A comparison of gingival depigmentation by Er:YAG laser and Kirkland knife: osmotic pressure and visual analog scale.

Background: The aim of this study was to compare osmotic pressure (OP) 1 week after the gingival depigmentation in two diffeent methods: Er: YAG laser and Kirkland knife. Methods: This study included 20 patients, 13 women, and 7 men who had esthetic complaints of gingival melanin hyperpigmentation. The left side of the maxilla and mandible were depigmented with Er:YAG laser using air and water spray and the right side was removed with a Kirkland knife. Gingival biopsies were obtained from attached gingiva of operation sides with approximate dimensions of 2 mm × 2 mm before and 1 week after the depigmentation. The visual analog scale (VAS) was used to evaluate the pain level experienced by each patient. Results: Patients reported no pain at the gingivoplasty sides after 4 days and at the laser sides after 3 days. There were not statistical differences between laser and gingivoplasty groups according to values of OP (P > 0.05). Conclusion: According to results of wound healing, OP and VAS, two depigmentation procedures can be used safely and effectively.

The effect of mesenchymal stem cells and sildenafil on flap viability in perforator-based flaps for ischemia/reperfusion injury: An experimental study.

PURPOSE: In this study, we evaluated the individual and combined effects of mesenchymal stem cells (MSCs) and sildenafil citrate (SC) on the viability of pedicled perforator flaps in which ischemia/reperfusion injury developed after induction of primary ischemia. MATERIALS AND METHODS: Seven Sprague-Dawley rats were used as donors of cells. Rectangular flaps (7 × 7 cm2 ) were created featuring the right second epigastric musculocutaneous perforator in 63 male Sprague-Dawley rats. The animals were randomly divided into two experimental groups (based on the ischemia time of 4 or 8 hours) and a control group. Each of the experimental group was further divided into four subgroups with no treatment, subcutaneous administration of MSCs after termination of ischemia, intraperitoneal administration of SC after termination of ischemia, and combined MSCs and SC treatments at the end of the period of ischemia (n = 7 for each subgroup). A sham group with no-ischemia to flap was used as the control (n = 7). On day 7, viable areas on the flaps were calculated from photographs. The levels of the antioxidative enzymes, such as superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPX), were analyzed in tissue samples obtained from the most distal regions of the flap prior to ischemia and on day 7 after induction of ischemia. RESULTS: No difference was detected between the no-ischemia group and 4-hours SC-treated subgroup, 4-hours combined MSC and SC treated subgroup, 8-hours MSC-treated subgroup, or 8-hours SC-treated subgroup (P > 0.05). In 4-hours ischemia group, the viable flap area of combined MSC and SC treated subgroup was significantly greater than that of the ischemia subgroup (17.17 ± 12.56 cm2 vs. 7.24 ± 7.17 cm2 ; P = 0.015). However, in 8-hours ischemia group, the viable flap area of MSC- treated subgroup was significantly greater than that of the ischemia subgroup (2.69 ± 3.71 cm2 vs. 14.52 ± 8.57 cm2 ; P = 0.004). There were no significant differences in SOD, CAT, and GPX levels detected between no-ischemia group and any of the treated subgroups in 4- and 8-hours ischemia groups (P > 0.05). However, SOD, CAT, and GPX levels in the no-ischemia group were lower than that in 4-hours ischemia control subgroup or 8-hours ischemia control subgroup (P < 0.05). CONCLUSION: In this rat pedicled perforator based abdominal flap, we found that after primary ischemia, application of MSCs and SC, either individually or in combined form, significantly enhanced antioxidant enzyme levels compared with those in the control group, and provided protection against ischemia/reperfusion injury. The two treatments acted synergistically to protect against damage after 4 hours of ischemia, but either treatment alone more effectively enhanced viable flap area after 8 hours of ischemia, although some flap damage was apparent. © 2015 Wiley Periodicals, Inc. Microsurgery 36:402-409, 2016.

Dietary-induced hyperparathyroidism affects serum and gingival proinflammatory cytokine levels in rats.

BACKGROUND: Poor diet and inadequate nutrition are suggested to affect the periodontium as well as impair the systemic health. This study investigated the systemic and periodontal effects of dietary-induced hyperparathyroidism (dHPT) by evaluating serum and gingival proinflammatory cytokine levels. METHODS: Twenty-four Sprague-Dawley rats were used in the study. dHPT was induced in 12 rats by calcium/phosphorus imbalance, and 12 rats were fed a standard diet (SD). Afterward, endotoxin-induced periodontitis was induced on the right mandibular molar teeth (mmt). Four study groups were created: dHPT + mmt without periodontitis (group 1), dHPT + mmt with periodontitis (group 2), SD + mmt with periodontitis (group 3), and SD + mmt without periodontitis (group 4). Interleukin (IL)-1beta and tumor necrosis factor-alpha (TNF-alpha) levels were measured by enzyme-linked immunosorbent assay to evaluate the proinflammatory cytokine profiles. Serum cytokines were analyzed in the blood samples collected prior to periodontitis induction, whereas gingival cytokines were analyzed in the gingival supernatants of the four groups. RESULTS: Serum cytokines were higher in dHPT rats than in SD rats (P <0.001), with a positive correlation between parathormone and the cytokines (P <0.001). Gingival cytokines were highest in group 2 and lowest in group 4 (group 2 > group 3 > group 1) (P <0.001). There was a positive correlation between parathormone and the gingival cytokines in group 1 (P <0.001 for IL-1beta; P <0.01 for TNF-alpha). CONCLUSION: The results suggested that increased serum proinflammatory cytokine production may be a complication of dHPT, and this may affect healthy and diseased periodontia by increasing gingival proinflammatory cytokine levels.

Local peptidergic innervation of gingiva in smoking and non-smoking periodontitis patients.

BACKGROUND: The present study aimed to investigate the local peptidergic innervation of diseased and healthy periodontia in smokers and non-smokers. METHODS: Fifteen smokers and 12 non-smokers, all with localized chronic periodontitis, participated in the study. Periodontally diseased and healthy tooth sites were selected in smokers (groups 1 and 2, respectively) and non-smokers (groups 3 and 4, respectively). Local peptidergic innervation was assessed by the concentrations of two neuropeptides, substance P (SP) and calcitonin gene-related peptide (CGRP), in the gingival biopsies obtained from the groups. Clinical data and biopsies were collected from the same two tooth sites in each group. SP and CGRP levels were measured by enzyme immunosorbent assay in the supernatants of gingival samples. RESULTS: Increased probing depth and attachment loss were found in group 1 compared to group 3 (P<0.05). SP was higher in group 1 compared to groups 2, 3, and 4, and it was higher in group 3 compared to groups 2 and 4 (P<0.05). CGRP was higher in group 1 than in groups 2, 3, and 4, but it was lower in group 3 than in groups 2 and 4 (P<0.05). CONCLUSION: The study results suggested that 1) although smoking may affect the neurogenic inflammation in the presence of periodontitis by increasing local peptidergic innervation, this effect may not be seen in periodontal health, and 2) SP may be regarded as an indicator of periodontitis, whereas CGRP may be important in the acute and/or initial periodontal inflammation.

The effect of glucose-insulin-potassium treatment on myocardial oxidative stress in patients with acute coronary syndromes undergoing percutaneous coronary intervention.

OBJECTIVES: In this study, we sought to examine the effect of glucose-insulin-potassium (GIK) treatment on oxidative stress in patients with acute coronary syndromes (ACSs) undergoing percutaneous coronary interventions (PCIs). METHODS: Patients with ACSs who had been electively treated with a stent implantation into the culprit vessel were included in this study. Patients were divided into two groups and were randomly administered either the GIK treatment (GIK group; n=28) or isotonic NaCl (control group; n=19) infusion during PCI. Blood samples from the coronary artery ostium (CO) were collected through the femoral artery and from the coronary sinus (CS) through the femoral vein, before and immediately after PCI. Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) activities were measured. RESULTS: A total of 47 patients were included in the study. SOD, CAT, and GSH-Px activities, whether in the CO or the CS, were similar in both the GIK and control groups before the intervention (P>0.05). In the control group, SOD (in both the CO and the CS), CAT (in the CS), and GSH-Px (in the CS) activities were higher compared with baseline values (P<0.05). Such increases were, however, not seen in the GIK group (P>0.05). Although the CS-CO activity differences (venous-arterial) of SOD, CAT, and GSH-Px, which are parameters of myocardial reactive antioxidant enzyme production, were increased in the control group, there was no increase in the GIK group. CONCLUSIONS: In patients with ACSs, reactive local enzyme activity increases for the scavenging to myocardial-free radicals during PCI. Administration of a solution of GIK as a metabolic support agent might prevent oxidative stress in the myocardial level, in these patients.

Fluid dynamics of gingiva in diabetic and systemically healthy periodontitis patients.

OBJECTIVES: The influence of diabetes mellitus (DM) on the fluid dynamics of periodontium has not been reported in periodontal disease. The objectives of this study were (i) to investigate the alterations in the fluid dynamics of periodontium in diabetic periodontitis patients, and present the association of this phenomenon with the metabolic control of DM; (ii) to reveal any correlation between the fluid dynamics of periodontium and clinical signs of periodontal disease in DM and periodontitis. DESIGN: Fifteen well-controlled diabetic chronic periodontitis patients (Group 1), 14 systemically healthy chronic periodontitis patients (Group 2), and 14 systemically and periodontally healthy individuals were included in the study. Gingival crevicular fluid volume (GCF-V) and gingival tissue osmotic pressure (GOP) were used as the parameters of periodontal fluid dynamics. GCF-V was measured by a Periotron device, while GOP was measured by a digital osmometer. Silness-Löe plaque index (PI), Löe-Silness gingival index (GI) and clinical attachment loss (AL) levels were recorded to determine the periodontal health status. RESULTS: PI, GI and AL were higher in Groups 1 and 2 than in Group 3 (P<0.05), but similar between Groups 1 and 2 (P>0.05). Increased GCF-V and GOP were observed in Groups 1 and 2 compared with Group 3 (P<0.01), and the increase in Group 1 was greater than that in Group 2 (P<0.01). There were strong positive correlations between GCF-V and GOP in all three groups: between GI and GCF-V and GI and GOP in Groups 1 and 2; and between AL and GCF-V and AL and GOP in Groups 2 and 3. CONCLUSION: The results suggest that (i) DM may have an additive influence on the fluid dynamics of periodontium in the presence of periodontal disease; (ii) this phenomenon may not be prevented by the metabolic control of DM; (iii) the clinical signs of periodontal disease may be affected by the fluid dynamics of periodontium in both DM and periodontitis.

Effect of glucose-insulin-potassium infusion on oxidative stress in patients with dilated cardiomyopathy.

OBJECTIVE: To investigate the effect of glucose-insulin-potassium (GIK) infusion on erythrocyte antioxidant enzyme activity levels during therapy and post-therapy in patients with dilated cardiomyopathy (DCM). METHODS: Forty-one patients with DCM were enrolled in the present study. GIK solution (50 U of insulin in 500 mL of 30% glucose, plus 60 mmol/L KCl), in addition to the standard treatment, was administered by 24 h infusion in 28 patients (GIK group). In the remaining 13 patients (control group), 0.9% NaCl solution was administered. Venous blood samples from all patients were collected at baseline, during therapy (2 h, 8 h, 12 h and 24 h after baseline) and after therapy (48 h after baseline). The activity levels of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSHP) were measured. RESULTS: In the GIK group, SOD values showed a significant increase at 24 h and 48 h compared with baseline and 2 h values (P<0.05). An increasing trend in CAT activity was observed during and after GIK infusion compared with baseline (0 h) values. However, these differences were not statistically significant (P>0.05). With regard to GSHP activity, no significant change was found in the GIK group during follow-up (P>0.05). In the control group, SOD, CAT and GSHP activity levels measured during and after therapy were found to be similar to those measured at baseline (P>0.05). CONCLUSION: Administration of GIK solution, in addition to standard therapy, in patients with DCM may improve the metabolic scope of the disease by reducing myocardial oxidative stress.

Levels of gingival tissue platelet activating factor after conventional and regenerative periodontal surgery.

The hypothesis, a relationship between gingival tissue platelet activating factor (PAF) levels and healing after periodontal surgery, was tested by measuring PAF levels in gingival tissues collected from sites that had undergone flap surgery and guided tissue regeneration (GTR) or flap surgery alone. Using a split-mouth design, 20 intrabony defects were randomly assigned to treatment with flap surgery and GTR (group 1) or with flap surgery alone (group 2). Gingival tissue samples were obtained at surgery (baseline) and at 6-month follow-up evaluation visit. One half of each sample was used for analysis of PAF levels by high-performance liquid chromatography, and the other half of the sample was used for histomorphometric analysis that included measurements of number and diameter of blood vessels. PAF levels and diameter of blood vessels were significantly decreased (p < 0.01), and the number of blood vessels was significantly increased (p < 0.05) in both groups after 6 months compared to the baseline values. Postoperative number of blood vessels were significantly higher in group 1 (p < 0.05), whereas there was no significant difference in postoperative PAF levels between the two groups (p > 0.05). Based on the reported results, it is suggested that a decrease in gingival PAF levels might be found after conventional and regenerative periodontal surgery.

Influence of diabetes on critical flaps based on the vascular axis of a sensory nerve.

Delayed sural flap based on the vascular axis of the sural nerve has been advocated for coverage of diabetic foot ulcers. In this study we compared the survival of neurovenous and standard inferior epigastric island flaps in diabetic and non-diabetic rats. VEGF concentrations and electrolyte balance of the flaps were also investigated during elevation and on the fifth day to explore the possible mechanisms that influence ischaemia of the flap during the hyperglycaemic state. There were no statistical differences in area surviving between diabetic and control rats for either flap. The VEGF concentrations were also similar in the two flaps in the two groups during elevation. On the fifth day, VEGF concentrations had decreased significantly in all of the flaps. Electrolyte balance paralleled VEGF concentrations. We conclude that flaps based on the vascular axis of a superficial nerve deserve further experimental and clinical attention as potential options for reconstruction of ulcers on diabetic feet.