Adjunctive Non-Surgical Therapy of Inflamed Periodontal Pockets During Maintenance Therapy Using Diode Laser: A Randomized Clinical Trial.

BACKGROUND: Numerous studies have documented the clinical outcomes of laser therapy for untreated periodontitis, but very few have reported on lasers treating inflamed pockets during maintenance therapy. The aim of this study is to compare the effectiveness of scaling and root planing (SRP) plus the adjunctive use of diode laser therapy to SRP alone on changes in the clinical parameters of disease and on the gingival crevicular fluid (GCF) inflammatory mediator interleukin-1ß (IL-1ß) in patients receiving regular periodontal maintenance therapy. METHODS: This single-masked and randomized, controlled, prospective study includes 22 patients receiving regular periodontal maintenance therapy who had one or more periodontal sites with a probing depth (PD) ≥ 5 mm with bleeding on probing (BOP). Fifty-six sites were treated with SRP and adjunctive laser therapy (SRP + L). Fifty-eight sites were treated with SRP alone. Clinical parameters, including PD, clinical attachment level (CAL), and BOP, and GCF IL-1ß levels were measured immediately before treatment (baseline) and 3 months after treatment. RESULTS: Sites treated with SRP + L and SRP alone resulted in statistically significant reductions in PD and BOP and gains in CAL. These changes were not significantly different between the two therapies. Similarly, differences in GCF IL-1ß levels between SRP + L and SRP alone were not statistically significant. CONCLUSION: In periodontal maintenance patients, SRP + L did not enhance clinical outcomes compared to SRP alone in the treatment of inflamed sites with ≥ 5 mm PD.

Oral ulceration due to chronic use of Nicorette gum: case report.

Oral ulceration is a common presentation in a dental clinic. These ulcers may be acute or chronic, based on the duration of symptoms. The etiology of oral ulceration can range from trauma to squamous cell carcinoma. It is the responsibility of the dentist to differentiate the various etiologies of oral ulceration for proper management. This case report is presented to remind dentists that the long-term use of Nicorette gum should be considered in the differential diagnosis of chronic oral ulcers.

Efficacy of sub-antimicrobial dose doxycycline in post-menopausal women: clinical outcomes.

AIMS: To determine the clinical efficacy of a 2-year continuous sub-antimicrobial dose doxycycline (SDD; 20 mg bid) in post-menopausal, osteopenic, oestrogen-deficient women on periodontal maintenance. MATERIALS AND METHODS: One-hundred and twenty-eight subjects were randomized to SDD (n=64) or placebo (n=64). Clinical measurements were performed at posterior interproximal sites at baseline and every 6 months during this 2-year randomized, double-blind, placebo-controlled clinical trial with adjunctive, no-cost 3-4-month periodontal maintenance. Statistical analyses of secondary outcomes from this clinical trial used Generalized Estimating Equations in primarily intent-to-treat analyses. RESULTS: For the placebo group, 3.4% of the sites showed improvement in clinical attachment levels (CAL) and 2.7% had progressive loss in CAL; for the SDD group, 5.0% of the sites showed an improvement in CAL and 2.2% had progressive loss in CAL. This difference (2.1% of sites) was more favourable in the SDD group than in the placebo [odds ratio (OR)=0.81 [corrected] 95% confidence interval (CI): 0.67-0.97, p=0.03] in these well-maintained patients, whereas probing depths, bleeding on probing and supragingival plaque did not differ significantly between groups (p>0.2). However, in exploratory subgroup analysis of non-smokers, SDD showed reduced bleeding versus placebo (27%versus 33%; p=0.05). In protocol-adherent subjects, the odds of bleeding were 34% lower for SDD (p=0.05). CONCLUSIONS: Analyses of secondary outcomes of this clinical trial indicated that SDD may be of benefit in reducing progressive attachment loss in post-menopausal females; additional research is needed to confirm these findings. Protocol registered at (ClinicalTrials.gov). Identifier:NCT00066027.

Inflammatory mediator release following bone grafting in humans: a pilot study.

AIM: The aim of this pilot study was to track markers of periodontal inflammation and bone resorption associated with decalcified freeze-dried bone allografts. MATERIAL AND METHODS: Eleven subjects completed standardized treatment of intrabony defects > or =3 mm with allografts. Gingival crevicular fluid was collected from the defect site and an adjacent interproximal site within the surgical field at baseline, 2, 4, and 8 weeks post-operatively, and analysed for biochemical markers of inflammation/bone resorption. Probing depth, recession, bleeding on probing, plaque, and 6-month radiographic bone height change were measured. RESULTS: Both prostaglandin E(2) (p=0.007) and bone-specific type 1 collagen (p=0.01) increased in crevicular fluid after 2 weeks in the bone graft sites. Matrix metalloproteinase-9 levels remained constant over time. There were positive correlations between prostaglandin levels during the first 8 weeks and bone height change over 6 months. CONCLUSIONS: Periodontal bone grafts stimulate an inflammatory response during the first 2 weeks post-operatively, and the potential negative effects of inhibiting prostaglandins post-operatively should be investigated further.

Pulp responses to precise thermal stimuli in dentin-sensitive teeth.

The purpose of this study was to determine whether pulpal responses to cold temperatures applied to enamel, using a method that precisely controls the intensity of the cold stimulus or measures the response time, could distinguish dentin-sensitive teeth from nonsensitive teeth. Eighteen human subjects were stimulated with cold temperatures decreasing in 5 degree C intervals (and with tetrafluoroethane) on exposed root and enamel of a dentin-sensitive tooth and enamel of a contralateral nonsensitive tooth. Pain threshold, intensity of pain, time to pain onset, and duration of pain at baseline, 4 h, 8 h, and 1 week were measured. Responses to enamel stimulation of sensitive teeth compared with the nonsensitive teeth usually were highly correlated and not significantly different. The exception was a longer duration of pain in the dentin-sensitive teeth (4.62 +/- 0.47 s) compared with nonsensitive teeth (2.92 +/- 0.49 s; p = 0.016) after enamel stimulation with tetrafluoroethane. Longitudinal studies are necessary to determine whether these slight increases in pain duration indicate an increased probability of pulpal degeneration or need for dentin protection.

Local biochemical markers of bone turnover: relationship to subsequent density of healing alveolar bone defects.

OBJECTIVES: This pilot study was designed to test whether biochemical markers of bone turnover in washes of periosteal or trabecular alveolar bone surfaces could be correlated with increases in bone density of an adjacent healing implant socket. METHODS: Ten subjects had a canula inserted into the alveolar crest and sterile phosphate-buffered saline was washed over the periosteal and trabecular surfaces and collected. Surgical flaps were reflected, 5 mm diameter bone cores were removed from the bone wash site, and standardized radiographs were taken. The sites were allowed to heal for 12 weeks, and radiographs were repeated. Bone washes of the healing sites were also collected after 2 and 12 weeks. Washes were analysed for bone turnover markers osteocalcin (OC; radioimmunoassay) and C-terminal telopeptide of Type 1 collagen (ICTP; enzyme-linked immunosorbent assay (ELISA)), and blood component albumin (ALB; ELISA). Changes in bone density during healing were determined by radiographic absorptiometry. RESULTS: OC/ALB and ICTP/ALB ratios were higher for trabecular than periosteal washes at baseline (p

Clinical evaluation of two adhesive composite cements for the suppression of dentinal cold sensitivity.

STATEMENT OF PROBLEMS: Postoperative cold sensitivity after the cementation of indirect restorations with composite cements has been reported frequently but not scientifically documented. PURPOSE: This controlled clinical study was designed to simulate the dentin/composite cement interface immediately after cementation of a cast restoration. The desensitizing capabilities of a composite cement that contains a self-etching, dual-polymerizing resin adhesive system were compared with those of a composite cement that use phosphoric acid etching followed by a single-bottle, light-activated primer/resin-based adhesive. MATERIAL AND METHODS: The hypersensitive root surfaces of selected teeth were randomized to receive 1 of 3 treatments: coating with a self-etching adhesive (Linkmax) and its respective cement, coating with a conventionally etched adhesive (RelyX ARC) and its cement, or no treatment (negative control). The sample size was 22. Dentin sensitivity was ascertained with an accurate cold testing device that slowly decreased in temperature. Tooth sensitivity was measured both immediately and at 7 days after placement. Two-way analysis of variance and Fisher's least significant difference test (P<.05) were used to determine whether significant differences existed as a function of treatment type or time. RESULTS: Immediately after placement, the self-etching adhesive and its respective cement resulted in more suppression of cold sensitivity than no treatment (control); with Linkmax treatment, the temperature at which teeth responded was reduced by 8.4 degrees C. The conventionally etched adhesive and its cement reduced the temperature at which teeth responded by 9.4 degrees C. After 1 week, these temperature reductions were 7.0 degrees C and 4.3 degrees C, respectively. Untreated controls at the 2 intervals showed a mean decrease in sensitivity to cold of 3.6 degrees C and 4.1 degrees C. Statistical analysis showed type of composite cement to be a significant factor. CONCLUSION: Within the limitations of this study and in comparison to untreated control teeth, Linkmax treatment resulted in a significant reduction in tooth root sensitivity over 1 week (P=.02), whereas RelyX ARC did not (P=.066).

Effect of narcotic pain reliever on pulp tests in women.

The purpose of this study was to determine the effect of one dose of a common narcotic-based pain reliever (Vicodin) on a battery of oral sensitivity tests across time in women. Fifteen Caucasian women randomly were given an oral dose of 10 mg of hydrocodone/1000 mg of acetaminophen or placebo in a double-blind, cross-over design. At baseline (before drug) and after 2, 4, and 8 h each subject was evaluated for sensitivity thresholds with four tests around an experimental tooth: (a) electric pulp tester applied to exposed root; (b) electric pulp tester on adjacent mucosa; (c) increasing probe pressure (grams) on adjacent mucosa; and (d) decreasing cold probe (degrees C) on the exposed root. The outcomes of all tests were not statistically different between drug and placebo treatments at any time point (p > 0.05). These results suggest that a systemic dose of hydrocodone/acetaminophen has little impact on healthy pulp or mucosa sensitivity in women as measured by common diagnostic tests.

Comparison of conventional periodontal maintenance versus scaling and root planing with subgingival minocycline.

BACKGROUND: Alternative regimens using subgingival antimicrobials compared to conventional periodontal maintenance (PM) may lead to more efficient protocols. The purpose of this study was to evaluate treatment time and clinical and radiographic outcomes in 2 periodontitis cohorts, one receiving conventional PM and the other receiving scaling and root planing (SRP) and multiple doses of subgingival minocycline. METHODS: Moderate to advanced chronic periodontitis patients were concurrently treated with either: 1) scaling and root planing and 4 subgingival doses of minocycline microspheres in all > or = 5 mm pockets over a 6-month period (RP/M; n = 24 patients); or 2) conventional 3-month periodontal maintenance (PM; n = 24 patients). Clinical and radiographic measurements, including probing depth (PD), clinical attachment level (CAL), and interproximal bone height (BH), were analyzed in 2 premolar/molar interproximal > or = 5 mm pockets at baseline and 1 year using paired t tests, analysis of variance, chi-square analysis, and correlation coefficients. RESULTS: Baseline clinical and radiographic data were similar between RP/M and PM patients. Probing depths showed greater mean improvement in RP/M (0.9 +/- 0.1 versus 0.4 +/- 0.1 mm, P = 0.02), with 25% of subjects in RP/M gaining > or = 2 mm compared to 4.2% in PM (differences were statistically significant). The mean loss in bone height and percent subjects losing bone height were less in RP/M (0.05 +/- 0.05 mm; 12.5%) than PM (0.09 +/- 0.08 mm; 16.7%), but bone height differences were not statistically significant. A subset of RP/M molar furcation sites responded with similar PD reduction and no BH loss over 1 year. While cross-sectional RP/M data between CAL and BH, or PD and CAL were highly correlated, changes over 1 year were not correlated among any of these parameters. CONCLUSIONS: Scaling and root planing and subgingival minocycline in experimental sites took little time (<5 minutes/appointment), but resulted in more probing depth reduction and less frequent bone height loss than conventional periodontal maintenance.