End-Stage Renal Disease in a Patient With Schmidt's Syndrome: A Case Report.

Schmidt's syndrome constitutes Addison's disease in conjunction with autoimmune hypothyroidism or type 1 diabetes mellitus. It has misleading symptomology and an unclear order of presentation of symptoms. This often results in missed and late diagnosis. Chronic kidney disease is a rarely reported phenomenon in Schmidt's syndrome. Multiple factors may have the potential to cause renal failure, such as Addison's disease and/or hypothyroidism, the understanding of which is still evolving. A 45-year-old gentleman who is a known case of Schmidt's syndrome presented to us with fatigue, anorexia, and weight gain. Further evaluation revealed a picture of chronic kidney disease. We would like to alert fellow peers of this potential complication and the importance of screening as well as timely diagnosis.

Effect of post-curing light exposure time on the physico-mechanical properties and cytotoxicity of 3D-printed denture base material.

OBJECTIVE: This study investigated the effect of post curing light exposure time on the physico-mechanical properties and cytotoxicity of a 3D-printed PMMA-based denture material in comparison to a conventional heat-cured alternative as a control. METHODS: 3D-printed specimens were fabricated followed by post-curing for 0, 5, 10 or 20 min at 200 W and light wavelength range of 390-540 nm. Heat-cured specimens were fabricated using a standard protocol. Specimens were placed in artificial saliva at 37 â„ƒ for 48 h (immediate groups) and 6 months (aged group), then evaluated flexural strength/modulus, fracture toughness, microhardness, and degree of conversion. Water sorption and solubility was assessed after 28 days. Flexural strength, flexural modulus, and fracture toughness were tested through three-point bending tests, while the surface hardness was tested using Vickers's test. Fractured specimens were viewed by scanning electron microscope (SEM). Cytotoxicity in term of cell viability was evaluated using human oral fibroblasts. RESULTS: Flexural strength/modulus, fracture toughness and surface hardness significantly improved with the increase in light curing time up to 20 min. The same pattern of improvement was found with degree of conversion, water sorption, solubility, and cell viability. There was no significant difference (p < 0.01) between heat-cured material and 3D specimens post-cured for 20 min in term of flexural strength/modulus, surface hardness, and degree of conversion at the two-storage time points. SIGNIFICANCE: Generally, the physico-mechanical properties of the 3D-printed denture base material improve as post curing time increases up to 20 min which exhibited comparable performance as the conventional heat-cured control.

Formulation of nano-graphene doped with nano silver modified dentin bonding agents with enhanced interfacial stability and antibiofilm properties.

OBJECTIVE: The aim of this study was to synthesize and characterize reduced nano graphene oxide (RGO) and graphene nanoplatelets (GNPs) doped with silver nanoparticles (nAg) and to prepare an experimental dentin adhesive modified with RGO/nAg and GNP/nAg nanofillers for studying various biological and mechanical properties after bonding to tooth dentin. METHODS: Nanoparticles were characterized for their morphology and chemical structure using electron microscopy and infrared spectroscopy. Experimental dentin adhesive was modified using two weight percentage (0.25% and 0.5%) of RGO/nAg and GNP/nAg to study its degree of conversion (DC), antimicrobial potential, and cytotoxicity. The effect and significance of these modified bonding agents on resin-dentin bonded interface were investigated by evaluating interfacial nanoleakage, micropermeability, nanodynamic mechanical analysis, micro-tensile bond strength (µTBS), and four-point bending strength (BS), RESULTS: Both 0.25% and 0.5% GNP/nAg graphene-modified adhesives showed comparable DC values to the commercial and experimental adhesive (range: 42-46%). The bacterial viability of the groups 0.25% and 0.5% GNP-Ag remained very low under 25% compared to RGO/nAg groups with low cytotoxicity profiles (cell viability>85%). Resin-bonded dentin interface created with GNP/nAg showed homogenous, well-defined hybrid layer and regularly formed long resin tags devoid of any microporosity as evidenced by SEM and confocal microscopy. The lowest nanoleakage and highest bending strength and µTBS was recorded for 0.25% GNP/nAg after 12 months of ageing. A significantly increased nanoelasticity was seen for all experimental groups except for control groups. SIGNIFICANCE: The addition of 0.25% GNP/nAg showed optimized anti-biofilm properties without affecting the standard adhesion characteristics.

Silanization of nanographene platelets improves interaction with the dentin bonding resin matrix and enhances interfacial bond integrity to dentin.

This study synthesized and characterized graphene nanoplatelets silanized with 3-(trimethoxysilyl)propyl methacrylate (MPS-GNP) for morphological and chemical characteristics. In addition, we modified a dentin bonding agent using different concentrations of MPS-GNP to study its interaction within the resin matrix of the adhesive, degree of conversion (DC), biological, and mechanical properties after bonding to tooth. Both 0.25% and 0.5% MPS-GNP-modified bonding agents showed comparable DC values to the unmodified control adhesive (range: 41%-43%). However, a statistically significant reduction in the DC was found when 0.25% and 0.5% non-silanized GNP was doped with the adhesive (<38%) (p < 0.05). On day 30, the bacterial viability of 0.5% GNP and MPS-GNP groups remained very low under 22% with the highest dead cell count (p < 0.05). GNP incorporated within the resin matrix of the dentin bonding agent showed clear evidence of several interfacial gap formations and non-union between the GNP surface and resin matrix, while the MPS-GNP modified dentin bonding agent showed MPS-GNP with no gap formation with complete union between the graphene surface and resin matrix. The decrease in the µTBS was least pronounced for 0.25% and 0.5% MPS-GNP groups. After 12 months of ageing, the groups 0.25% and 0.5% MPS-GNP also showed the highest BS as compared to the rest of the groups. Statistically significant reduction was seen in nanohardness at the hybrid layer and adhesive layer for GNP groups after 4 months of storage. The addition of up to 0.5% MPS-GNP showed optimized DC, antibiofilm activity, and micro-tensile bond strength without affecting the standard adhesion characteristics as compared to GNP alone.

Characterization of multiscale interactions between high intensity focused ultrasound (HIFU) and tooth dentin: the effect on matrix-metalloproteinases, bacterial biofilms and biological properties.

The aim of this study was to characterize multiscale interactions between high intensity focused ultrasound (HIFU) and dentin collagen and associated matrix-metalloproteinases, in addition to the analysis of the effect of HIFU on bacterial biofilms and biological properties. Dentin specimens were subjected to 5, 10 or 20 s HIFU. XPS spectra were acquired and TEM was performed on dentin slabs. Collagen orientation was performed using Raman spectroscopy. Calcium measurements in human dental pulpal cells (hDPCs) were carried out after 7 and 14 days. For macrophages, CD36+ and CD163+ were analysed. Biofilms were analyzed using CLSM. Tandem mass spectroscopy was performed for the detection of hydroxyproline sequences along with human MMP-2 quantification. Phosphorus, calcium, and nitrogen were detected in HIFU specimens. TEM images demonstrated the collagen network appearing to be fused together in the HIFU 10 and 20 s specimens. The band associated with 960 cm-1 corresponds to the stretching ν1 PO43-. The control specimens showed intensive calcium staining followed by HIFU 20 s > HIFU 10 s > HIFU 5 s specimens. Macrophages in the HIFU specimens co-expressed CD80+ and CD163+ cells. CLSM images showed the HIFU treatment inhibiting bacterial growth. SiteScore propensity determined the effect of HIFU on the binding site with a higher DScore representing better site exposure on MMPs. Multiscale mapping of dentin collagen after HIFU treatment showed no deleterious alterations on the organic structure of dentin.

Longitudinal evaluation of clinical, spectral and tissue degradation biomarkers in progression of periodontitis among cigarette and electronic cigarette smokers.

OBJECTIVES: To longitudinally evaluate the periodontal parameters and MMP-8 and CTX (C-terminal crosslinked telopeptide of type I collagen) levels from diseased and healthy sites from cigarette and electronic cigarette (e-cig) smokers and characterize the gingival crevicular fluid (GCF) samples using Raman spectroscopy In addition, to longitudinally determine if MMP-8 and CTX are predictive factors for attachment loss in periodontitis sites. METHODS: Sixty periodontally healthy and 60 periodontitis/diseased sites from 30 e-cig and 30 cigarette smokers were monitored at baseline, 3 months, and 6-months. GCF was sampled to study the MMP-8 and CTX concentrations using enzyme-linked immunosorbent assay. Infra-red absorption spectra of GCF were acquired at all time points and processed to identify key functional groups. RESULTS: A significantly increased attachment loss was observed at 6 months for both smokers when compared with baseline (p < 0.01). This difference was significantly high for cigarette smokers compared with e-cig users (p < 0.01). MMP-8, CTX, smoking pack-years were significantly correlated with probing depth and clinical attachment loss among both e-cig and cigarette smokers. For MMP-8 and CTX, the periodontitis sites showed a statistically significant difference between e-cig and cigarette smokers at both 3- and 6 months follow-up. From baseline to 6 months follow-up, periodontitis sites from both groups showed higher spectral band intensities with deconvulations and Raman shifts for Amide I and Amide II peaks. CONCLUSION: Cigarette smokers showed higher periodontal worsening than e-cig smokers. Smoking, MMP-8, CTX are prognostic factors for clinical attachment loss in cigarette and e-cig smokers. CLINICAL SIGNIFICANCE: Data for Raman scattering and spectral information identifying collagen degradation among e-cig and cigarette smokers have been analyzed. This type of analysis proves a robust diagnostic and prognostic tool for periodontal diseases. Smoking, MMP-8, and CTX are prognostic factors for clinical attachment loss in cigarette and e-cig smokers.

Development of 3D printed resin reinforced with modified ZrO2 nanoparticles for long-term provisional dental restorations.

OBJECTIVE: To characterize and investigate efficacy of loading functionalized ZrO2 nanoparticles in 3-dimensional (3D) printed acrylate ester-based resin subjected to accelerated aging in artificial saliva. As well as to evaluate the effect of ZrO2 nanoparticle volume fraction addition on mechanical and physical properties of printed composite. METHODS: Functionalized ZrO2 nanoparticles were characterized using TEM and Raman spectroscopy. 3D printed dental resin was reinforced, with ZrO2 nanoparticles, in the concentration range (0-5wt.%). The resulted nanocomposites, in term of structure and physical/mechanical properties were evaluated using different mechanical testing, microscopic and spectroscopic techniques. RESULTS: ZrO2 based nanocomposite was successful and formed composites were more ductile. Degree of conversion was significant at the highest level with blank resin and 1wt.%. Sorption revealed reduction associated with volume fraction significant to neat resin, however solubility indicated neat and 4wt.% had the lowest significant dissolution. Vickers represented critical positive correlation with filler content, while nanohardness and elasticity behaved symmetrically and had the maximum strength at 3wt.% addition. In addition, 3wt.% showed the highest fracture toughness and modulus. Improvement of flexural strength was significantly linked to filler concentration. Overall properties dramatically were enhanced after 3 months aging in artificial saliva, especially degree of conversion, microhardness, nanoindentation/elasticity, and flexural modulus. However, significant reduction was observed with flexural modulus and fracture toughness. SIGNIFICANCE: The outcomes suggest that the newly developed 3D printed nanocomposites modified with ZrO2 nanoparticle have the superior potential and efficacy as long-term provisional dental restoration materials.

Formulation of pH-sensitive chlorhexidine-loaded/mesoporous silica nanoparticles modified experimental dentin adhesive.

We formulated a pH-sensitive chlorhexidine-loaded mesoporous silica nanoparticles (MSN) modified with poly-(lactic-co-glycolic acid) (CHX-loaded/MSN-PLGA) and incorporated into experimental resin-based dentin adhesives at 5 and 10 wt%. Nanocarriers were characterized in terms of morphology, physicochemical features, spectral analyses, drug-release kinetics at varying pH and its effect on dentin-bound proteases was investigated. The modified dentin adhesives were characterized for cytotoxicity, antimicrobial activity, degree of conversion (DC) along with CHX release, micro-tensile bond strength (µTBS) and nano-leakage expression were studied at different pH values and storage time. CHX-loaded/MSN-PLGA nanocarriers exhibited a significant pH-dependent drug release behavior than CHX-loaded/MSN nanocarriers without PLGA modification. The highest percentage of CHX release was seen with 10 wt% CHX-loaded/MSN-PLGA doped adhesive at a pH of 5.0. CHX-loaded/MSN-PLGA modified adhesives exhibited more profound antibiofilm characteristics against S. mutans and more sustained CHX-release which was pH dependent. After 6 months in artificial saliva at varying pH, the 5 wt% CHX-loaded/MSN-PLGA doped adhesive showed excellent bonding under SEM/TEM, higher µTBS, and least nano-leakage expression. The pH-sensitive CHX-loaded/MSN-PLGA could be of crucial advantage for resin-dentin bonding applications especially in reduced pH microenvironment resulting from biofilm formation; and the activation of dentin-bound proteases as a consequence of acid etching and acidic content of bonding resin monomers.

pH-dependent delivery of chlorhexidine from PGA grafted mesoporous silica nanoparticles at resin-dentin interface.

BACKGROUND: A low pH environment is created due to the production of acids by oral biofilms that further leads to the dissolution of hydroxyapatite crystal in the tooth structure significantly altering the equilibrium. Although the overall bacterial counts may not be eradicated from the oral cavity, however, synthesis of engineered anti-bacterial materials are warranted to reduce the pathogenic impact of the oral biofilms. The purpose of this study was to synthesize and characterize chlorhexidine (CHX)-loaded mesoporous silica nanoparticles (MSN) grafted with poly-L-glycolic acid (PGA) and to test the in vitro drug release in various pH environments, cytotoxicity, and antimicrobial capacity. In addition, this study aimed to investigate the delivery of CHX-loaded/MSN-PGA nanoparticles through demineralized dentin tubules and how these nanoparticles interact with tooth dentin after mixing with commercial dentin adhesive for potential clinical application. RESULTS: Characterization using SEM/TEM and EDX confirmed the synthesis of CHX-loaded/MSN-PGA. An increase in the percentage of drug encapsulation efficiency from 81 to 85% in CHX loaded/MSN and 92-95% in CHX loaded/MSN-PGA proportionately increased with increasing the amount of CHX during the fabrication of nanoparticles. For both time-periods (24 h or 30 days), the relative microbial viability significantly decreased by increasing the CHX content (P < 0.001). Generally, the cell viability percentage of DPSCs exposed to MSN-PGA/Blank, CHX-loaded/MSN, and CHX-loaded/MSN-PGA, respectively was > 80% indicating low cytotoxicity profiles of experimental nanoparticles. After 9 months in artificial saliva (pH 7.4), the significantly highest micro-tensile bond strength value was recorded for 25:50 CHX/MSN and 25:50:50 CHX/MSN-PGA. A homogenous and widely distributed 50:50:50 CHX-loaded/MSN-PGA nanoparticles exhibited excellent bonding with the application of commercially available dentin adhesive. CONCLUSIONS: A pH-sensitive CHX release response was noted when loaded in MSN grafted PGA nanoparticles. The formulated drug-loaded nanocarrier demonstrated excellent physicochemical, spectral, and biological characteristics. Showing considerable capacity to penetrate effectively inside dentinal tubules and having high antibacterial efficacy, this system could be potentially used in adhesive and restorative dentistry.

Multiscale in-vitro analysis of photo-activated riboflavin incorporated in an experimental universal adhesive.

OBJECTIVE: To investigate the effect of blue light photoactivated riboflavin modified universal adhesives on dentin collagen biodegradation resistance, dentin apparent elastic modulus, and resin-dentin bond strength with interfacial morphology. METHODS: Dentin slabs were treated with 0.1% riboflavin-5-phosphate modified (powder added slowly while shaking and then sonicated to enhance the dispersion process) Universal Adhesive Scotch Bond and Zipbond™ along with control (non-modified) and experimental adhesives, photoactivated with blue light for 20s. Hydroxyproline (HYP) release was assessed after 1-week storage. Elastic-modulus testing was evaluated using universal testing machine at 24 h. Resin-dentin interfacial morphology was assessed with scanning electron-microscope, after 6-month storage. 0.1% rhodamine dye was added into each adhesive and analyzed using CLSM. Detection of free amino groups was carried out using ninhydrin and considered directly proportional to optical absorbance. Collagen molecular confirmation was determined using spectropolarimeter to evaluate and assess CD spectra. For molecular docking studies with riboflavin (PDB ID file), the binding pocket was selected with larger SiteScore and DScore using Schrodinger PB software. After curing, Raman shifts in Amide regions were obtained at 8 µm levels. Data were analyzed using Two-way analysis of variance (ANOVA, p ≤ 0.05) and Tukey-Kramer multiple comparison post hoc tests. RESULTS: At baseline, bond strength reduced significantly (p ≤ 0.05) in control specimens. However, at 6 months' storage, UVA Zipbond™ had significantly higher µTBS. Resin was able to diffuse through the porous demineralized dentin creating adequate hybrid layers in both 0.1%RF modified adhesives in CLSM images. In riboflavin groups, hybrid layer and resin tags were more pronounced. The circular dichroism spectrum showed negative peaks for riboflavin adhesive specimens. Best fitted poses adopted by riboflavin compound are docked with MMP-2 and -9 proteases. Amide bands and CH2 peaks followed the trend of being lowest for control UA Scotch bond adhesive specimens and increasing in Amides, proline, and CH2 intensities in 0.1%RF modified adhesive specimens. All 0.1%RF application groups showed statistically significant (p < 0.05) less levels of HYP released compared to controls. Dentin Eappr of riboflavin application was significantly (p < 0.05) more as compared to control groups. CONCLUSION: Blue light photoactivated 0.1% riboflavin modified adhesives improved the biochemical and biomechanical properties of demineralized dentin as well as the long-term resin-dentin interfacial integrity and bond strength of universal adhesive to dentin.

Effect of statins on orthodontic tooth movement: A systematic review of animal and clinical studies.

OBJECTIVE: The objective was to systematically-review the effect of statin drugs on orthodontic-tooth-movement (OTM). DESIGN: The focused-question was "Does statin therapy affect OTM?" PubMed, Ovid Medline, Cochrane Library, Scopus, EMBASE and Web of Science databases were searched without time and language restrictions using different key words. Studies assessing the effect of adjunctive statin administration on OTM compared with orthodontic treatment alone were included. The search was performed up to and including December 2018. Data regarding the study design/grouping, subjects, age/gender, duration of follow-up, outcome variables and parameters related to OTM and statins administration were evaluated. RESULTS: Nine studies (1 clinical and 8 studies performed in animal-models) were included. Six studies used Simvastatin, whereas three studies used Atorvastatin. Six experimental studies and one clinical study reported reduction in OTM upon statin administration. Two experimental studies reported no effect of statin administration on OTM. In 90 % of the studies, the risk-of-bias was high. CONCLUSION: Based upon the high risk-of-bias and methodological inconsistencies among the included studies, the influence of statin delivery on OTM remains debatable.

Levels of advanced glycation end products in gingival crevicular fluid of chronic periodontitis patients with and without type-2 diabetes mellitus.

BACKGROUND: It is hypothesized that levels of advanced glycation end products (AGEs) are higher in the gingival crevicular fluid (GCF) of chronic periodontitis (CP) patients with type-2 diabetes mellitus (type-2 DM) than controls (systemically healthy individuals without CP. The aim was to assess the levels of AGEs in the GCF of CP patients with and without type-2 DM. METHODS: Participants were divided into three groups as follows. Group-1: Patients with type-2 DM and CP; group-2: Non-diabetic individuals with CP; group-3: Non-diabetic individuals without periodontal diseases. Demographic data were collected using a questionnaire. Full-mouth plaque-index (PI), bleeding-on-probing (BOP), probing depth (PD), clinical attachment loss (AL), and marginal-bone-loss (MBL) were assessed. Hemoglobin A1c (HbA1c) levels were recorded. The GCF was collected and levels of AGEs were assessed using standard techniques. Group comparisons were performed and P <0.05 was considered statistically significant. RESULTS: Ninety-four individuals (32, 31, and 31 individuals in groups 1, 2, and 3, respectively) were included. Mean HbA1c levels were significantly higher in group-1 than groups 2 (P <0.05) and 3 (P <0.05). The mean age of individuals in groups 1, 2, and 3 were 55.2, 51.5, and 50.7 years, respectively. The mean duration of type-2 DM among individuals in group-1 was 8.2 years (7 to 10 years). Levels of AGEs were detected in all the patients. The mean GCF levels of AGEs were significantly higher among patients in group-1 (521.9 pg/mL [428.5 to 569.3 pg/mL]) (P <0.01) than groups 2 (234.84 pg/mL [216.8 to 318.9 pg/mL]) and 3 (87.2 pg/mL [75.2 to 97.8 pg/mL]). The mean GCF levels of AGEs were significantly higher among patients in group-2 (P <0.01) than group-3 (P <0.01). CONCLUSION: The GCF levels of AGEs are higher in CP patients with type-2 DM compared to systemically healthy individuals with and without periodontal diseases.

Clinical efficacy of photodynamic therapy and laser irradiation as an adjunct to open flap debridement in the treatment of chronic periodontitis: A systematic review and meta-analysis.

BACKGROUND: The aim of this systematic review and meta-analyses was to assess the quality of evidence and efficacy of antimicrobial photodynamic therapy (aPDT) and laser irradiation (LI) as an adjunct to open flap debridement (OFD) in the treatment of chronic periodontitis. METHODS: Electronic searches were conducted in databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials Register databases) up to March 2019. Randomized clinical trials (RCTs) comparing clinical efficacy of either aPDT and/or LI, placebo, or no treatment were included. Primary outcomes included clinical attachment level (CAL), while secondary outcomes were reduction in probing depth (PD) and gingival recession (GR) depth. The weighted mean differences (WMD) of outcomes and 95% confidence intervals (CI) for each variable were calculated using random effect model. RESULTS: Six RCTs were included. For aPDT studies, the overall mean difference for CAL gain (WMD = -0.61, 95% CI = -1.22 to -0.016, P = .044) and PD reduction (WMD = -1.79, 95% CI = -3.44 to -0.14, P = .034) was significant between aPDT and OFD groups at follow-up. No significant overall mean difference was observed for GR depth (WMD = 0.02, 95% CI = -0.75 to 0.79, P = .95). For LI studies, none of the clinical periodontal parameters including CAL gain (WMD = 0.23, 95% CI = -0.09 to 0.55, P = .159, Figure 3A), PD reduction (WMD = 0.31, 95% CI = -0.67 to 1.31, P = .52, Figure 3B) and GR depth (WMD = -0.34, 95% CI = -2.47 to 1.78, P = .74, Figure 3C) were found to be significant between LI and OFD groups at follow-up. CONCLUSION: With the limited data available, only aPDT as an adjunct to OFD showed superior results for clinical periodontal parameters compared to OFD alone in the treatment of chronic periodontitis. Further RCTs are warranted in order to obtain robust conclusions with regard to laser therapy.

Influence of increased body mass index on orthodontic tooth movement and related parameters in children and adolescents: A systematic review of longitudinal controlled clinical studies.

OBJECTIVES: To assess the impact of increased body mass index (BMI) on orthodontic tooth movement (OTM) and related parameters in children and adolescents. SEARCH SOURCES: A search of six electronic databases and manual searching were performed up to June 2019 without language and time restrictions. DATA SELECTION: Eligibility criteria were as follows: (1) longitudinal controlled clinical studies; (2) children and adolescents undergoing orthodontic therapy (OT); (3) no systemic diseases; (4) experimental group: patients with increased BMI; and (5) control group: patients with normal BMI. DATA EXTRACTION: Screening, study selection and data extraction were performed; bias within studies was assessed using the Risk of Bias In Non-randomised Studies (ROBINS-I) tool. RESULTS: Seven studies were included. One study showed that an increased BMI is associated with less wear-time of removable orthodontic appliances and one study found no significant association. One study showed that an increased BMI is associated with less cooperation during OT; however, not with the treatment results. One study reported higher pain experience during OT in adolescents with than without increased BMI. Two studies showed that increased BMI in adolescents is related to OTM, one with increased and one with decreased rates of OTM, respectively. One study reported an association between increased BMI and incidence of white spot lesions and gingivitis during OT. The ROBINS-I tool showed low to moderate risk of bias within studies. CONCLUSIONS: The influence of BMI on OTM and related parameters in children and adolescents remains debatable.

Efficacy of mechanical debridement with adjunctive probiotic therapy in the treatment of peri-implant mucositis in cigarette-smokers and never-smokers.

BACKGROUND: Efficacy of mechanical debridement (MD) with adjunctive probiotic therapy (PT) in the treatment of peri-implant mucositis (PiM) in cigarette-smoking and never-smoking subjects remains uninvestigated. PURPOSE: The aim was to assess the efficacy of MD with adjunctive PT in the treatment of PiM in cigarette-smoking and never-smoking individuals. MATERIALS AND METHODS: Patients with (group I) and without PiM (group II) were included. Demographic data was collected using a questionnaire. Treatment-wise, patients in groups I and II were subdivided into: (a) Patients that underwent MD with adjunct PT (using Lactobacillus reuteri); and (b) MD alone. In all groups, probing depth (PD), plaque index (PI), and bleeding on probing (BOP) were measured at baseline and compared after 3- and 6-months. Baseline peri-implant crestal bone levels were also measured. Sample-size estimation was performed, and statistical comparisons were done using one-way analysis of variance and Bonferroni post-hoc adjustment tests. P values under .05 were deemed significant. RESULTS: Eighty individuals (group I: 40 cigarette-smokers and group II: 40 never-smokers) with PiM participated in this study. At all-time intervals, no significant difference in PD, PI, and BOP were observed in all patients in group I. At 3-months' follow-up, the differences in BOP (P < .05), and PI (P < .05) were significantly higher in group II that underwent MD + PT than MD alone. At 6-months' follow-up, there was no difference in the changes in BOP and PI among subjects that underwent MD with and without adjunct PT. CONCLUSION: On a short-term basis, MD with adjunct PT is more effectual in the treatment of PiM than MD alone in never-smokers. Cigarette-smoking compromises peri-implant soft tissue healing following MD with or without adjunct PT.

Clinical efficacy of photodynamic therapy as an adjunct to scaling and root planing in the treatment of chronic periodontitis among cigarette smokers: A systematic review and meta-analysis.

BACKGROUND: The aim of the study was to evaluate the clinical efficacy of adjunctive photodynamic therapy (PDT) as compared to scaling and root planing (SRP) alone in the treatment of chronic periodontitis among cigarette smokers. METHODS: Electronic databases including EMBASE, MEDLINE, Cochrane Oral Health Group Trials Register and Cochrane Central Register of Controlled Trials were searched up to January 2019. Randomized clinical trials (RCTs) with data on comparison between adjunctive PDT compared to SRP in each group were included. Primary outcomes included clinical attachment level (CAL) gain, while secondary outcomes was probing depth (PD) reduction. The weighted mean differences (WMD) of outcomes and 95% confidence intervals (CI) for each variable were calculated using random and fixed effect models. RESULTS: A total of 5 RCTs were included. Two clinical trials were classified as having a low risk of bias and 3 clinical trials as high risk of bias. The overall effect for CAL gain (WMD= -0.088, 95% CI= -0.40 to 0.23, p = 0.58) and PD reduction (WMD= -0.35, 95% CI= -0.87 to -0.17, p = 0.18) was not statistically significant between PDT and SRP groups at follow-up, respectively. CONCLUSION: Within the limitations of this study, it remains debatable whether PDT as an adjunct to SRP is more effective in clinical attachment level gain as compared to SRP alone in cigarette smokers given that the available scientific evidence is weak.

Clinical periodontal status and gingival crevicular fluid cytokine profile among cigarette-smokers, electronic-cigarette users and never-smokers.

OBJECTIVE: There are no studies that have compared the clinical (plaque index [PI], bleeding on probing [BOP], probing depth [PD], clinical attachment loss [AL] and number of missing teeth [MT]) and radiographic (marginal bone loss [MBL]) periodontal parameters and gingival crevicular fluid (GCF) levels of proinflammatory cytokines among cigarette-smokers and individuals using electronic-cigarettes. The aim was to compare the clinical periodontal status and gingival crevicular fluid (GCF) cytokine profile among cigarette-smokers (Group-1), electronic-cigarette users (Group-2) and never-smokers (Group-3). METHODS: Demographic data including age, gender, duration and reason for smoking and vaping and daily frequency and duration of smoking and vaping was collected using a questionnaire. Clinical (PI, BOP, PD and clinical AL) and radiographic (MBL) periodontal parameters were recorded. The volume of collected GCF was determined and levels of interleukin (IL) 1ß, IL-6, tumour-necrosis-factor-alpha (TNF-α), matrix metalloproteinase (MMP)-8 and interferon-gamma (IFN-γ) were investigated. RESULTS: Forty-six cigarette-smokers, 44 electronic-cigarette users and 45 never-smokers were included in groups 1-3, respectively. Mean scores of PI (P < 0.05), PD (P < 0.05) and clinical AL (P < 0.05) were significantly higher among individuals in Group-1 than Group-3. Compared with groups 1 (P < 0.05) and 2 (P < 0.05), BOP was more often manifested among patients in Group-3. Compared with Group-3, MBL was significantly higher in groups 1 (P < 0.01) and 2 (P < 0.01). GCF volume was significantly higher in Group-1 compared with groups 2 and 3. The concentrations of IL-1ß, IL-6, IFN-γ, TNF-α and MMP-8 were significantly higher in the GCF samples of individuals in Group-1 (P < 0.05) than groups 2 and 3. CONCLUSION: Periodontal status is poorer and GCF levels of proinflammatory cytokines are higher in cigarette-smokers compared with electronic-cigarette smokers and never-smokers. However, the probability of increased periodontal inflammation and GCF proinflammatory cytokine levels in electronic-cigarette users than never-smokers cannot be annulled.

Cytokine levels and their role in the etiopathogenesis of Burning Mouth Syndrome: A systematic review.

INTRODUCTION: Burning Mouth Syndrome is characterized by variable symptoms that include pain, burning and paraguesia in an otherwise healthy-appearing oral mucosa. Although the etiopathogenesis of Burning Mouth Syndrome is unknown, some studies provide evidence of subclinical inflammation leading to disrupted cytokine levels. AIM: To investigate the expression of cytokines and role in the etiopathogenesis of Burning Mouth Syndrome. METHODS: Online databases (MEDLINE and EMBASE) were searched from November 1986 to November 2018 for case control/cross-sectional studies comparing the levels of cytokines in patients with Burning Mouth Syndrome and healthy controls. RESULTS: A total of eight studies were included in the current review. Four studies were of high and four studies were of moderate quality. Seven studies evaluated IL-6, out of which four showed comparable results, two showed higher levels and one study reported lower levels in Burning Mouth Syndrome patients compared to controls. Four studies assessed IL-2, out of which two reported comparable results whereas one study reported higher levels and one study reported lower levels in Burning Mouth Syndrome patients compared to controls. IL-10 levels were measured in three studies that reported no significant differences in the levels between Burning Mouth Syndrome and healthy controls. DISCUSSION AND CONCLUSION: The etiopathogenesis of Burning Mouth Syndrome is multifactorial. Studies have provided scientific evidence that inflammation plays a key role in Burning Mouth Syndrome pathogenesis. However, whether up-regulation or down-regulation of specific cytokines contribute to the etiopathogenesis of Burning Mouth Syndrome remains debatable. Further high-quality studies with larger sample size and assessing a wider array of cytokines are warranted in order to obtain strong conclusions.

Clinical and radiographic peri-implant outcomes of short dental implants placed in posterior jaws of patients with treated generalized aggressive periodontitis: A 3-year follow-up study.

BACKGROUND: Studies assessing clinical and radiographic peri-implant parameters around short dental implants (SDIs) in treated generalized aggressive periodontitis (GAgP) patients are scant. OBJECTIVES: This 3-year follow-up study aimed to compare the clinical peri-implant and radiographic bone status around SDIs placed in partially edentulous patients treated for GAgP and periodontally healthy patients and to assess the implant success rate between both the groups. MATERIALS AND METHODS: A total of seven patients clinically diagnosed with GAgP and seven periodontally healthy patients was included in the clinical study. Forty-eight (29 maxilla; 19 mandible) and 11 (8 maxilla; 3 mandible) SDIs were placed in the GAgP group and healthy group, respectively. Plaque index (PI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were recorded at six sites around all teeth and implants. Marginal bone loss (MBL) was studied incorporating in a specialized software and examined on a calibrated computer display screen with the help of an image analyzer. Patient satisfaction was recorded using a questionnaire sheet that contained questions regarding esthetics and function of the restorations. RESULTS: The implant survival rate after 3 years was 81.25%. BOP and CAL around SDIs of GAgP patients were significantly higher than in periodontally healthy subjects (P = .01) throughout the follow-up. CAL around the teeth of GAgP patients was significantly greater during the follow-up than around the teeth of periodontal healthy subjects (P = .02). The PI and BOP between the teeth and implants showed no statistical significant difference. The mean PD at teeth was 0.4 mm greater than at implants. Implants showed significantly increased attachment loss than teeth (P = .01). The overall mean satisfaction of visual analogue scale was 12.8 ± 1.45. CONCLUSION: This short-term follow-up study indicates SDIs remain functionally stable in the posterior jaws of treated GAgP patients.