Diode laser for harvesting de-epithelialized palatal graft in the treatment of gingival recession defects: a randomized clinical trial.

AIMS: The aim of present randomized controlled clinical study was to evaluate the effects of the use of diode laser for graft harvesting and palatal wound irradiation on post-operative morbidity and root coverage outcomes after a coronally advanced flap (CAF) with de-epithelialized gingival grafts (DGG). METHODS: Fifty-two patients with isolated recessions were treated. The CTG resulted from the de-epithelialization of a free gingival graft (FGG) with blade (control group:DGG-B) or diode laser (DL) (test group:DGG-L). The DL was used to de-epithelialize the outer part of the FGG and photo-biostimulate the palatal wound area. Post-operative morbidity was evaluated by using Oral Health-related Quality of Life (OHQoL) and Visual Analogue Scale-discomfort (VAS). Root coverage outcomes were also evaluated 6 months after operation. RESULTS: Statistically significant differences were found for OHQoL (p = 0.0001) and VAS (p = 0.0001) at the 7th day post-operatively favouring test sites. Root coverage results did not show a statistically significant difference. CONCLUSIONS: While both techniques were effective with regard to root coverage at 6 months, the DGG-L technique decreased post-operative morbidity associated with palatal donor-site surgery.

The effect of a streptococci containing probiotic in periodontal therapy: a randomized controlled trial.

AIM: To evaluate the adjunctive effects of a Streptococcus oralis KJ3, Streptococcus uberis KJ2 and Streptococcus rattus JH145 containing probiotic tablet after scaling and root planing (SRP). MATERIALS AND METHODS: Forty-eight periodontitis patients were included in this double-blind, placebo-controlled clinical trial. After root planing, patients used either a placebo or a probiotic tablet twice a day for 12 weeks. The pocket probing depth (primary outcome measure), bleeding on probing and relative attachment levels were measured at baseline, 12 and 24 weeks. At baseline, 4, 8, 12 and 24 weeks, microbiological sampling was performed and plaque and gingival indices were recorded. RESULTS: The primary and secondary outcome measures were significantly (p < 0.05) improved at the 12- and the 24-week evaluation in both groups. However, no significant inter-group differences could be detected at any time point, except from the % of sites with plaque that were significantly lower in the probiotic group than in the control group at the 24-week evaluation. In addition, at the 12-week time point, the salivary Prevotella intermedia counts were significantly lower in the probiotic group. CONCLUSIONS: No differences were detected when comparing the adjunctive use of a placebo or the investigated streptococci containing probiotic tablet after SRP. ClinicalTrials.gov Identifier: NCT02403960.

Prediction of root coverage for single recessions in anterior teeth: a 6-month study.

BACKGROUND: The aim of this study was to evaluate the predictive values of baseline inter-dental papilla height (IPH), loss of inter-dental papilla height (LPH), avascular exposed root surface area (AERSA) and inter-dental clinical attachment level (ICAL) measurements on complete root coverage (CRC) of single recession defects treated with coronally advanced flap and connective tissue graft technique (CAF+CTG). MATERIAL & METHODS: A total of 122 patients with one isolated gingival recession were enrolled. All recession defects without loss of ICAL (ID-CAL) (RT1) and with an amount of ID-CAL equal or smaller to the buccal attachment loss (RT2), located at upper and lower anterior teeth were treated with CAF+CTG. IPH, LPH, AERSA and ICAL parameters were analysed for possible correlation with CRC after 6 months. RESULTS: The CRC was 86.7% for RT1, 74.2% for RT2 groups. The ROC analyses revealed acceptable cut-off points for baseline AERSA, IPH and LPH for achieving CRC. The results of logistic regression analyses showed that having baseline AERSA≥19 mm(2) (OR:23.7), IPH lower ≤1 mm (OR:97.3) and belonging to RT2 group (OR:15.0) were found to be independent risk factors related with not achieving final CRC. CONCLUSION: This study indicates that AERSA and IPH may be used to predict the final CRC outcomes in RT1 and RT2 defects treated with CAF+CTG.

An explorative study to develop a predictive model based on avascular exposed root surface area for root coverage after a laterally positioned flap.

BACKGROUND: The aim of this study is to evaluate the reliability of the avascular exposed root surface area (AERSA) as a prognostic test for gingival recessions (GRs) and to compare the predictive value of the avascular root surface area calculation and Miller classification on the final root-coverage outcomes. METHODS: Ninety-one patients with 91 isolated single GRs (32 Miller Class I, 29 Miller Class II, and 30 Miller Class III defects) located at the upper and lower incisors and canines were treated with a laterally positioned flap. Clinical parameters were recorded and correlated with the achievement of complete root coverage (CRC) after 6 months. RESULTS: From all clinical parameters used, AERSA showed the highest sensitivity and specificity for predicting CRC. Receiver operating characteristic curves analyses revealed three acceptable cutoff points based on baseline AERSA for achieving CRC with higher sensitivity and specificity values compared to GR depth, GR width, and gingival thickness. Both univariate and multiple linear regression analyses reported that the models could explain the 86% of the mean root coverage with AERSA. CONCLUSIONS: This prospective longitudinal study indicates that AERSA may be used to classify GR defects. The newly developed prognostic model may be used to predict the final root coverage outcomes.

Laser-assisted laterally positioned flap operation: a randomized controlled clinical trial.

OBJECTIVE: The purpose of this randomized, controlled clinical trial was to compare the effectiveness of a new treatment approach, which consisted of laterally positioned flap (LPF) procedure combined with an external vestibular releasing incision made by a diode laser (LALPF) to LPF alone for the treatment of isolated gingival recession defects. METHODS: Thirty-two healthy patients presenting single Miller class II isolated gingival recessions with minimal loss of interdental papilla were treated with an LPF technique. Sixteen patients were randomly assigned to the test group (laser-assisted laterally positioned flap [LALPF]), and the other 16 patients were assigned to the control group (LPF). In the test group, diode laser was used for vestibular deepening in order to obtain maximum maneuverability of the advanced flap. Clinical and patient-centered parameters (visual analog scale for pain and aesthetics [VAS]) were measured at baseline, 7 days, and 6 months after the surgery. RESULTS: Complete root coverage from baseline to 6 months post-surgery was achieved for 46.7% of the control group and 81.2% of the test group (p=0.044). There were no differences in VAS pain measurements between the groups. Patient satisfaction with aesthetics was higher in LALPF group than in the LPF group. CONCLUSIONS: Six month results showed that the LALPF approach was effective for the treatment of single Miller class II gingival recessions.

Role of 3D animation in periodontal patient education: a randomized controlled trial.

AIM: This randomized controlled parallel trial investigates the effect of 3D animation on the increase and recall of knowledge on periodontitis by patients with periodontitis. The effects of a 3D animation (3D animation group) were compared with narration and drawing (control group) for periodontal patient education. MATERIAL AND METHODS: A total of 68 periodontitis patients were stratified according to educational level and then randomly allocated to control or 3D animation groups. All patients received: (1) a pre-test (baseline knowledge), (2) a patient education video (3D animation or control video), (3) a post-test (knowledge immediately after looking at the video), and (4) a follow-up test (knowledge recall after 2 weeks). Each test contained 10 multiple-choice questions. RESULTS: There was no significant difference in baseline knowledge. Patients receiving the 3D animations had significantly higher scores for both the post-test and the follow-up test, when compared with patients receiving sketch animations. CONCLUSION: 3D animations are more effective than real-time drawings for periodontal patient education in terms of knowledge recall. 3D animations may be a powerful tool for assisting in the information process.

Inter-bacterial correlations in subgingival biofilms: a large-scale survey.

AIM: Although the complexity of the oral ecology and the ecological differences between health and disease are well accepted, a clear view on the dynamics in relation to disease is lacking. In this study, the prevalence and abundance of 20 key oral bacteria was assessed in health and disease and more importantly a closer look was given to the inter-bacterial relationships. MATERIALS AND METHODS: A blinded microbiological database was analysed in this cross-sectional, retrospective study. The database was constructed based on microbiological analyses of samples from 6308 patients, with gradations of periodontitis (healthy to periodontitis). Data concerning the abundance of 20 oral bacteria and probing pocket depth were provided. RESULTS: Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Eubacterium nodatum, Porphyromonas micra and Porphyromonas intermedia showed a clear increase in abundance and prevalence with increasing pocket depth. Correlation matrices illustrated that almost all microorganisms were in one way correlated to other species and most of these correlations were significant. Several beneficial bacteria showed strong correlations with other beneficial bacteria. CONCLUSION: Knowledge on bacterial correlations can pave the way for new treatment options focusing on restoring the shifted balance.

Clinical and microbiological effects of Lactobacillus reuteri probiotics in the treatment of chronic periodontitis: a randomized placebo-controlled study.

AIM: The aim of this randomized placebo-controlled clinical trial was to evaluate the effects of Lactobacillus reuteri-containing probiotic lozenges as an adjunct to scaling and root planing (SRP). MATERIAL AND METHODS: Thirty chronic periodontitis patients were recruited and monitored clinically and microbiologically at baseline, 3, 6, 9 and 12 weeks after therapy. All patients received one-stage full-mouth disinfection and randomly assigned over a test (SRP + probiotic, n = 15) or control (SRP + placebo, n = 15) group. The lozenges were used two times a day for 12 weeks. RESULTS: At week 12, all clinical parameters were significantly reduced in both groups, while there was significantly more pocket depth reduction (p < 0.05) and attachment gain (p < 0.05) in moderate and deep pockets; more Porphyromonas gingivalis reduction was observed in the SRP + probiotic group. CONCLUSIONS: The results indicate that oral administration of L. reuteri lozenges could be a useful adjunct to SRP in chronic periodontitis.

Periodontal disease in men.

In relation to periodontal diseases associated with sex-steroid hormones, men have been the forgotten sex. It is not surprising that there has been less scrutiny of the effects of sex-steroid hormones in men considering the more striking changes that occur in women during different periods of their life. Despite the gingival inflammatory changes reported in women, men have been reported to have a higher prevalence of destructive periodontal diseases. The information presented in this review will provide a contemporary evaluation of male susceptibility to periodontal diseases.

Coronally advanced flap adjunct with low intensity laser therapy: a randomized controlled clinical pilot study.

AIM: Coronally advanced flap (CAF) technique and its modifications have been proposed in the literature. Low intensity laser therapy (LILT) is shown to increase wound healing. The aim of this split-mouth randomized controlled pilot study was to assess the effects of LILT with respect to root coverage after CAF procedure for the treatment of multiple-recession type defects (MRTD). MATERIAL AND METHODS: Ten patients with symmetrical 74 Miller I and II gingival recessions were included in this study (37 in test, 37 in control group). A diode laser (588 nm) was applied to test sites before and immediately after surgery, and for 5 min. daily 7 days post-operatively. Comparisons of the surgical sites were made with clinical measurements. RESULTS: Statistically significant differences were observed between test and control sites in the gingival recession depth (GRD), gingival recession width (GRW) and width of the keratinized tissue (WKT) and clinical attachment level (CAL) measurements after 1 year (p = 0.014, p = 0.015, p = 0.009 and p = 0.018 respectively). The test group presented greater complete root coverage (n = 7, 70%) compared with the control group (n = 3, 30%) after treatment. CONCLUSION: Within the limitations of this study, the results indicated that LILT may improve the predictability of CAF in multiple recessions.

Treatment of multiple gingival recessions using a coronally advanced flap procedure combined with button application.

AIM: The purpose of this randomized controlled clinical trial was to evaluate the effectiveness of a new treatment approach, which consists of coronally advanced flap (CAF) procedure combined with orthodontic button application (CAF+B) for the treatment of multiple recession-type defects in patients with aesthetic demands. MATERIALS AND METHODS: Forty-one healthy subjects presenting at least three adjacent Miller Class I or II multiple gingival recessions were treated with a CAF technique. Twenty-one patients were randomly assigned to the test group, and the other 20 patients were assigned to the control group. On the test group, orthodontic buttons were used for the stabilization of advanced flaps. Clinical and patient centered parameters were measured at baseline, 7 days and 6 months after the surgery. RESULTS: A total of 155 recessions were treated. Complete root coverage from baseline to 6 months post-surgery was 61% for the control group and 84% for the test group. There was no difference on visual analog scale-pain measurements among the treatment groups. Patient satisfaction with aesthetics was very high in CAF+B group when compared with CAF group. CONCLUSION: Six months results showed that the CAF+B approach was effective for the treatment of multiple gingival recessions in patients with aesthetic demands.

Interleukin-1 and tumor necrosis factor-alpha gene polymorphisms in Turkish patients with localized aggressive periodontitis.

Localized aggressive periodontitis (LAgP) is a complex multifactorial periodontal disease to which genetic factors are thought to predispose individuals. Interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-alpha) are potent immunomodulators and proinflammatory cytokines that have been implicated in the pathogenesis of autoimmune and infectious diseases and proposed to be risk factors for LAgP. Our aim was to investigate IL-1 alpha (+4845), IL-1 beta (+3954), and TNF-alpha (-308) gene polymorphisms in Turkish LAgP patients. We genotyped 31 LAgP patients and 31 healthy controls for IL-1alpha(+4845), IL-1beta(+3954), and TNF-alpha(-308) using standard PCR amplification followed by restriction enzyme digestion and gel electrophoresis. Higher prevalence of heterozygosity for IL-1alpha(+4845) was found in cases (65%) when compared to controls (35%) (P < 0.05). While homozygous allele 1 of IL-1beta(+3954) was the most frequent genotype in cases (62%), no controls were homozygous for this allele (P < 0.001). Homozygous allele 1 was the most common TNF-alpha genotype in both groups, however no significant difference in TNF-alpha genotypes was found between groups. In conclusion, in this Turkish population, susceptibility to LAgP is increased by heterozygosity for allele 1 of IL-1alpha(+4845) or homozygosity for allele 1 of IL-1beta(R+3954). Moreover, IL-1 gene polymorphisms appear to have a role in susceptibility to LAgP, and the above-mentioned genotypes could be an important risk factor for LAgP in the Turkish population.

Improved wound healing by low-level laser irradiation after gingivectomy operations: a controlled clinical pilot study.

AIM: Low-level laser therapy (LLLT) may induce morphological, molecular and cellular processes, which are involved in wound healing. The aim of this split-mouth controlled clinical trial was to assess the effects of LLLT on healing of gingiva after gingivectomy and gingivoplasty. MATERIAL AND METHODS: Twenty patients with inflammatory gingival hyperplasias on their symmetrical teeth were included in this study. After gingivectomy and gingivoplasty, a diode laser (588 nm) was randomly applied to one side of the operation area for 7 days. The surgical areas were disclosed by a solution (Mira-2-tones) to visualize the areas in which the epithelium is absent. Comparison of the surface areas on the LLLT-applied sites and controls were made with an image-analysing software. RESULTS: Despite the prolonged time needed for application, patients have tolerated LLLT well. While there were no statistically significant differences between the stained surface areas of the LLLT applied and the control sites immediately after the surgery, LLLT-applied sites had significantly lower stained areas compared with the controls on the post-operative third, seventh and 15th day (p<0.001 for each). CONCLUSIONS: Within the limitations of this study, the results indicated that LLLT may enhance epithelization and improve wound healing after gingivectomy and gingivoplasty operations.

The immunohistochemical analysis of vascular endothelial growth factors A and C and microvessel density in gingival tissues of systemic sclerosis patients: their possible effects on gingival inflammation.

OBJECTIVE: In systemic sclerosis (SSC), certain abnormalities can occur in fibroblasts, endothelial cells, and immune system cells. Severe pathological changes such as visceral fibrosis and obliteration of the lumen of arteries may develop due to functional alterations of these cells. Because the vascular abnormality is a central mechanism of sclerosis, the aim of this study was to further investigate the impaired vascularity in the gingival tissues of SSC patients by means of immunohistochemistry using vascular endothelial growth factor A (VEGF-A), VEGF-C, and CD34 staining. STUDY DESIGN: Thirteen SSC patients and 11 systemically healthy controls who had moderate gingivitis were included in the study. Gingival biopsies were obtained from the interdental papilla, and VEGF-A, VEGF-C, and CD34 analyses were done by using immunohistochemical methods. RESULTS: Patients with scleroderma had higher levels of inflammatory infiltrate (P = .041) and microvessel density (P = .003) in their gingival biopsy samples. In contrast, when compared with the controls, the expressions of VEGF-A and VEGF-C were significantly lower in scleroderma patients (P = .033 and P = .015, respectively). CONCLUSION: These findings may reflect the defective vascularity and the pronounced histological inflammation of the gingival tissues in systemic scleroderma and may provide a novel target for treatment methods for the gingival involvement in these patients.

Enamel matrix derivative and low-level laser therapy in the treatment of intra-bony defects: a randomized placebo-controlled clinical trial.

AIM: The aim of this study was to evaluate the immediate post-operative pain, wound healing and clinical results after the application of an enamel matrix protein derivative (EMD) alone or combined with a low-level laser therapy (LLLT) for the treatment of deep intra-bony defects. MATERIAL AND METHODS: This study was an intra-individual longitudinal test of 12 months' duration conducted using a blinded, split-mouth, placebo-controlled and randomized design. In 22 periodontitis patients, one intra-bony defect was randomly treated with EMD+LLLT, while EMD alone was applied to the contra-lateral defect site. LLLT was used both intra- and post-operatively. Clinical measurements were performed by a blinded periodontist at the time of surgery, in the first week and in the first, second, sixth and 12th month. Visual analogue scale (VAS) scores were recorded for pain assessment. RESULTS: The results have shown that the treatment of intra-bony defects with EMD alone or EMD+LLLT leads to probing depth reduction and attachment-level gain. In addition, EMD+LLLT had resulted in less gingival recession (p<0.05), less swelling (p<0.001) and less VAS scores (p<0.02) compared with EMD alone. CONCLUSION: This study shows that EMD is an effective, safe and predictable biomaterial for periodontal regeneration and LLLT may improve the effects of EMD by reducing post-operative complications.

Epileptic seizures triggered by the use of a powered toothbrush.

BACKGROUND: Reflex epilepsy is characterized by seizures that are triggered in response to a specific stimulus and tooth-brushing epilepsy is an extremely rare form of reflex epilepsy in which the seizures are mainly induced by the act of tooth brushing. In this report, we describe an epilepsy patient whose seizures were exclusively triggered by the use of a powered toothbrush. METHODS AND RESULTS: A 31-year old female had been treated for partial epilepsy of left temporal or frontal lobe for 20 years and she did not have seizures for the last 3 years. However, she experienced periods of auras, partial complex seizures, and nocturnal generalized seizures after she started using a powered toothbrush. The interictal electroencephalography revealed slow wave paroxysm over the left temporal or frontal lobe. CONCLUSIONS: This case report is, to our knowledge, the first report of reflex epilepsy in which the seizures were triggered by the use of a powered toothbrush. Possible mechanisms to explain the novel type of this rare disorder are discussed.

Immediate post-operative effects of different periodontal treatment modalities on oral health-related quality of life: a randomized clinical trial.

AIM: Oral health-related quality of life (OHQoL) characterizes a person's perception of how oral health influences an individual's life quality. The aim of this study is to investigate how the treatment modalities may affect the immediate post-operative quality of life of patients with periodontitis. MATERIALS AND METHODS: Sixty psychologically and socio-demographically matched periodontitis patients were randomly divided into three groups [20 non-surgical (NS), 20 surgical (SG), 20 surgical plus enamel matrix protein derivative (S+EMD)]. The OHQoL was assessed with two patient-centred outcome measures [Oral Health Impact Profile-14 (OHIP-14) and General Oral Health Assessment Index (GOHAI)] in the post-operative period of 1 week. RESULTS: Whereas there were no differences of OHQoL at the baseline, the patients treated by surgery had reported that they had experienced a worse OHQoL compared with the NS and S+EMD groups both in the OHIP-14 and GOHA indexes (p=0.001). CONCLUSIONS: The results of this study clearly indicated that patient perceptions on the immediate post-operative period were significantly better in the NS and S+EMD groups when compared with the SG group. These findings need to be confirmed in further studies with larger populations.

Combined treatment approach of gingivectomy and CO2 laser for cyclosporine-induced gingival overgrowth.

The aim of this report is to present a combined treatment approach with gingivectomy and CO2 laser for the management of cyclosporine-induced gingival overgrowth in 4 cases. Four renal transplant patients were surgically treated for marked gingival overgrowth by means of gingivectomy and CO2 laser. Postoperatively, all patients were followed for bleeding, pain, infection during the early healing period, and recurrence of gingival overgrowth for 12 months. The healing was uneventful, and no signs of bleeding, postoperative pain, or infection were observed in any patient during the early healing period. In the 12th postoperative month, there was evidence of mild recurrence in 1 patient, while no sign of recurrence was observed in the other patients during the follow-up period. The advantages of this combined technique include satisfactory bleeding control and clear visibility during the procedure, as well as reduced postoperative pain and swelling.

The phenotypic overlap of syndromes associated with hereditary gingival fibromatosis: follow-up of a family for five years.

Hereditary gingival fibromatosis (HGF) is characterized by the slowly progressive fibrous enlargement of gingival tissue. It usually develops as an isolated disorder but can also be one feature of various syndromes. The currently preferred terminology of these syndromes mainly describes the clinical features of the disorder without identifying the cause. In this report, we present the 5-year follow up of a family with HGF and features of 3 previously described syndromes: Jones syndrome, Zimmerman-Laband syndrome, and HGF-hypertrichosis syndrome. The 45-year-old father had HGF, hypertrichosis, hearing loss, and short stubby fingers and toes with hypoplasia of the terminal phalanges and hypoplasia of the nails on the thumbs. The features of 13-year-old son were almost identical to those of his father except for hypertrichosis, but in addition he was mentally retarded. Although the 10-day-old son had HGF and defective fingers, the mother and 7-year-old daughter were unaffected. Owing to the overlap of these syndromes, we argue that the identification of the genetic pathways and mechanisms will be the most important factor in classifying these disorders, with the phenotype playing a minor role.