In Vitro Photobiomodulation Effects of Blue and Red Diode Lasers on Proliferation and Differentiation of Periodontal Ligament Mesenchymal Stem Cells.

Introduction: This study aimed to assess the photobiomodulation effects of blue and red lasers on the proliferation and osteogenic differentiation of periodontal ligament mesenchymal stem cells (PDLMSCs). Methods: PDLMSCs were cultured and tested in 4 groups. The first two groups were exposed to 445 nm diode laser irradiation (200 mW, 6 and 12 J/cm2 ), and the third group was exposed to 660 nm diode laser irradiation (50 mW, 4 J/cm2 ). The fourth group was also considered as the control group without irradiation. Cell viability/proliferation was assessed by MTT assay. RUNX2, alkaline phosphatase (ALP), collagen type 1 (col1), and osteocalcin (OCN) were evaluated by RT-PCR, and Alizarin red was used to evaluate the colonization. The data were analyzed by means of one-way analysis of variance. Results: The results of our study showed that cell survival/proliferation in the second group was significantly lower than that in the control group on days 1 and 7 (P<0.05). RT-PCR showed a significant increase in osteogenic genes in all three laser groups compared to the control group (P<0.05). All groups showed a significant increase in calcium content compared to the control group (P<0.05). ALP activity also confirmed the osteoblastic differentiation of cells in laser groups. Conclusion: 445 nm and 660 nm lasers with the studied parameters showed positive effects on the proliferation and osteoblastic differentiation of PDLMSCs.

Effect of antibacterial photodynamic therapy with chitosan nanoparticles on Aggregatibacter actinomycetemcomitans.

BACKGROUND: This study aimed to assess the effect of antibacterial photodynamic therapy (aPDT) with chitosan nanoparticles on Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) in the culture medium. MATERIALS AND METHODS: In this in vitro, experimental study, chitosan nanoparticles (CHNPs) containing indocyanine green (ICG) were first synthesized and characterized. A. actinomycetemcomitans was cultured on trypticase soy agar. The culture media containing A. actinomycetemcomitans were randomly subjected to the following six decontamination protocols: negative control subjected to sterile phosphate buffered saline (PBS) for 5 min, positive control exposed to 0.2 % chlorhexidine (CHX) for 5 min, exposure to 0.25 mg/mL ICG in the dark at 37 °C for 5 min, aPDT with 0.25 mg/mL ICG and diode laser (808 nm, 250 mW, 14.94 J/cm2, 30 s, 1 mm distance, 8 mm tip diameter), exposure to CHNPs containing 0.25 mg/mL ICG in the dark at 37 °C for 5 min, and aPDT with CHNPs containing 0.25 mg/mL ICG and diode laser. The number of colonies was counted, and analyzed by one-way ANOVA and Tamhane test (alpha=0.050). RESULTS: Antimicrobial PDT with CHNPs, and CHX groups comparably showed the highest decontamination efficacy (P = 0.000). CONCLUSION: The results showed optimal efficacy of aPDT with CHNPs containing 0.25 mg/mL ICG and 808 nm diode laser for reduction of A. actinomycetemcomitans colony count. Thus, aPDT appears to be as effective as CHX, but with fewer adverse effects.

An evaluation of photobiomodulation effects on human gingival fibroblast cells under hyperglycemic condition: an in vitro study.

An in vitro study was designed to evaluate the effects of photobiomodulation (PBM) with 915-nm diode laser on human gingival fibroblast (HGF) cells under hyperglycemic condition. The HGF cells were cultured in Dulbecco's modified eagle medium (DMEM) medium containing 30 mM glucose concentration for 48 h to mimic the hyperglycemic condition. Subsequently, the cells received three sessions of PBM (915 nm, continuous emission mode, 200 mW, energy density values of 3.2, 6, and 9.2 J/cm2). Twenty-four hours post-irradiation, cell proliferation, expression of interleukin 6 (IL-6), and vascular endothelial growth factor (VEGF) were assessed with MTT and real-time polymerase chain reaction (PCR) tests, respectively. Also, reactive oxygen species (ROS) production was measured using CM-H2DCFDA fluorimetry. No changes were detected in the cell proliferation rate between the high glucose control group and laser-treated cells, while VEGF and IL-6 gene expression levels increased significantly after PBM in the high glucose-treated cells group. ROS level was significantly decreased in the irradiated cells in high-glucose medium compared with the high glucose control group. Our study revealed the inductive role of 915-nm-mediated PBM on VEGF and the inflammatory response while concurrently reducing reactive oxygen species production in HGF cells in hyperglycemic conditions.

The effect of ostrich acellular dermal matrix on keratinized gingival width.

Background: Xenogeneic grafts have gained attention due to advantages in compare of autografts. This study aimed to compare Xeno (ostrich) Acellular Dermal Matrix (XADM) with the free gingival graft (FGG) to increase the width of Keratinized gingiva (KGW) in dogs. Materials and Methods: This split mouth animal study was performed on 10 mixed breed dogs. The upper second premolar sites were randomly selected for grafting by XADM (test) or FGG (control). Measurements of KGW were recorded before surgery, 1, 3, and 6 months after surgery. Biopsies from grafted sites for histologic and histomorphometric evaluations were harvested 6 months after surgery. Data were analyzed by repeated measured, paired samples t-test, and Wilcoxon Signed rank test. P < 0.05 was considered statistically significant. Results: KGW increased in the two study groups after surgery with no significant statistical difference between them at any time intervals (P > 0.05). The graft shrinkage was 23% and 21% for the test and control groups, respectively, without statistically significant difference (P > 0.05). Histomorphometric evaluation showed no significant difference between the two study groups. Foreign body reaction was not seen in any of the study groups. Conclusion: Increased KWG was similar between the two study groups. With regard to FGG limitations, XADM may be assumed as a suitable alternative for FGG. It should be noted that this research was an animal study and clinical trials on human should be performed to approve the efficacy and safety of this material.

Effects of diode and erbium lasers as an adjunct to scaling and root planing on clinical and immunological parameters in non-surgical periodontal treatment: a split-mouth randomized controlled clinical trial-"effects of lasers on immunological parameters".

This study evaluated the effects of diode and erbium lasers, as an adjunct to scaling and root planing (SRP), on clinical and immunological parameters in non-surgical periodontal therapy. In this split-mouth randomized controlled clinical trial, 17 participants with at least one periodontally involved tooth in each quadrant received oral hygiene instruction and full-mouth SRP. At baseline, probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and full-mouth plaque index (FMPI) were measured, and gingival crevicular fluid (GCF) sampling was performed. Next, one random quadrant in each participant received 940 nm diode laser (1 W, continuous-wave), and another quadrant received 2780 nm Er,Cr:YSGG laser (1.5 W, 30 Hz) irradiation. The GCF levels of interleukin (IL)-10 and matrix metalloproteinase (MMP)-13 were measured at baseline, and after 2 and 6 months using ELISA. The clinical parameters were also measured. Data were analyzed by repeated measures ANOVA. Significant clinical improvement was noted in all groups (P < 0.05). CAL in the control group was higher at 6 months than 2 months. The increase in IL-10 in erbium group was significantly greater than that in other groups (P < 0.001). The MMP-13 level was significantly lower in laser groups with greater reduction in erbium group (P < 0.001). Application of 940 nm diode and 2780 nm Er,Cr:YSGG lasers as an adjunct to SRP significantly decreased the GCF level of MMP-13, with no significant clinical advantage over SRP monotherapy. Application of 2780 nm Er,Cr:YSGG laser in addition to SRP increased the GCF level of IL-10.Trial registration numbers: IRCT20140318017053N11 and IRCT20140318017053N9.

A Comparison between Mucoderm® and Connective Tissue Graft for Root Coverage.

Statement of the Problem: Subepithelial connective tissue graft (SCTG) is the gold stand-ard treatment for root coverage procedure; however, this technique has limitations such as the need for a donor site and the difficulty of the harvesting procedure. The potential bene-fits of Mucoderm®, a collagen matrix derived from porcine dermis, as an alternative treat-ment for root coverage can be investigated. Purpose: This study aimed to evaluate the efficacy of Mucoderm® for root coverage and compare its results with SCTG. Materials and Method: This double-blind split-mouth randomized clinical trial was con-ducted on seven patients with 12 bilateral gingival recessions (24 recession sites). Coronally advanced flap + Mucoderm® was applied on one side and coronally advanced flap + con-nective tissue graft (CTG) was applied on the contralateral side. We measured the periodon-tal pocket depth (PPD), clinical attachment level (CAL), recession depth (RD), keratinized tissue width (KTW) and gingival thickness (GT) with a surgical stent at baseline (preopera-tively) and at 1, 3 and 6 months postoperatively. The Wilcoxon and Friedman tests were used to analyse the data. Results: The mean percentage of root coverage was 26% in the Mucoderm® group and 60% in the SCTG group at 6 months, compared with baseline. The mean percentage of root coverage was significantly different between the two groups (p Value< 0.05). The results indicated that Mucoderm® did not increase the KTW, while CTG significantly increased the KTW (p Value< 0.05 at 1, 3 and 6 months). Conclusion: The results of this study showed that Mucoderm® might not be an appropriate alternative for the CTG in root coverage procedures.

Clinical Efficacy of Aloe Vera Toothpaste on Periodontal Parameters of Patients with Gingivitis-A Randomized, Controlled, Single-masked Clinical Trial.

AIM AND OBJECTIVE: This study aims to assess the effects of aloe vera toothpaste on dental plaques and gingivitis. MATERIALS AND METHODS: This single-center, single-blind, randomized, two-period crossover study was performed on 20 dental students with a mean age of 24.5 ± 4 years with gingivitis. Subjects were randomly assigned to two groups (n = 10). After 14 days of trial period, plaque index (PI) and gingival index (GI) were assessed for each group. The first group used aloe vera toothpaste for 30 days and then their PI and GI were recorded. A 2-week washout period was allowed and then the subjects used fluoride toothpaste for the next 30 days and underwent PI and GI assessment again. This order was reversed in group 2. RESULTS: Toothpaste-containing aloe vera showed no significant improvement in the GI and PI scores as compared with a fluoride-containing dentifrice. PI was 2.14 ± 1.3 at baseline and 1.84 ± 1.02 in 30 days (p <0.098). GI was 0.62 ± 0.74 at baseline and 0.25 ± 0.46 at 30 days (p <0.068). During the trial, no side effects were seen due to the use of aloe vera or fluoride toothpaste. CONCLUSION: The effect of aloe vera toothpaste on PI and GI was similar to that of fluoride toothpaste and it seems that this toothpaste can be used as an alternative to a chemical toothpaste. CLINICAL SIGNIFICANCE: The use of an aloe vera toothpaste in improving the progression of gingivitis can be evaluated.

Efficacy of antimicrobial photodynamic therapy for elimination of Aggregatibacter actinomycetemcomitans biofilm on Laser-Lok titanium discs.

BACKGROUND: Antimicrobial Photodynamic therapy (aPDT) is a novel modality suggested for treatment of peri-implantitis. This study aimed to assess the effect of aPDT with toluidine blue (TBO) and indocyanine green (ICG) and 635 nm and 808 nm diode laser on Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) biofilm formed on Laser-Lok titanium discs. MATERIALS AND METHODS: Eighty sterile Laser-Lok titanium discs were inoculated with A. actinomycetemcomitans to form biofilm and were randomly divided into 8 groups (n = 10) of control, chlorhexidine (CHX), TBO, ICG, 635 nm diode laser with 220 mW power, 808 nm diode laser with 250 mW power, 100 µg/mL TBO+635 nm diode laser and ICG+808 nm diode laser. Number of colony forming units (CFUs) on the surface of each disc was counted after the intervention. Data were analyzed using the Kruskal-Wallis test. RESULTS: Significant differences were noted in colony count among the eight groups after the intervention (P = 0.001). Pairwise comparisons with adjusted P value test showed that aPDT with TBO+635 nm laser and ICG+808 nm laser caused significant reduction of bacterial biofilm compared to the control group (P = 0.0001). TBO alone caused significant reduction of biofilm compared to the control group (P = 0.004). No other significant differences were noted (P > 0.05). CONCLUSION: Within the limitations of this study, the results showed that aPDT is a potential modality for decontamination of implant surface and reduction of A. actinomycetemcomitans biofilm in vitro. In this study, aPDT with TBO+635 nm diode laser and ICG+808 nm diode laser decreased the bacterial load on titanium discs.

Efficacy of 2% ibuprofen subgingival irrigation as an adjunct to non-surgical therapy in the treatment of chronic periodontitis: A randomized controlled, split-mouth, clinical trial.

Background: Pharmacological factors, such as ibuprofen, released topically in the periodontal pocket modulate the host response and enhance the influence of non-surgical periodontal treatment. Methods: In this double-blind, randomized, split-mouth, clinical trial, 38 outpatients with mild to moderate chronic periodontitis were enrolled by applying the simple random sampling method. They had at least one tooth with a periodontal pocket depth of >4 mm in each quadrant and had undergone phase I of periodontal treatment one week after scaling and root planing (SRP). The parameters of clinical periodontal evaluation, including probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding index (BI), were measured. In addition, two mandibular molar teeth in one quadrant were randomly nominated for subgingival irrigation with 0.5 mL of 2% ibuprofen or placebo mouthwash. The measurements were repeated after at least one week for three months. Results: Thirty-four individuals (18 women and 16 men), with an age range of 28‒36 years, were evaluated for three months. Moreover, periodontal clinical parameters were assessed within three months. There was a significant improvement in pocket depth (PD) and clinical attachment level (CAL) readings after 12 weeks in both groups (paired t-test). On comparing, the group with scaling and root planing (SRP) + ibuprofen showed more favorable results than the group with SRP + placebo (P<0.05). There were significant improvements in PI and BI in both groups; the differences between the two groups were significant (P<0.05). Conclusion: The mouthwashes containing ibuprofen might reduce the symptoms of periodontal disease and might be used as an adjunct in the healing process.

Effect of nonsurgical periodontal therapy on the level of salivary antioxidants in patients with generalized moderate-to-severe chronic periodontitis.

Background: In the course of periodontal diseases, polymorphonuclear leukocytes (PMNs) produce oxidative agents and free radicals, thus triggering oxidant-antioxidant disequilibrium in the saliva. Due to the reduction of antioxidant protective effect, oxidative stress is induced, destroying periodontal tissues. This study aimed to investigate the consequences of the non-surgical phase of periodontal therapy on the level ofsalivary antioxidantsin patients with generalized moderate-to-severe chronic periodontitis. Methods: Un-stimulated salivary samples were collected from 43 patients with generalized moderate-to-severe chronic periodontitis for 5 minutes. Clinical parameters, including clinical attachment loss (CAL), bleeding on probing (BoP) and pocket depth (PD), were recorded in each tooth and subsequently, scaling and root planing (SRP) was carried out. After four weeks, salivary samples were collected once again, and the above-mentioned clinical parameters were recorded. Following centrifugation and freezing at a temperature of -80°C, salivary samples were examined simultaneously in a single day, and the level of their antioxidants was measured with ferric reducing ability of plasma (FRAP) method using a spectrophotometer. Results: The concentration of salivary antioxidants significantly increased four weeks following the non-surgical periodontal therapy (P<0.0001). Moreover, the clinical parameters of CAL, BoP and PD showed a significant decrease in 4 weeks as well (P<0.0001). Conclusion: The level of salivary antioxidants in patients with generalized moderate to severe chronic periodontitis significantly increased after etiotropic periodontal therapy, indicating the possible beneficial influence of periodontal therapy on the level of salivary antioxidants in patients suffering from periodontitis.

Clinical and Histomorphometric Assessment of Lateral Alveolar Ridge Augmentation Using a Corticocancellous Freeze-Dried Allograft Bone Block.

Horizontal ridge augmentation with allografts has attracted notable attention because of its proper success rate and the lack of disadvantages of autografts. Corticocancellous block allografts have not been adequately studied in humans. Therefore, this study clinically and histomorphometrically evaluated the increase in ridge width after horizontal ridge augmentation using corticocancellous block allografts as well as implant success after 12 to 18 months after implantation. In 10 patients receiving implants (3 women, 7 men; mean age = 45 years), defective maxillary alveolar ridges were horizontally augmented using freeze-dried bone allograft blocks. Ridge widths were measured before augmentation, immediately after augmentation, and ∼6 months later in the reentry surgery for implantation. This was done at points 2 mm (A) and 5 mm (B) apically to the crest. Biopsy cores were acquired from the implantation site. Implant success was assessed 15.1 ± 2.7 months after implantation (range = 12-18 months). Data were analyzed using Friedman and Dunn tests (α = 0.05). At point A, ridge widths were 2.77 ± 0.37, 8.02 ± 0.87, and 6.40 ± 0.66 mm, respectively, before surgery, immediately after surgery, and before implantation. At point B, ridge widths were 3.40 ± 0.39, 9.35 ± 1.16, and 7.40 ± 1.10 mm, respectively, before surgery, immediately after surgery, and before implantation. The Friedman test showed significant increases in ridge widths, both at point A and point B (both P = .0000). Postaugmentation resorption was about 1.5-2 mm and was statistically significant at points A and B (P < .05, Dunn). The percentage of newly formed bone, residual graft material, and soft tissue were 33.0% ± 11.35% (95% confidence interval [CI] = 24.88%-41.12%), 37.50% ± 19.04% (95% CI = 23.88%-51.12%), and 29.5%, respectively. The inflammation was limited to grades 1 or zero. Twelve to 18 months after implantation, no implants caused pain or showed exudates or pockets. Radiographic bone loss was 2.0 ± 0.7 mm (range = 1-3). It can be concluded that lateral ridge augmentation with corticocancellous allograft blocks might be successful both clinically and histologically. Implants might have a proper clinical success after a minimum of 12 months.

Association of Serum Triglyceride Level and Gemfibrozil Consumption With Periodontal Status.

BACKGROUND: Hyperlipidemia is a major risk factor for cardiovascular diseases. Considering the suggested association between periodontal and cardiovascular diseases, this study sought to assess the association, if any, between serum triglyceride (TG) levels and gemfibrozil consumption with periodontal parameters. METHODS: This cross-sectional study was conducted on 90 participants, including 30 individuals with a normal lipid profile (group H), 30 patients with hypertriglyceridemia and not on medication (group N), and 30 patients with hypertriglyceridemia and taking gemfibrozil over a 3-month period (group M). Periodontal parameters including probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and plaque index were measured at four sites of each tooth. Serum levels of total cholesterol (TC), TG, low-density lipoprotein, and high-density lipoprotein were measured. RESULTS: Mean values for PD and CAL in the two hypertriglyceridemic groups were significantly higher than those of the H group (P <0.001). After controlling for confounding variables, significant linear correlations were noted between PD and BOP, PD and TC, PD and TG, and CAL and TG in each group (P <0.01). CONCLUSIONS: Patients with hypertriglyceridemia had worse periodontal status than healthy controls. Patients with hypertriglyceridemia who were taking gemfibrozil did not show significant differences in CAL and PD compared with untreated patients with hypertriglyceridemia.

Connective tissue graft vs. emdogain: A new approach to compare the outcomes.

BACKGROUND: The aim of this clinical trial study was to clinically evaluate the use of enamel matrix protein derivative combined with the coronally positioned flap to treat gingival recession compared to the subepithelial connective tissue graft by a new method to obtain denuded root surface area. MATERIALS AND METHODS: Thirteen patients, each with two or more similar bilateral Miller class I or II gingival recession (40 recessions) were randomly assigned to the test (enamel matrix protein derivative + coronally positioned flap) or control group (subepithelial connective tissue graft). Recession depth, width, probing depth, keratinized gingival, and plaque index were recorded at baseline and at one, three, and six months after treatment. A stent was used to measure the denuded root surface area at each examination session. Results were analyzed using Kolmogorov-Smirnov, Wilcoxon, Friedman, paired-sample t test. RESULTS: The average percentages of root coverage for control and test groups were 63.3% and 55%, respectively. Both groups showed significant keratinized gingival increase (P < 0.05). Recession depth decreased significantly in both groups. Root surface area was improved significantly from baseline with no significant difference between the two study groups (P > 0.05). The results of Friedman test were significant for clinical indices (P < 0.05), except for probing depth in control group (P = 0.166). CONCLUSION: Enamel matrix protein derivative showed the same results as subepithelial connective tissue graft with relatively easy procedure to perform and low patient morbidity.