODS: One hundred and twenty-three subjects with hyperlipidaemia and 68 systemically healthy controls (C) were included in the study. Hyperlipidaemic groups were divided into two groups as suggested diet (HD) and prescribed statin (HS). Both groups were divided into three subgroups as healthy (h), gingivitis (g) and periodontitis (p). The clinical periodontal parameters, fasting venous blood and GCF samples were obtained, and serum tumour necrosis factor-alpha (TNF-α), interleukin (IL)-1ß (IL-1ß) and IL-6 levels were evaluated. RESULTS: The ratio of total cholesterol to high-density lipoprotein (TC/HDL) was associated with gingival index and percentage of bleeding on probing (BOP%) in both hyperlipidaemic groups. In HS group, GCF and serum IL-6 were positively correlated with BOP% and TC/HDL. GCF TNF-α was positively associated with probing pocket depth and clinical attachment level, whereas serum TNF-α was associated with BOP% in the HD group. Serum and GCF TNF-α and IL-1ß were significantly associated with TC/HDL in the HD group. CONCLUSIONS: Serum pro-inflammatory cytokines may play an important role in the association between periodontal disease and hyperlipidaemia.

Dental Hygiene Fear Survey: reliability and validity of the Turkish version.

The aims of the present study were to 1) investigate patient anxiety as it relates to dental hygiene procedures and 2) conduct validity and reliability testing of the Turkish version of the Dental Hygiene Fear Survey (DHFS) to test its psychometric properties in the Turkish culture. The study consisted of 200 periodontal patients. The patients completed the DHFS, the Modified Dental Anxiety Scale (MDAS), and a questionnaire designed to elicit sociodemographic and clinical characteristics. Reliability was estimated by Cronbach's alpha. Validity was examined by correlating the DHFS with measures found in the literature that correlate with dental fear and anxiety. Construct validity was determined using exploratory factor analysis with a direct oblimin (oblique) rotation, which revealed a model with three factors accounting for 62.8 of the variance when item 11, which has the lowest item total correlation, was omitted. The Cronbach alpha coefficients of the subscales in the fifteen-item scale (generalized anxiety, dental hygiene specific anxiety, and catastrophe) were 0.83, 0.86, and 0.79, respectively. The overall reliability of the DHFS was 0.91. Significant negative correlations were found between total DHFS scores and age (p<0.05). Females reported dental hygiene fear more frequently than did males. The DHFS demonstrated good psychometric properties in spite of being translated into another language and used in a culture different from the one where it was originally developed. The Turkish version of the DHFS is a valid and reliable instrument and may be included in assessments designed to measure fear related to dental hygiene treatment procedures.

A multidisciplinary approach to dental erosion: a case report.

Chemical erosion is the loss of superficial tooth structure by chemical action in the continued presence of demineralizing agents. This can be prominent in patients with oral habits such as constant citrus ingestion (like lemon chewing), chlorinated swimming pool water or gastrointestinal problems that produce repeated exposure of teeth to gastric acids. In this case report, a multidisciplinary approach to restore the severe wear due to dental erosion by proper techniques and materials was presented.

Appropriate oral hygiene motivation method for patients with fixed appliances.

OBJECTIVE: To determine the most appropriate oral hygiene motivation method (OHMM) for orthodontic patients with fixed appliances. MATERIALS AND METHODS: A total of 150 orthodontic patients, scheduled for their regular controls, were included in this study. The patients were divided into five groups (n = 30) according to the verbal OHMM and instructed as follows: only verbal information (V), verbal information with demonstration on model (M), verbal information with demonstration on model and self application by the patient (M+A), verbal information using the illustration catalog (I), and verbal information using the illustration catalog and self application by the patient (I+A). All of the applications of the patients were made under the supervision of the clinicians. The periodontal parameters (plaque index [PI], gingival index [GI], and bleeding on probing [BOP]) were recorded at the baseline (before the instructions of the OHMM), 1 week later, and 4 weeks after the OHMM. RESULTS: All periodontal parameters showed significant decreases after 4 weeks in all OHMM groups (P < .05). I+A group has significantly lower PI scores and BOP percentages than the other groups (P < .05) after 4 weeks. The difference between the V group and M+A, I, and I+A groups in the GI scores were significant (P < .05), and the I+A group has presented the lowest GI score. CONCLUSIONS: The OHMM applied by the patients under the supervision of the clinician seemed to be more successful in the elimination of plaque and inflammatory symptoms in patients with fixed appliances.

Does the periodontal health of thalassemia major patients have an impact on the blood lipid profiles? A preliminary report.

Cardiac symptoms and premature death from cardiac causes are still suggested to be a major problem in thalassemic patients. One of the main reasons for the cardiovascular events in thalassemia major (TM) patients has suggested having iron overload, in addition to other reasons such as hypoxia, abnormal lipoproteins levels, atherosclerotic conditions, etc. This study aims to investigate whether the periodontal health has an impact on the blood lipid levels. Twenty-four TM patients and sex-matched controls (C) enrolled to this study. The measurements of the periodontal parameters (gingival index, plaque index, bleeding on probing, probing depth, and clinical attachment level) were recorded. Besides, in venous blood samples the lipid profile was investigated. All of the periodontal parameters were significantly higher in TM group than in C group (P<0.05). Triglyceride and cholesterol/high density lipoprotein ratio had significant positive correlations with the periodontal parameters (P<0.05). Multiple regression analyses present significant associations between gingival index, plaque index scores, and the cholesterol/high density lipoprotein ratio (P<0.001). Our study results showed that the lipid profile of TM patients might be affected by their periodontal health. Further studies are needed to determine the lipid profile involvement magnitude and the cardiovascular disease risk caused by the periodontal health of TM patients.

Application of chitosan gel in the treatment of chronic periodontitis.

Local administration of antibiotics in periodontal therapy can be provided with an appropriate delivery system. The purpose of this study was to evaluate the clinical effectiveness of chitosan, both as a carrier in gel form and as an active agent in the treatment of chronic periodontitis (CP). The chitosan gel (1% w/w) incorporated with or without 15% metronidazole was prepared and applied adjunctive to scaling and root planing (SRP) in comparison to SRP alone (control group-C), in CP patients. The clinical parameters such as probing depth (PD), clinical attachment level, the amount of gingival recession, plaque index, gingival index, and gingival bleeding time index were recorded at baseline and at weeks 6, 12, and 24. In all groups, significant improvements were observed in clinical parameters between baseline and week 24 (p < 0.05). The reductions in PD values were 1.21 mm for Ch, 1.48 mm for Ch + M, and 0.94 mm for C groups. No complications related to the chitosan were observed in patients throughout the study period. It is suggested that chitosan itself is effective as well as its combination with metronidazole in CP treatment due to its antimicrobial properties.