A Single Dose of Piperacillin Plus Tazobactam Gel as an Adjunct to Professional Mechanical Plaque Removal (PMPR) in Patients with Peri-Implant Mucositis: A 6-Month Double-Blind Randomized Clinical Trial.

OBJECTIVES: This randomized, placebo-controlled, double-masked clinical trial aimed to evaluate the clinical and microbiological efficacy of professional mechanical plaque removal (PMPR) with or without adjunctive application of piperacillin plus tazobactam gel in the treatment of peri-implant mucositis (PiM) for up to 6 months. MATERIALS AND METHODS: The study included 31 patients with peri-implant mucositis (bleeding on probing (BoP) > 1 at at least one site at baseline, absence of peri-implant bone loss compared with a previous radiograph). After randomized assignment to test and control groups, patients received full-mouth supragingival scaling with or without piperacillin plus tazobactam gel. Clinical examination was performed at baseline and after 3 and 6 months, and a microbiological examination was performed at baseline and after 3 months. RESULTS: After six months, both treatment modalities resulted in significant reductions and improvements in clinical parameters at the implant sites. Neither study group achieved a complete resolution of PiM (i.e., BoP ≤ 1 per implant). The number of implants with BoP decreased statistically significantly between subsequent time points (p < 0.001) in both the test and the control group. Significant BoP differences (p = 0.039) were observed between groups at 6 months (difference to baseline) following therapy. CONCLUSIONS: Within the limitations of the present study, the single use of a slow-release, locally applied antibiotic combination of piperacillin and tazobactam gel, adjunctive to PMPR, showed an improvement in clinical variable of implants diagnosed with PiM. The adjunctive treatment resulted in higher BoP reduction when compared to the control, but no significant differences were observed regarding the changes in other clinical and microbiological parameters.

Clinical and Radiological Characterization of the Long-Term Association between Unaffected/Minimally Affected Implants and History of Severe Periodontitis: A Retrospective Study.

OBJECTIVES: The objectives of this research were to compare, retrospectively, the clinical and radiographic modifications of periodontal parameters and peri-implant conditions and to analyze the relationship between the changes in periodontal parameters and peri-implant conditions over a mean follow-up period of 7.6 years in a treated population with progressive/uncontrolled periodontitis and at least one unaffected/minimally affected implant. MATERIALS AND METHODS: Nineteen partially edentulous patients having 77 implants inserted, with a mean age of 54.84 ± 7.60 years, were matched for age, gender, compliance, smoking status, general health, and implant characteristics. Periodontal parameters were evaluated in the remaining teeth. Means per teeth and implants were used when making comparisons. RESULTS: Statistically significant differences were observed between baseline and final examination in teeth for tPPD, tCAL and MBL. Furthermore, at 7.6 years, statistically significant differences existed between implants and teeth with regard to iCAL and tCAL (p = 0.03). Multiple regression analyses were performed and revealed a significant association regarding iPPD and CBL with smoking and periodontal diagnosis. In addition, FMBS was significantly associated with CBL. Unaffected/minimally affected implants were found more frequently in the posterior mandible, with longer lengths (>10 mm) and small diameters (<4 mm), including in screwed multi-unit bridges. CONCLUSIONS: The study results appear to reflect minimally affected mean crestal bone-level loss around implants in comparison to the marginal bone-level loss around teeth when exposed to uncontrolled severe periodontal disease over a mean period of observation of 7.6 years, while the unaffected/minimally affected implants seemed to benefit from a combination of clinical factors, including posterior mandibular position, smaller diameters, and screwed multi-unit restorations.

Anti-Inflammatory and Antioxidant Properties of Carvacrol and Magnolol, in Periodontal Disease and Diabetes Mellitus.

Periodontal disease and diabetes mellitus are two pathologies that are extremely widespread worldwide and share the feature of chronic inflammation. Carvacrol is a phenolic monoterpenoid, produced by a variety of herbs, the most well-known of which is Origanum vulgare. Magnolol is a traditional polyphenolic compound isolated from the stem bark of Magnolia officinalis, mainly used in Chinese medicine. The purpose of this paper is to review the therapeutic properties of these bioactive compounds, in the treatment of periodontitis and diabetes. Based on our search strategy we conducted a literature search in the PubMed and Google Scholar databases to identify studies. A total of one hundred eighty-four papers were included in the current review. The results show that carvacrol and magnolol have anti-inflammatory, antioxidant, antimicrobial, anti-osteoclastic, and anti-diabetic properties that benefit both pathologies. Knowledge of the multiple activities of carvacrol and magnolol can assist with the development of new treatment strategies, and the design of clinical animal and human trials will maximize the potential benefits of these extracts in subjects suffering from periodontitis or diabetes.

The Antioxidant Effect of Curcumin and Rutin on Oxidative Stress Biomarkers in Experimentally Induced Periodontitis in Hyperglycemic Wistar Rats.

BACKGROUND: There is a growing interest in the correlation between antioxidants and periodontal disease. In this study, we aimed to investigate the effect of oxidative stress and the impact of two antioxidants, curcumin and rutin, respectively, in the etiopathology of experimentally induced periodontitis in diabetic rats. METHODS: Fifty Wistar albino rats were randomly divided into five groups and were induced with diabetes mellitus and periodontitis: (1) (CONTROL)-control group, (2) (DPP)-experimentally induced diabetes mellitus and periodontitis, (3) (DPC)-experimentally induced diabetes mellitus and periodontitis treated with curcumin (C), (4) (DPR)-experimentally induced diabetes mellitus and periodontitis treated with rutin (R) and (5) (DPCR)-experimentally induced diabetes mellitus and periodontitis treated with C and R. We evaluated malondialdehyde (MDA) as a biomarker of oxidative stress and reduced glutathione (GSH), oxidized glutathione (GSSG), GSH/GSSG and catalase (CAT) as biomarkers of the antioxidant capacity in blood harvested from the animals we tested. The MDA levels and CAT activities were also evaluated in the gingival tissue. RESULTS: The control group effect was statistically significantly different from any other groups, regardless of whether or not the treatment was applied. There was also a significant difference between the untreated group and the three treatment groups for variables MDA, GSH, GSSG, GSH/GSSG and CAT. There was no significant difference in the mean effect for the MDA, GSH, GSSG, GSH/GSSG and CAT variables in the treated groups of rats with curcumin, rutin and the combination of curcumin and rutin. CONCLUSIONS: The oral administration of curcumin and rutin, single or combined, could reduce the oxidative stress and enhance the antioxidant status in hyperglycemic periodontitis rats.

A qualitative and semiquantitative SEM study of the morphology of the biofilm on root surfaces of human teeth with endodontic-periodontal lesions.

Over the last decades, scanning electron microscopy (SEM) proved to be invaluable for ultrastructural investigation, allowing imaging of the overall appearance and/or specific features of oral biofilms, e.g., microbial colonies and individual cells, glycocalyx, the presence of inorganic products. The aim of this study was the observation and evaluation of the morphology of the biofilm of endodontic-periodontal lesions (EPL) with a modified protocol involving a simplified histologic sample preparation and a low-vacuum SEM examination method. Twenty-one teeth with endodontic-periodontal involvement, extracted for periodontal reasons, were carefully washed with saline, underwent fixation in modified Karnovsky solution and were dehydrated in alcohol series. Samples were examined under low-vacuum SEM. Radicular surfaces were evaluated qualitatively and semiquantitatively for several characteristics, including the presence of bacterial types, the biofilm morphology and the content of root resorptions. Radicular surfaces were divided in four conventional zones Surfaces were evaluated for several characteristics: Presence of bacterial types, biofilm morphology, presence of root resorptions. High-quality images, relevant for endodontic-periodontal biofilms were collected. Continuous, established biofilm was found on all examined surfaces, its detection varying from 19% of the samples on the wall of cemental cone to 52.3% on the radicular surface of the periodontal pocket. Observed microorganisms included cocci, rods an filaments. Spirils and motile bacteria were only accidentally found. SEM investigation of surfaces involved in EPL revealed less surfaces covered by mature biofilm (in only 28.5% of the samples in the 'transition zone'), especially rods and filaments associated with cemental resorptions and calculus. Biofilm elements were better represented in periodontal pockets than in other zones of EPL (detected in up to 81% of the samples). A strong correlation between mature biofilm and the presence of cocci appears on all investigated zones (P<0.01). Microbiota appeared to be morphologically similar in apical and periodontal areas, especially in old EPL.

Changes in clinical and microbiological parameters of the periodontium during initial stages of orthodontic movement in patients with treated severe periodontitis: A longitudinal site-level analysis.

Applying orthodontic braces makes oral hygiene difficult and increases plaque accumulation, frequently resulting in gingival inflammation. In patients with previous severe periodontitis, this inflammation overlaps with the pre-existing inflammatory challenge and can lead to further progression of periodontal attachment loss. The aim of this study was to assess longitudinal site-level changes as mirrored by clinical and microbiological parameters during the initial remodeling of alveolar bone and the periodontal ligament, produced as an effect of light orthodontic forces in adult patients with severe periodontal disease that underwent standard (non-surgical and conventional surgical) periodontal therapy. Thirteen patients with previously treated severe generalized periodontitis were given fixed orthodontic appliances for re-alignment of teeth misaligned or displaced during the course of periodontitis. Before insertion of orthodontic appliances and at 2, 4, and 6 months of treatment, periodontal clinical parameters were recorded in the same deepest residual pocket of at least 3 mm in each patient. The same pocket was sampled at baseline and after 6 months of orthodontic treatment for the frequency of positive detection of Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tanerella forsythia (Tf), Treponema denticola (Td). An average reduction in Pocket Depth by 0.2 mm at the end of the assessment period was identified. The only clinical parameter with statistically significant improvement was bleeding on probing. The frequency of detection of Aa, Pg, Pi, and Tf was not significantly different between baseline and 6 months of treatment, while a marginally significant increase of Td was found. There were no significant differences in the clinical parameters or microflora in the initial phase of orthodontic treatment in patients with reduced periodontal support. By correlating clinical and microbiological data, we concluded that the presence of periopathogens do not negatively influence periodontal health during orthodontic treatment in adult patients treated for severe periodontitis.

A Custom-Made Orthodontic Mini-Implant-Effect of Insertion Angle and Cortical Bone Thickness on Stress Distribution with a Complex In Vitro and In Vivo Biosafety Profile.

BACKGROUND: Orthodontic mini-implant failure is a debatable subject in clinical practice. However, the most important parameter to evaluate the success rate of mini-implant is the primary stability, which is mainly influenced by cortical bone thickness (CBT) and insertion angle. MATERIALS AND METHODS: Three-dimensional finite element models of the maxilla were created and a custom-made, self-drilling, tapered mini-implant was designed. For the pull-out test, 12 simulations were performed, sequentially increasing the thickness of the cortical bone (1, 1.5 and 2 mm) and the insertion angle (30°, 60°, 90°, 120°). For the force analysis, 24 simulations were performed using an experimental orthodontic traction force of 2 N both in the horizontal and vertical axis. RESULTS: Insertion angle and CBT have significant impact on force reaction values (p < 0.05). Cortical bone stress had the lowest value when the mini-implant had a 30° insertion angle and the highest value when the implant had a 120° insertion angle, while the CBT was 1 mm. Cortical bone stress had the lowest value with an insertion angle of 90° and the highest value when the implant was inserted at an angle of 30°, while the CBT was 2 mm independent of the force direction. Regarding the biosafety profile of the mini-implant alloy, the present results reveal that the custom-made mini-implant presents good biocompatibility. CONCLUSIONS: When the CBT is reduced, we recommend inclined insertion while, when the CBT is appropriate, perpendicular insertion is advised.

Association of Vitamin D Receptor Gene Polymorphisms with Chronic Periodontitis in a Population in Western Romania.

PURPOSE: Recent data indicate that gene polymorphisms, e.g. those of vitamin D-receptor (VDR), are associated with an increased susceptibility to chronic periodontitis (CP). This study investigated whether VDR gene polymorphism is associated with chronic periodontitis in a population in Western Romania, by determining the prevalence of the BsmI (rs1544410), ApaI (rs7975232), TaqI (rs731236) and FokI (rs2228570) genotypes and comparing the CP group with a periodontally healthy group. MATERIALS AND METHODS: This case-control study included 53 patients with CP and 47 healthy patients. VDR polymorphisms were genotyped using real-time polymerase chain reaction (PCR). The associations between VDR polymorphisms and CP were determined using logistic regression models, adjusted for patient age and serum level of Vitamin D. RESULTS: We found a statistically significant association between the single nucleotide polymorphism (SNP) rs2228570 (FokI) and CP. Compared with subjects having the Thymine-Thymine (TT) genotype, those with the Cytosine-Cytosine (CC) variant were 19 times more likely to have the disease (adjusted odd ratio [OR]: 19.58; 95% confidence interval [CI]: 2.67 - 198.92) and with the Thymine-Cytosine (TC) variant, 8 times more likely (adjusted OR: 7.86; 95% CI: 1.29 - 61.56). Also, for the SNP rs1544410 (BsmI), compared with the Adenine-Adenine (AA) genotype, the Adenine-Guanine (AG) variant had an increased risk of periodontal disease (crude OR: 3.76; 95% CI: 1.15 - 13.80). CONCLUSION: This case-control study of a Western Romanian population shows an association between vitamin D receptor (VDR) polymorphisms (FokI and BsmI) and CP susceptibility.

Interaction between a 3D collagen matrix used for periodontal soft tissue regeneration and T-lymphocytes: An in vitro pilot study.

Previous experimental models showed that activation of the immune system, particularly T cells, is required for optimal healing following wounds or surgery in the oral cavity. Therefore, studies to explore the interactions between the immune system and the collagen matrix are mandated. The specific aim of the present study was to analyze the interactions between T lymphocytes and a resorbable three-dimensional (3D) collagen matrix routinely used for soft tissue regeneration during periodontal surgery. Peripheral venous blood samples were collected from five patients. Following Ficoll-Paque separation, mononuclear cells were grown on fully resorbable 3D collagen matrices for 5 days. Lymphocytes were analyzed by flow cytometry for different surface markers, including CD4, CD8, CD38 and CD69. Cell viability and late apoptosis/necrosis were assessed in each group using an apoptosis assay based on Annexin V/propidium iodide staining. After 5 days in contact with the collagen matrix, the T cells expressed different surface markers. The overall T cell population increased significantly in the collagen matrix group compared to the respective controls (31.9±6.5 vs. 38.7±3.8%). CD8 and CD69 also increased significantly compared to their controls (CD69: 19.7±3.0 vs. 27.1±4.5% for collagen vs. control groups). At the same time, CD4 and CD38 expression was similar in both groups. Viability and apoptosis/necrosis were also identical in the samples and controls. These results show that the interaction between the collagen matrix and the immune cells stimulated activation of T cells and did not impair the healing process.

Hyaluronic Acid/Bone Substitute Complex Implanted on Chick Embryo Chorioallantoic Membrane Induces Osteoblastic Differentiation and Angiogenesis, but not Inflammation.

Microscopic and molecular events related to alveolar ridge augmentation are less known because of the lack of experimental models and limited molecular markers used to evaluate this process. We propose here the chick embryo chorioallantoic membrane (CAM) as an in vivo model to study the interaction between CAM and bone substitutes (B) combined with hyaluronic acid (BH), saline solution (BHS and BS, respectively), or both, aiming to point out the microscopic and molecular events assessed by Runt-related transcription factor 2 (RUNX 2), osteonectin (SPARC), and Bone Morphogenic Protein 4 (BMP4). The BH complex induced osteoprogenitor and osteoblastic differentiation of CAM mesenchymal cells, certified by the RUNX2 +, BMP4 +, and SPARC + phenotypes capable of bone matrix synthesis and mineralization. A strong angiogenic response without inflammation was detected on microscopic specimens of the BH combination compared with an inflammatory induced angiogenesis for the BS and BHS combinations. A multilayered organization of the BH complex grafted on CAM was detected with a differential expression of RUNX2, BMP4, and SPARC. The BH complex induced CAM mesenchymal cells differentiation through osteoblastic lineage with a sustained angiogenic response not related with inflammation. Thus, bone granules resuspended in hyaluronic acid seem to be the best combination for a proper non-inflammatory response in alveolar ridge augmentation. The CAM model allows us to assess the early events of the bone substitutes⁻mesenchymal cells interaction related to osteoblastic differentiation, an important step in alveolar ridge augmentation.

Changes in anatomic position of root canal orifices in pluriradicular teeth following re-location during endodontic treatment.

Direct access to the root canals in posterior teeth for endodontic treatment is most frequently facilitated by the straightening of the coronal parts of the root canals, having as a consequence the relocation of the canal orifices on the map of the floor of the pulp chamber (Christie and Thompson, 1994). This procedure intentionally moves the coronal aspect of a canal away from the center of the chamber, while simultaneously removing internal dentin from the pulp chamber walls. The aim of this study was to evaluate the displacement resulting from the relocation of root canal orifices during the initial phase of rotary root canal treatment in molars using the dental operating microscope (DOM) and digital image processing. Forty-three molars (17 maxillary and 26 mandibular) belonging to 43 patients (aged 18-62 years) with indications for root canal treatment were endodontically treated. The differences between the initial perimeter and the perimeter of the root canal orifices polygon after relocation varied between 2.7 and 3.4µm (mean 3.0µm), while the differences between the initial area and the area after relocation varied between 2,448,456.8 and 3,249,306.6µm2 (mean 2,848,881.7). The increase in access to the cavities and the alterations of the pulp chambers can be satisfactorily approximated by the variations of the perimeters and areas of the pulp floor polygons during root canal treatment. From a clinical perspective, these results indicate that there is a significant decrease in tooth substance in molars (except MB2).

Evaluation of oral keratinocyte progenitor and T-lymphocite cells response during early healing after augmentation of keratinized gingiva with a 3D collagen matrix - a pilot study.

BACKGROUND: The aim of the present study is to analyze the behavior of selected populations of oral keratinocytes and T-lymphocytes, responsible for re-constructing and maintaining the oral epithelial tissue architecture, following augmentation of the keratinized oral mucosa using a 3D-collagen matrix. METHODS: Different groups of oral keratinocytes were isolated from biopsies harvested from 3 patients before the surgical procedure, as well as 7 and 14 days after the augmentation procedure. T-lymphocytes were isolated from peripheral blood at same timepoints. Keratinocytes were characterized for stem and differentiation markers, such as p63, cytokeratin 10 and 14, and in vitro parameters, such as cell viability, cell size and colony-forming efficiency. T-lymphocytes were analyzed for viability and the expression of various cluster of differentiation markers. The methods included magnetic separation of cell populations, immunofluorescence, flow cytometry, and histology of oral biopsies. RESULTS: Both at 7 and 14 days, the majority of cells that repopulate the matrix were actively proliferating/progenitor oral keratinocytes with the phenotype integrin alfa6beta4 + CD71+. These cells display in vitro characteristics similar to the progenitor cells analyzed before the matrix placement. T-lymphocytes expressed CD8 and CD69 markers, while CD25 was absent. CONCLUSION: The study shows that two weeks after the collagen membrane placement, the healing process appeared to be histologically complete, with no abnormal immune response induced by the matrix, however, with a higher than usual content of active proliferating cells, the majority of keratinocytes being characterized as transit amplifying cells.

Short-Term Results in Evaluating a Gingiva-Adhesive Hydrophobic-Chlorhexidine-Gel for Chronic Periodontitis.

BACKGROUND AND AIMS: Oral mucosa and interproximal spaces of the teeth could favor the colonization of periodontopathogenic bacteria, which could be targeted by chemical antiplaque agents such as chlorhexidine, present in different oral hygiene products, thus improving the control of biofilm growth and delaying microbial accumulation. The study aimed to evaluate whether the use of a hydrophobic gel with good gingival adhesion for 14 days after the scaling and root planing of patients with chronic periodontitis would improve the treatment outcome, when compared with the use of a regular hydrophyllic gel. MATERIAL AND METHODS: Patients with moderate disease were included in two study groups. At baseline and 3 months after the treatment the following parameters were recorded: pocket depth, Approximal Plaque Index, Modified Gingival Index, Simplified Oral Hygiene Index, bleeding on probing. Patients received scaling and root planing in two sessions at 24 hours interval. After the treatment, patients in the test group applied the hydrophobic adhesive chlorhexidine gel once a day, every other day, while in the control group the gel was used twice daily. RESULTS: Both treatments resulted in significant improvement in all clinical indices, except Approximal Plaque Index, which deteriorated significantly in both groups. Three months after mechanical treatment, the mean probing depth changed in the test group from 4.16±0.45 mm to 2.80±0.42 mm, and in the control group from 4.16±0.30 to 2.69±0.19. CONCLUSIONS: Both adjunctive anti-infective therapies induced clinical improvement 3 months from baseline. The differences between the two treatments were not statistically significant.