Air powder waterjet technology using erythritol or glycine powders in periodontal or peri-implant prophylaxis and therapy: A consensus report of an expert meeting.

OBJECTIVES: To attain a collective expert opinion on the use of air powder waterjet technology (APWT) with erythritol and glycine powders in the prophylaxis and therapy of periodontal and peri-implant diseases. MATERIAL AND METHODS: In the first step, a modified one-round online Delphi survey including 44 five-point Likert scale questions was conducted among a group of 10 expert clinicians and researchers with thorough knowledge and experience in this topic. In the second step, the single questions and the survey results were discussed during a meeting, and consensus statements were formulated, respectively. RESULTS: An agreement was reached on most items, especially opinions supporting glycine and erythritol powders as favorable with respect to efficiency, safety, and comfort. More scientific evidence is needed to support the improvement in clinical attachment on teeth and implants, especially when APWT with erythritol is used. In addition, APWT needs more long-term evaluation and studies in terms of microbiome/microbiological effects as well as effects on the inflammatory response on natural teeth and implants, also in light of a guided biofilm therapy concept. CONCLUSIONS: In line with the expert opinions and supported by the evidence, it was concluded that the use of APWT with erythritol and glycine powders in nonsurgical periodontal and peri-implant therapy and prophylaxis is patient compliant and efficient.

Effect of Low-Level Laser Irradiation (810 nm) on the Proliferation and Differentiation of Osteoblast-Like Cells Cultured on SLA Titanium Discs Exposed to a Peri-implantitis Environment.

Introduction: Elimination of inflammation and re-osseointegration are the major objectives of peri-implantitis therapy. Existing data, however, do not support any decontamination approach. Thus, the present in vitro study aims to assess whether the air-debriding decontamination method with erythritol powder restores the biocompatibility of infected titanium discs and to investigate the potent biomodulatory ability of diode laser (810 nm) irradiation to promote cell proliferation and differentiation of premature osteoblast-like cells (MG63) towards osteocytes. Methods: The experimental groups consisted of cells seeded on titanium discs exposed or not in a peri-implantitis environment with or without biomodulation. Infected discs were cleaned with airflow with erythritol powder. Cell cultures seeded on tricalcium phosphate (TCP) surfaces with or without biomodulation with a laser (810 nm) were used as controls. The study evaluated cell viability, proliferation, adhesion (SEM) at 24, 48 and 72 hours, and surface roughness changes (profilometry), as well as the effects of low-level laser therapy (LLLT) on ALP, OSC, TGF-b1, Runx2, and BMP-7 expression in MG63 cells' genetic profile on days 7, 14, and 21. Results: The MTT assay as well as the FDA/PI method revealed that cell proliferation did not show significant differences between sterile and decontaminated discs at any timepoint. SEM photographs on day 7 showed that osteoblast-like cells adhered to both sterile and disinfected surfaces, while surface roughness did not change based on amplitude parameters. The combination of airflow and LLLT revealed a biomodulated effect on the differentiation of osteoblast-like cells with regard to the impact of laser irradiation on the genetic profile of the MG63 cells. Conclusion: In all groups tested, osteoblast-like cells were able to colonize, proliferate, and differentiate, suggesting a restoration of biocompatibility of infected discs using airflow. Furthermore, photomodulation may promote the differentiation of osteoblast-like cells cultured on both sterile and disinfected titanium surfaces.

Systemic inflammatory markers following adjunctive Nd:YAG (1064 nm) laser irradiation to step 2 of periodontal therapy: a 12-month, randomized, controlled trial.

OBJECTIVES: The aim of this study was to investigate whether the use of adjunctive Nd:YAG (1064 nm) laser irradiation to full-mouth scaling and root planing (FM-SRP) may offer additional benefit in the systemic inflammatory status of the patient, as depicted in a variety of systemic biomarkers over FM-SRP alone, up to 12 months after treatment. MATERIALS AND METHODS: A total of 60 otherwise healthy stage III/IV periodontal patients were equally distributed in 3 groups. The control group received FM-SRP. In laser A group, 1 week after FM-SRP, Nd:YAG laser irradiation was delivered in periodontal pockets with PD ≥ 4 mm using specific settings (3 W, 150 mJ, 20 Hz, 100 µs). In laser B group Nd:YAG laser irradiation was delivered twice, 1 week after FM-SRP and 1 week later with different settings compared to laser A (2 W, 200 mJ, 10 Hz, 100 µs). RESULTS: A significant reduction (p = 0.038) of IL-1ß serum levels at the 6-month time point was observed for laser A group. IL-6 was found statistically significantly increased (p = 0.011) in the control group at the 6-week time point, whereas no difference was reported for the laser-treated groups (laser A, laser B). CONCLUSIONS: The adjunctive use of Nd:YAG laser irradiation, prevented from IL-6 increase after FM-SRP, 6 weeks after treatment. Similarly, Nd:YAG laser irradiation (3 W, 150 mJ, 20 Hz,100 µs) was associated with significantly lower IL-1ß levels, 6 months post-operatively. CLINICAL RELEVANCE: Additional Nd:YAG laser application to FM-SRP may provide a potential beneficial effect on systemic inflammation. TRIAL REGISTRATION NUMBER: ISRCTN26692900. REGISTRATION DATE: 09/06/2022.

Free titanium particles and P. gingivalis lipopolysaccharide create a potentially synergistical effect in a periimplantitis model.

OBJECTIVE: Our aim was to examine the effect of titanium particles and lipopolysaccharide (LPS) from P. gingivalis on the inflammatory profile expression of human gingival fibroblasts (hGFs), cultured on rough titanium discs, in an in vitro peri-implantitis simulation. DESIGN: Human gingival fibroblasts cultured on SLA and TCP surfaces were challenged with LPS, titanium particles or both. At 24, 48 and 72 h after treatment, MTT assay was performed to assess cell proliferation. FDA/PI staining was performed for the same time periods, in order to evaluate cell viability/apoptosis. At 5 and 7 days after the treatment, qPCR was performed to assess gene expressions of IL-6, IL-8 and COL1A1, as well as SEM on titanium discs. RESULTS: All groups presented a significant increase of their population between the time periods of examination. Regarding the interleukin gene expression, the combination of LPS and particles significantly increased the levels of Interleukin-8. Treatment with LPS and particles also induced a significant increase of Interleukin-6 and collagen. FDA/PI microscopy has revealed several apoptotic cells in the treatment groups. SEM micrographs have shown the difficulty of hGFs to adhere on rough surfaces. CONCLUSIONS: The combination of titanium particles and LPS significantly upregulated the expression of IL-6, IL-8 and Col-1a. It appears that particles may arouse similar reactions to the endotoxin, while synergistically intensifying it.

Adjunctive Nd:YAG laser irradiation in the treatment of stage III/IV periodontitis: a 12-month, randomized, controlled trial.

OBJECTIVES: The aim of this study was to evaluate the clinical efficacy of the adjunctive use of Nd:YAG laser (1064 nm) to full-mouth scaling and root planning (FMS), in stage III/IV periodontitis patients. MATERIALS AND METHODS: Sixty stage III/IV periodontitis patients were randomly assigned to three groups. The control group received FMS, laser 1 group received combined FMS/single Nd:YAG laser irradiation (3 W, 150 mJ, 20 Hz,100 µs), and laser 2 group received combined FMS/double Nd:YAG laser irradiation with 1-week interval (2.0 W, 200 mJ, 10 Hz, 100 µs). PD, CAL, FMPS, GI, FMBS, and GR were evaluated at baseline, 6 weeks, 3, 6, and 12 months after treatment. Patient-reported outcomes were evaluated 1 week after treatment. RESULTS: A significant improvement (p < 0.001) for all clinical parameters was observed during the entire study period, with the exception of mean CAL gain for the laser 2 group at 12 months. The percentage of pockets ≤ 4 mm was significantly higher compared to baseline for all groups throughout the study, with no inter-group differences at any time point. Patient-reported analgesic consumption was higher for laser 1 group. CONCLUSIONS: The adjunctive use of Nd:YAG laser irradiation was similarly effective to FMS alone, during the entire study period. A slightly higher, though not statistically significant improvement was reported for PD at 6 and 12 months after a single post-FMS application of Nd:YAG laser for pocket epithelium removal and coagulation. CLINICAL RELEVANCE: Additional Nd:YAG laser application for sulcular epithelium removal and coagulation may provide minor long-term improvements compared to FMS or laser irradiation for pocket disinfection and detoxification. TRIAL REGISTRATION: ISRCTN26692900. Registration date: 09/06/2022.

The necessity of administrating antibiotic prophylaxis to patients with diabetes mellitus prior to oral surgical procedures-a systematic review.

BACKGROUND AND AIMS: Μany studies suggest the use of antibiotic prophylaxis (AP) as an appropriate preventive measure for patients with diabetes mellitus (DM) due to the increased possibility of an impaired wound healing and infections after surgical procedures in the oral cavity. Existing recommendations regarding antibiotic prophylaxis before surgical procedures are not definitive and are based on expert opinions. The purpose of this study was to review the available scientific data about the necessity of administrating AP as a preventive measure prior to oral surgical procedures. METHOD: PubMed®, Scopus® και Cochrane Central Register of Controlled Trials (CENTRAL) were used as databases to search for published research. All articles were initially identified and classified based on the title and subsequently on their abstract. For the next level the full scientific paper was read and evaluated. RESULTS: Overall, 22 articles were included in the study, of which 2 were systematic reviews, 2 cohort studies, 2 case-control studies, 1 case series, 8 case reports and 7 professional association publications. CONCLUSIONS: In the scientific literature, there is a wide range of recommendations and inconsistency regarding the need to administer AP prior to surgical dental operations in patients with DM, while there is no scientific evidence demonstrating its' effectiveness as a precautionary measure. Both blood glucose level measurements and recent HbA1c measurement should be evaluated before any dental procedure. Poor regulation may result to life-threatening infections after tooth extraction. AP is recommended prior to the placement of dental implant. Randomized, controlled, clinical trials with large number of participants and greater variety of surgical dental procedures are needed.

Dosage Effects of an 810 nm Diode Laser on the Proliferation and Growth Factor Expression of Human Gingival Fibroblasts.

Introduction: A substantial amount of evidence supports the positive effect of photobiomodulation on the proliferation and differentiation of various cell types. Several laser wavelengths have been used for wound healing improvement, and their actual outcome depends on the settings utilized during irradiation. However, the heterogeneous wavelengths and laser settings applied in the existing literature make it difficult to draw solid conclusions and comparison of different studies. The aim of the present study is to evaluate and compare the effects of various doses of laser energy, provided by an 810 nm diode, on human gingival fibroblasts in terms of proliferation and expression of growth factors with a pivotal role in wound healing. Methods: Human gingival fibroblasts were cultured on plastic tissue culture and irradiated with 2, 4, 6 or 12 J/cm2. The effects of the low-level laser therapy (LLLT) using an 810 nm diode laser on growth factor expression (EGF, TGF and VEGF) were evaluated by qPCR at 72 hours and 7 days after irradiation. Cell proliferation was evaluated at 24, 48 and 72 hours after LLLT using MTT assay. Results: Energy density of 12 J/cm2 provoked irradiated gingival fibroblasts to demonstrate significantly higher proliferation as well as higher gene expression of Col1, VEGF and EGF. LLLT positive effects were obvious up to 7 days post-irradiation. Conclusion: LLLT with 810 nm presents beneficial effects on proliferation, collagen production and growth factor expression in human gingival fibroblast cells. The application of 12 J/cm2 can be suggested as the optimal energy density for the enhancement of the wound healing process.

Low Level Laser Therapy With an 810-nm Diode Laser Affects the Proliferation and Differentiation of Premature Osteoblasts and Human Gingival Fibroblasts In Vitro.

Introduction: Photomodulation is a promising strategy for optimizing tissue healing, but its photomodulatory effects on the synergistic cellular metabolism of gingival and bony tissues remain largely unknown. The aim of the present study was to evaluate the photomodulatory effects of a diode laser (810 nm) on osteoblasts, HGFs and their co-cultures in vitro. Methods: Primary cultures of HGFs, cultures of immature osteoblastic cells (MG63) and their co-cultures were irradiated with a diode laser (810 nm), 15 J/cm2. Cell cultures were examined for cellular proliferation (MTT assay), viability (FDA/PI staining) after 24, 48 and 72 hours and cell differentiation (qPCR of collagen type 1a - COL1a and alkaline phosphatase expressions - ALP) after 7 days. Results: Photomodulation with an 810-nm diode laser increased cell proliferation at all time points. COL1a gene expression increased both in HGF and co-cultures. ALP expression was up-regulated in osteoblastic cultures, but co-cultures with fibroblasts negated this response. Conclusion: The 810-nm diode laser positively affected cell proliferation and viability in all experimental groups. The statistically significant increased COL1a gene expression at 7 days after irradiation both in the irradiated HGF and co-cultures suggests that low-level laser therapy (LLLT) stimulated extracellular matrix (ECM) formation signaling in both cell types.

The ever-changing landscape in modern dentistry therapeutics - Enhancing the emptying quiver of the periodontist.

INTRODUCTION/OBJECTIVES: Periodontitis comprises of a wide range of inflammatory conditions of the gums leading to soft tissue damage and attachment loss. The initiation of periodontitis constitutes a rather complex disease pathogenesis which is based on pathogenic shifts of the oral microbiota combined with the host-microbiome interactions. The severity of the periodontitis is multifactorial depending on genetic, environmental, as well as host immunity factors. DATA AND SOURCES: To make an inclusive analysis on the periodontitis therapeutics, reading of the recent relevant literature was carried out using the MEDLINE/PubMed database, Google Scholar and the NIH public online database for clinical trials (http://www.clinicaltrials.gov). CONCLUSIONS: Tackling the inflammation associated periodontal defects can be succeeded with conventional therapy or resective and regenerative treatment. To date, the mechanical removal of the supragingival and subgingival biofilm is considered the "gold standard" of periodontal therapy in combination with the use of antibacterial compounds. The antimicrobial resistance phenomenon tends to turn all the currently applied antibacterials into "endangered species". Ongoing efforts through the conduct of clinical trials should be focused on understanding the advantages of modern approaches in comparison to traditional therapies.

Immunomodulatory effects of Nd:YAG (1064 nm) and diode laser (810 nm) wavelengths to LPS-challenged human gingival fibroblasts.

OBJECTIVE: Human gingival fibroblasts (hGFs) are involved in inflammatory responses to bacteria by recognizing pathogen-associated molecular patterns. In search of host modulation strategies to increase LPS tolerance, Low level laser therapy (LLLT) has been suggested as an alternative treatment that reduces periodontal tissue inflammation. In this study, we investigate whether 810 nm (diode) and 1064 nm (Nd:YAG) laser wavelengths, modulate pro-inflammatory responses to LPS challenges in hGFs. DESIGN: Primary hGFs were challenged with Porphyromonas gingivalis LPS and irradiated with either Diode (810 nm) or with Nd:YAG (1064 nm) lasers. Cell cultures were examined for cell proliferation by MTT assay and IL-6 and IL-8 expression by qPCR at 24, 48 and 72 h. IL-6 and IL-8 protein levels were detected via ELISA. RESULTS: Naïve hGF populations irradiated with both Diode 810 nm and Nd:YAG 1064 nm lasers demonstrated cellular proliferation (p < 0.05), but LLLT did not affect cellular viability in LPS-challenged cells. IL-6 and IL-8 gene expression levels revealed significant anti-inflammatory effects of irradiation with both examined wavelengths on hGFs challenged with P. gingivalis LPS. Protein levels of these cytokines were increased by LPS challenge. Treatment with LLLT inhibited this increase for both wavelengths evaluated in the study at a statistically significant level particularly for the first 48 h. CONCLUSIONS: The present study demonstrates a modulatory effect of LLLT using both 810 nm diode and Nd:YAG 1064 nm lasers in gingival fibroblasts by decreasing the production of IL-6, IL-8 in response to LPS.

Mechanical Enhancement of Cytocompatible 3D Scaffolds, Consisting of Hydroxyapatite Nanocrystals and Natural Biomolecules, Through Physical Cross-Linking.

Bioinspired scaffolds mimicking natural bone-tissue properties holds great promise in tissue engineering applications towards bone regeneration. Within this work, a way to reinforce mechanical behavior of bioinspired bone scaffolds was examined by applying a physical crosslinking method. Scaffolds consisted of hydroxyapatite nanocrystals, biomimetically synthesized in the presence of collagen and l-arginine. Scaffolds were characterized by X-ray diffraction, Fourier transform infrared spectroscopy, scanning electron microscopy (SEM), microcomputed tomography, and nanoindentation. Results revealed scaffolds with bone-like nanostructure and composition, thus an inherent enhanced cytocompatibility. Evaluation of porosity proved the development of interconnected porous network with bimodal pore size distribution. Mechanical reinforcement was achieved through physical crosslinking with riboflavin irradiation, and nanoindentation tests indicated that within the experimental conditions of 45% humidity and 37 °C, photo-crosslinking led to an increase in the scaffold's mechanical properties. Elastic modulus and hardness were augmented, and specifically elastic modulus values were doubled, approaching equivalent values of trabecular bone. Cytocompatibility of the scaffolds was assessed using MG63 human osteosarcoma cells. Cell viability was evaluated by double staining and MTT assay, while attachment and morphology were investigated by SEM. The results suggested that scaffolds provided a cell friendly environment with high levels of viability, thus supporting cell attachment, spreading and proliferation.

Correction: Determinants of corrosion resistance of Ti-6Al-4V alloy dental implants in an In Vitro model of peri-implant inflammation.

[This corrects the article DOI: 10.1371/journal.pone.0210530.].

Determinants of corrosion resistance of Ti-6Al-4V alloy dental implants in an In Vitro model of peri-implant inflammation.

BACKGROUND: Titanium (Ti) and its alloys possess high biocompatibility and corrosion resistance due to Ti ability to form a passive oxide film, i.e. TiO2, immediately after contact with oxygen. This passive layer is considered stable during function in the oral cavity, however, emerging information associate inflammatory peri-implantitis to vast increases in Ti corrosion products around diseased implants as compared to healthy ones. Thus, it is imperative to identify which factors in the peri-implant micro-environment may reduce Ti corrosion resistance. METHODS: The aim of this work is to simulate peri-implant inflammatory conditions in vitro to determine which factors affect corrosion susceptibility of Ti-6Al-4V dental implants. The effects of hydrogen peroxide (surrogate for reactive oxygen species, ROS, found during inflammation), albumin (a protein typical of physiological fluids), deaeration (to simulate reduced pO2 conditions during inflammation), in an acidic environment (pH 3), which is typical of inflammation condition, were investigated. Corrosion resistance of Ti-6Al-4V clinically-relevant acid etched surfaces was investigated by electrochemical techniques: Open Circuit Potential; Electrochemical Impedance Spectroscopy; and Anodic Polarization. RESULTS: Electrochemical tests confirmed that most aggressive conditions to the Ti-6Al-4V alloy were those typical of occluded cells, i.e. oxidizing conditions (H2O2), in the presence of protein and deaeration of the physiological medium. CONCLUSIONS: Our results provide evidence that titanium's corrosion resistance can be reduced by intense inflammatory conditions. This observation indicates that the micro-environment to which the implant is exposed during peri-implant inflammation is highly aggressive and may lead to TiO2 passive layer attack. Further investigation of the effect of these aggressive conditions on titanium dissolution is warranted.

A randomized controlled clinical trial on the effectiveness of three different mouthrinses (chlorhexidine with or without alcohol and C31G), adjunct to periodontal surgery, in early wound healing.

OBJECTIVES: The use of chlorhexidine (CHX) with or without alcohol has been recommended for a number of clinical applications. On the other hand, there is a plethora of widely subscribed antiseptics, such as agent C31G (alkyl dimethyl glycine/alkyl dimethyl amine oxide), which has not yet been evaluated postsurgically. The effectiveness of three different mouthrinses (CHX with and without alcohol, C31G) in plaque control and early wound healing was compared postoperatively. MATERIALS AND METHODS: In this, randomized, double-blind, controlled clinical trial 42 patients were allocated to three groups assigned to 2 weeks rinsing after non-regenerative periodontal flap surgery with or without osseous surgery with C31G (group A), alcohol-free CHX 0.12% (group B) or alcohol-based CHX 0.12% (group C). At days 7 and 14, plaque and early wound healing indices were recorded. At day 14, total bacterial counts were estimated utilizing real-time quantitative polymerase chain reaction (qPCR). Statistics included linear and generalized linear mixed models. RESULTS: At day 7, healing response was not significantly different among groups. At day 14, group A revealed the highest while group C demonstrated the lowest plaque index values (B vs A, odds ratio-OR = 0.18, p = 0.012; C vs A, OR = 0.01, p < 0.001; C vs B, OR = 0.06, p < 0.001). Group C demonstrated the lowest bacterial counts levels at day 14 (38.470 × 106, 48.190 × 106, and 3.020 × 106 for groups A, B, and C, respectively). At day 14, healing was significantly better in group C compared to B (p = 0.007). Group A showed no significant differences compared to other groups. CONCLUSIONS: (1) The presence of alcohol may increase the effectiveness of CHX in early wound healing, (2) C31G might be an alternative solution prescribed during early postoperative period after non-regenerative periodontal flap surgery. CLINICAL RELEVANCE: The present study found that active agent C31G displayed no significant differences to CHX formulations regarding periodontal wound healing improvement and might be used alternatively after non-regenerative periodontal flap surgery. In addition, an alcohol based 0.12% CHX mouthwash was more effective than an alcohol-free 0.12% CHX and C31G mouthrinse on plaque control in the absence of mechanical oral hygiene.

Osteostimulative calcium phosphosilicate biomaterials partially restore the cytocompatibility of decontaminated titanium surfaces in a peri-implantitis model.

Bacterial peri-implant biofilms, and the chemotherapeutics for their removal alter titanium surface cytocompatibility. In this study we aimed to assess the adjunctive use of an osteostimulative biomaterial utilizing a peri-implantitis model under the hypothesis that it will increase cell migration towards treated titanium surfaces. Acid-etched titanium surfaces were inoculated with a multi-species biofilm model and treated with 1.5% NaOCl in a previously characterized in vitro peri-implantitis model. Cell migration of MG63 cells towards the treated titanium surface (CTRL) was significantly reduced following inoculation with biofilm and chemotherapeutic treatment as compared to sterile controls. Addition of a tricalcium phosphate biomaterial (TCP) as a control for Ca+2 had a small non-significant effect, while BG significantly increased MG63 chemotaxis to titanium to levels comparable to sterile (STE). Similarly, cell viability at 5 days was increased in BG and TCP as compared to CTRL. SEM imaging confirmed the improved cytocompatibility of BG and TCP surfaces as compared to CTRL. Osteostimulative BG exhibited a strong chemotactic effect to osteoblasts, which was stronger than what was expected due to the chemotactic effect of Ca+2 alone (TCP). In addition, substantially increased cell attachment and viability was found on treated implant surfaces as compared to CTRL. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2645-2652, 2018.

Nd:YAG laser radiation (1.064 nm) accelerates differentiation of osteoblasts to osteocytes on smooth and rough titanium surfaces in vitro.

BACKGROUND: A number of studies revealed beneficial effects of low-level laser therapy (LLLT) regarding cell proliferation and differentiation. AIM: To investigate the effect of Nd:YAG (1.064 nm) laser radiation in the proliferation and differentiation potential of MG-63 osteoblast-like cells. Additionally, the effects of the surface configurations were to be evaluated. MATERIAL AND METHODS: MG-63 osteoblast cells were cultured on different surfaces: plastic tissue culture, smooth (polished) titanium-PT and rough titanium-SLA. The effects of both titanium surfaces and low-level laser therapy (LLLT) on cell adhesion were evaluated by the gene expression of molecules involved in cell proliferation and differentiation. In addition, scanning electron microscopy (SEM) and MTT proliferation assays were used to examine cell morphology and proliferation, respectively. RESULTS: Compared to smooth (PT) surfaces, SLA surfaces favoured MG-63 cell differentiation. Following the application of Nd:YAG laser irradiation, cells yielded statistically significantly improved differentiation on both smooth and SLA surfaces compared with non-irradiated surfaces. CONCLUSIONS: The findings of this present study suggest that both surface morphology and Nd:YAG laser irradiation influence the proliferation and differentiation potential of MG-63 cells.

Osseointegration of Dental Implants in a Patient with Hajdu-cheney Syndrome.

BACKGROUND: Hajdu-Cheney Syndrome (HCS) is a rare hereditary bone metabolism disorder characterized by acro-osteolysis, short stature, craniofacial changes, periodontitis and premature tooth loss. Extensive search of the current literature revealed no reports of implant placement in patients with HCS. CASE REPORT: A 22-year old woman with osteoporosis, generalized advanced chronic periodontitis and premature tooth loss was referred to the Postgraduate Clinic of Periodontology, University of Athens-Greece. The patient was diagnosed in 2001 with HCS. The patient received non-surgical periodontal treatment and several teeth were extracted due to extensive alveolar bone loss. After careful consideration of the possible implications deriving from the patient's condition and having taken her young age into account, initially, a dental implant was placed in the upper right first premolar region. Specific protocols such as longer healing periods were implemented, so five years after placement and successful osseointegration of this implant, four additional dental implants were placed in the posterior regions of the maxilla and the mandible. Prosthetic rehabilitation followed 6 months after implant placement. Upon completion of periodontal treatment, the patient was enrolled in a periodontal maintenance program. RESULTS: Clinical and radiographic examination of the patient during the periodontal maintenance program after implant placement revealed no abnormalities in the implant region. CONCLUSION: Patients with HCS suffer from periodontitis, bone destruction and premature tooth loss. This case indicates the successful osseointegration of dental implants in patients with HCS. However, further research is required in order to determine the predictability of dental implant placement in those patients.

Effect of Nd:YAG Low Level Laser Therapy on Human Gingival Fibroblasts.

Aim. To evaluate the effect of Low Level Laser Therapy (LLLT) on human gingival fibroblasts in terms of proliferation and growth factors' secretion (EGF, bFGF, and VEGF). Materials and Methods. Primary cultures of keratinized mucosa fibroblasts were irradiated by a Nd:YAG laser 1064 nm with the following energy densities: 2.6 J/cm(2), 5.3 J/cm(2), 7.9 J/cm(2), and 15.8 J/cm(2). Controls were not irradiated. Cultures were examined for cell proliferation and growth factors' secretion after 24, 48, and 72 hours. All experimental procedures were performed in duplicate. Data were analyzed by Student's t-test (p < 0.05). Results. All laser-irradiation doses applied promoted a higher cell proliferation at 48 hours in a dose-response relationship compared to controls. This difference reached statistical significance for the cultures receiving 15.8 J/cm(2) (p = 0.03). Regarding EGF, all laser irradiation doses applied promoted a higher secretion at 48 hours in a reverse dose-response pattern compared to controls. This difference reached statistical significance for the cultures receiving 2.6 J/cm(2) (p = 0.04). EGF levels at the other time points, bFGF, and VEGF showed a random variation between the groups. Conclusion. Within the limits of this study, LLLT (Nd:YAG) may induce gingival fibroblasts' proliferation and upregulate the secretion of EGF. Further studies are needed to confirm these results.

Impact of cigarette smoking on clinical outcomes of periodontal flap surgical procedures: a systematic review and meta-analysis.

BACKGROUND: Periodontal flap surgery is frequently used to remove subgingival deposits, yielding consequential reductions in gingival inflammation and probing depth (PD) with a gain in clinical attachment level (CAL) to treat advanced periodontal disease. However, clinical studies have reported diminished periodontal healing in smokers compared with non-smokers. The aim of the present systematic review and meta-analysis was to assess the impact of cigarette smoking on clinical outcomes following periodontal flap surgical procedures. METHODS: A systematic electronic review of articles relevant to periodontal flap surgical procedures in smokers was conducted from 1977 to March 2014 inclusive, using predefined, optimized search strategies. Meta-analyses were done separately for changes in the two primary outcomes of PD and CAL. RESULTS: The initial search yielded 390 titles and abstracts. After screening, eight controlled clinical studies were finally selected. Three studies were assessed as having a low risk of bias, two as having moderate risk of bias, and three as having a high risk of bias. Qualitative assessment of the articles consistently showed an improved treatment effect among non-smokers versus smokers. The reduction in PD in smokers and non-smokers ranged from 0.76 to 2.05 mm and 1.27 to 2.40 mm, respectively. For CAL, the gain in non-smokers versus smokers ranged from 0.29 to 1.6 mm and 0.09 to 1.2 mm, respectively. Meta-analysis on eight studies reporting on 363 study participants demonstrated an increased reduction in mean (95% confidence interval) PD of 0.39 (0.33 to 0.45) mm. Similar results were found for mean gain in CAL (0.35 [0.30 to 0.40] mm, n = 4 studies). CONCLUSIONS: Considering the relatively homogenous information available, the authors conclude that active smokers could be candidates for periodontal flap surgical procedures. However, the magnitude of the therapeutic effect is compromised in smokers compared with non-smokers. Therefore, cigarette smokers should be: 1) encouraged to abstain from smoking; and 2) thoroughly informed preoperatively of substantial reduction in clinical outcomes compared with non-smokers.