Comparison of Guided Bone Regeneration with Periosteal Pocket Flap Technique Versus Autogenous Bone Block Graft for Horizontal Bone Augmentation: A Clinical Trial Study

The aim of this study was to assess changes in the horizontal dimension of the alveolar ridge when the autogenous bone block (ABB) or periosteal pocket flap (PPF) techniques were performed prior to implant placement. This randomized trial study was conducted on 25 patients in need of horizontal bone augmentation, who were randomly divided into two groups as follows: 13 patients underwent ridge augmentation using ABB, allograft, and a collagen membrane, while the remaining 12 underwent horizontal bone augmentation via the PPF technique. For all patients, radiographic examinations via CBCT were performed both before and 26 weeks after the operation. Following the surgery, dimensional changes in the ridge width were measured both within and between the two groups in the three regions of 0, 3, and 5 mm from the top of the alveolar crest. A total of 11 patients in the ABB group and 12 patients in the PPF group successfully completed the study. Statistical analysis showed that the increase in alveolar ridge width in each group was significant, but not significantly different between the two groups at any of the measured spots (0 mm from the crest, P = .25; 3 mm, P = .38; and 5 mm, P = .73). However, more postoperative complications were observed with the ABB technique. According to the results of the present study, there was no statistically significant difference between the PPF and ABB techniques in terms of horizontal bone gain.

Comparison of the Effectiveness of CO2 and Diode Lasers for Gingival Melanin Depigmentation: A Randomized Clinical Trial.

Introduction: Gingival hyperpigmentation is an esthetic concern for some individuals. This study compared the effectiveness of CO2 and diode lasers for gingival depigmentation. Methods: This randomized, split-mouth, clinical trial consisted of 12 patients with the chief complaint of hyperpigmented gingival areas. The upper right and left anterior segments and the mandibular anterior segment were randomly allocated to one of the treatment groups. The segments in group 1 underwent gingival depigmentation with a diode laser (810 nm) at 6 W and pulsed mode, whereas group 2 was ablated with a diode laser at 3 W and continuous mode. The removal of gingival pigments in group 3 was contemplated with a CO2 laser (10600 nm, 3 W, continuous mode). The operation chair time, bleeding during the procedure and post-operative pain were recorded. The gingival color and esthetic appearance were measured before the operation and at 1 week and 6 months later. Results: There was no significant difference in the bleeding scores, pain level, and color alteration values between the groups (P>0.05). The operation chair time was significantly shorter when the diode laser was applied at pulsed mode (P<0.05). The segments treated with the diode laser (pulsed or continuous mode) showed a higher esthetic appearance at the 6-month follow-up compared to those ablated with the CO2 laser (P<0.05). Conclusions: Higher esthetic appearance is expected when using the diode laser for gingival depigmentation compared to the CO2 laser. The application of the diode laser at pulsed mode could be recommended for gingival depigmentation, as it produced pleasing esthetic outcomes at reduced chair time.

Evaluation of cannabinoid receptors type 1-2 in periodontitis patients.

BACKGROUND: As effective immune modulators, Endocannabinoids may suppress the inflammatory responses in periodontitis. This study assessed the expression of cannabinoid receptors in gingiva and the impact on periodontitis. METHODS: A cross-sectional study on 20 patients with more than stage II and Grade A periodontitis and a control group consisting of 19 healthy individuals was performed. The gingival biopsies were assessed for the expression of CB1 and CB2 using the quantitative reverse transcription polymerase chain reaction, TaqMan method. RESULTS: The study sample consisted of 39 subjects, 31 females (79.5%) and 8 males (20.5%), including 20 periodontitis subjects (80% female and 20% male), and control groups (78.9% female and 21.1% male). The mean ages of cases and controls were 33.3 ± 4.7 and 35.7 ± 5.1 years, respectively. The gene expression of CB2 in periodontitis was 27.62 ± 7.96 and in healthy subjects was 78.15 ± 23.07. The CB2 was significantly lower than the control group (p = .008). In comparison, the gene expression index of CB1 in the periodontal group (9.42 ± 3.03) was higher than the control group (6.62 ± 1.13) but did not meet a significant value (p = .671). CONCLUSION: The lower expression of CB2 receptors in the periodontitis group may be due to the reduced protective effect of anti-inflammatory agents. These elements include cannabinoids and the imbalance leading to the predominance of pro-inflammatory effects. Therefore, the local effects of cannabinoids as an immunomodulator could be useful for oral inflammatory diseases such as periodontitis.

Association between periodontitis and periodontal indices in newly diagnosed bronchial asthma.

Background. Periodontitis is an inflammatory disease of the tooth-supporting structures. Current data suggest that periodontal disease may be a risk factor for asthma. The present study aimed to assess the prevalence of periodontitis and its relationship with the severity of asthma in asthmatic patients. Methods. This study was conducted on 70 newly diagnosed asthmatic patients as the case group and 70 healthy subjects as the control group, aged 20‒50. The asthma was diagnosed by a pulmonologist according to Global Initiative for Asthma (GINA) guideline. All the participants underwent peri-odontal examinations, which included measuring the pocket depth (PD), attachment loss (AL), gingi-val index (GI), and plaque index (PI) in one tooth from each sextant, including the incisor/canine and left and right premolar/molar regions for both the maxillary and mandibular dental arches. Results. Periodontal disease was significantly more prevalent in newly diagnosed asthma patients. Patients with asthma had significantly higher PI, GI, PD, and AL scores (P<0.001). Furthermore, dry mouth in asthmatic patients with cough and mucosal changes in asthmatic patients with wheeze were significantly more common than in non-asthmatic patients (P<0.05). The median AL in wheezing patients and the median AL and PD in participants who had asthma attacks within the previous month were significantly higher than in other patients. Furthermore, there was a significant negative correlation between AL with Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) and PD with FEV1 and FVC. Conclusion. Our results showed that periodontal diseases were more prevalent in newly diagnosed asthmatic patients, and asthma was more severe in periodontitis patients.

Evaluating Vitality and Sensitivity of Teeth Adjacent to the Site of Closed Sinus Lift Surgery before and after Treatment.

The aim of this study was to evaluate the effect of closed sinus lift surgery on dental vitality and periodontal sensitivity of teeth adjacent to the surgery area. Thirty patients undergoing closed sinus lift surgery by osteotomes were evaluated for dental vitality and periodontal sensitivity of adjacent teeth. Dental vitality and sensitivity were evaluated using the electric pulp tester (EPT) and cold spray once before surgery and one week, one month, and six months after surgery. In order to increase the validity of the study, one contralateral tooth in each patient was considered the control. In the test group, the number of teeth that did not respond to EPT and cold stimuli increased from baseline to six months after surgery and showed a significant difference between the four time intervals (P = 0.015 for EPT; P = 0.007 for cold stimuli). Thus, the vitality of teeth adjacent to the closed sinus lift area was lost over time. There was no significant difference between the two groups at any time for either stimuli. According to this research, tooth sensitivity to EPT and cold stimuli was not significantly different between test subjects and controls. For both cold and electrical stimulation, the number of teeth that did not respond was highest at one week after surgery and significantly different from baseline. However, after six months postsurgery, this number decreased, indicating recovery. However, some teeth were considered necrotic in the sixth month. It can be concluded that closed sinus lift surgery may cause necrosis in adjacent teeth, but more studies are required.

Clinical and Histological Evaluation of Tissue Healing in Beveled or Perpendicular Vertical Releasing Incision.

OBJECTIVES: The aim of this investigation was to evaluate the clinical and histological differences in wound healing between beveled and perpendicular vertical releasing incisions in dogs. MATERIAL AND METHODS: Four male mongrel dogs were used in this investigation. In each quadrant, a vertical releasing incision was made on either the mesial or the distal aspect of the cuspid teeth of each animal all on the same day. The sites were randomly selected to either receive a beveled incision or a perpendicular incision. A sulcular muco-periosteal flap was raised, reapproximated, and then sutured using 3-0 Vicryl. The animals were evaluated daily for the first week, and then at different time intervals during this investigation. One animal was killed at each time interval of 9, 14, 21, and 28 days after surgery. One animal was killed at each time interval, and a bone block consisting of the cuspid teeth and their surrounding bone and soft tissues was harvested, formalin fixed, and paraffin embedded. Samples were sectioned serially and stained with hematoxylin-eosin. Specimens were evaluated using a microscope with magnification ranging from ×10 to ×400 by a histopathologist. Four indices were used for histologic evaluation. RESULTS: At day 9 after surgery, a visible groove was seen in the marginal tissues of both perpendicular and beveled incisions. At day 9, both of the histologic sections showed less organized connective tissue and capillary networks with no significant difference in inflammation. In the 14-day samples, a depression was still present at the perpendicular incision sites, but not in the beveled incision group, where the groove was not visualized at all. In the 21- and 28-day samples, irregular capillary arrangements were seen in the connective tissue of the perpendicular incision groups with completely healed epithelium. There were no statistically significant differences noted histologically between the beveled and perpendicular incision groups noted at 9, 14, 21, or 28 days (P > .05). CONCLUSION: Based on these findings, it appears that clinical and histologic healing of beveled or perpendicular releasing incisions are similar 28 days after surgery.

Low level laser therapy, Er,Cr:YSGG laser and fluoride varnish for treatment of dentin hypersensitivity after periodontal surgery: A randomized clinical trial.

This clinical trial aimed to compare the effects of low-level laser therapy (LLLT), Er,Cr;YSGG laser, and fluoride varnish, as compared to the placebo laser on decreasing dentin hypersensitivity (DH). This randomized, double-blinded clinical trial included 60 jaw quadrants in 24 patients who underwent periodontal surgery. The quadrants were randomly assigned to 4 groups and received treatments as follows. Group 1: LLLT with a combination of red and infrared wavelengths, group 2: Er,Cr:YSGG laser (0.25 W and 0.5 W), group 3: fluoride varnish, and group 4: placebo laser. The sensitivity response to the cold spray was recorded using visual analogue scale (VAS) at baseline, immediately, and 1 week post-treatment. The data were analyzed by repeated measures analysis at the significance level of P<0.05. There was a significant reduction in DH after treatment by low-level lasers, Er,Cr:YSGG laser, or fluoride varnish compared to the baseline data (P<0.05), but the placebo group displayed no significant alteration in DH (P=0.069). At 1 week, the VAS score in the Er,Cr:YSGG laser group was significantly lower than that of the LLLT (P= 0.043) and placebo (P<0.001) groups. Furthermore, the subjects who received fluoride varnish exhibited significantly lower DH compared with the placebo group (P = 0.023). Er,Cr:YSGG laser was the most effective strategy in dealing with DH, as it caused the greatest pain reduction over the study period and showed a significant superiority over LLLT and placebo groups. Alternatively, the application of fluoride varnish could be recommended for attenuating DH following periodontal surgery.

Evaluating Vitality and Periodontal Sensitivity of Teeth Adjacent to the Site of Open Sinus Lift Surgery before and after Treatment: A Case Series Study.

The aim of this study was to evaluate the effect of open sinus lift surgery on dental vitality and periodontal sensitivity of teeth adjacent to a surgery area. Forty-one patients undergoing open sinus lift surgery were evaluated for dental vitality and periodontal sensitivity of adjacent teeth. Dental vitality was evaluated using an electric pulp tester and cold spray. Periodontal sensitivity of teeth in the surgery area of open sinus lift was evaluated by interview and visual analogue scale before surgery and one, three, and six weeks after surgery. In order to increase the validity of the study, one healthy tooth was considered as a control. In the experimental group, differences in periodontal sensitivity were significant between the four measured times (P < 0.001). Pretreatment compared with three weeks posttreatment, pretreatment compared with one week posttreatment, six weeks posttreatment compared with one week posttreatment, and three weeks posttreatment compared with one week posttreatment showed significant differences (P = 0.001). In the control group, the periodontal sensitivity between the four measured times did not differ significantly (P = 0.421). In the experimental group, pulpal sensitivity was significant between the four measured times (P = 0.019). It was found that the test and control groups showed significant differences in pretreatment versus six weeks posttreatment and one week posttreatment versus three weeks posttreatment (P < 0.001). Pulse sensitivity significantly changed after open sinus lift surgery, making it clear that the surgery may lead to necrosis of adjacent teeth. However, further research is needed. Also, teeth in area of the surgery may be periodontally affected, but will undergo recovery.

Marginal Bone Loss Around One-Piece Implants: A 10-Year Radiological and Clinical Follow-up Evaluation.

PURPOSE: This study was conducted to investigate one-piece narrow-diameter implants installed in maxillary lateral and mandibular incisor sites using immediate nonfunctional loading. MATERIALS AND METHODS: In this 10-year clinical trial study, 42 narrow-diameter (3.0-mm) one-piece implants for 35 patients were inserted. Clinical and radiographic measurements were recorded in 10 years and analyzed statistically using t test. RESULTS: A total of 26 patients (20 females and 6 males) with 30 implants were available for the 10-year follow-up. The 10-year implant survival rate was 100%. A statistically significant mean marginal bone loss was observed between 12 months and 10 years (0.18 ± 0.29 mm). The mean pocket depth increase was statistically significant (0.68 ± 0.83 mm). No bleeding on probing was observed around 90% of the implants. Full-mouth plaque index was registered at 20% of the implants. CONCLUSION: The results obtained in this analysis suggest that modest marginal bone loss was observed around the implants. One-piece narrow-diameter implants (Maximus 3.0; BioHorizons) can predictably restore missing maxillary lateral incisors and mandibular incisors in cases of careful patient selection.

The effect of toothbrushing and flossing sequence on interdental plaque reduction and fluoride retention: A randomized controlled clinical trial.

BACKGROUND: Mechanical plaque control methods such as brushing and flossing are highly recommended to remove dental plaque. The aim of this study is to evaluate the efficacy of the sequence of brushing and flossing on reducing interdental plaque and increasing fluoride retention in that area. METHODS: This randomized controlled crossover trial was conducted on 25 dental students. After prophylaxis, they were asked to discontinue all forms of oral hygiene for 48 hours. The study was performed in two phases with two-week washout intervals. In one phase, they first brushed, then flossed (sequence 1: brush-floss group). In the other phase they initially used dental floss then brushed (sequence 2: floss-brush group). At each phase, dental plaque (using the Rustogi Modified Navy Plaque Index) and fluoride concentrations (using a fluoride ion specific electrode) were measured before and after flossing and brushing, and the dental plaque reduction and fluoride increase were compared between the two groups using the mixed model test. A significance level of 5% was selected. RESULTS: In the floss-brush group interdental and whole plaque was reduced significantly more than the brush-floss group (p = 0.001, p = 0.009 respectively). However, marginal plaque did not show any statistically significant difference between the two groups (p = 0.2). Fluoride concentrations in interdental plaque were significantly higher in the floss-brush group than the other group (p = 0.027). CONCLUSION: The results showed that flossing followed by brushing is preferred to brushing then flossing in order to reduce interdental plaque and increase fluoride concentration in interdental plaque.

Crestal Sinus Floor Elevation with Autogenous Press-Fit Dowel Bone Harvested Using Trephine Drills: A New Method.

The aim of this study was clinical and radiographic evaluation of sinus floor lifting from the alveolar crest with trephine bur and autogenous bone graft. In this research, a press-fit dowel bone technique with application of an autogenous bone block was used for elevating the sinus floor. Ten closed sinus lift surgeries were performed on 10 patients; all patients possessed atrophic ridges in an edentulous maxilla. Bone height of the ridge ranged between 3 and 5 mm. Surgery included forming a bony cylinder with a trephine bur to reach the sinus cortical floor and then elevating the sinus floor bone with anosteotom and placing an autogenous bone block at the site and fitting it with strikes of a hand mallet. The amount of an osteotom sinus floor height gain was measured during implant placement and via radiography before surgery and four months postsurgery. Average height of the sinus floor bone after surgery was 8.33 mm with SD = 1.39 mm. Mean bone height gain after surgery in evaluated patients was 3.47 mm with SD = 1.4 mm. As a result, bone sinus floor height following surgery was significantly increased (P value = 0.044), with a significant difference between sinus floor bone height before and after surgery (P value = 0.041). No significant difference was observed between sinus floor bone height gain and sex, age, and smoking before and after the operation. The sinus floor lift method by trephine and autogenous bone graft is a practical and simple way to reduce the time needed for implantation in patients with moderate atrophy of the posterior maxilla.

Comparative evaluation of IL-17 and TGF-ß expression in tissues of patients with chronic periodontitis and healthy individuals using real-time PCR.

Background: The present study aimed to determine the association between periodontal disease and the Th17/Treg balance by examining the genetic expression of IL-17 and TGF-ß, which influence incidence and suppression of inflammation. Methods: In this case-control study, samples were collected in a randomized and task-oriented order. Thirty-seven patients referred to professional periodontology clinics in Mashhad and the Periodontology Department of the Mashhad Dentistry Faculty for periodontal (case) or crown-length (control) surgery was enrolled. IL-17 and TGF-ß gene expression indices were measured in tissue samples by real-time polymerase chain reaction. Results: The IL-17 gene expression index was higher in the case group (2.68±0.91) than in the control group (1.68±0.41), but this difference was not significant. The TGF-ß gene expression index was significantly higher in the case group (54.42±7.88) than in the control group (24.12±3.38). Conclusion: L-17 and TGF-ß expression is increased in chronic periodontitis patients, but TGF-ß plays a more important role in periodontal inflammation in patients with chronic periodontitis. Further studies of the roles of Th17 and Treg cells are warranted.

Relationship between periodontal variables and disease severity in patients with chronic obstructive pulmonary disease.

Background: The present study investigated the relationship between certain periodontal variables and severity of disease in COPD patients. Methods: The present cross-sectional study included 50 patients suffering from COPD. Lung function examination, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, SpO2, and Modified Medical Research Council (MMRC) Dyspnea Scale were performed. Periodontal clinical examination index included probing depth (PD), attachment loss (AL), gingival index (GI) and plaque index (PI). A quality of life validated index, the COPD assessment test (CAT index), was also calculated. Results: The FEV1 and FVC indices showed a significant negative correlation with PI and AL variables only. The COPD assessment test (CAT) index showed a significant but positive correlation with PI and AL variables only. The SpO2 index presented a significant negative correlation with GI and AL variables. The FEV1/FVC ratio was found to have a negative correlation with PD and AL variables. It is worth noting that MMRC exhibited no significant relationship with any of the periodontal variables. The only variable that was significantly different (P=0.022) among the three smoking groups was the FVC index. The FVC value was significantly higher in the group of subjects who smoked more than 10 cigarettes per day versus the non-smoking group (P=0.017). Conclusion: Based on the findings of this study, in view of the relationship between periodontal variables and respiratory indices in the course of COPD, early treatment of periodontal diseases, might considerably reduce the severity of COPD.

Comparing the Quality of Life of Patients Requesting Dental Implants Before and After Implant.

BACKGROUND AND OBJECTIVES: Tooth loss is a serious life event that impairs two important functions, namely, eating and speaking, and has significant side effects on different aspects of quality of life. These effects are internalized by the individual. The present study aimed to compare the quality of life (QOL) of patients requesting dental implants before and after implant. MATERIALS AND METHODS: This analytical cross-sectional study was conducted on patients referred to the Mashhad faculty of Dentistry and private clinics with dental implants in 2015. Patient Quality Of Life (QOL) was assessed using the Oral Impact on Daily Practice (OIDP) questionnaire. Data were analyzed using SPSS software. RESULTS: In this study, the most common problems reported by patients were eating (78%), smiling, laughing, and embarrassment (53%) before surgery. The quality of life associated with eating; speaking clearly; clean teeth or dentures; light physical activities, such as working at home, going out to work or meeting others; smiling; laughing; showing teeth without discomfort and embarrassment; emotional conditions, such as becoming upset quicker than usual, enjoying communication with others (i.e., friends, relatives and neighbors); and job-related activities significantly increased after surgery, but QOL associated with the amount of sleep and resting did not improve. No significant association was noted between quality of life after implantation and place of residence, education and gender. CONCLUSION: In this study, implants had a favorable impact on a patient's quality of life.

Comparing the effect of a desensitizing material and a self-etch adhesive on dentin sensitivity after periodontal surgery: a randomized clinical trial.

OBJECTIVES: This double-blind randomized placebo-controlled clinical trial evaluated the ability of a desensitizing agent and a self-etch adhesive on cervical dentin sensitivity (CDS) after periodontal surgery. MATERIALS AND METHODS: Ninety hypersensitive teeth of 13 subjects were included in the study. After periodontal surgery, the teeth of each posterior sextant treated with one of the following materials: G1: Clearfil S3 Bond (Kuraray Dental), G2: Gluma Desensitizer (Heraeus Kulzer), and G3: placebo (water). The sensitivity was assessed using evaporative stimuli before treatment (baseline, T0), 1 day after treatment (T1), after 1 week (T2), and after 1 month (T3) according to visual analog scale (VAS). RESULTS: Following the treatment, all the 3 groups showed significant reduction of CDS in T1 compared to T0. Reduction of CDS between T1 and T2 was observed only in G1 but there was no significant difference between T2 and T3 in this group. Although we observed a significant difference in T3 compared to T1 and T2 in G2 and G3, comparison of treatment groups in each assessment time showed a significant difference only in T3. According to paired comparison, this was due to the difference between G2 and G3. CONCLUSIONS: Dentin sensitivity following periodontal surgery will decrease spontaneously over time, but treating the sensitive teeth with Gluma Desensitizer and Clearfil S3 Bond can have some benefits.

Comparison of Three types of Tooth Brushes on Plaque and Gingival Indices: A Randomized Clinical Trial.

OBJECTIVE: To compare clinical results of three types of manual tooth brushes on plaque removal efficacy and gingivitis. METHOD: This study is a single blind randomized trial with crossover design which involved 30 periodontaly healthy individuals. Professional plaque removal and oral hygiene instruction were performed for all the participants in the first step of our study followed by asking them to avoid brushing for 2 days. Thereafter plaque and gingivitis scores were measured using plaque and gingival indices (PI and GI). Then subjects were instructed to use Pulsar tooth brush for a two-week period and then, GI and PI indices were assessed again. After passing one-week period for wash out, subjects didn't brush for 2 days and indices were recorded again. The same procedure was done for CrossAction, and Butler 411 tooth brushes respectively and at the end of the study these variables were analyzed using SPSS software ver.16. Repeated measurement ANOVA test was used to compare the scores between different brushes. RESULT: Finding of this study reveals that using all three types of tooth brushes resulted in significant plaque and gingivitis reduction compared to baseline levels. Pulsar tooth brush was significantly more effective in diminishing PI and GI than Butler tooth brush (p=0.044 and 0.031 respectively). CONCLUSION: According to our findings all 3 types of tooth brushes are effective in reduction of plaque and gingivitis and this reduction is significantly greater for Pulsar tooth brush compared to Butler and CrossAction tooth brushes.

Clinical and histological evaluation of increase in the residual ridge width using mineralized corticocancellous block allografts: A pilot study.

Background. Lateral ridge augmentation is conventionally accomplished by means of autogenous bone grafts. However, due to its complications, the application of autogenous bone graft substitutes, e.g. mineralized corticocancellous allograft, is ecommended. Methods. In the present study, twelve patients were included, with insufficient alveolar ridge widths in the designated sites for dental implant placement. During the primary surgery, mineralized corticocancellous block allografts were fixed in deficient sites with titanium screws and resorbable collagen membranes were used to cover the blocks. After a period of six months, a flap was raised and variations in ridge width values was measured. Finally, a micro-biopsy was obtained from the sites for histologic investigation prior to preparing them for subsequent implant placement. Results. All the applied blocks were incorporated into the underlying bone except for one. A statistically significant difference was seen between the average ridge widths before placing the allografts compared with that of implant placement stage (2.62±1.02 mm vs. 7.75±1.63 mm, respectively). Vital bone tissue was detected in all the histological specimens obtained from the interface of blocks and the underlying bone. Conclusion. The results suggest that mineralized corticocancellous block allografts might be used as scaffolds for bone growth and ridge width augmentation.

The Effects of Smoking on Expression of IL-12 and IL-1ß in Gingival Tissues of Patients with Chronic Periodontitis.

AIM: The purpose of this study was to compare IL-1ß and IL-12 gene expression in the gingival tissue of smokers and non-smokers either with healthy periodontium or with chronic periodontitis. MATERIALS AND METHODS: 41 individuals consisting of 21 healthy controls (11 non-smokers and 10 smokers) and 20 chronic periodontitis patients (10 non-smokers and 10 smokers) participated in this study. Samples were collected from papillary regions of targeted areas and cytokines were analyzed using Real Time PCR. Shapiro-Wilk, Mann-Witney and Independent T tests were employed for statistical analysis. RESULTS: IL-1ß gene expression in gingival tissue of non-smoker group with chronic periodontitis was significantly higher than non-smoker-healthy group (p=0.011). Smoker-chronic periodontitis group showed lower IL-1ß gene expression than non-smoker-chronic periodontitis group (p=0.003). IL-12 gene expression was not significantly different between analyzed groups. CONCLUSION: IL-1ß gene expression increases in gingival tissue of non-smoker-chronic periodontitis patients due to inflammatory processes but smoking reduces the expression of this cytokine in diseased periodontal tissues. On the other hand periodontal condition and smoking habits do not seem to affect IL-12 gene expressions in gingival tissues. Authors concluded that reduced levels of IL1 and in some extent IL12 in smoking patients are responsible for higher tissue and bone degenerations and less treatment responses in smokers.

A Review Over Benefits and Drawbacks of Combining Sodium Hypochlorite with Other Endodontic Materials.

INTRODUCTION: As the root canal system considered to be complex and unpredictable, using root canal irrigants and medicaments are essential in order to enhance the disinfection of the canal. Sodium hypochlorite is the most common irrigant in endodontics. Despite its excellent antimicrobial activity and tissue solubility, sodium hypochlorite lacks some important properties such as substantivity and smear layer removing ability. OBJECTIVE: The aim of this review was to address benefits and drawbacks of combining sodium hypochlorite with other root canal irrigants and medicaments. DISCUSSION: According to the reviewed articles, NaOCl is the most common irrigation solution in endodontics. However, it has some drawbacks such as inability to remove smear layer. One of the drawbacks of NaOCl is its inability to remove the smear layer and lack of substantivity. CONCLUSION: The adjunctive use of other materials has been suggested to improve NaOCl efficacy. Nevertheless, further studies are required in this field.