The Adjunctive Effect of Platelet-Rich Fibrin to Connective Tissue Graft in the Treatment of Buccal Recession Defects: Results of a Randomized, Parallel-Group Controlled Trial.

BACKGROUND: Platelet-rich fibrin (PRF) is an autologous preparation that has encouraging effects in healing and regeneration. The aim of this trial is to evaluate the effectiveness of coronally advanced flap (CAF) + connective tissue graft (CTG) + PRF in Miller Class I and II recession treatment compared to CAF + CTG. METHODS: Forty patients were treated surgically with either CAF + CTG + PRF (test group) or CAF + CTG (control group). Clinical parameters of plaque index, gingival index, vertical recession (VR), probing depth, clinical attachment level (CAL), keratinized tissue width (KTW), horizontal recession (HR), mucogingival junction localization, and tissue thickness (TT) were recorded at baseline and 3 and 6 months after surgery. Root coverage (RC), complete RC (CRC), attachment gain (AG), and keratinized tissue change (KTC) were also calculated. RESULTS: All individuals completed the entire study period. At baseline, mean VR, HR, CAL, KTW, and TT values were similar (P >0.05). In both groups, all parameters showed significant improvement after treatment (P <0.001), and except TT (P <0.05), no intergroup difference was observed at 6 months after surgery. The amount of RC and AG, but not KTC and CRC, was higher in the PRF-applied group (P <0.05). CONCLUSIONS: According to the results, the addition of PRF did not further develop the outcomes of CAF + CTG treatment except increasing the TT. However, this single trial is not sufficient to advocate the true clinical effect of PRF on recession treatment with CAF + CTG, and additional trials are needed.

The comparative effect of propolis in two different vehicles; mouthwash and chewing-gum on plaque accumulation and gingival inflammation.

OBJECTIVE: In general, chemical plaque agents have been used in mouthwashes, gels, and dentifrices. In some situations, application of mouthwashes and dentifrices can be difficult. Therefore, different approaches for oral health-care have been needed. The aim of this study was to evaluate the effect of propolis chewing-gum compared to propolis-containing mouthwash on gingival inflammation and plaque accumulation on patients that refrained from daily oral hygiene procedures for 5 days. MATERIALS AND METHODS: 10 college students with systemically healthy and very good oral hygiene and gingival health were included in this randomized, single-blind, crossover 5-day plaque regrowth with a 3-day washout period clinical study. After plaque scores were reduced to zero, participants were asked to refrain from oral hygiene procedures and allocated to either propolis mouthwash or chewing-gum group. Chewing-gum was performed after meals 3 times a day for 20 min mouthwash group was instructed to rinse mouthwash 2 times a day for 1 min. On day 5, the clinical periodontal measurements containing plaque and gingival indexes were taken from the participants. RESULTS: The both plaque and gingival indexes of propolis mouthwash group were significantly lower than that of the propolis chewing-gum group (P = 0.005). CONCLUSION: It was demonstrated that the propolis mouthwash was more effective than the propolis chewing gum on the plaque inhibition and the gingival inflammation.

Evaluation of salivary procalcitonin levels in different periodontal diseases.

BACKGROUND: The present study aims to investigate the levels of salivary procalcitonin (ProCT) in patients with different periodontal diseases. METHODS: Seventy-two non-smokers are included in this study: 21 individuals with chronic periodontitis (CP), 14 individuals with generalized aggressive periodontitis (GAgP), 18 individuals with gingivitis (G), and 19 periodontally healthy (H) participants. Clinical periodontal parameters, including probing depth (PD), clinical attachment level (CAL), plaque index, and gingival index (GI), were assessed in all participants. Saliva samples were collected and examined for evaluating ProCT levels. RESULTS: It was found that the median (interquartile range) salivary ProCT level was lowest in the H group: 0.00 (0.09) ng/mL; followed by the G group: 0.09 (0.11) ng/mL; the CP group: 0.15 (0.29) ng/mL; and highest in the GAgP group 0.28 (0.68) ng/mL. These differences were statistically significant between the H group and the other groups (P <0.05). There were positive correlations between the mean salivary ProCT level and GI, CAL, and PD. CONCLUSION: According to the present results, ProCT might play a role during periodontal inflammation, and an elevated salivary ProCT level is suggested as a potential biomarker for periodontal diseases.

Crevicular fluid levels of interleukin-8, interleukin-17 and soluble intercellular adhesion molecule-1 after regenerative periodontal therapy.

OBJECTIVE: The aim of this study is to evaluate the influence of regenerative periodontal therapy on clinical parameters and interleukin-8 (IL-8), IL-17 and soluble intercellular adhesion molecule-1 (sICAM-1) levels in gingival crevicular fluid (GCF) of subjects with chronic periodontitis (CP). MATERIALS AND METHODS: Fifteen patients received demineralized freeze-dried bone allograft (DFDBA) surgically to the site of infrabony defect. Clinical periodontal indices were recorded, and GCF samples were collected at baseline and at the 6(th) and the 9(th) month after the surgery. RESULTS: Except plaque index, all clinical parameters improved following surgery (P < 0.05). The volume of GCF diminished from baseline to follow-up periods (P < 0.05). However, no effect was observed on the total amount of IL-8, IL-17 and sICAM-1 in GCF. CONCLUSION: DFDBA improved clinical outcome in CP subjects and was effective on decreasing the volume of GCF, but no effect was determined on IL-8, IL-17 and sICAM-1. Findings did not indicate a direct relationship between biochemical parameters and periodontal healing after demineralized freeze-dried bone grafting.

Effect of initial periodontal therapy on oxidative stress markers in gingival crevicular fluid, saliva, and serum in smokers and non-smokers with chronic periodontitis.

BACKGROUND: The aim of this case-control study with an intervention arm is to determine the effect of initial periodontal treatment on oxidative stress biomarkers in smokers and non-smokers with chronic periodontitis (CP). METHODS: The study included 47 patients with CP (24 smokers [S+P+] and 23 non-smokers [S-P+]) and 46 periodontally healthy individuals (23 smokers [S+P-] and 23 non-smokers [S-P-]) for a total of 93 participants. Gingival crevicular fluid (GCF), serum, and saliva samples were obtained and clinical periodontal measurements were recorded at baseline and at the first and third months after periodontal therapy. 8-hydroxydeoxyguanosine (OHdG) and 4-hydroxynonenal (HNE) and enzyme activity of glutathione peroxidase (GSH-Px) were analyzed with enzyme-linked immunosorbent assay. RESULTS: The level of 8-OHdD in GCF was found to be significantly higher in both periodontitis groups compared with both periodontally healthy groups. 8-OHdG and GSH-Px in saliva in both periodontitis groups were significantly increased compared with the S-P- group. In the S+P+ group, 4-HNE in GCF was found to be significantly higher than in periodontally healthy participants. After initial periodontal treatment, the levels of 8-OHdG in GCF and saliva were significantly decreased in both periodontitis groups. CONCLUSION: Initial periodontal therapy may be helpful for diminishing oxidative stress in periodontitis.

Periodontal health in children exposed to passive smoking.

AIM: To determine (1) the cotinine levels of saliva, urine and gingival crevicular fluid (GCF) of children in families with and without smoking members and (2) a possible association between the periodontal health of the children and exposure to passive smoking. MATERIAL AND METHODS: The study population comprised of 109 children in the age range 6-12 years. Children were classified as exposed to passive tobacco smoking (PTS-exposed, n=51) and as unexposed controls (PTS-unexposed, n=58). Plaque index, gingival index, bleeding on probing, probing depth and clinical attachment level (CAL) were recorded. GCF, saliva and urine samples were also collected. The levels of cotinine in these fluids were determined by enzyme-linked immunosorbent assay. RESULTS: The mean salivary cotinine concentration was significantly increased in PTS-exposed children compared with PTS-unexposed children (p<0.05). Further, in a dose-dependent way, the mean salivary concentration was significantly higher in children whose father or mother was a smoker (p<0.05) as compared, respectively, with children whose fathers and mothers were non-smokers. The mean CAL was significantly less in PTS-exposed children compared with non-PTS-exposed children (0.09 mm; p<0.05) and also in children whose father was a smoker (p<0.05), but not in children whose mother was a smoker as compared with non-smoker fathers and mothers, respectively. The GCF cotinine levels were below the detection limits with the assay method that was used. CONCLUSIONS: We have observed that children who are exposed to passive smoking have elevated cotinine levels in their saliva concomitant with a lowered CAL.

Evaluation of systemic markers related to anemia of chronic disease in the peripheral blood of smokers and non-smokers with chronic periodontitis.

OBJECTIVES: The aim of this study was to investigate the effect of cigarette smoking on clinical parameters and signs anemia of chronic disease in chronic periodontitis patients. METHODS: The study base consisted of 88 patients with chronic periodontitis including 45 volunteer current smokers with age range of 30-69 (45.5+/-8.5) and 43 volunteer non-smokers with age range of 32-61 years (45.8+/-7.9). The clinical parameters including plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL) were recorded and several red blood cell parameters were determined from peripheral blood samples. RESULTS: In smokers, PI, PD and CAL were significantly higher than non-smokers (P<.05). The number of erythrocytes and the levels of hemoglobin, hematocrit and iron were lower in smokers compared to non-smokers (P<.05). CONCLUSIONS: In the present study, it is concluded that cigarette smoking may be effective on the signs of anemia of chronic disease in patients with chronic periodontitis.

Effect of smoking on folic acid and vitamin B12 after nonsurgical periodontal intervention.

AIM: The main purpose of this study was to investigate the effect of smoking on the serum levels of folic acid and vitamin B(12) in smokers and nonsmokers with chronic periodontal disease after nonsurgical intervention. MATERIAL AND METHODS: The study base consisted of 45 current smokers and 43 nonsmokers. The clinical parameters included plaque index (PI), gingival index (GI), pocket depth (PD), and clinical attachment level (CAL). Folic acid and vitamin B(12) were determined from peripheral blood samples. Clinical measurements and blood samples were collected at baseline and 1, 3, and 6 months after the intervention. RESULTS: Mean PI was significantly greater in smokers compared with non-smokers throughout the observation period (p<0.001). During the first month, GI levels significantly decreased in both groups. From months 1 through 6, a significant return towards an increased GI level was observed in smokers (p<0.001). PD and CAL levels significantly decreased during the first month in both groups. Thereafter, increasing levels of PD and CAL were seen in both groups, although significantly more pronounced in smokers. Throughout the observation period, the mean CAL was significantly greater in smokers relative to nonsmokers (p<0.001). In smokers, the mean folic acid level gradually and significantly decreased and a slight and significant decrease in mean vitamin B(12) levels was observed in both groups over the entire observation period (p<0.001). CONCLUSION: The clinical response to nonsurgical intervention is impaired by smoking and smoking seems to negatively influence the serum level of folic acid following non-surgical intervention.

Evaluation of the oral health status of the people aged 65 years and over living in near rural district of Middle Anatolia, Turkey.

The aim of this study was to assess the oral health status of aged 65 years and over, and evaluate the level of edentulousness and study the factors that could have an influence on edentulism. The participants of this study were 215 patients; 94 males (47.3%) and 121 females (56.3%), aged 65 years and over. Each subject underwent a comprehensive dental and radiographic examination by one examiner. Periodontal attachment loss observed in the panoramic radiographs was divided into three diagnostic categories: infrabony defects, horizontal bone loss, and furcation lesions. The number of teeth with apical periodontitis lesions, the number of carious teeth, and restorations, type of dentures and wear duration, intrabony root remains, impacted teeth, smoking status, educational level and self-reported medical history of the participants were recorded. Extent of tooth loss was significantly higher in females than males and increased with increasing age (p<0.05). Tooth loss was significantly associated with educational levels; lower literacy level was found to be associated with a higher number of missing teeth (p<0.01). Also, as the educational levels of the participants increased, the number of infrabony defects, furcation lesions and number of carious teeth decreased (p<0.05). Low literacy level and female gender are found to be high-risk groups for tooth loss. Community-based oral disease prevention programs should be implemented to reduce the risk for tooth loss in this population.

Cytotoxicity of mouthrinses on epithelial cells by micronucleus test.

OBJECTIVES: To determine the cytotoxicity of three commercial mouthrinses Klorhex, Andorex and Tanflex on buccal epithelial cells using micronucleus (MN) test. MATERIALS AND METHODS: 28 patients with aged 16-24 undergone three mouthrinses' application were analyzed before and after one week exposure. Physiologic saline was used for the control group. The MN incidence was scored in the buccal epithelial of each participants. The difference in pre- and post-treatment after one week incidence of MN and plaque (PI) and gingival indices (GI) was compared by non-parametric statistical tests. RESULTS: The micronuclei incidence increased in Klorhex, Tanflex and Andorex groups after exposure to mouth rinses (P<.05). But when compared with the control group, there was not any difference between Andorex and control group (P>.05). In the other study groups, MN incidence was significantly increased after 7 days treatment (P<.05). GI scores of all groups were decreased significantly (P<.05). PI scores were decreased only in the Klorhex group (P<.05). CONCLUSIONS: Our primary findings support the presence of possible cytotoxic effects of the mouthrinses on gingival epithelial cells.

An industrial dental-erosion by chromic Acid: a case report.

A case of uncommon occupational dental erosion was reported in an individual who had worked in the war industry for twenty years. This occupation involved daily, at least 8 hours, inhalation of chromic acid being used for cleaning of barrel of cannons. The erosion manifested as dental sensitivity with excessive cervical erosion even with pulpal exposure in certain teeth. Moreover, due to the adverse effect of the chemical against to gingival and/or periodontal tissues, the lesions were extremely harmful with respect to the exposed root-cementum. After proper periodontal therapy, cervical lesions were treated conservatively with a compomer based restorative material without cavity preparation. Although today it is not common due to the well-controlled working conditions, occupational combined dental and medical problems via airborne fumes and/or elements can be seen at workers in chemical factories. A cumulative biohazardous effect is generally seen as not only medical but also dental disorders.

Relationship between smoking and folic acid, vitamin B12 and some haematological variables in patients with chronic periodontal disease.

AIM: The purpose of this study was to investigate the relationship between cigarette smoking and the serum levels of folic acid, vitamin B(12) and some haematological variables in patients with periodontal disease. PATIENTS AND METHODS: The study base consisted of 88 volunteer patients with periodontal disease, including 45 current smokers in the age range 31-68 years and 43 non-smokers in the range 32-66 years. The clinical parameters included plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD) and clinical attachment loss (CAL). Folic acid, vitamin B(12) and haematological variables were determined from peripheral blood samples. RESULTS: PI, PD and CAL means were significantly higher in smokers than non-smokers (p<0.05). The serum folic acid concentration of smokers was lower than that of non-smokers (p<0.05), whereas the white blood cell count was higher in smokers than in non-smokers (p<0.05). CONCLUSION: The results of this study suggest that among patients with periodontal disease the serum folic acid concentration is lower in smokers compared with non-smokers.

The detection of salivary minerals in smokers and non-smokers with chronic periodontitis by the inductively coupled plasma-atomic emission spectrophotometry technique.

BACKGROUND: The purpose of this study was to evaluate the effect of smoking on the salivary minerals in subjects with chronic periodontitis by the inductively coupled plasma-atomic emission spectrophotometry (ICP-AES) technique. METHODS: The study group included 24 subjects-12 smokers and 12 non-smokers-with chronic periodontitis. Clinical measurements and non-stimulated whole saliva were obtained, and the levels of five elements-sodium, potassium, calcium, magnesium, and phosphate-in each specimen were analyzed. RESULTS: When the clinical parameters were compared between groups, only plaque index was significantly higher in smokers than non-smokers (P <0.05). The mean plaque index of smokers and non-smokers was 1.93 +/- 0.51 and 1.51 +/- 0.39, respectively. The results of this study showed that there were no significant differences between groups in the mineral content of saliva. In smokers, there were positive correlations between the levels of calcium, sodium, and magnesium and clinical attachment level. There was also a positive correlation between the level of phosphate and the percentage of bleeding on probing. In non-smokers, there was a negative correlation only between the mean level of sodium and plaque index (P <0.05). CONCLUSIONS: The present study showed that no significant differences were found between the mineral content of saliva of smokers and non-smokers by the ICP-AES technique. It is a useful, fast, and sensitive technique compared to other techniques, and it can be advised for researchers while analyzing the mineral content of saliva.

Orthodontic movement of a horizontally fractured tooth: a case report.

Intra-alveolar root fractures are relatively uncommon, and sometimes may be healed without treatment. Diagnosis of intra-alveolar root fracture is frequently made by exclusion of clinical signs of other traumatic injury, and by radiographic examination with films taken at different tube angulations. This case report presents a horizontal root fractured tooth that was healed satisfactory without treatment and moved orthodontically after prolonged time from trauma.

Periodontal treatment needs of patients with renal disease receiving haemodialysis.

AIM/OBJECTIVE: The aim of this study was to perform periodontal assessment, using the CPITN index, on patients undergoing renal dialysis. METHODS: The periodontal conditions of 342 subjects undergoing renal dialysis from eight renal dialysis centres were examined using CPITN. Subjects were distributed into four age groups, 16-19, 20-34, 35-44 and > or =45 years. The study was conducted during a 6-month period. All clinical examinations were performed by one examiner. RESULTS: There was a significant positive relationship between the CPITN scores and age (r=0.164, p=0.002) and dialysis duration (r = 0.240, p=0.000). There was no statistically significant difference between male and female patients (p>0.05). None of the age groups had healthy sextants. The 35-44 year-age group had a higher number of sextants with deep pockets (0.19) than the other age groups and edentulous sextants were the highest among the oldest age group (1.89). CONCLUSION: A very small portion of the renal dialysis population is affected by severe forms of periodontitis requiring complex periodontal treatment. However, all such patients should be given oral hygiene education as a priority.

Effects of smoking on clinical parameters and the gingival crevicular fluid levels of IL-6 and TNF-alpha in patients with chronic periodontitis.

OBJECTIVE: Smoking is an important environmental risk factor for the initiation and progression of periodontal diseases. The aim of this study was to evaluate the effects of smoking on clinical parameters and the gingival crevicular fluid (GCF) contents of the pro-inflammatory cytokines interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) levels in patients with chronic periodontitis. MATERIAL AND METHODS: The study base consisted of 41 patients including 22 volunteer current smokers with an age range of 32-59 (44.41+/-7.88) years and 19 volunteer non-smokers with an age range of 36-59 (46.94+/-6.07) years. The first month after non-surgical periodontal therapy was accepted as the baseline of the study. The clinical parameters including plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL) were recorded and GCF samples were collected for analysis of GCF contents of IL-6 and TNF-alpha levels. At the 3rd and 6th months, all of these procedures were repeated. RESULTS: In smokers, only CAL was significantly higher at the 3rd month compared with non-smokers (p<0.05). GI and BOP were higher in non-smokers than smokers in both periods (p<0.05). PI showed increases from the initial to the 6th month in smokers (p<0.05). Although the differences between two groups with regard to IL-6 and TNF-alpha were not significant (p>0.05), the total amount of TNF-alpha in GCF decreased from the initial to the 6th month in smokers (p<0.05). There were no significant correlations between the mean total amount of IL-6 and TNF-alpha in GCF and clinical parameters in both evaluation periods in smokers (p>0.05). CONCLUSION: The present study demonstrated that cigarette smoking increases the amount of dental plaque over time in smokers and does not influence GCF contents of IL-6 and TNF-alpha.