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Purpose: Both diabetes and periodontal disease are common chronic diseases. It has been established that diabetes adversely affects periodontal health. Evidence is also increasing to support treating periodontal infection to improve glycemic control in people with diabetes. This evidence comes from reports of intervention studies evaluating the effect of treating patients with varying periodontitis severity in controlled settings. Reports on the relationship between frequency of dental prophylaxis and glycemic control are sparse. The purpose of this analysis was to test the hypothesis that people who report more frequent or more recent dental prophylaxes are more likely to have better glycemic control.Methods and Materials: We analyzed screening data from 240 university hospital clinic and HMO subjects with type 2 diabetes, who were recruited for an ongoing clinical trial to investigate whether recency of dental prophylaxis appointments was associated with glycemic control as measured by level of hemoglobin A1c (HbA1c). Bivariable analysis and multiple regression modeling were conducted to evaluate associations of HbA1c with continuous and categorical variables collected from interviews and clinical examinations. The primary explanatory variables of interest were responses to interview questions on time elapsed since dental prophylaxis appointments.Results: In bivariable analysis of numerous demographic, medical, and behavioral variables, only oral diabetes medication/insulin usage status (P = .03) and doctor-recommended frequency of checking blood glucose levels (P < .01) showed statistically significant associations with HbA1c. Results from multiple regression modeling indicated that race/ethnicity, education level, and doctor-recommended frequency of checking blood glucose levels were significant predictors (P < .05), while diastolic blood pressure, low activity level, and current tobacco use were marginally non-significant predictors (P > .05). Time elapsed since dental prophylaxis appointments showed a positive but statistically non-significant association with HbA1c in both bivariable (P > .25) and regression analysis (P = .2).Conclusion: Further, more rigorous investigation of predictors of HbA1c is needed to determine if recency and frequency of dental prophylaxis contribute to glycemic control in subjects with diabetes. [ABSTRACT FROM AUTHOR]

Introduction: The historical separation between medicine and dentistry has resulted in the creation of separate health records, which have the potential to negatively impact patient care and safety. Of particular importance, errors or omissions in medication lists in separate electronic health records (EHRs) may lead to medical errors and serious adverse outcomes., Objective: This study aimed to compare medication lists reported in the EHRs of active patients treated by both the University of Michigan School of Dentistry and Michigan Medicine to determine if differences exist., Methods: In this cohort study, EHRs of a population of 159,733 patients that the University of Michigan medical and dental clinics share in common were investigated for agreement in the reporting of 16 medications. After exclusion of minors and patients not seen in the last 5 y, records of 27,277 patients were examined., Results: The maximum percentage of agreement in medications reported in both records was 52% for levothyroxine, and the minimum was 7% for sildenafil. The medical record had a significantly higher number of unique medications than the dental record, suggesting higher underreporting in the dental setting., Conclusion: The lack of agreement in the report of medications with serious dental and medical implications argues in favor of unification of records and use of available technology to increase accurate medication reporting., Knowledge Transfer Statement: The results demonstrate a lack of agreement between medications reported in medical and dental records, which can have serious implications to patients' health. A unified health record, employing available technology to increase accurate medication reporting, would mitigate this problem.

The advent of the COVID-19 pandemic in the final months of 2019 prompted an extraordinary response on the part of the scientific community, with fundamental research on the biology of the virus and the human immune response, and development of testing, therapeutics, and vaccines occurring on an unprecedentedly short timescale. Within a year after the worldwide outbreak of the disease, more than 40 vaccine candidates had emerged, with 21 candidates in phase 3 trials or already being used on an emergency basis. Many of these vaccines have involved innovative platforms. In this concise review, the authors will summarize the characteristics and performance of the leading vaccines and discuss considerations of virus mutations and asymptomatic spread that may affect the ability of the worldwide community to use these vaccines as a means to defeat the pandemic and restore pre-COVID-19 normality.

Article Title and Bibliographic Information: Levels of smoking and dental implants failure: A systematic review and meta-analysis. Naseri R, Yaghini J, Feizi A. J Clin Periodontol. 2020;47(4):518-528., Source of Funding: Information not available., Type of Study/design: Systematic review with meta-analysis of data., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: In 1974, the American Dental Association first considered recommending that dental offices measure blood pressure (BP) routinely, and it has been further encouraged since 2006. Investigators in several dental publications have recommended cancellation of dental procedures based solely on BP greater than 180/110 millimeters of mercury for urgent oral health care and greater than 160/100 mm Hg for elective oral health care, in the absence of prior medical consultation., Methods: The authors reviewed the evidence for cancellation of any dental or surgical procedures by using an Ovid MEDLINE search for the terms dental, elevated blood pressure, and hypertension. In addition, the authors searched resources at ebd.ada.org using the same criteria. The authors collaborated to develop recommendations in view of 2017 guidelines on this subject., Results: To the authors' knowledge, there are no professionally accepted criteria or study evidence indicating a specific BP elevation at which to prohibit oral health care. Researchers of a 2015 review on management of comorbidities in ambulatory anesthesia failed to find increased morbidity from hypertension in the outpatient setting., Conclusions: To the authors' knowledge, there are no prospective study investigators that have addressed whether or when to cancel dental procedures due to office-measured elevated BP. The authors recommend using current anesthesiology guidelines based on functional status and past BP measurements to prevent unnecessary cancellations., Practical Implications: It is seldom necessary to cancel dental procedures on the basis of BP measured before a planned procedure for patients under a physician's care., (Copyright © 2020 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Article Title and Bibliographic Information: Management of anticoagulated patients in implant therapy: a clinical comparative study. Clemm R, Neukam FW, Rusche B, Bauersachs A, Musazada S, Schmitt CM. Clin Oral Implants Res 2016;27(10):1274-82., Source of Funding: Information not available TYPE OF STUDY/DESIGN: Cohort study., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: The purpose of this multicenter randomly controlled clinical trial was to compare two acellular dermal matrix (ADM) materials produced by different processing techniques, freeze-dried (FDADM) and solvent-dehydrated (SDADM) ADM, in their ability to correct Miller Class I and II recession defects., Methods: Eighty individuals from four study centers, each with a single maxillary anterior Miller Class I or II recession defect were enrolled. Participants were randomly assigned and treated with coronally advanced flap (CAF) + FDADM (n = 42) or CAF + SDADM (n = 38). Gingival thickness, recession depth, recession width, probing depth (PD), clinical attachment level, gingival index, plaque index, patient discomfort, and wound healing index were recorded before surgery (day 0), immediately after surgery (day 1), and 2, 4, 12, 24, and 52 weeks postoperatively. The Student t test, paired t test, and Kruskal-Wallis one-way ANOVA were used to analyze the data., Results: When evaluating the clinical parameters after 1 year, both groups showed significant (P <0.05) improvement for most of the parameters evaluated when compared to baseline (day 0). For example, percentage of root coverage was 77.21% ± 29.10% for CAF + FDADM and 71.01% ± 32.87% for CAF + SDADM. Conversely, no significant differences were observed between the two materials for any clinical parameter tested or for patient satisfaction except PD on the mesial side of the defects (P = 0.03)., Conclusions: Both FDADM and SDADM can be used successfully to correct Miller Class I or II recession defects. There were no statistically significant differences between groups for any of the clinical parameters tested.

Background: Enamelin-null (ENAM(-/-)) mice have no enamel. When characterizing ENAM(-/-) mice, alveolar bone height reduction was observed, and it was hypothesized that enamel defects combined with diet are associated with the periodontal changes of ENAM(-/-)mice. The aim of the present study is to compare the dimension of interradicular bone of ENAM(-/-) (knock-out [KO]) with wild-type (WT) mice, maintained on hard (HC) or soft (SC) chow., Methods: A total of 100 animals divided into four groups were studied at 3, 8, and 24 weeks of age: 1) KO/HC; 2) KO/SC; 3) WT/HC; and 4) WT/SC. Microcomputed tomography was performed, and the following measurements were made between mandibular first (M1) and second (M2) molars: relative alveolar bone height (RBH), crestal bone width (CBW), bone volume (BV), bone mineral content (BMC), and bone mineral density (BMD). The position of M1 and M2 in relation to the inferior border of the mandible was also determined at 24 weeks. All variables were analyzed by one-way analysis of variance and Dunnett test for pairwise comparisons. Morphologic analyses were conducted on hematoxylin and eosin-stained sections., Results: Radiographically, the enamel layer was absent in ENAM(-/-) mice. Interproximal open contacts were observed exclusively in ENAM(-/-) mice, and the prevalence decreased over time, suggesting that a shifting of tooth position had occurred. Additionally, in the two ENAM(-/-) groups, RBH was significantly lower at 8 and 24 weeks (P <0.02); CBW, BV, and BMC were significantly less (P <0.05) at 24 weeks. No differences in BMD were found among the four groups. The molars migrated to a more coronal position in ENAM(-/-) mice and mice on HC. Histologic findings were consistent with radiographic observations. After eruption, the junctional epithelium was less organized in ENAM(-/-) mice., Conclusion: The interdental bone density was not affected in the absence of enamelin, but its volume was, which is likely a consequence of alternations in tooth position.

Introduction: Teriparatide comprises the first 34 amino acids of parathyroid hormone and is a systemic anabolic agent that is Food and Drug Administration approved for the treatment of osteoporosis but not for periodontitis. To our knowledge, this is the first clinical case report to document the treatment of a patient with severe periodontitis using an open-flap debridement procedure in conjunction with teriparatide., Case Presentation: A 45-year-old female patient was diagnosed with severe chronic periodontitis, including the presence of an intrabony defect on tooth #6. She received open-flap debridement surgery in conjunction with daily systemic administration of 20 μg teriparatide, oral vitamin D, and calcium supplements for 6 weeks. Radiographic, clinical, gingival crevicular fluid (pyridinoline cross-linked carboxy-terminal propeptide of type I procollagen, procollagen type 1 N-propeptide, and osteocalcin), and serum parameters (parathyroid hormone, bone alkaline phosphatase, calcium, and 25-hydroxyvitamin D) were assessed. Treatment outcomes were evaluated over 4 years, with successful radiographic and clinical results throughout the follow-up period., Conclusion: Teriparatide administration in conjunction with traditional open-flap debridement surgery offers potential for the treatment of severe intrabony defects resulting from chronic periodontitis., (© 2012 American Academy of Periodontology.)

Vitamin D regulates calcium and immune function. While vitamin D deficiency has been associated with periodontitis, little information exists regarding its effect on wound healing and periodontal surgery outcomes. This longitudinal clinical trial assessed outcomes of periodontal surgery and teriparatide administration in vitamin-D-sufficient and -insufficient individuals. Forty individuals with severe chronic periodontitis received periodontal surgery, daily calcium and vitamin D supplements, and self-administered teriparatide or placebo for 6 wks to correspond with osseous healing time. Serum 25(OH)D was evaluated at baseline, 6 wks, and 6 mos post-surgery. Clinical and radiographic outcomes were evaluated over 1 yr. Placebo patients with baseline vitamin D deficiency [serum 25(OH)D, 16-19 ng/mL] had significantly less clinical attachment loss (CAL) gain (-0.43 mm vs. 0.92 mm, p < 0.01) and probing depth (PPD) reduction (0.43 mm vs. 1.83 mm, p < 0.01) than vitamin-D-sufficient individuals. Vitamin D levels had no significant impact on CAL and PPD improvements in teriparatide patients at 1 yr, but infrabony defect resolution was greater in teriparatide-treated vitamin-D-sufficient vs. -deficient individuals (2.05 mm vs. 0.87 mm, p = 0.03). Vitamin D deficiency at the time of periodontal surgery negatively affects treatment outcomes for up to 1 yr. Analysis of these data suggests that vitamin D status may be critical for post-surgical healing. (ClinicalTrials.gov number, CT00277706).

Background: Intermittent administration of teriparatide, a drug composed of the first 34 amino acids of parathyroid hormone, has anabolic effects on bone. Although teriparatide has been evaluated for the treatment of osteoporosis and for the healing of fractures, clinical trials evaluating it for the treatment of osseous conditions of the oral cavity in humans are lacking., Methods: A total of 40 patients with severe, chronic periodontitis underwent periodontal surgery and received daily injections of teriparatide (20 μg) or placebo, along with oral calcium (1000 mg) and vitamin D (800 IU) supplementation, for 6 weeks. The patients were followed for 1 year. The primary outcome was a radiographic linear measurement of alveolar bone level. Secondary outcomes included clinical variables, bone turnover markers in serum and oral fluid, systemic bone mineral density, and quality of life., Results: Radiographic linear resolution of osseous defects was significantly greater after teriparatide therapy than after placebo beginning at 6 months, with a mean linear gain in bone at 1 year of 29% as compared with 3% (P<0.001). Clinical improvement was greater in patients taking teriparatide than in those taking placebo, with a reduction in periodontal probing depth of 33% versus 20% (2.42 mm vs. 1.32 mm) and a gain in clinical attachment level of 22% versus 7% (1.58 mm vs. 0.42 mm) in target lesions at 1 year (P = 0.02 for both comparisons). No serious adverse events were reported; however, the number of patients in the study was small. No significant differences were noted with respect to the other variables that were assessed., Conclusions: Teriparatide, as compared with placebo, was associated with improved clinical outcomes, greater resolution of alveolar bone defects, and accelerated osseous wound healing in the oral cavity. Teriparatide may offer therapeutic potential for localized bone defects in the jaw. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT00277706 .).

Aim: The purpose of this study was to evaluate factors associated with the fill of inter-dental spaces by gingival papillae., Materials and Methods: Ninety-six adult subjects were evaluated. Papilla score (PS), tooth form/shape, interproximal contact length and gingival thickness were recorded for 672 maxillary anterior and first pre-molar interproximal sites. Statistical analyses included a non-parametric chi(2) test, anova, the Mixed Procedure for SAS and Pearson's correlation coefficient (r)., Results: Papilla deficiency was more frequent in older subjects (p<0.05), as papilla height decreased 0.012 mm with each year of increasing age (p<0.05). Competent papillae (complete fill inter-dentally) were associated with: (1) crown width: length >or=0.87; (2) proximal contact length >or=2.8 mm; (3) bone crest-contact point or=1.5 mm. Gingival thickness correlated negatively with PS (r=-0.37 to -0.54) and positively with tissue height (r=0.23-0.43). Tooth form (i.e. crown width to length ratio) correlated negatively with PS (r=-0.37 to -0.61). Other parameters failed to show any significant effects., Conclusions: Gingival papilla appearance was associated significantly with subject age, tooth form/shape, proximal contact length, crestal bone height and interproximal gingival thickness.

Background: Anxiety, stress, and depression affect the use of health care services, treatment decision-making, and responses to periodontal treatment. This study explored periodontists' confidence in detecting patient anxiety, stress, or depression, as well as their knowledge concerning the relationships between these factors and patients' pain, use of pain medication, and wound healing after periodontal treatment. In addition, this research surveyed if (and which) special accommodations were offered when treating patients with high levels of anxiety, stress, or depression., Methods: Data were collected from 171 members of the American Academy of Periodontology (response rate = 34.41%). Most respondents were male (82.2%), white (88.2%), and practiced in solo practices (60.9%)., Results: The respondents were more knowledgeable about the effects of anxiety and stress on pain, the use of pain medication, and wound healing than about the impact of depression on these outcomes. They agreed more strongly with statements that they were more confident in their ability to perceive when patients were anxious and stressed than when they were depressed. They also offered more special accommodations for patients with anxiety and stress than for patients with depression., Conclusions: The respondents were significantly less knowledgeable about the impact of depression on patients' responses to periodontal treatment than about the effect of anxiety and stress. Given the evidence concerning the relationships among depression, pain, pain medication use, and wound healing, it is important to educate periodontists about the role of anxiety and stress and the significance of depression on their patients' responses to periodontal therapy.

Background: This research explored how patients with surgical versus non-surgical periodontal treatment differ in trait anxiety, depression, perceived stress, and well-being on the day of surgery and in their reported pain and use of pain medication 2 and 4 weeks after treatment. In addition, it was investigated how psychosocial factors affected reported pain, use of pain medication, and wound healing., Methods: Data were collected from 70 dental patients (34 males and 36 females; average age: 54.79 years; SD=13.206) on the day of their periodontal treatment and 2 and 4 weeks after this treatment. The psychosocial factors (i.e., trait anxiety, depression, perceived stress, and well-being) were measured with standardized scales. The patients' providers assessed their wound healing 2 weeks after treatment., Results: On the day of treatment, non-surgical patients had higher anxiety, depression, and stress, and poorer well-being than surgical patients. However, surgical patients reported a higher level of pain during the second week, and greater consumption of analgesics during the second and fourth week. Anxiety, depression, stress, and well-being correlated with the reported level of pain, the use of pain medication, and wound healing after periodontal treatment., Conclusions: Psychosocial factors (i.e., anxiety, depression, stress, and well-being) can affect the patients' quality of life on the day of periodontal treatment and the pain experience and medications used after surgical and non-surgical periodontal therapy (4-week period). Patient-provider communication should address the role of these factors in the treatment process.

Objective: The purpose of this study was to compare the accuracy of linear tomography (LT) and direct ridge mapping (RM) for determining alveolar ridge dimensions., Study Design: One site in the posterior mandible was selected for evaluation in each of 5 cadaver heads. Vacuum-formed stents made from models of the cadaver ridges were used to identify 3 sets of measurement points for each specimen: coronal (intersection of coronal and middle third of ridge), middle (intersection of middle and apical third), and apical (base of vestibule). The imaging stent contained 2-mm metal balls at each point, while the RM stent had holes drilled at corresponding locations. Linear tomograms and periapical radiographs (PA) were taken of the selected sites. RM measurements were made with calipers. Five blinded examiners measured ridge width at the designated measurement points with both LT and RM as well as distance from the ridge crest to mandibular canal (using PAs for RM group). Mandibles were then sectioned and an independent examiner made direct measurements (DM). MANOVA was used to determine whether LT and RM differed significantly from DM., Results: There were no significant differences between LT and RM for ridge width measurements. However, both techniques underestimated ridge dimensions compared to DM ( P < .05). Measurement of mandibular canal height was accurate when determined by periapical radiographs but not by LT., Conclusion: Neither LT nor RM proved to be completely accurate in determining ridge width in the posterior mandible.

The model of explosion pressure build up in enclosures with inertial vent covers and the CINDY code implementing the model are validated against experiments by Hochst and Leuckel (1998) in a 50 m3 vessel with a pair of ceiling-mounted upwards-opening hinged doors in a 'butterfly' configuration with surface densities of 73 and 124 kg/m2 under conditions of initially quiescent and turbulent mixtures. The model and the code are further validated against an experiment by Zalosh (1978) in a 33.5 m3 room-like enclosure with a pair of wall-mounted rectangular doors, in a parallel configuration, each hinged at its bottom edge with a surface density of 23.1 kg/m2 and initially quiescent mixture. A formula for the torque acting upon a rotating venting door is derived under conditions of vent cover jet formation. The vent cover jet effect decreases the torque three times compared to an elementary approach valid at the start of vent cover movement. It is demonstrated that, similar to translating vent covers, the vent cover jet effect is crucial for prediction of interdependent vent cover displacement in time and pressure transients.

Background: Studies utilizing collagen membranes for guided tissue regeneration (GTR)-based root coverage procedures have reported promising results. However, creating and maintaining space underneath the membrane remains a challenge. Therefore, the purpose of this clinical trial was to determine whether the addition of bone graft (i.e., demineralized freeze-dried bone allograft [DFDBA]) significantly affects the outcome of collagen membrane GTR-based root coverage procedures., Methods: Twenty patients participated. One Miller's Class I or II recession defect per patient was treated with a collagen membrane covered by a coronally positioned flap. Half of the patients also had DFDBA placed under the membrane. Clinical parameters recorded included: recession depth, recession width, width of keratinized tissue, clinical attachment level, and probing depth, measured to the nearest 0.5 mm. Presurgery and postsurgery (6-month) data were compared using Student's paired t test for parametric data and the Wilcoxon matched pairs test for non-parametric data., Results: Guided tissue regeneration with collagen (COLL) and collagen + DFDBA (COBA) both resulted in statistically significant (P <0.05) reductions in recession depth (2.1 +/- 0.9 mm and 2.5 +/- 0.5 mm), recession width (1.5 +/- 1.7 mm and 2.2 +/- 1.6 mm), increase in keratinized tissue (0.7 +/- 0.8 mm and 1.2 +/- 1.0 mm), and gain of clinical attachment level (2.1 +/- 1.0 mm and 3.0 +/- 1.0 mm), when comparing 6-month data to baseline. Mean root coverage was 68.4 +/- 15.2% with COLL and 74.3 +/- 11.7% with COBA. However, there were no statistically significant differences between groups for recession depth, recession width, width of keratinized tissue, clinical attachment level, and probing depth., Conclusions: Both techniques are effective in attaining root coverage. Although root coverage tended to be better with the addition of DFDBA, the difference was not statistically significant. Further studies with a larger sample size are needed to determine whether adding DFDBA to GTR-based procedures using collagen membranes is of any benefit.

Background: Gingival crevicular fluid (GCF) biomarkers associated with bone resorption may be useful to determine periodontal disease status and response to therapy. The pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP), a bone-specific degradation product, and interleukin 1-beta (IL-1), a potent bone-resorptive cytokine, have both been associated with periodontal disease activity. Minocycline is a tetracycline derivative possessing antimicrobial effects on periodontal pathogens and inhibitory properties on matrix metalloproteinases (MMPs) associated with tissue destruction. The aim of this study was to evaluate the effect of periodontal treatment in the form of scaling and root planing (SRP) and locally administered minocycline microspheres on the GCF levels of ICTP and IL-1., Methods: Forty-eight chronic periodontitis patients were randomly assigned to 2 groups (SRP plus subgingival application of vehicle control [SRP + V], or SRP plus subgingival application of minocycline microspheres [SRP + M]) and monitored at 8 sites per subject at baseline and 1, 3, and 6 months. Four shallow (PD < or = 3 mm) and 4 deep (PD > or = 5 mm) sites were evaluated for both marker levels and for probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP). Eight periodontally healthy control subjects with no probing depths >3 mm and no loss of attachment were also monitored at the same time intervals. GCF levels of ICTP and IL-1 were determined using radioimmunoassay and enzyme-linked immunosorbent assay techniques, respectively., Results: Significant differences (P<0.001) in GCF levels of ICTP and IL-1 were found between deep and shallow sites at all time points in both treatment groups. In addition, healthy subjects demonstrated significantly reduced levels of both markers compared to both shallow and deep sites in periodontitis patients (P <0.001). Only the SRP + M treated patients exhibited significant reductions (P <0.05) in both ICTP and IL-1 levels 1 month after treatment. Furthermore, the SRP + M group demonstrated significantly lower IL-1 levels (P <0.02) at 1 month compared to the SRP + V group., Conclusions: Results of this study indicate that GCF levels of ICTP and IL-1 correlate with clinical measures of periodontal disease and may aid in assessing disease status and response to periodontal therapy. Furthermore, local administration of minocycline microspheres led to a potent short-term reduction in GCF IL-1 levels. Additional studies are needed to address whether repeated administration of scaling and root planing along with minocycline microspheres will achieve long-term reductions in GCF ICTP and IL-1 levels.

Background: The authors previously suggested that an adjunctive, controlled-release chlorhexidine, or CHX, chip may reduce periodontal surgical needs at little additional cost. This article presents an economic analysis of the CHX chip in general dental practice., Methods: In a one-year prospective clinical trial, 484 chronic periodontitis patients in 52 general practices across the United States were treated with either scaling and root planing, or SRP, plus any therapy prescribed by treating, unblinded dentists; or SRP plus other therapy as above but including the CHX chip. Economic data were collected from bills, case report forms and 12-month treatment recommendations from blinded periodontist evaluators., Results: Total dental charges were higher for SRP + CHX chip patients vs. SRP patients when CHX chip costs were included (P = .027) but lower when CHX chip costs were excluded (P = .012). About one-half of the CHX chip acquisition cost was offset by savings in other charges. SRP + CHX chip patients were about 50 percent less likely to undergo surgical procedures than were SRP patients (P = .021). At the end of the trial, periodontist evaluators recommended similar additional procedures for both groups: SRP, about 46 percent; maintenance, about 37 percent; surgery, 56 percent for SRP alone and 63 percent for SRP + CHX chip., Conclusions: Adjunctive CHX chip use for general-practice patients with periodontitis increased costs but reduced surgeries over one year. At study's end, periodontists recommended similar additional surgical treatment for both groups., Clinical Implications: In general practice, routine use of the CHX chip suggests that costs will be partially offset by reduced surgery over at least one year.

Background: Biochemical markers harvested from gingival crevicular fluid (GCF) may be useful to identify and predict periodontal disease progression and to monitor the response to treatment. C-telopeptide pyridinoline cross-links (ICTP), a host-derived breakdown product specific for bone, and interleukin-1beta (IL-1), a potent bone-resorptive cytokine, have been associated with periodontal tissue destruction. The aim of this study was to examine the effect of non-surgical periodontal therapy on GCF levels of ICTP and IL-1., Methods: Twenty-five chronic periodontitis subjects were monitored at 8 sites per subject at baseline prior to scaling and root planing and 1, 3, and 6 months after therapy. Four shallow (probing depths < 4 mm) and 4 deep (probing depths > or = 5 mm) sites were monitored for both marker levels and clinical parameters. GCF was collected for 30 seconds on paper strips, and levels of ICTP and IL-1 were determined using radioimmunoassay (RIA) and enzyme-linked immunosorbent assay (ELISA) techniques, respectively. Clinical measurements included probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP)., Results: Deep sites exhibited significantly (P<0.001) higher ICTP and IL-1 levels compared to shallow sites at all time intervals. ICTP demonstrated a stronger association to clinical parameters than IL-1 including a modest correlation (r = 0.40, P<0.001) between ICTP and attachment loss. Significant improvements in PD, CAL, and BOP were observed at 1, 3, and 6 months in all sites (P<0.01). However, non-surgical mechanical therapy did not significantly reduce ICTP and IL-1 levels over the 6-month period. Further examination of subjects based on smoking status revealed that ICTP levels were significantly reduced at 3 and 6 months and IL-1 levels reduced at 3 months among non-smokers only., Conclusions: A single episode of non-surgical mechanical therapy did not significantly reduce biochemical markers associated with bone resorption in patients exhibiting chronic periodontitis. Future longitudinal studies are warranted to specifically evaluate the relationship between C-telopeptide pyridinoline cross-links and periodontal disease progression.

This study evaluated the use OF bioactive glass (BG) for repairing/regenerating periodontal intrabony defects. Fourteen systemically healthy patients participated. Each patient had 2 contralateral sites with > or = 6 mm clinical probing depth and radiographic evidence of an intrabony defect. One defect was treated with flap debridement plus BG (test) and the other with flap debridement alone (control). Baseline measurements included gingival index (GI), plaque index (PI), position of the free gingival margin (S/FGM), clinical attachment level (CAL), probing depth (PD), and mobility. At the time of surgery and at surgical reentry (9 to 13 months later), hard tissue measurements included: stent to defect base, bone crest to defect base, and defect width at the bone crest. One-way repeated ANOVA was used to analyze the treatment effect. Friedman's test was used to detect any significant changes of GI, PI and mobility at different time periods (baseline, 3 months, 6 months, and reentry). For multivariate analysis, the random coefficients mixed effect model was applied to adjust the intra-correlation effect. Both treatments resulted in decreased PD and gain of CAL. These changes were only significant (P < 0.05) for the BG treated sites (PD reduction = 1.24+/-0.43 mm, CAL gain = 0.87+/-0.38 mm) from baseline. Defect fill was significant for test (1.1+/-0.4 mm) and control (1.4+/-0.4 mm) alike (P < or = 0.01). Although BG treated sites had more PD reduction and CAL gain than debridement only controls, there were no statistically significant differences between groups for any parameter measured. Further studies are required to clarify the beneficial effects, if any, of BG alloplast in treating periodontal intrabony defects.

In vitro cytotoxicity studies of periodontal dressings have not generally produced a result consistent with in vivo observations. These prior in vitro studies have not used human intraoral cell lines. We tested the effects of two eugenol containing and two non-eugenol periodontal dressings on cultured human gingival fibroblasts (HGF) (ATCC #1292). Replicate HGF cultures grown in microtiter plates were exposed to stock, 1:4 and 1:16 dilutions of extracts made from each of the four periodontal dressings. The HGF cultures were pulse labelled with tritiated thymidine (3HTdR) after 24, 48, and 72 hours. Incorporations of the labelled thymidine were measured using liquid scintillation counting and expressed as counts per minute. The results showed that undiluted extracts from all four periodontal dressings totally inhibited 3HTdR uptake (P less than 0.05). The 1:4 dilution of eugenol dressings inhibited 3HTdR uptake significantly more than non-eugenol dressings (P less than 0.05). Interestingly, at 72 hours the 1:16 dilution of the non-eugenol dressings caused significantly increased 3HTdR uptake which was not observed with the eugenol dressings. The present results suggest that the use of a human fibroblastic cell line for testing the effects of periodontal dressings may provide information about the relative biological effects of these dressings. Using this cell line, we have found that eugenol dressings inhibit fibroblast proliferation to a greater extent than non-eugenol dressings.