Assessment of gingival translucency at the mandibular incisors with two different probing systems. A cross sectional study.

OBJECTIVES: Increasing evidence indicates that the thickness of periodontal soft tissues plays an important role in various clinical scenarios, thus pointing to the need of further clinical research in this area. Aim of the present study was to assess gingival thickness at the mandibular incisors by translucency judgement with two different probes and to validate if these methods are comparable and applicable as diagnostic tools. MATERIALS AND METHODS: A total of 200 participants were included; gingival tissue thickness was measured by judging probe translucency at both central mandibular incisors, mid-facially on the buccal aspect of each tooth using a standard periodontal probe and a set of color-coded probe, each with a different color at the tip, i.e. Colorvue Biotype Probe (CBP). Frequencies and relative frequencies were calculated for probe visibility. Agreement between the standard periodontal probe and the CBP was evaluated via the kappa statistic. RESULTS: When the periodontal probe was visible, the frequency of CBP being visible was very high. Kappa statistic for the agreement between the standard periodontal probe and the CBP was 0.198 (71.5% agreement; p-value < 0.001) for tooth 41 and 0.311 (74.0% agreement; p-value < 0.001) for tooth 31, indicating a positive association of the two methods. CONCLUSIONS: An agreement that reached 74% was estimated between the standard periodontal probe and the color-coded probe at central mandibular incisors.  CLINICAL RELEVANCE: In the context of the present study, the two methods of evaluating gingival thickness seem to produce comparable measurements with a substantial agreement. However, in the 1/4 of the cases, the visibility of the color-coded probe could not assist in the categorization of the gingival phenotype.

Gingival thickness threshold and probe visibility through soft tissue: a cross-sectional study.

OBJECTIVES: The aim was to retrieve the threshold of gingival thickness (GT), where the attribute of gingival translucency through probe visibility was altered. METHODS: In 200 patients, the soft tissue thickness was evaluated at both central mandibular incisors using ultrasound quantification (USD). Additionally, probe visibility was determined using a standard periodontal probe (PB) (CPU 15 UNC, Hu-Friedy), inserted 1 mm deep into the gingival sulcus. Frequencies and relative frequencies were calculated. Repeatability analyses and receiver operating characteristics (ROC) were conducted to determine the USD cut-off point for probe visibility. RESULTS: Regression model indicated that the probe was not visible at a thickness of 0.82 mm for the mandibular left central incisor (95% CIs 0.77, 0.86) and became visible at a thickness of 0.69 mm (95% CIs 0.65, 0.72). The respective values for the mandibular right central incisor were 0.82 mm (95% CIs 0.77, 0.87) and 0.70 mm (0.68, 0.74). ROC analysis confirmed the retrieved regression results by indicating the best fitting balance for specificity and sensitivity at a thickness of 0.8 mm for both mandibular incisors. CONCLUSIONS: In the frame of the current study, the data revealed that gingiva becomes non-transparent at a thickness of approximately 0.8 mm. CLINICAL RELEVANCE: Probe visibility at mandibular incisors for the discrimination between thin and thick soft tissues was correlated with a gingival thickness of 0.8 mm and a high repeatability.

Bone turnover markers in gingival crevicular fluid and blood serum of patients with fixed orthodontic appliances.

AIM: Bone remodelling can be followed through the bone turnover markers (BTMs). Aim of the present study was to record the fluctuation of an osteoclastic and an osteoblastic BTM [C-terminal telopeptide of type I collagen (CTX) and N-terminal pro-peptide of type I pro-collagen (PINP), respectively] in both the gingival crevicular fluid (GCF) and the serum of orthodontic patients before and after the initial application of orthodontic forces. MATERIALS AND METHODS: Twenty-one Caucasian patients were prospectively evaluated. GCF and blood samples were collected in order to measure the selected biomarkers by ELISA at three time-points: exactly before, 5 days, and 14 days after bonding of the appliances. Standardized sample handling and patient preparation procedures were adopted in order to reduce pre-analytical variability. RESULTS: GCF and serum CTX levels were found to be independent of age, although higher in the serum of female subjects. PINP levels were found higher in the serum of patients ≥25 years old, as well as in the GCF of males. A positive correlation between serum and GCF baseline PINP levels was observed. LIMITATIONS: The effect of orthodontic treatment on bone remodelling might not be absolutely representative of the local bone microenvironment as the levels of the specific BTMs where measured within the GCF of the lower front teeth. CONCLUSIONS: This is the first time PINP and CTX have been evaluated in the GCF and serum of orthodontic patients with fixed appliances. No statistically significant alterations of CTX and PINP levels in the GCF and the serum of patients were recorded over time during the initial stages of orthodontic treatment.

Gingival Thickness Assessment at Mandibular Incisors of Orthodontic Patients with Ultrasound and Cone-beam CT. A Cross-sectional Study.

PURPOSE: To use and evaluate two methods for measuring gingival thickness (GT) at mandibular incisors of orthodontic patients and compare their performance in assessing periodontal anatomy through soft tissue thickness. MATERIALS AND METHODS: The sample consisted of 40 consecutive adult orthodontic patients. GT was measured just before bracket placement at both central mandibular incisors, mid-facially on the buccal aspect, 2 mm apically to the free gingival margin with two methods: clinically with an ultrasound device (USD) and radiographically with cone-beam computed tomography (CBCT). RESULTS: CBCT measurements were consistently higher than USD measurements, with the difference ranging from 0.13 mm to 0.21 mm. No statistically significant difference was noted between the repeated CBCT measurements at the right central incisor (bias = 0.05 mm; 95% CI = -0.01, 0.11; p = 0.104). Although the respective results for the left incisor statistically indicated that the measurements were not exactly replicated, the magnitude of the point estimate was small and not clinically significant (bias = 0.06 mm; 95% CI = 0.01, 0.11; p = 0.014). Small differences between CBCT measurements made by the 2 examiners at the left central incisor (bias = 0.06 mm; 95% CI = 0.01, 0.11; p = 0.014) were detected. However, this difference was minor and also not clinically significant. The respective analysis on the right incisor showed no statistically significant difference (bias = 0.05 mm; 95% CI = -0.01, 0.11; p = 0.246). CONCLUSIONS: Based on reproducibility, CBCT imaging for gingival thickness assessment proved to be as reliable as ultrasound determination. However, CBCT consistently yielded higher values, albeit at a marginal level, than did the ultrasound device.

Transgingival probing: a clinical gold standard for assessing gingival thickness.

OBJECTIVE: Transgingival probing is often used in the clinic to assess gingival thickness. However, what is not completely known is how well this method represents the true value of soft tissue thickness. The aim of this study was to assess differences and variation in gingival thickness when measured with transgingival probing or scanned with an intraoral device. METHOD AND MATERIALS: This ex vivo study evaluated gingival thickness on 20 porcine cadavers. Gingival thickness was assessed at both central and lateral mandibular incisors through transgingival probing with a standard metal periodontal probe and also using intraoral scanning, which was considered as the method providing the 'true value' of soft tissue thickness. Intra-examiner repeatability and method error were evaluated. RESULTS: No evidence of systematic difference for any of the mandibular central or lateral incisors (mandibular right incisors: mean difference -0.17 to -0.01 mm, and mandibular left incisors: mean difference -0.11 to 0.04 mm) was observed between the periodontal probe and intraoral scanning methods. The absolute differences between the repeated measurements with intraoral scanning for each tooth type (n = 30) were calculated: the overall median was 0.089 mm and the interquartile range was 0.080 mm. CONCLUSIONS: Transgingival probing with a standard metal periodontal probe for assessing gingival thickness is a reliable method, with values very close to the true gingival thickness, and it can thus be considered as the clinical gold standard.

Clinical and Radiographic Gingival Thickness Assessment at Mandibular Incisors: an Ex Vivo Study.

PURPOSE: Gingival phenotype influences the outcomes of various dental procedures. The objective of the current study was to assess the agreement between various clinical and radiographic methods for evaluating gingival thickness. MATERIALS AND METHODS: This ex-vivo study evaluated gingival thickness on 20 porcine cadavers. Gingival thickness was assessed at both central mandibular incisors with: a) trans-gingival probing with a standard periodontal probe (PB); b) trans-gingival probing with a stainless steel acupuncture needle (AN); c) ultrasound device (USD); and d) Cone Beam Computed Tomography (CBCT). Intra-examiner reproducibility and method error were also evaluated. RESULTS: Trans-gingival measurements with the standard PB and the AN were found to be almost identical in gingival thickness assessment (mean GT 1.11 mm vs 1.14 mm for the left incisor and mean GT 1.12 mm vs 1.11 mm for the right incisor, respectively). USD and CBCT yielded values that were statistically significantly higher than AN. Both USD and CBCT values were higher than PB, but this difference was statistically significant only for the left central incisor. Finally, USD values exceeded CBCT measurements, but this difference was not statistically significant. There was no evidence of systematic differences between the repeated CBCT measurements (p = 0.06 for the left incisor and p = 0.55 for the right incisor). CONCLUSIONS: CBCT measurements proved to be highly repeatable and comparable to the USD measurements, while there were some indications that both CBCT and USD measurements were systematically higher than either PB or AN.

Promoting prudent use of antibiotics: the experience from a multifaceted regional campaign in Greece.

BACKGROUND: Antibiotic resistance, a major public health problem, has been linked to antibiotic consumption. In Greece both consumption and resistance rates are among the highest in Europe. A multifaceted campaign targeting both physicians and parents of school children was implemented for the first time in order to educate the public and update doctors, aiming to promote judicious use of antibiotics and hopefully decrease its consumption. METHODS: The programme consisted of a public education campaign and academic detailing of primary care physicians in the district of Corinth in Peloponnese. The experience and perceptions of parents were recorded in the meetings in the form of course evaluation and assessment, anonymous questionnaires. The use of Rapid Antigen Detection Test (RADT) for streptococcal pharyngitis by primary care physicians was also assessed by use of anonymous questionnaires. Antibiotic consumption was compared before and after the programme between the district of Corinth and the other districts of Peloponnese, as well as at a national level. RESULTS: Antibiotic consumption remained unaltered at 26 Defined daily doses per 1000 Inhabitants per Day (DID) in accordance with the trend in other regions and at a national level. However, the utilization of Amoxycillin and Penicillin was increased by 34.3%, while the use of other antimicrobial classes including macrolides, cephalosporins and fluoroquinolones decreased by 6.4-21.9%. The use of RADT did not lead to a significantly decreased antimicrobial consumption. CONCLUSIONS: A multifaceted educational programme targeting both the general public and primary care physicians was associated with rationalization in the choice of antimicrobial. A reduction in the total antimicrobial consumption was not achieved.

Comparison of direct antimicrobial susceptibility testing methods for rapid analysis of bronchial secretion samples in ventilator-associated pneumonia.

Two hundred and fifty tracheal aspirates were subjected to direct antimicrobial susceptibility testing by disk diffusion, Etest and inoculation on antibiotic-enriched MacConkey agar plates. Results were compared with those obtained using an automated system on microorganisms recovered from standard quantitative culture. A total of 255 microorganisms were isolated from 194 positive samples by the standard quantitative procedure. A total of 85.1%, 82.5% and 72.5% agreement between direct disk diffusion, Etest and antibiotic-enriched MacConkey agar plates, respectively, and the standard procedure was observed in 64 microorganisms obtained from monomicrobial cultures that corresponded to 240 individual microorganism-antimicrobial agent combinations. Three (1.3%) and four (1.7%) very major errors for direct disk diffusion and Etest methods were observed, respectively. The antibiotic-enriched MacConkey agar plate method compared with the standard procedure demonstrated an unacceptable rate of very major (6.7%) and major errors (14.2%). Clinical evaluation of direct susceptibility tests based on the speculative impact on clinical practice by guiding patient's early treatment, if all positive cultures corresponded to infection, was correct in 79.9% for the direct disk diffusion test, 77.8% for the direct Etest method and 68.0% for antibiotic-enriched MacConkey agar plates. Direct diffusion tests (Etest or disk diffusion) applied on respiratory samples are rapid techniques that provide results comparable with standard antimicrobial susceptibility testing in <24 h.

Hepatic fibroblast growth factor 21 is regulated by PPARalpha and is a key mediator of hepatic lipid metabolism in ketotic states.

Mice fed a high-fat, low-carbohydrate ketogenic diet (KD) exhibit marked changes in hepatic metabolism and energy homeostasis. Here, we identify liver-derived fibroblast growth factor 21 (FGF21) as an endocrine regulator of the ketotic state. Hepatic expression and circulating levels of FGF21 are induced by both KD and fasting, are rapidly suppressed by refeeding, and are in large part downstream of PPARalpha. Importantly, adenoviral knockdown of hepatic FGF21 in KD-fed mice causes fatty liver, lipemia, and reduced serum ketones, due at least in part to altered expression of key genes governing lipid and ketone metabolism. Hence, induction of FGF21 in liver is required for the normal activation of hepatic lipid oxidation, triglyceride clearance, and ketogenesis induced by KD. These findings identify hepatic FGF21 as a critical regulator of lipid homeostasis and identify a physiological role for this hepatic hormone.

Functional specificity of two hormone response elements present on the human apoA-II promoter that bind retinoid X receptor alpha/thyroid receptor beta heterodimers for retinoids and thyroids: synergistic interactions between thyroid receptor beta and upstream stimulatory factor 2a.

DNA binding and mutagenesis in vitro established that the -67/-55 region of the apoA-II (apolipoprotein A-II) promoter contains a thyroid HRE (hormone response element), which strongly binds RXRalpha (retinoid X receptor alpha)/T(3)Rbeta (thyroid receptor beta) heterodimers and weakly T(3)Rbeta homodimers, but does not bind other homo- or heterodimers of RXRalpha or orphan nuclear receptors. Transactivation was abolished by point mutations in the thyroid HRE. In co-transfection experiments of HEK-293 (human embryonic kidney 293) cells, the -911/+29 human apoA-II promoter was transactivated strongly by RXRalpha/T(3)Rbeta heterodimers in the presence of RA (9- cis retinoic acid) or T(3) (tri-iodothyronine). Homopolymeric promoters containing either three copies of the -73/-40 (element AIIAB) or four copies of the -738/-712 (element AIIJ) apoA-II promoter could be transactivated by RXRalpha/T(3)Rbeta heterodimers in COS-7 cells only in the presence of T(3) or RA respectively. RXRalpha/T(3)Rbeta heterodimers and USF2a (upstream stimulatory factor 2a) synergistically transactivated the -911/+29 apoA-II promoter in the presence of T(3). USF2a also enhanced the activity of a GAL4-T(3)Rbeta fusion protein in the presence of T(3) and suppressed the activity of a GAL4-RXRalpha fusion protein in the presence of RA. These findings suggest a functional specificity of the two HREs of the apoA-II promoter for retinoids and thyroids, which is modulated by synergistic or antagonistic interactions between RXRalpha/T(3)Rbeta heterodimers and the ubiquitous transcription factor USF2a.