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Objective: The aim of this study was to compare the clinical and immunological results of nonsurgical periodontal treatment with or without the erbium, chromium:yttrium–scandium–gallium–garnet (Er,...

The aim of our study was to obtain similar surface properties and elemental composition to virgin implants after debridement of contaminated titanium implant surfaces covered with debris. Erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser, erbium, chromium-doped:yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser, curette, and ultrasonic device were applied to contaminated implant surfaces. Scanning electron microscopy (SEM) images were taken, the elemental profile of the surfaces was evaluated with energy dispersive X-ray spectroscopy (EDX), and the surface roughness was analyzed with profilometry. Twenty-eight failed implants and two virgin implants as control were included in the study. The groups were designed accordingly, titanium curette group, ultrasonic scaler with polyetheretherketone (PEEK) tip, Er: YAG very short pulse laser group (100 μs, 120 mJ/pulse 10 Hz), Er: YAG short-pulse laser group (300 μs, 120 mJ/pulse, 10 Hz), Er: YAG long-pulse laser group (600 μs, 120 mJ/pulse, 10 Hz), Er, Cr: YSGG1 laser group (1 W 10 Hz), Er, Cr: YSGG2 laser group (1.5 W, 30 Hz). In each group, four failed implants were debrided for 120 s. When SEM images and EDX findings and profilometry results were evaluated together, Er: YAG long pulse and ultrasonic groups were found to be the most effective for debridement. Furthermore, the two interventions have shown the closest topography of the sandblasted, large grit, acid-etched implant surface (SLA) as seen on virgin implants.

This study aimed to determine the association between the root taper and proximity of single-rooted teeth with periodontitis using cone-beam computed tomography (CBCT). CBCT images of 362 single-rooted teeth from 37 patients were evaluated. This case–control study analyzed 17 participants with stage II and III periodontitis, (n = 161 teeth, periodontitis group) and 20 participants with healthy periodontium (n = 201 teeth, control group). Multiplanar reconstructions were used for proximity measurements, and cross-sectional images for calculating the angle of the root tapers. Root proximity, root length, and root taper were measured. Multivariate binary logistic regression analysis was used to determine association with periodontitis. In the periodontitis group, the upper lateral root-taper was 18.33° ± 3.25° and was significantly higher when compared to the control group (p = 0.001). The root taper of the lateral incisor was associated with the diagnosis of periodontitis (p = 0.01) with an odds ratio of 1.541 according to regression analysis. Root length was also identified as a potential protective parameter. The risk of being diagnosed with periodontitis decreases when root length increases by 0.785 times (p = 0.043). Upper canines in the periodontitis group presented shorter root lengths (p = 0.039) and higher root tapers (p = 0.01). Also, mandibular canines were closer form adjacent teeth in the periodontitis group (p = 0.042). This study indicated that short-root and increased root-taper at specific teeth could be considered as risk indicators for periodontitis.

Background: This cross-sectional study evaluated the utility of the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classifications of epidemiological studies in terms of periodontitis severity, prevalence and associated risk factors and the 2012 American Academy of Periodontology/Centers for Disease Control and Prevention (AAP/CDC) case definitions. Methods: We included 488 participants aged 35–74 years. Measurements were recorded at six sites per tooth by two qualified examiners. The evaluated parameters included pocket depth (PD), clinical attachment loss (CAL) and bleeding on probing (BOP). Periodontitis prevalence and severity were reported using the 2018 EFP/AAP classification and the AAP/CDC case definitions. The data were stratified by recognized risk factors (age, diabetes and smoking status). Results: The 2018 EFP/AAP classification indicated that all patients suffered from periodontitis. When CAL served as the main criterion, the frequency of patients with severe (Stages III–IV) periodontitis was 54%. When the AAP/CDC case definitions were applied, the prevalence of periodontitis was 61.9% and that of severe periodontitis 16.8%. Age was the most significant risk factor, regardless of the chosen case definition. Conclusion: It is essential to employ a globalized standard case definition when monitoring periodontitis and associated risk factors.

A possible association between periodontitis and obstructive sleep apnea (OSA) has been suggested. The aim of this study is to compare periodontitis prevalence between controls and patients with OSA by assessing clinical periodontal parameters and gingival crevicular fluid (GCF) levels of interleukin (IL)-1β, tumor necrosis factor (TNF)-α, and high-sensitive C-reactive protein (hs-CRP); serum hs-CRP was also sampled.A case-control study was performed that included 163 individuals: 83 individuals (18 females and 65 males) with OSA and 80 non-OSA individuals (23 females and 57 males) as controls. The test group was classified according to OSA severity. Clinical periodontal measurements were recorded, and GCF samples were collected. GCF hs-CRP, IL-lβ, and TNF-α levels were analyzed using an enzyme-linked immunosorbent assay method. Serum hs-CRP was measured by latex-enhanced immunoturbidimetric assay.Prevalence of periodontitis in the OSA group (96.4%) was significantly higher than in the control group (75% [P0.001]). Severe periodontitis prevalence was higher in the OSA group than control group. All periodontal clinical parameters and GCF IL-lβ concentrations were significantly higher in patients with OSA than in controls (P = 0.001). No significant differences were found between the mild OSA and moderate-to-severe OSA groups. Additionally, there was no significant difference in GCF TNF-α and hs-CRP levels between the groups (P0.05). Serum hs-CRP levels were significantly higher in patients with OSA. A significant correlation was found between GCF IL-1β and all clinical parameters.Results demonstrated higher prevalence of periodontitis and higher levels of GCF IL-1β and serum hs-CRP in patients with OSA. However, there is still a need for randomized clinical trials testing oral care interventions.

Background: The determination of the impact of risk factors such as smoking in periodontal disease development is of importance to better characterize the disease. However, its impact on host response remains unclear. This study aimed to evaluate the effects of tobacco smoking on GCF levels of neutrophil enzymes (myeloperoxidase (MPO), beta-glucuronidase (BGD), neutrophil elastase (NE) and periodontal parameters in healthy young adults with dental plaque biofilm-induced gingivitis. Methods: The study population consisted of 60 systemically healthy young adults (39 smokers (Sm) and 21 non-smokers (n-Sm)) diagnosed with plaque-induced gingivitis. The periodontal examination consisted of a plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing (BoP), and clinical attachment level (CAL). GCF MPO, BGD, and NE levels were determined by means of an enzyme-linked immunosorbent assay (ELISA). Results: PI, GI, and BoP were significantly increased in the Sm group (p &lt, 0.05). PD and CAL showed no significant difference between Sm and n-Sm groups (p &gt, 0.05). In GCF, MPO, BGD, and NE levels were significantly increased in Sm group (p &lt, 0.05). NE levels showed a significant correlation with GI and BoP (p &lt, 0.05 for both). Moreover, a positive correlation between BGD and NE levels (p &lt, 0.05) was measured. Conclusions: It may be concluded that, even in young patients, tobacco consumption affects the host’s immune response related to gingival inflammation. It is, therefore, mandatory to inform young patients about the risk related to tobacco consumption for their gingival health.

Purpose: To evaluate the effect of hormone replacementtherapy(HRT) on periodontal treatment outcomes ina group of postmenopausal women with periodontitis.Materials and Methods: 23 post-menopausalchronic periodontitis patients were included in thisstudy. The test group(n=11) consisted of womenwho started HRT with this study and receivedconjugated estrogen and medroxyprogesteron. Thecontrol group(n=12) was women not taking any HRTor supplement therapy. Study groups received thesame periodontal treatment. All subjects examiendby recording the following: plaque index (PI), sulcusbleeding index (SBI), periodontal pocket depth (PD)and relative attachment level (RAL) from 6 sites ineach tooth. Measurements were recorded at thebaseline, 1 month, 3 months, and 6 months followingperiodontal treatment. Serum estrogene level andbone mineral density was recorded at baselineand 6 months following periodontal treatment.Results: The GI change was greater in thecontrol group. There wasn’t significant differenceby means of PD, the attachment gain wassignificantly greater in the HRT receiving group.Conclusion: HRT seems to have a positiveeffect on periodontal treatment outcomes., Amaç: Bu çalışmanın amacı periodontitisli postmenopozal kadınlarda postmenopozal hormon tedavisinin (PHT), periodontal başlangıç tedavisi sonuçları üzerindeki etkilerini incelemektir.Gereç ve Yöntem: 23 kronik periodontitisli daha önce hormon tedavisi görmemiş olan postmenopozal kadın çalışmaya dâhil edilmiştir. Deney grubuna (n=11) konjuge östrojen ve medroxyprogesteron kullandırılmış, kontrol grubuna(n=12) herhangi bir hormon tedavisi verilmemiştir. Çalışmadaki tüm bireyler bireylere aynı periodontal başlangıç tedavisi uygulanmıştır. Plak indeksi(PI), dişeti oluğu kanama indeksi (DOKİ), sondalanabilir cep derinliği (SD), rölatif ataşman düzeyi (RAD) ölçümleri başlangıçta, 1., 3., ve 6. aylarda, serum östrojen düzeyi, sistemik kemik yoğunluğu ölçümleri başlangıçta ve 6. ayda gerçekleştirilmiştir. Bulgular: DOKİ, kontrol grubunda daha fazla değişim göstermiştir. SD açısından gruplar arasında fark yoktur. PHT kullanmakta olan kadınlarda klinik atasman kazanci daha fazla bulunmuştur. Sonuç: PHT kullanımının periodontal tedavi sonuclarina olumlu katki sağladığı söylenebilir

Objective: The aims of this descriptive, cross-sectional investigation were to evaluate the gingival health awareness of dental students by comparing their clinical gingival bleeding scores and self-reports, and to compare differences in awareness between males and females. Methods: In total, 100 (51 males, 49 females) freshman dental students were included in the study. Periodontal indices recorded were: Presence of plaque percentage (plaque index [PI], %), percentage of sites of bleeding on probing (BOP, %), probing depth, and community periodontal index (CPI). Percent agreement, kappa agreement, sensitivity, and specificity were calculated by comparing their self-reported gingival bleeding and BOP%. Results: The self-reports of gingival bleeding exhibited statistically significant correlations with BOP% in females (r = 0.42, P = 0.003). Female students showed a higher degree of awareness when kappa agreement, 0.23 (males: 0.16, females: 0.39), sensitivity, 48% (males: 42%, females: 51%), and specificity, 95% (males: 90%, females: 100%) were calculated. Although male dental students had higher PI and CPI scores, there was no significant difference by gender in the clinical measurements. Conclusions: According to our results, the validity of self-reported gingival bleeding was higher among dental students than in previous population-based studies. Female dental students showed a higher degree of awareness than males of their gingival health. Half of the included dental students could not differentiate whether they had gingival bleeding when there was actual bleeding. More emphasis should be given to the education of dental students regarding the relationship between gingival bleeding and active periodontal disease.

Objective: The aim was to compare the efficacy of plaque control and potential effects on gingival recession of the toothbrushes with angled and straight bristles. Materials and Methods: A total of 40 healthy dental students (25 females and 15 males; age range: 23-25 years) participated and two study groups were constituted. Participants were randomly distributed into two groups to use either angled or standard design manual tooth brushes with soft bristles. Oral hygiene indicators and soft tissue levels were monitored for 6 months. Plaque index, gingival index (GI), probing depth, clinical attachment level, and bleeding on probing were measured at six sites. Vertical recession (VR) and horizontal recession (HR) were also recorded. All measurements were repeated at 3 and 6 months. Results: Plaque scores were reduced significantly at 6 months compared to baseline in both groups (P < 0.05 and P < 0.005 in criss-cross and standard design brushes, respectively). Mean GI scores of the criss-cross design were reduced significantly at 6 months (P < 0.05). Inter-group comparisons revealed that gingival recession (GR) values were not statistically significant (P > 0.05) at baseline, 3 and 6 months suggesting no pronounced impact of bristle design in terms of GR (VR = 0.596, HR = 0.572; VR = 0.884, HR = 0.572; VR = 0.884, HR = 0.572 in the groups). Conclusions: Bristle design has little impact on plaque removal capacity of a toothbrush. Both designs are safe enough to prevent GR as long as soft bristle material is used.

In this split-mouth clinical trial, we evaluated the clinical benefits of low-level laser therapy (LLLT) as an adjunct to nonsurgical periodontal treatment in patients with type 2 diabetes mellitus (DM).The impaired wound healing seen in diabetic patients may affect the results of periodontal treatment and may require an additional approach.In total, 22 chronic periodontitis patients with type 2 DM were included. Applying a split-mouth design, two quadrants were treated with only scaling and root planing (SRP) as the control and those in the other two were treated with SRP + LLLT as the test sites in each patient. An 808 nm GaAlAs diode laser was performed in the test sites at the energy density of 4.46 J/cmTest sites showed significant improvement in PI and BOP in deep pockets at the 1-month follow-up period (p 0.001 and0.001, respectively), whereas no difference was found between the control and the test sites in other periodontal parameters.LLLT during periodontal treatment offered minimal short-term additional benefit in deep pocket healing in patients with type 2 DM.

The aim of this study is to evaluate the effect of low-level laser therapy (LLLT) as an adjunct to non-surgical periodontal therapy of smoking and non-smoking patients with moderate to advanced chronic periodontitis.All 36 systemically healthy patients who were included in the study initially received non-surgical periodontal therapy. The LLLT group (n = 18) received GaAlAs diode laser therapy as an adjunct to non-surgical periodontal therapy. A diode laser with a wavelength of 808 nm was used for the LLLT. Energy density of 4 J/cm(2) was applied to the gingival surface after periodontal treatment on the first, second, and seventh days. Each of the LLLT and control groups was divided into two groups as smoking and non-smoking patients to investigate the effect of smoking on treatment. Gingival crevicular fluid samples were collected from all patients and clinical parameters were recorded on baseline, the first, third, and sixth months after treatment. Matrix metalloproteinase-1, tissue inhibitor matrix metalloproteinase-1, transforming growth factor-β1, and basic-fibroblast growth factor levels in the collected gingival crevicular fluid were measured.The primary outcome variable in this study was change in gingival bleeding and inflammation. At all time points, the LLLT group showed significantly more improvement in sulcus bleeding index (SBI), clinical attachment level, and probing depth (PD) levels compared to the control group (P0.001). There were clinically significant improvements in the laser-applied smokers' PD and SBI levels compared to smokers to whom a laser was not applied, between the baseline and all time points (P0.001) (SBI score: control group 1.12, LLLT group 1.49; PD: control group 1.21 mm, LLLT group 1.46 mm, between baseline and 6 months). Transforming growth factor-β1 levels and the ratio of matrix metalloproteinase-1 to tissue inhibitor matrix metalloproteinase-1 decreased significantly in both groups at 1, 3, and 6 months after periodontal therapy (P0.001). Basic-fibroblast growth factor levels significantly decreased in both groups in the first month after the treatment, then increased in the third and sixth months (P0.005). No marker level change showed significant differences between the groups (P0.05).LLLT as an adjunctive therapy to non-surgical periodontal treatment improves periodontal healing.

Hormonal changes during puberty, pregnancy, and menopause may impact periodontal tissues by altering the host response. There are only a few studies that examined gingival changes during the menstrual cycle. This longitudinal and prospective study aims to investigate clinical and laboratory markers of gingival inflammation in women at different phases during their menstrual cycles.Twenty-seven females were included in this study. Subjects were given oral hygiene instructions before the study, and their plaque index scores were recorded once a week for 2 months. The duration and regularity of the menstrual cycle were also checked at the same time. The gingival index and bleeding on probing (BOP) were recorded. Probing depths were measured to assess the periodontal condition of the subjects. Gingival crevicular fluid (GCF) was collected to analyze the levels of interleukin (IL)-1beta and tumor necrosis factor-alpha on the first menstruation day (MD), estimated ovulation day (OD), and estimated predominant progesterone secretion day (PgD). These exact menstrual cycle days were determined according to serum progesterone and estradiol levels.BOP and IL-1beta levels in GCF showed significant increases from the MD to PgD under optimal plaque control. Among the 12 subjects that had premenstrual symptoms, six subjects reported oral complaints during the premenstrual period, whereas apthous lesions were more frequent during the menstruation period.These results demonstrate that the fluctuation of sex steroid hormones impact gingival inflammation during menstruation.

Objectives: To evaluate the plasma and salivary total antioxidant capacity (TAOC) in patients with generalized chronic periodontitis (CP), generalized aggressive periodontitis (AgP), and periodontally healthy controls. Methods: This cross-sectional study includes of 88 individuals seeking dental treatment at the Faculty of Dentistry, Istanbul University, Istanbul, Turkey between January 2011 and March 2012. Fifteen AgP patients were compared with 21 healthy controls (C1), while 36 CP patients were compared with 16 healthy controls (C2). Clinical periodontal measurements were recorded, and plasma and saliva samples were collected. The TAOC of the plasma and saliva samples were determined using a commercially available colorimetric kit. Results: The plasma TAOC of both AgP and CP patients was significantly lower for C1 and C2. The salivary TAOC of CP patients was significantly lower for C2, but there was no significant difference between AgP patients and C1. Conclusion: Our results demonstrate that severe periodontitis may be associated with a lower plasma antioxidant capacity. The reduced antioxidant capacity in patients with severe periodontitis, especially with aggressive forms may be an important contributing factor to severe tissue destruction. Saudi Med J 2015; Vol. 36 (7): 856-861 doi: 10.15537/smj.2015.7.11954

BACKGROUND: Periodontitis is a chronic multifactorial inflammatory disease caused by microorganisms and characterized by progressive destruction of the tooth supporting tissues leading to tooth loss. Periodontal diseases are associated with an increase in CRP (C-reactive protein) levels. Release of the cytokines such as prostaglandin-E2 (PGE2), and interleukin-1-beta (IL-1β) from the periodontal lesion, stimulate hepatocytes and circulating leukocytes to produce CRP. The purpose of this cross-sectional study was to evaluate serum levels of hs-CRP (high sensitive C-reactive protein) and gingival crevicular fluid (GCF) levels of hs-CRP, PGE2, and IL-1β in patients with varying degrees of periodontal disease. METHODS: A total of 60 (30 mild and 30 severe) chronic periodontitis patients were included in this study. GCF and serum samples were collected and whole-mouth clinical periodontal measurements were recorded. GCF levels of hs-CRP, PGE2, IL-1β, and serum levels of hs-CRP were measured by Enzyme-Linked Immunosorbent Assay (ELISA). Serum hs-CRP levels were measured by latex-enhanced immunoturbidimetric assay. Correlation analyses were performed between the sampled site PD, CAL, and the biomarkers. RESULTS: The groups were similar with regard to age, gender, and number of teeth. All periodontal clinical parameters were increased in the severe periodontitis group. GCF IL-1β and PGE2 levels were significantly higher in the severe periodontitis group than in the mild periodontitis group (p = 0.04). Serum and GCF levels of hs-CRP were not significantly different between severe and mild cases. There was no significant correlation between serum and GCF levels of CRP. GCF IL-1β levels were positively correlated with the PD of the sampled site (r = 0.52, p = 0.003). CONCLUSIONS: IL-1β in GCF could be a marker of disease severity and activity. Neither serum nor GCF levels of hs-CRP differed with disease severity. Serum hs-CRP levels did not reflect GCF levels in periodontitis patients. Local and systemic involvement of CRP in periodontal disease remains to be determined.