Enamel matrix derivate induces periodontal regeneration by activating growth factors: A review.

OBJECTIVE: The aim of this article is to review the effect of enamel matrix derivate (EMD) on growth factors activation for periodontal regeneration. MATERIAL AND METHODS: Online databases, such as PubMed, Cochrane Library, PMC, Science Direct were searched by using the following keywords in various combinations: emdogain, periodontal regeneration, growth factors, transforming growth factor, bone morphogenetic protein, fibroblast growth factor and vascular endothelial growth factors. All studies fulfilling the selection criteria were carefully reviewed for the focused question: "Does enamel matrix derivate induces the activity of growth factors, important in periodontal regeneration?". RESULTS: 1378 articles were found in the databases using keywords. After duplicate citations screened, inclusion/exclusion criteria applied, excluded articles after titles, summaries and full-text reading 14 articles were included in the literature review. CONCLUSION: Enamel matrix derivate (EMD) was found to have a possitive effect on periodontal tissue regneration. By stimulating secretion and activating functions of growth factors, such as transforming growth factor-ß (TGF-ß), bone morphogenetic proteins (BMP), vascular endothelial growth factors (VEGF) and fibroblast growth factor-2 (FGF-2), EMD induces production of new alveolar bone, new root cementum and functionl periodontal ligament (PDL) and new blood vessels formation in periodontal area. Due to this production, the probing depth of periodontal pocket is being reduced.

Clinical and Microbiological Effects of Weekly Supragingival Irrigation with Aerosolized 0.5% Hydrogen Peroxide and Formation of Cavitation Bubbles in Gingival Tissues after This Irrigation: A Six-Month Randomized Clinical Trial.

INTRODUCTION: The study investigated the effect of weekly supragingival irrigation with aerosolized 0.5% hydrogen peroxide (H2O2) solution as a maintenance periodontal therapy on clinical and microbiological parameters in patients with chronic periodontitis. The other purpose was to investigate whether cavitation bubbles can penetrate not only into periodontitis-damaged tissues but also into ex vivo porcine healthy periodontal tissues. MATERIALS AND METHODS: The study included 35 systemically healthy patients with chronic periodontitis (CP). After nonsurgical periodontal debridement (NSPD), all patients were randomized into two groups: the Control group (NSDP alone, n = 18) and the Test group (NSDP plus supragingival irrigation, n = 17). Clinical (Approximal Plaque Index (API), Bleeding Index (BI), and Modified Gingival Index (MGI)) and microbiological (Polymerase Chain Reaction technology (using a micro-IDent® kit)) measurements were performed at the initial time point, 3 months, and 6 months after NSPD. The impact of supragingival irrigation on diseased gingival tissues of CP patients (n = 5) and on ex vivo porcine healthy gingival tissue samples (n = 3) was evaluated to estimate morphological changes in healthy and diseased gingival tissues. RESULTS: Morphological data revealed that supragingival irrigation caused the formation of cavitation bubbles in diseased gingival tissue of CP patients and in healthy porcine gingival tissues. The decrease in API, BI, and MGI scores after 6 months in the Test group significantly (p ≤ 0.01, p ≤ 0.05, and p ≤ 0.01, respectively) exceeded that in the Control group. Test group patients demonstrated a decrease in periodontal sites showing Pocket Probing Depth > 4 mm and, after 6 months, a statistically significant decrease in the proportion of periopathogenic bacteria. CONCLUSION: The effectiveness of mechanical periodontal treatment combined with weekly supragingival irrigation with aerosolized 0.5% H2O2 solution on clinical and microbiological parameters of periodontal tissues of periodontitis patients is reliably higher than that of mechanical periodontal debridement alone. It has been found that cavitation bubbles as a result of irrigation with the aerosolized 0.5% hydrogen peroxide solution can form not only in periodontal tissues of periodontitis patients but also in ex vivo porcine healthy gingival tissues.

Effect of Supragingival Irrigation with Aerosolized 0.5% Hydrogen Peroxide on Clinical Periodontal Parameters, Markers of Systemic Inflammation, and Morphology of Gingival Tissues in Patients with Periodontitis.

BACKGROUND Various studies have shown that non-surgical periodontal treatment is correlated with reduction in clinical parameters and plasma levels of inflammatory markers. The aim of this study was to evaluate the effect of long-term weekly supragingival irrigations with aerosolized 0.5% hydrogen peroxide as maintenance therapy followed by non-surgical periodontal treatment on clinical parameters, plasma levels of inflammatory markers, and morphological changes in gingival tissues of patients with periodontitis. MATERIAL AND METHODS In total, 43 patients with chronic periodontitis were randomly allocated to long-term maintenance therapy. The patients' periodontal status was assessed using clinical parameters of approximal plaque index, modified gingival index, bleeding index, pocket probing depth, and plasma levels of inflammatory markers (high-sensitivity C-reactive protein and white blood cell count) at baseline and after 1, 2, and 3 years. The morphological status of gingival tissues (immediately after supragingival irrigation) was assessed microscopically. RESULTS Complete data were obtained on 34 patients. A highly statistically significant and consistent reduction was observed in all long-term clinical parameters and plasma levels of inflammatory markers. Morphological data showed abundant spherical bubbles in gingival tissues. CONCLUSIONS 1. The present study showed that non-surgical periodontal treatment with long-term weekly supragingival irrigations with aerosolized 0.5% hydrogen peroxide improved clinical periodontal status and plasma levels of inflammatory markers and may be a promising method in periodontology. 2. We found that supragingival irrigation with aerosolized 0.5% hydrogen peroxide created large numbers of spherical bubbles in gingival tissues.

Inhibition of peripheral blood neutrophil oxidative burst in periodontitis patients with a homeopathic medication Traumeel S.

BACKGROUND: The anti-inflammatory effects of a homeopathic remedy, Traumeel S, have been observed in experimental and clinical studies; however, its antioxidant properties have not been elucidated. The aim of the present study was to evaluate the antioxidant effects of Traumeel S on peripheral blood neutrophils in patients with periodontitis. MATERIAL/METHODS: The study was performed using venous blood of 22 individuals with chronic periodontitis and 21 healthy subjects. The antioxidant effects of Traumeel S on the production of reactive oxygen species by unstimulated and stimulated with unopsonized E. coli neutrophils were investigated using luminol- and lucigenin-dependent chemiluminescence (CL). RESULTS: Polymorphonuclear leukocytes of periodontitis patients produced higher levels (p<0.01) of light output of lucigenin-dependent chemiluminescence and significantly reduced (p<0.01) light output of luminol-dependent chemiluminescence than analogous cells of healthy subjects. Highly diluted (10⁻4 of the stem solution) Traumeel S significantly (by approximately 50%) reduced superoxide-induced oxidation of lucigenin by unstimulated and stimulated with unopsonized E. coli polymorphonuclear leukocytes of periodontitis patients and had a tendency to intensify luminol-dependent chemiluminescence. Preincubation of the unstimulated and stimulated with unopsonized E. coli polymorphonuclear leukocytes of healthy subjects with Traumeel S exerts no inhibitory action on the luminol- and lucigenin-dependent chemiluminescence of the above-mentioned cells. CONCLUSIONS: This study indicates that Traumeel S may significantly reduce production of superoxide anion by unstimulated and stimulated peripheral blood polymorphonuclear neutrophils of periodontitis patients.

Effect of Perilla frutescens aqueous extract on free radical production by human neutrophil leukocytes.

OBJECTIVE: The present study was intended to evaluate the antioxidant properties of aqueous extract of the Perilla frutescens (L.) Britton. MATERIAL AND METHODS: The antioxidant properties of Perilla frutescens were analyzed employing neutrophil leukocytes stimulated by the nonopsonized Escherichia coli. The neutrophil leukocytes were affected by adding an aqueous extract of Perilla. The generation of the reactive oxygen species by neutrophil leukocytes was investigated using assessment of luminol- and lucigenin-dependent chemiluminescence. RESULTS: We found out that the treatment of neutrophil leukocytes with the Perilla aqueous extract inhibited the release of reactive oxygen species, measured as luminol- and lucigenin-dependent chemiluminescence, by about 30% and more than 90%, respectively. CONCLUSION: The results of this study show that the aqueous extract of the Perilla frutescens inhibits significantly free radical production by neutrophil leukocytes, which was especially obvious when the lucigenin-dependent chemiluminescence assessment method was applied.

Oxidative function of neutrophils in periodontitis patients with type 1 diabetes mellitus.

BACKGROUND: The involvement of reactive oxygen species in periodontal diseases is unclear. The aim of the present study was to explore the oxidative function of neutrophilic leukocytes of the peripheral venous blood in patients with severe periodontitis and type 1 diabetes mellitus and in the control subjects with healthy periodontal tissues and without systemic diseases. MATERIALS AND METHODS: The leukocytes for the present investigation were obtained from peripheral venous blood of 38 patients with severe periodontitis and type 1 diabetes mellitus and 27 control subjects. The maximal luminol-dependent chemiluminescence and peak time values of neutrophils stimulated with non-opsonized Escherichia coli ATCC 25922 and Staphylococcus aureus 256 were measured. RESULTS: The maximal luminol-dependent chemiluminescence of neutrophils in patients with severe periodontitis, stimulated with non-opsonized Escherichia coli and Staphylococcus aureus, is mainly lower than that in the control group subjects (p < 0.001). Luminol-dependent chemiluminescence of neutrophils reached its maximal value at the same time in both the diseased and the healthy patients. CONCLUSION: In periodontitis, local non-opsonized bacteria might stimulate neutrophilic leukocytes to release oxygen species. However, these cells in patients with periodontitis are characterized by a lower intensity of luminol-dependent chemiluminescence (p < 0.001) compared to analogous findings in people with healthy periodontal tissues. This might indicate insufficient microbicidal activity of these cells in patients with periodontitis.

Generation of superoxide anion by peripheral blood leukocytes in periodontitis patients with type 1 diabetes mellitus.

UNLABELLED: The involvement of reactive oxygen species in periodontal diseases is unclear. The aim of present study was to explore oxidative function of neutrophil leukocytes of patients with severe periodontitis who have type 1 diabetes mellitus, and control subjects with healthy periodontal tissues and without systemic diseases. MATERIALS AND METHODS: The leukocytes for present investigation were obtained from peripheral venous blood of 38 patients with severe periodontitis who have type 1 diabetes mellitus and 27 control subjects. The maximal lucigenin-dependent chemiluminescence and peak time values of neutrophils stimulated with non-opsonized Escherichia coli ATCC 25922 and Staphylococcus aureus 256 were measured. RESULTS: The maximal lucigenin-dependent chemiluminescence of neutrophils of patients with severe periodontitis stimulated with non-opsonized E. coli and S. aureus was much higher than that in control subjects (p<0.001). In both affected and healthy patients, chemiluminescence of neutrophil leukocytes reached its peak value at similar time. The maximum value of chemiluminescence of leukocytes stimulated with non-opsonized E. coli in both studied groups was reached statistically significantly earlier than when stimulating with non-opsonized S. aureus bacteria (p<0.001). CONCLUSION: In periodontitis, local non-opsonized bacteria might stimulate neutrophil leukocytes to release reactive oxygen species, which can cause inflammation and destruction of periodontal tissue.

The influence of microvascular complications caused by diabetes mellitus on the inflammatory pathology of periodontal tissues.

The aim of our study was to analyze inflammatory pathology of periodontal tissues in patients with diabetes mellitus, and the relationship of this pathology with other complications caused by diabetes mellitus. In our study, we evaluated 126 people aged 16-53 years (42 males and 84 females) with diabetes mellitus admitted to the Clinic of Endocrinology of the Hospital of Kaunas University of Medicine (HKUM). The condition of periodontal tissues was evaluated according to the World Health organization (WHO) CPITN index. Oral hygiene was evaluated using a simplified oral hygiene index (OHI-S) according to Green-Vermillion. Out of 126 subjects with diabetes mellitus, periodontitis was detected in 96 patients (36 males and 60 females) (CPITN index 2-5). Gingivitis was found in 27 subjects (CPITN index 1). Only 2.4% of the studied patients had healthy periodontal tissues. The study analyzed complications of other organs (neuropathy, and nephropathy and retinopathy) caused by diabetes mellitus. The obtained findings showed that microvascular complications were diagnosed more frequently in the presence of more severe inflammatory pathology of periodontal tissues. Retinopathy was diagnosed in patients with CPITN index 2.8+/-0.1, while patients with CPITN index 1.8+/-0.3 had no retinopathy. Neuropathy was more common among patients whose CPITN index was 2.9+/-0.1, while the condition was absent in cases where the CPITN index was 1.8+/-0.2. Comparable results were yielded by the studies of nephropathies in relation with changes in periodontium. Nephropathy was diagnosed in patients whose CPITN index was 3.0+/-0.1, and was not found in patients with CPITN index 2.1+/-0.2. The generalization of the obtained study data allows for stating that a more detailed analysis of factors causing complications of diabetes mellitus will also allow for a more profound understanding of the etiopathogenetic mechanisms that cause inflammatory pathology of periodontal tissues.