Toward accelerated bone regeneration by altering poly(D,L-lactic-co-glycolic) acid porogen content in calcium phosphate cement.

This work aimed to compare in vitro degradation of dense PLGA microspheres and milled PLGA particles as porogens within CPC, considering that the manufacturing of milled PLGA is more cost-effective when compared with PLGA microspheres. Additionally, we aimed to examine the effect of porogen amount within CPC/PLGA on degradation and bone formation. Our in vitro results showed no differences between both forms of PLGA particles (as porogens in CPC; spherical for microspheres, irregular for milled) regarding morphology, porosity, and degradation. Using milled PLGA as porogens within CPC/PLGA, we evaluated the effect of porogen amount on degradation and bone forming capacity in vivo. Titanium landmarks surrounded by CPC/PLGA with 30 and 50 wt % PLGA, were implanted in forty femoral bone defects of twenty male Wistar rats. Histomorphometrical results showed a significant temporal decrease in the amount of CPC, for both formulas, and confirmed that 50 wt % PLGA degrades faster than 30 wt%, and allows for a 1.5-fold higher amount of newly formed bone. Taken together, this study demonstrated that (i) milled PLGA particles perform equal to PLGA microspheres, and (ii) tuning of the PLGA content in CPC/PLGA is a feasible approach to leverage material degradation and bone formation.

Hepatocyte growth factor levels in the saliva and gingival crevicular fluid in smokers with periodontitis.

Hepatocyte growth factor (HGF) production by oral fibroblasts is enhanced by various molecules that are induced during inflammatory conditions including periodontitis. HGF plays an important role in the progression of periodontitis, by stimulating intense growth of epithelial cells and preventing regeneration of connective tissue attachments. Smokers have a greater risk factor in the pathogenesis and progression of periodontal disease. The objective of the study was to estimate the level of HGF in saliva and gingival crevicular fluid (GCF) in smokers with periodontitis and to compare these levels with that of nonsmokers with periodontitis and healthy controls. The HGF levels were found to be significantly high in the saliva and GCF of smokers with periodontitis compared to both never-smokers with periodontitis and the healthy control group. The elevated levels of HGF in the saliva and GCF in the study population could explain the intrinsic mechanism triggering the severity of the periodontitis in smokers. Further studies are necessary to validate the current observations and to establish a sensitive marker to predict periodontal disease activity.

Oral fluid-based biomarkers in periodontal disease - part 2. Gingival crevicular fluid.

Periodontal diagnosis and treatment plan are based on the assessment of probing depth, clinical attachment level, plaque index, gingival index, bleeding on probing, suppuration, furcation involvement, mobility, and radiographic findings. However, these clinical parameters are not sufficiently sensitive and specific to identify disease activity in individual sites or to predict future attachment loss. Hence, attention is focused on the development of diagnostic tools that could screen and differentiate the active inflamed sites and predict future tissue destruction. Gingival crevicular fluid (GCF), has gained great interest on possible diagnostic value in periodontal disease. It contains a large number of proteins and peptides derived from inflamed host tissues. The analysis of the GCF components can reflect the disease status of individual sites and thus, identify potential biomarkers of periodontitis. A literature search was carried out to find out all the available tests that indicate periodontal disease markers in GCF. All major databases were searched to compile the information on published reports between 1999 and 2014. The list of GCF-biomarkers available to date is compiled and presented in a table format. Based on the available literature on GCF biomarkers, it can be concluded that several sensitive and reliable markers are present to detect the presence, severity, and response to treatment. Further studies are warranted to analyze the sensitivity and reliability of these indicators which might help in developing noninvasive tests that could help in the diagnosis of periodontal disease.

Oral fluid based biomarkers in periodontal disease: part 1. Saliva.

Traditional clinical measurements such as probing pocket depth, bleeding on probing, clinical attachment loss; plaque index and radiographs used for periodontal diagnosis are often of limited usefulness as they are indicators of previous periodontal disease rather than present disease activity. A literature search was carried out to find out all the available tests that indicate periodontal disease markers in saliva. All major databases were searched to compile the information on published reports between 1999 and 2014. The list of biomarkers available to date is compiled and presented in a table format. Each biomarker is discussed separately based on the available evidence. Based on the evidence, it can be concluded that several sensitive salivary indicators of periodontitis are available to detect the presence, severity and response to treatment. Further studies are warranted to analyze the sensitivity and reliability of these indicators that might help in developing non-invasive tests that could help in the diagnosis of periodontal disease.

Influence of smoking on clinical parameters and gingival crevicular fluid volume in patients with chronic periodontitis.

BACKGROUND: Tobacco smoking is regarded as one of the most significant risk factors for the development and progression of periodontal disease. In particular, studies have shown an alteration in Gingival Crevicular Fluid (GCF) volume and its components in smokers. OBJECTIVE: The purpose of this study was to compare the GCF volume in smoking and non-smoking Saudi subjects with chronic periodontitis. METHODS: In this study, 30 smoking patients and 30 non-smoking patients with chronic periodontitis were enrolled. Periodontal Probing Depth (PPD), Clinical Attachment Level (CAL), Plaque Index (PI), and Bleeding on Probing (BOP) were measured to assess the pattern of periodontal destruction for each patient at six sites in selected teeth. Gingival inflammation was registered at six sites, where Gingival Crevicular Fluid (GCF) was also collected. The GCF volume was measured with a Periotron 8000®. Comparisons were made between smoking and non-smoking groups with periodontitis. RESULTS: Smokers demonstrated significantly deeper periodontal pockets (4.64±0.30 mm) than non-smokers (4.24±0.38 mm). Smoking subjects also presented significantly greater attachment loss (3.08±0.28 mm) than non-smoking subjects (2.74±0.42 mm), whereas the GCF volume was found to be significantly lower in smokers (0.25±0.04 µl) than in non-smokers (0.31±0.05 µl) (P<0.01). Among smoking subjects, lingual sites showed reduced GCF levels compared to facial sites (0.22±0.03 µl vs. 0.25±0.03 µl). CONCLUSION: Smoking appears to have considerable adverse effects on the inflammatory process, thereby promoting the progression of periodontal disease in smokers. CLINICAL SIGNIFICANCE: The adverse effect of smoking on the initiation and progression of periodontal disease is highlighted in this study. In particular, estimation of the GCF volume may serve as an indicator to assess the severity as well as the prognosis of periodontitis in smokers.

Study of the anesthetic efficacy of inferior alveolar nerve block using articaine in irreversible pulpitis.

AIM: The purpose of this study was to determine the anesthetic efficacy of inferior alveolar nerve block (IANB) using 4% articaine and 2% lidocaine supplemented with buccal infiltration. MATERIALS AND METHODS: Forty five patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth were included in the study. The first group of 15 patients received 2% lidocaine with 1:200000 epinephrine, the second group 2% lidocaine with 1: 80,000 epinephrine and the third group of 15 subjects received 4% articaine with 1:100000 epinephrine. During the access cavity preparation those patients who complained of pain received an additional buccal infiltration. The percentage of subjects who got profound anesthesia and failure to achieve anesthesia were calculated and tabulated using a visual analog scale. RESULTS: The results revealed that 87% of subjects who received 4% Articaine with 1:100,000 epinephrine got satisfactory anesthesia with inferior alveolar nerve block alone. Only 2 (13%) subjects received an additional buccal infiltration and none of the patients failed to obtain complete anesthesia with articaine. In comparison only 40% of subjects got complete anesthesia with 2% lidocaine with 1:200000 and 60% with 2% lidocaine with 1:80,000. CONCLUSION: It can be concluded that 4% articaine can be used effectively for obtaining profound anesthesia for endodontic procedures in patients with irreversible pulpitis.

Oral Cavity as an Extragastric Reservoir of Helicobacter pylori.

Background. Several studies were reported on the prevalence, and relationship between the existence of Helicobacter pylori (H. pylori) in oral cavity and in stomach of patients. The purpose of this study was to systematically review the existing literature on the presence of H. pylori in the oral cavity and its link to gastric infection, the existence of coinfection, and the impact of anti-H. pylori therapy on the dental plaque and vice versa. Method. Two authors independently searched the Medline, EMBASE, Cochrane Library, Web of Science, Google Scholar, and Scopus databases for relevant studies. The articles were analyzed critically and all qualified studies were included. The search was carried out by using a combined text and the MeSH search strategies: using the key words Helicobacter, Helicobacter pylori, and H. pylori in combination with dental plaque, periodontitis, and oral hygiene. Results. The data was presented in 8 tables and each topic separately discussed. Conclusion. Based on the systematic review of the available literature on H. pylori infection and its presence in the oral cavity, it can be concluded that dental plaque can act as a reservoir, and proper oral hygiene maintenance is essential to prevent reinfection. Due to the diversified methods and population groups involved in the available literature, no concrete evidence can be laid down. Further studies are necessary to establish the role of H. pylori in the oral cavity and its eradication on preventing the gastroduodenal infection.

Increased levels of serum and gingival crevicular fluid monocyte chemoattractant protein-1 in smokers with periodontitis.

BACKGROUND: Smoking alters the host response, including vascular function, neutrophil/monocyte activities, adhesion molecule expression, antibody production, and cytokine and inflammatory mediator release. Monocyte chemoattractant protein-1 (MCP-1) is involved in the activation and recruitment of inflammatory and immune cells to infected sites, thereby mediating a variety of pathophysiologic conditions. Estimation of serum and gingival crevicular fluid (GCF) MCP levels could be a reliable indicator of periodontal disease activity. Hence, the objective of this study is to analyze the serum and GCF MCP-1 levels of smokers and never-smokers with periodontitis and compare them with those in periodontally healthy individuals. METHODS: A total of 90 participants (30 periodontally healthy individuals, 30 non-smoking individuals with periodontitis, and 30 smokers with periodontitis) formed the study group. Serum and GCF samples were collected, and MCP-1 levels were estimated using enzyme-linked immunosorbent assay. RESULTS: Mean MCP-1 levels in serum and GCF were found to be highest in smokers with periodontitis, followed by the periodontitis group, and then by the healthy controls. The values were statistically significant (P <0.001). CONCLUSIONS: It can be concluded that the high levels of both serum and GCF MCP-1 found in smokers could explain the severity of periodontitis in smokers. More longitudinal, prospective studies will help to verify the observations of the present study. Further research in this direction could reveal reliable markers to forecast the progression of periodontitis in high-risk groups.