The effect of different treatment protocols with diode laser on regeneration in axonetmesis injuries of the inferior alveolar nerve: an animal study.

The inferior alveolar nerve can be damaged during dental procedures, leading to symptoms, such as tingling, numbness, and reduced quality of life. Recovery depends on factors such as medications, surgery, and photobiomodulation therapy. Photobiomodulation therapy has shown the potential to improve nerve function and reduce regeneration time; however, there is no standard treatment protocol yet. This study aimed to examine the effect of diode lasers on nerve regeneration in patients with axonetmesis injuries. In this experiment on animals, Wistar rats' damaged sensory systems were treated with lasers to restore them. Animals were randomly divided into six groups: a sham group, a control group, and four laser treatment groups(1st group: performed every day, 10 sessions; 2nd group: performed every 2 days, 10 sessions; 3rd group: performed every day, 20 sessions; and 4th group: performed every 2 days, 20 sessions). Sensory function was determined using the Semmes-Weinstein monofilament test, which was repeated after the surgical procedure. The results showed that the 20-session group had the best improvement, most closely resembling the group without sensory test damage. The histomorphometric results showed that the number of axons was significantly lower in the group that received 10 daily sessions and in the control group than in the undamaged nerve. Axon diameter was lower in all groups than in the sham group. In conclusion, the remarkable aspect of this study is that consecutive-day 20-session laser treatment showed better improvement than the over-the-day 20-session treatment protocol.

Anti-inflammatory and pro-regenerative effects of a monoterpene glycoside on experimental periodontitis in a rat model of diabetes.

OBJECTIVE: Paeoniflorin (Pae) is a monoterpene glycoside with immune-regulatory effects. Several studies have already demonstrated the impact of Pae on periodontitis, but its effect on diabetic periodontitis is unclear. In this study, our aim was to test the hypothesis that Pae had a strong anti-inflammatory effect that prevented bone loss in diabetic periodontitis. METHODS: Thirty male Wistar albino rats were randomly divided into control (healthy, n = 10), periodontitis (PD) + diabetes (DM; n = 10), and PD + DM + Pae (n = 10) groups. Ligature-induced periodontitis was created by placing 4-0 silk ligatures around the lower first molars on both sides of the mandibulae. Experimental DM was created via an injection of 50 mg/kg and streptozotocin (STZ). Hyperglycemia was confirmed by the blood glucose levels of rats (>300 mg/dL). The bone mineral density (BMD), trabecular number, trabecular thickness, and bone loss were measured by micro-CT. The expression levels of IL-1ß, IL-6, and TNF-α were measured in tissue homogenates by ELISA. RESULTS: The PD + DM + Pae group had significantly less alveolar crest resorption when compared to the PD + DM group. There was also a significant difference between the PD + DM + Pae group compared to PD + DM group in trabecular thickness, BMD, and the number of trabeculae. Pae application led to a statistically significant decrease in IL-1ß, IL-6, and TNF-α levels in diabetic periodontitis. CONCLUSION: Systemic application of Pae suppressed inflammation caused by PD and DM, leading to reduced bone loss and enhanced bone quality.

Effect of Photobiomodulation Therapy on Peri-Implant Bone Healing in Extra-Short Implants in a Rabbit Model: A Pilot Study.

Objective: To evaluate the effects of photobiomodulation therapy (PBMT) at distinct energy levels on peri-implant bone healing in extra-short implants in a experimental rabbit model. Background: The effect of PBMT on peri-implant bone healing in short implants remains unclear. This explored the effect of PBMT on extra-short implants in terms of bone-implant contact (BIC) length and rate, and implant stability quotient (ISQ). Methods: Fifteen white New Zealand rabbits were randomly divided into five groups. In all groups, extra-short implants (3.5 × 4 mm; Nucleoss T6, Izmir/Turkey) were placed in both tibias of the rabbits. PBMT was performed in four groups (group 1, 5 J/cm2; group 2, 10 J/cm2; group 3, 20 J/cm2; and group 4, 25 J/cm2); no PBMT was performed in the control group. On the 30th day, the rabbits were sacrificed and peri-implant tissue samples were obtained to determine the BIC length and BIC rate. Implant stability levels were measured by resonance frequency analysis using the Osstell penguin device and were determined as ISQ values on the 1st and 30th days of the study. Results: PBMT significantly increased the BIC length and BIC rate in groups 3 and 4 (p < 0.001). For the ISQ values, there were significant differences between the 1st and 30th day (p < 0.001). On the 30th day, the ISQ values were significantly higher in groups 3 and 4 compared with the remaining groups (p < 0.001). Conclusions: In this study, PBMT improved peri-implant bone healing through increase in BIC length, BIC rate, and ISQ parameter values in extra-short implants.

The clinical and systemic effects of periodontal treatment in diabetic and non-diabetic obese patients.

The purpose of the present study was to evaluate the response to periodontal management in obese individuals with poorly controlled diabetes mellitus (DM) and obese individuals without DM. Changes in clinical and biochemical parameters were also investigated. Seventeen obese patients with poorly controlled DM and 14 obese non-DM patients with generalized chronic periodontitis were enrolled. The anthropometric measurements, periodontal parameters, and serum levels of lipid (triglyceride, high-density lipoprotein cholesterol, total cholesterol, low-density lipoprotein cholesterol) and glucose (fasting plasma glucose [FPG], insulin, insulin resistance [IR], hemoglobin [Hb]A1c) metabolism, pro-inflammatory mediators (high-sensitivity C-reactive protein, tumor necrosis factor-α [TNF-α] and Pentraxim-3), and interleukin-6 were measured before and at 3 months, and 6 months after full-mouth scaling and root planing (FM-SRP) together with full-mouth disinfection (FMD). A significant reduction in TNF-α (P < 0.001) values was observed in both groups following periodontal healing. However, significant changes in FPG (P < 0.05), HbA1C (P < 0.05), and the homeostasis model assessment of IR (HOMA-IR; P < 0.05) were only observed after 3 months in the DM group. Our findings suggest that obesity with or without DM does not seem to be a modifying factor for the clinical outcome of FM-SRP and FMD.(J Oral Sci 58, 523-531, 2016).

An ignored cause of inflammation in patients undergoing continuous ambulatory peritoneal dialysis: periodontal problems.

AIM: We aimed to assess whether there is a significant relation between periodontal health status and inflammation in uremic patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and also to reveal the efficiency of periodontal treatment in patients with various degrees of periodontal problems. PATIENTS AND METHODS: Overall, 68 patients undergoing CAPD were included in the study. Clinical indices and measurements were obtained at baseline and panoramic radiographies were used for the diagnosis. According to the baseline values, patients were stratified into four groups according to the severity of periodontal problems as follows: healthy/gingivitis, slight-to-moderate, and severe periodontitis. A control examination was performed 3 months after the periodontal treatment for only 43 patients. Clinical and laboratory parameters before and after treatment were compared. RESULTS: The frequency of periodontal disease was found to be high in uremic patients on CAPD. The frequency and severity of periodontitis was also found to be significantly (p < 0.01) higher in patients with high sensitive C-reactive protein levels and longer duration of peritoneal dialysis (p < 0.01). In addition, the periodontitis rate was found to be higher in patients with cardiovascular disease (p < 0.05) and diabetes mellitus (p < 0.01). CONCLUSION: A meticulous periodontal examination should be a routine part of management of the uremic patients on CAPD because periodontal disease could be one of the hidden sources of unexplained inflammatory status.

Generalized Aggressive Periodontitis in a Patient With Nephrotic Syndrome Associated With Primary Renal Amyloidosis: A Case Report.

INTRODUCTION: Renal amyloidosis may lead to renal disease, and then nephrotic syndrome may develop. To the best of the authors' knowledge, this is the first case report in which a patient presents with generalized aggressive periodontitis (GAgP) and nephrotic syndrome in conjunction with renal amyloidosis. CASE PRESENTATION: An 18-year-old male presented to the periodontology department for generalized gingival recessions. He was diagnosed as having primary renal amyloidosis by his physician. The patient presented with severe gingival inflammation and alveolar bone loss. Biochemical tests were within normal limits except for serum albumin level. No amyloid deposition was found in a gingival biopsy, and the patient was diagnosed as having GAgP. Non-surgical periodontal treatment, in combination with antibiotic treatment, was performed. After 3 years, his systemic and periodontal conditions showed deterioration. CONCLUSIONS: The effects of systemic factors related to nephrotic syndrome in conjunction with renal amyloidosis and deterioration in oral hygiene may play a significant role in the progression of periodontal disease. Even if there is no amyloid deposition in periodontal tissues, clinicians should consider that nephrotic syndrome associated with systemic amyloidosis may provide an important contribution to the periodontal breakdown by the modifying conditions that affect the host response to the accumulation of dental biofilm.

Changes in inflammatory and metabolic parameters after periodontal treatment in patients with and without obesity.

BACKGROUND: Non-surgical periodontal treatment decreases serum levels of inflammatory cytokines in patients with and without obesity. However, the changes in metabolic parameters in association with these decreases in levels of inflammatory markers by periodontal treatment have not been evaluated in patients with obesity. The aim of this study is to evaluate the short-term changes in systemic inflammatory, lipid, and glucose parameters in the presence of obesity after periodontal treatment. METHODS: The study included 22 dyslipemic patients with obesity and 24 healthy individuals without obesity with generalized chronic periodontitis. The periodontal parameters, anthropometric measurements, and serum levels of triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and lipoprotein-a, high-sensitive C-reactive protein, fasting blood glucose, insulin, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and leptin were measured. A homeostasis model assessment of the insulin resistance (HOMA-IR) score was calculated before and 3 months after non-surgical periodontal treatment. RESULTS: Both groups responded well to the periodontal treatment in terms of periodontal parameters. The treatment was also associated with a decrease in serum TNF-α and IL-6 levels and HOMA-IR scores in individuals with obesity and with a decrease in IL-6 levels in patients without obesity. Conversely, there were insignificant decreases in lipid profiles and serum fasting glucose of patients with obesity. CONCLUSION: The non-surgical periodontal treatment causes a decrease in the levels of some circulating proinflammatory cytokines and may be associated with a decrease in insulin resistance in the obese population.

Turkish dental students' and dentists' ability to assess gingival health status with DAAGS software.

The aim of this study was to compare the ability of final-year Turkish dental students and dentists to assess the level of gingival health status by using the Development of Ability to Assess Gingival Status (DAAGS) computer program. Forty-eight students in their final year of dental education and 240 dentists participated in DAAGS tests in which they judged twenty-four photos. The participants were organized into one group of students and five groups of dentists: those who graduated in the last five years, in the last six to ten years, in the last eleven to fifteen years, in the last sixteen to twenty years, and twenty and/or more years ago. A gold standard of each photo was shown to participants after they completed test 1; then, test 2 was conducted immediately. Participants were asked to evaluate the DAAGS by written survey. There were significant differences between the parameters of two tests for all groups. Significance levels differed for each group and both tests considering correct answers, reproducibility, irrelevant answers, and overall ability. The findings from this study indicated that the DAAGS software is easier for more recently graduated dentists to use.

Interventions for cleaning dentures in adults.

BACKGROUND: Removing denture plaque may be essential for maintaining the oral health of edentulous people. Brushing and soaking in chemical products are two of the most commonly used methods of cleaning dentures. OBJECTIVES: To evaluate the effectiveness and safety of different methods for cleansing removable dentures. SEARCH STRATEGY: We searched the following databases: the Cochrane Oral Health Group Trials Register (to May 2009); CENTRAL (The Cochrane Library 2009, Issue 2); MEDLINE (1965 to May 2009); EMBASE (1980 to May 2009); LILACS (1980 to May 2009); and CINAHL (1997 to May 2009). There were no language restrictions. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing any mechanical method (e.g. brushing or ultrasound) or chemical (e.g. enzymes, sodium hypochlorite, oral rinses or peroxide solutions) in adults over the age of 18 wearing removable partial dentures or complete dentures.The primary outcomes considered were the health of denture bearing areas (soft tissues, periodontal tissues and teeth) and participants' satisfaction and preference. Secondary outcomes included denture plaque coverage area, indicators of halitosis and microbial counts on abutment teeth, soft tissues or denture base or saliva. DATA COLLECTION AND ANALYSIS: Two independent review authors screened and extracted information from, and independently assessed the risk of bias in the included trials. MAIN RESULTS: Although six RCTs were included in this review, the wide range of different interventions and outcome variables did not permit pooling of data in a meta-analysis. Isolated reports indicated that chemicals and brushing appear to be more effective than placebo in the reduction of plaque coverage and microbial counts of anaerobes and aerobes on complete denture bases. AUTHORS' CONCLUSIONS: There is a lack of evidence about the comparative effectiveness of the different denture cleaning methods considered in this review. Few well designed RCTs were found. Future research should focus on comparisons between mechanical and chemical methods; the assessment of the association of methods, primary variables and costs should also receive future attention.

Dental students' ability to assess gingival health status with DAAGS software.

The aim of this study was to evaluate the ability of dental students at different levels of education (Basic, Preclinic, and Clinic groups) to assess the level of gingival health status by using the Development of Ability to Assess Gingival Status (DAAGS) computer software program designed according to the Oral Rating Index (ORI) criteria. Two hundred and thirteen dental students at three levels of dental education voluntarily participated in three DAAGS tests in which they judged twenty-four photos. The three groups were first- and second-year dental students (Basic), third- and fourth-year dental students who had not yet participated in the clinical periodontology course (Preclinic), and fifth-year dental students who had completed the clinical periodontology course (Clinic). A gold standard of each photo was shown after completing Test 1, and then Test 2 was conducted immediately. Two weeks later, the third test was performed. Analyses of differences among the groups and between the tests for each groups were carried out by using Kruskal-Wallis and Wilcoxon Sign Rank tests, respectively. Students were asked to evaluate the DAAGS by written survey. Most of the students had a positive opinion. There were significant differences among the groups for correct and irrelevant answers and overall ability (p<0.001). The Basic group showed a significant (p<0.01) improvement between Test 1 and Test 2. This improvement was greater than Preclinic students and almost equal to Clinic students. The findings from this study indicate that the DAAGS software can serve as a useful instructional tool for education.

Short-term side effects of 0.2% alcohol-free chlorhexidine mouthrinse used as an adjunct to non-surgical periodontal treatment: a double-blind clinical study.

BACKGROUND: The aims of this clinical study were to evaluate the short-term subjective (by means of questionnaire) and objective (by means of clinical examination) side effects of 0.2% chlorhexidine (CHX) mouthrinse without alcohol used as an adjunct to non-surgical periodontal treatment and to elucidate the relationship between the subjective and objective evaluations. METHODS: This was a randomized, double-blind, placebo-controlled clinical trial with two groups: 1) the test group, rinsing with the test product (0.2% CHX without alcohol) twice per day for 1 week, and 2) the control (placebo) group, rinsing with a placebo solution twice per day for 1 week. Following the start of rinsing, patients were subjectively and objectively evaluated for the presence and severity of side effects (pain, burning sensation, pruritus, dryness of mouth, taste disturbance, mucosal irritations, and discoloration of tooth and tongue surfaces) at days 1, 3, and 7 of the rinsing period. The presence of subjective and objective side effects of the groups was compared via use of chi2 and Fisher exact tests. Analysis of the subjective and objective side effects within the evaluation periods was done by McNemar test. Spearman correlation analysis was used to assess the relationships between the subjective and objective side effects. RESULTS: None of the patients in either group complained of dryness of the mouth. The most commonly reported side effect was the change in color of the labial and buccal mucosa, particularly of the gingiva, after day 3 of rinsing. There were significant (r=0.308 to 0.835; P<0.05) correlations between the discolorations of tongue and tooth surfaces reported by the patients and clinically detected at all evaluation periods. There was a significant and positive relationship between the subjective side effects and the soft tissue irritations when the duration of rinsing increased. CONCLUSION: Within the limits of this clinical evaluation, rinsing with 0.2% alcohol-free CHX for 1 week caused more irritation to oral mucosa, greater burning sensation, and increased altered taste perception compared to the placebo rinse.

Alterations in gingival dimensions following rapid canine retraction using dentoalveolar distraction osteogenesis.

The aim of this clinical prospective study was to evaluate the alterations that occurred in the gingival dimensions of canine teeth following dentoalveolar distraction (DAD) during a 12 month follow-up period.The study sample comprised 36 maxillary canines of 18 growing or adult subjects with a mean age of 16.94 years (13.08-25.58 years) at the start of treatment. Full retraction of the canines was achieved in 10.36 +/- 1.93 days (range 8-14 days) at a rate of 0.8 mm/day using a custom-made intraoral rigid tooth-borne distraction device. Before surgery (pre-DAD), immediately after removal of the device (post-DAD), and at 1, 6, and 12 months post-DAD, the plaque index (PI), gingival index (GI), pocket depth (PD) and width of keratinized gingiva were recorded and the width of attached gingiva was calculated. The alterations in clinical measurements among different evaluation periods were analysed by Friedman and repeated measure ANOVA tests. There were significant differences between pre- and post-DAD for PD measurements for all sites, with the highest at the distal site. The palatal sites likewise showed significant differences at the 1, 6, and 12 month follow-up periods compared with the post-DAD period. The buccal sites showed no significant changes at any time point. The width of keratinized gingiva also showed no significant change during the follow-up period, while the width of attached gingiva was significant only between the pre- and post-DAD periods (P < 0.01). On the basis of the above findings, it could be concluded that DAD is an innovative technique with no unfavourable long-term effects on the gingival tissues of rapidly retracted canine teeth.

Distribution of different morphologic types of subgingival calculus on proximal root surfaces.

OBJECTIVES: To evaluate the distribution of morphologic types of subgingival calculus at different parts of the proximal root surface. METHOD AND MATERIALS: Ninety extracted teeth from 29 chronic periodontitis patients were collected. The mean pocket depths and periodontal attachment levels of the extracted teeth were 5.93 +/- 1.51 mm and 7.82 +/- 1.75 mm, respectively. The proximal root surfaces below the gingival margin were divided into three parts in an apicocoronal direction, and each of these portions was further divided into three parts in a buccolingual direction. Subgingival calculus present was classified as: 1 = crusty, spiny, or nodular; 2 = ledge or ring; 3 = thin, smooth veneers; 4 = finger- or fernlike; 5 = individual calculus islands/spots; or 6 = supramarginal upon submarginal deposits. The distribution of different morphologic types of subgingival calculus on each division of the mesial and distal proximal root surfaces was evaluated with a magnifier. RESULTS: Regardless of the morphologic type, calculus deposits were observed at around 30% of proximal root surfaces. The coronal thirds of the root surfaces were found to have significantly more calculus deposits than the middle thirds (P < .05). In general, it was observed that most of the deposits were of the thin, smooth veneer type on all root surfaces. CONCLUSION: Within the limits of this study, the distribution of various calculus types was similar on different parts of the root surface; however, calculus was found more frequently on the coronal thirds than on the more apical regions.

Alterations in location of the mucogingival junction 5 years after coronally repositioned flap surgery.

BACKGROUND: The aim of this clinical study was to evaluate whether the mucogingival junction (MGJ) reverts back towards its original location following coronally repositioned flap (CRF) procedure over a 5-year follow-up period. METHODS: Thirteen systemically healthy patients with 26 Miller Class I buccal gingival recessions were treated using the CRF technique. At baseline, and 1, 6, 12, and 60 months after surgery, location of gingival margin (LGM), probing depth (PD), clinical attachment level (CAL), width of keratinized gingiua (WKG), and location of mucogingival junction (LMGJ) were recorded. The alterations in the clinical measurements at the different evaluation times were analyzed using the Friedman and the repeated measure analysis of variance (ANOVA) tests, where applicable. Degree of association between continuous variables was calculated by the Pearson's correlation coefficient. RESULTS: The mean percentage of root coverage obtained at the end of 1 month was 68.26% +/- 30.37% (P<0.05) and at 60 months, it was reduced to 44.86% +/- 33.91% (P<0.01). LGM (r=0.592, P<0.001), CAL (r=0.590, P<0.01), WKG (r=0.442, P<0.05), and LMGJ (r=0.653, P<0.001) were found to be significantly correlated with the 60-month postoperative values of LMGJ. At the end of the 60-month follow-up period, the mean apical displacement of LGM was 0.67 +/- 0.72 mm and the same mean apical displacement value for LMGJ was 0.98 +/- 1.19 mm. CONCLUSIONS: Within the limits of this study, the 60-month follow-up findings indicated that the CRF procedure failed to maintain the gingival tissue in a coronal position and that the observed movement of the MGJ back to its original position was partially dependent on the apical movement of gingival margin.

Evaluation of non-surgical periodontal treatment using 2 time intervals.

BACKGROUND: The aim of the present study was to evaluate the effectiveness of non-surgical mechanical instrumentation at 2 different time intervals on short-term healing and to assess patient reactions following non-surgical periodontal therapy. METHODS: The study population consisted of 100 patients with moderate periodontal disease. Patients were equally distributed into 2 groups, treated daily or weekly. The daily group received full-mouth daily scaling and root planing for 4 consecutive days. The weekly group was treated once a week for 4 weeks. All patients were asked for objective (lymphadenopathy, aphthous stomatitis, and edema) and subjective (fatigue, pain, pruritus, burning sensation, and dentinalgia) reactions. Clinical measurements of plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing (BOP), and gingival recession (GR) were taken at baseline and 3 months after treatment. All of the objective and subjective reactions were recorded after each treatment session. RESULTS: The results of our study revealed a significant decrease in PI, GI, BOP, and PD measurements at the end of the third month, but no significant changes in GR. The incidence of subjective and objective reactions was higher in the daily treated group compared to those in the weekly group. Most of these complaints were observed after the third treatment session. CONCLUSIONS: Within the limits of this study, no differences were observed between the study groups when the clinical parameters were evaluated. However, taking the subjective and objective reactions into consideration, the smallest time interval for non-surgical periodontal procedures might be 1 week.