Inter- and intra-examiner agreement of three classification systems of gingival recession.

Background: Several classifications have been proposed for gingival recession defects. Correct diagnosis of the type of gingival recession is necessary for proper treatment planning and assessment of the prognosis. Considering the existing uncertainty regarding the reliability of different classification systems available for gingival recession and their shortcomings, this study sought to assess the reproducibility and reliability of accuracy of three available classifications (Cairo, Mahajan and Miller's classification systems) for gingival recession. Methods: This descriptive study was conducted on 32 patients presenting to the Department of Periodontics, who were selected using convenience sampling. The screening process entailed two sessions and those with a minimum of one site of gingival recession disclosing the cementoenamel junction (CEJ) of the tooth with no adjacent tooth loss at the site of recession were enrolled. Each patient was separately evaluated by three calibrated examiners twice with a minimum of one-week interval. Grading of the gingival recession defects was determined using the Cairo, Mahajan and Miller's classification systems for gingival recession. The gradings of each examiner were separately recorded by a blinded examiner. A total of 120 single recession defects were examined and data were analyzed using intra-class correlation coefficient (ICC) and Spearman's test. Level of agreement was evaluated according to Landis and Koch. Results: The results showed that the reliability of all the three methods was almost perfect (P<0.05), and no significant difference was noted in reliability of the Cairo, Mahajan and Miller's classifications for gingival recession (P=0.7). Conclusion: Based on the results of the study, the highest intra- and inter-observer agreement in the use of the three classifications belonged to the Cairo classification; however, all the three classifications showed high reliability.

Evaluation of Impacting Factors on Facial Bone Thickness in the Anterior Maxillary Region.

BACKGROUND: The goal of the current study was to measure the width of the labial alveolar bone of the overlying maxillary anterior teeth, based on cone-beam computed tomography (CBCT) images, and the distance between cementoenamel junction (CEJ) and bone crest in adult patients. METHODS: A cross-sectional study was performed using a sample of 132 tomographic scans. Intact maxillary anterior with healthy periodontium and teeth was randomly selected and afterwards assessed by 2 calibrated and independent reviewers. RESULT: The average bone thickness at 2 mm from the CEJ of the maxillary right central incisors was 0.63 ±â€Š0.69 mm and over the maxillary left central incisors was 0.59 ±â€Š0.71 mm. Moreover on the right and left lateral maxillary incisors, the crestal bone width averaged 0.64 ±â€Š0.81 and 0.61 ±â€Š0.7 mm, respectively. Concerning the maxillary canine region on both sides, the crestal bone thickness averaged 0.72 ±â€Š0.9 and 0.66 ±â€Š0.69 mm, in the maxillary right and left the canine regions, respectively. Furthermore, according to the gender and systemic disease, there were some recognizable differences in the facial bone thickness between the left and the right side. CONCLUSIONS: The current study has advocated the outcome of a mostly thin buccal bone overlying the maxillary anterior teeth; hence, clinicians should always consider the thickness of the facial cortical plate of the extraction site and the positioning of the implant placement in the socket.

Detection of simulated periodontal defects using cone-beam CT and digital intraoral radiography.

OBJECTIVES:: This study sought to assess the diagnostic value of CBCT and digital intraoral radiography for the detection of periodontal defects in the sheep mandible. METHODS:: In this in vitro study, 80 periodontal defects including Grades I, II and III furcation involvements, one-, two-, three-wall and trough-like infrabony defects, fenestration and dehiscence were artificially created in the sheep mandible by burr. Intraoral digital radiographs using photostimulable phosphor plates and CBCT scans were obtained. Three periodontists evaluated the images for the presence and type of defects. The results were compared with the gold standard (photographs of the created defects). RESULTS:: CBCT scans were significantly superior to digital radiographs for the detection of Grade I furcation involvements, three-wall defects, fenestrations and dehiscence (p < 0.05). No significant difference was noted between CBCT and digital radiography for the detection of Grades II and III furcation involvements, one-wall, two-wall and trough-like defects (p-value > 0.05). CONCLUSIONS:: CBCT was superior to digital intraoral radiography for the detection of Grade I furcation involvements, three-wall defects, dehiscence and fenestrations.

Relationship of Halitosis with Gastric Helicobacter Pylori Infection.

OBJECTIVES: Gastric infection with Helicobacter pylori may be one of the main causes of halitosis. This study was performed to evaluate the relationship of Helicobacter pylori infection with halitosis. MATERIALS AND METHODS: This case control study was performed on 44 dyspeptic patients with a mean age of 34.29±13.71 years (range 17 to 76 years). The case group included 22 patients with halitosis and no signs of diabetes mellitus, renal or liver failure, upper respiratory tract infection, malignancies, deep carious teeth, severe periodontitis, coated tongue, dry mouth or poor oral hygiene. Control group included 22 patients without halitosis and the same age, sex, systemic and oral conditions as the case group. Halitosis was evaluated using organoleptic test (OLT) and Helicobacter pylori infection was evaluated by Rapid Urease Test (RUT) during endoscopy. The data were statistically analyzed using chi square, Mann Whitney and t-tests. RESULTS: Helicobacter pylori infection was detected in 20 (91%) out of 22 halitosis patients, and 7 control subjects (32%) (P<0.001). CONCLUSION: Helicobacter pylori gastric infection can be a cause of bad breath. Dentists should pay more attention to this infection and refer these patients to internists to prevent further gastrointestinal (GI) complications and probable malignancies.

Effects of smoking severity and moderate and severe periodontitis on serum C-reactive protein levels: an age- and gender-matched retrospective cohort study.

BACKGROUND AND PURPOSE: C-reactive protein (CRP) which might affect cardiovascular events can be affected by chronic diseases and smoking. Since the effects of smoking dosage as well as the mutual effect of smoking and periodontitis on CRP levels have not been evaluated, we aimed to assess these. MATERIALS AND METHODS: This retrospective age- and gender-matched study was performed on 120 dental patients. Clinical attachment loss, pocket probing depth (PPD), bleeding on probing (BoP), O'Leary plaque index and serum CRP were recorded. Patients were divided into one control and five cohort groups (n = 20 each) according to smoking severity [pack years (PY) below or above 30] and periodontal condition (healthy periodontium and moderate/severe periodontitis). The effects of clinical measurements, age, gender, smoking and periodontitis on CRP were assessed using one- and two-way analyses of variance, Tukey and Bonferroni post hoc tests, and multiple linear regression (α = 0.05). RESULTS: CRP concentrations were 0.07255 ± 0.009539, 0.09645 ± 0.010625, 0.122235 ± 0.018442, 0.3758 ± 0.187369, 0.81595 ± 0.0410299 and 1.8717 ± 0.652728 mg/l, respectively, in the control (PY ≤ 30 with healthy periodontium), cohort 1 (PY > 30 with healthy periodontium), cohort 2 (PY ≤ 30 with moderate periodontitis), cohort 3 (PY > 30 with moderate periodontitis), cohort 4 (PY ≤ 30 with severe periodontitis) and cohort 5 (PY > 30 with severe periodontitis). The positive effects of age, smoking severity, periodontitis and PPD, on CRP increase were significant (Regression p < 0.02). BoP had a negative effect (p = 0.015). CONCLUSIONS: Clinicians should warn the patients, especially the older ones, about the effects of their gingival health and smoking on their cardiovascular condition.

Receptor activator of nuclear factor kappa B ligand and osteoprotegerin levels in gingival crevicular fluid.

BACKGROUND: OSTEOCLASTOGENESIS IS COORDINATED BY THE INTERACTION OF THREE MEMBERS OF THE TUMOR NECROSIS FACTOR (TNF) SUPERFAMILY: Osteoprotegerin (OPG)/receptor activator of nuclear factor kappa B ligand (RANKL)/receptor activator of nuclear factor kappa B (RANK). The aim of this study was to investigate RANKL and OPG levels, and their relative ratio in gingival crevicular fluid (GCF) of patients with chronic and aggressive periodontitis, as well as healthy controls. MATERIALS AND METHODS: In this analytical study, GCF was obtained from healthy (n = 10), mild chronic periodontitis (n = 18), moderate chronic periodontitis (n = 18), severe chronic periodontitis (n = 20), and generalized aggressive periodontitis (n = 20) subjects. RANKL and OPG concentrations were measured by enzyme-linked immunosorbent assay. Statistical tests used were Kruskal-Wallis test, Mann-Whitney U rank sum test, and Spearman's rank correlation analysis. The level of statistical significance was set at P < 0.05. RESULTS: Mean RANKL concentration showed no statistically significant differences between groups (P = 0.58). There were also no significant differences between mean OPG concentration in the five groups (P = 0.0.56). Moreover, relative RANKL/OPG ratio did not reveal a significant difference between the three study group subjects: healthy, chronic periodontitis (mild, moderate, severe), and aggressive periodontitis (P = 0.41). There was statistically significant correlation between the concentration of sRANKL and Clinical Attachment Level (CAL) in moderate chronic periodontitis patients (R = 0.48, P = 0.04). There was also negative correlation between OPG concentration and CAL in moderate chronic periodontitis patients, although not significant (R = -0.13). CONCLUSION: RANKL was prominent in periodontitis sites, especially in moderate periodontitis patients, whereas OPG was not detectable in some diseased sites with bleeding on probing, supporting the role of these two molecules in the bone loss developed in this disease.

Receptor activator of nuclear factor kappa B ligand (RANKL) levels in peri-implant crevicular fluid.

BACKGROUND: Receptor activator of nuclear factor kappa B ligand (RANKL) is one of the key cytokines in the induction of osteoclastogenesis both in vitro and in vivo. Several reports indicated the presence of sRANKL in gingival crevicular fluid of patients with periodontal diseases. OBJECTIVE: To determine the presence of RANKL in peri-implant crevicular fluid samples of implants with peri-implantitis, peri-implant mucositis and healthy controls. METHODS: In this study, 40 implants were categorized as clinically healthy, peri-implant mucositis and peri-implantitis according to the clinical and radiographic findings. Filter paper strips were used to collect peri-implant crevicular fluid for 30 seconds in the base of the crevice/pocket. Peri-implant crevicular fluid (PICF) samples were obtained from buccal and lingual aspects of implants. Plaque index, probing depth, gingival index and bleeding on probing were recorded at six sites per implant. Enzyme-linked immunosorbent assay (ELISA) was performed to determine the PICF levels of sRANKL. RESULTS: There were no statistically significant differences in sRANKL concentration between healthy group, peri-implant mucositis and periimplantitis (p=0.12). There were also no statistical correlation between the concentration of sRANKL and probing pocket depth (R=0.051, p=0.65), or any of the other clinical regarding (p>0.05). No differences between the mean sRANKL concentration in the buccal and lingual sites were found (p=0.693). CONCLUSION: Our results may suggest that peri-implant crevicular fluid analysis of sRANKL in conjunction with some other osteoclastogenic mediators could be further investigated in further well-designed prospective longitudinal studies on a larger-scale sample size in the evaluation of dental implants.

Relationship between obesity and periodontal status in a sample of young Iranian adults.

AIM: To examine the possible relationship between body weight and periodontal disease in a sample of the young Iranian population. DESIGN: An analytical (Case-Control) study. PARTICIPANTS: Eighty individuals aged 18 to 34 years (40 normal and 40 overweight and obese subjects) were evaluated in this study. METHODS: The periodontal examination consisted of: Plaque Index (PLI), Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL). Body Mass Index (BMI) and Waist circumference (WC) were used as measures of overall and abdominal fat content. Socio-demographic variables and periodontal disease risk factors (age, gender, education, time elapsed since last dental visit, smoking and diabetes) were evaluated as covariates. The statistical tests used were: Kolmogorov-Smirnov, Independent Samples T-test, ANOVA, Exact fisher, Chi-Square test and Spearman's rank correlation (Rsp). RESULTS: PPD and CAL were significantly higher in the case group compared to control (2.82 +/- 0.4 versus 2.56 +/- 0.36, P < 0.002 and 1.98 +/- 0.5 versus 1.63 +/- 0.335, P < 0.000 respectively). Subjects with a high waist circumference had significant differences of PPD and CAL when compared to normal waist circumference subjects (P < 0.000). There were also positive correlations between measures of overall fat content BMI and PPD (Rsp = 0.33), CAL (Rsp = 0.39) and age (Rsp = 0.42) on one side and the measure of WC and PPD (Rsp = 0.32), CAL (Rsp = 0.44), age (Rsp = 0.48) and PLI (Rsp = 0.3) on the other. CONCLUSION: The results indicate that overall and abdominal obesity were associated with the extent of periodontal disease in a sample of Iranian young individuals and therefore prevention and management of obesity may be an additional factor for improving periodontal health.

Effect of general health and sociocultural variables on periodontal status of pregnant women.

BACKGROUND: The influence of sociocultural variables, pre-existing conditions of general, oral and dental health and hormonal changes on periodontal status during pregnancy has been reported in some clinical studies and there has been speculation about the effects of these parameters on periodontal health during pregnancy. MATERIALS AND METHODS: This study evaluates the periodontal condition (plaque index, gingival index, probing pocket depth and clinical attachment level) of 140 pregnant women and its relationship to demographic (age, professional level and education) and clinical variables (previous pregnancy, gestation period, previous periodontal maintenance, previous live births and health status). All periodontal data were recorded by the same examiner. Statistical tests used were ANOVA, ANCOVA, Kolmogorov-Smirnov, Kruskal-Wallis and Spearman's rank correlation. The level of statistical significance was established at p< or =0.05. RESULTS: There were statistically significant differences between plaque index levels across educational level categories, the plaque index decreased as the level of education increased (p=0.0068). Clinical attachment loss was also significantly higher in patients not holding a salaried position (p=0.045). Plaque indexes were significantly higher in patients who did not have regular periodontal visits than in patients who did visit regularly (p=0.05). Differences between gingival index levels across different age categories were obvious, with gingival indexes increasing with age (p=0.014). There were strong positive correlations between gingival index and clinical attachment level (Rsp=0.76) and gingival index and probing pocket depth (Rsp=0.72). CONCLUSIONS: The results of the present study suggest that there is an inverse relationship between education level and plaque index. Gingivitis due to accumulation of plaque was related to previous periodontal maintenance, age and education level. So it might be suggested that special government-supported education and behavioral modification programs of periodontal disease prevention for pregnant women is useful.