Effect of Amnioguard and Biomesh GTR Membranes with Novabone Putty in the Treatment of Periodontal Osseous Defects-A Communication.

(1) Background: Guided tissue regeneration was an effective surgical procedure in the management of intrabony defects and has undergone a number of changes in terms of materials and techniques. The aim of this study is to compare AmnioGuard and BioMesh in combination with NovaBone putty in intrabony defects. (2) Methodology: Ten patients who needed regenerative periodontal therapy were randomly allocated into two groups based on the inclusion criteria. These patients were subjected to phase I therapy followed by which Group A patients were treated with AmnioGuard + NovaBone putty whereas Group B with BioMesh + NovaBone putty. The clinical indices were obtained at baseline, 3 months and 6 months post-operatively while radiographic parameters were obtained at 6 months post-op. (3) Results & Conclusion: At six months after surgery, Group B (33% bone gain) showed a statistically significant change from Group A (16% bone gain) in both the clinical and radiographic measures (p < 0.05).

The relationship between glycated hemoglobin level and the stage of periodontitis in individuals without diabetes.

Glycemic control appears to have a significant impact on the relationship between periodontitis and diabetes. The current study aimed to investigate the association between the stage of periodontitis and hemoglobin A1c (HbA1c) levels in patients considered to be normoglycemic. A total of 135 patients (100 females and 35 males) with no history of diabetes were included in the study. The mean age of the participants was 38.4 years old. All patients underwent a full-mouth periodontal examination. Periodontal diagnosis was determined according to the 2017 World Workshop on the Classification of Periodontal Disease. The glycemic state of the patients was assessed using a chair-side HbA1c analyzer. Ninety patients were diagnosed with periodontitis. Higher average HbA1c levels were associated with the different stages of periodontitis (p<0.01). Most of the non-periodontitis patients were in the non-diabetes group (67%), while most of the periodontitis patients were in the undiagnosed pre-diabetes group (47% of the stages I and II group, and 44% of the stages III and IV groups) (p<0.001). Periodontitis was found to be significantly associated with elevated glycated hemoglobin levels in patients not previously diagnosed with diabetes, and the elevation in HbA1c levels was more evident in patients with stage III and IV periodontitis.

Prosthetically Driven Computer-Guided 1-Piece Zirconia Implant Placement and Restoration Replacing Missing Central Incisor: A Case Report.

Currently, the gold standard material of choice for dental implants is the commercially available pure titanium and titanium alloys. However, this material may have suboptimal anterior esthetic outcome due to the dark grayish burnout. To enhance the esthetic outcomes, zirconium dioxide materials, with reported long-term success in medical uses and tooth-like color, were introduced as a dental implant material. This case report describes the fully guided planning and placement of a 1-piece zirconia implant replacing a missing central incisor. A 21-year-old nonsmoker male patient in excellent general health, presented with a missing tooth #9 (maxillary left central incisor). Straumann PURE (4.1 × 10 mm) Ceramic implant was placed. Three months post-surgery, the soft tissue architecture has been achieved and stabilized, and the healing was satisfactory around the zirconia implant and provisional restoration. The final layered zirconia crown was fabricated. A 2-step cementation technique was used to minimize the excess cement during the final delivery of the crown. After delivery of the final restoration, the patient was followed after 1, 3, 6, and 12 months.

Prevalence, Predictors, and Reasons for Permanent Tooth Extraction Among High School Students in Saudi Arabia: A National Cross-Sectional Study.

Background Tooth loss is a major dental health concern that has adverse consequences on the remaining dentition and on the patient's general well-being. This present study aimed to assess predictors and causes of permanent tooth extraction among students. Methods This national cross-sectional study in Saudi Arabia included a random sample of school students of both genders from grades 10 to 12 (15-18 years of age) and spanned the period of September 2012 to January 2016. Demographic, social, and medical history were recorded. Moreover, a list of possible reasons for tooth extraction was discussed with participants and their parents. The questionnaire was divided into two parts. They first asked for the patient's gender, age, marital status, education level, history of smoking, and the time of the last dental visit. Periodontal and dental examinations were performed. Multivariable logistic regression was used to determine predictors of tooth loss among the sample. Results A total of 2,435 school students were included in the study. Notably, 24% of the students had extractions of at least one permanent tooth. Nearly 27% of female students had a permanent tooth extraction compared with only 21.7% of male students, which was statistically significant. Students who visited dentists regularly had significantly more tooth extractions (39%) than students who did not (20.6%). Multivariate logistic regression analysis showed that the significant predictors for permanent tooth extraction were age, regular dental visits, and mean probing depth (PD). Caries (15%) followed by orthodontic treatment (6%) were the main reason for permanent tooth extraction among the sample. Conclusion Caries was responsible for most of the tooth loss among the study population. Significant predictors for permanent tooth extraction were age, regular dental visits, and mean probing depth. It follows that there is a need for intensified oral health education and awareness programs in the population with an emphasis on the prevention of dental caries.

Evaluating Soft Tissue Healing after Implant Placement Using Two Different Mouthwashes (Myrrh and Chlorhexidine Gluconate): A Randomized Control Trial.

The use of mouthwash is often recommended by dental experts for dental healing. A double-blind, randomized clinical study was conducted to evaluate the efficacy of two mouthwashes (myrrh and chlorhexidine gluconate) on postoperative pain and their effects on tissues after dental implant placement in 35 patients (18 in the myrrh group and 17 in the chlorhexidine gluconate group). Soft tissue healing was evaluated in terms of wound closure, soft tissue swelling, and the color of the gingiva at 1 week postoperative. To decrease the chances for error, only the participants who did not show preoperative symptoms of infection and those who committed to practicing better oral hygiene were included in the study. The samples were evaluated for the infiltration of inflammatory cells (using inflammatory extent and inflammatory cellularity grades), maturation of collagen (osteoblast activity), and arrangement of cells (for detecting the remodeling phase). A questionnaire pertaining to mouthwash satisfaction, the duration of postoperative pain after the procedure, the time of stoppage of bleeding at the surgical site, and any sensitivity at the surgical site was given to the patients. The Chi-square test and Mann-Whitney U-test were used to analyze the data. The difference in postoperative surgical swelling, pain, bleeding, and redness in the patients was not statistically significant between the myrrh and chlorhexidine gluconate mouthwash groups. However, in the acute phase, the myrrh mouthwash showed a positive impact on the process of wound healing after implant placement. The small sample size and inability to compare wound healing in different anatomical areas of the oral cavity were the study limitations.

The Efficacy of Low-Level Laser Therapy Combined with Single Flap Periodontal Surgery in the Management of Intrabony Periodontal Defects: A Randomized Controlled Trial.

This study aimed at assessing the clinical outcomes of the Single Flap Approach (SFA) with the additional use of Low-level laser therapy (LLLT). The defects were treated as per the principles of SFA, whereby 20 defects received only SFA (control group) and 20 defects received additional LLLT for bio stimulation/bio modulation (test group). Stable primary closure of the flaps was obtained with vertical internal mattress sutures. Plaque indices (FMPS), clinical attachment levels (CAL), probing pocket depth (PPD), and gingival bleeding scores (FMBS) were calculated at baseline, and at the 3rd and 6th months in both groups. An EHI score of 1 was observed at all sites except for two, where a score of 2 in the control group at week 2 was observed. In the test group, the PPD reduction at 6 months was 3.60 ± 0.95 and in the control group it was 3.75 ± 0.91 mm. CAL gain at 6 months was 2.70 ± 1.36 mm and 3.45 ± 1.2 mm in the test group and showed no statistical significance. These data suggested the positive effect of LLLT over CAL gain; thus, LLLT may be combined with SFA to potentially enhance the early wound healing and higher clinical outcomes in terms of increase in CAL and decrease in PPD.

Interleukin-34 permits Porphyromonas gingivalis survival and NF-κB p65 inhibition in macrophages.

Interleukin-34 (IL-34) is a cytokine that supports the viability and differentiation of macrophages. An important cytokine for the development of epidermal immunity, IL-34, is present and plays a role in the immunity of the oral environment. IL-34 has been linked to inflammatory periodontal diseases, which involve innate phagocytes, including macrophages. Whether IL-34 can alter the ability of macrophages to effectively interact with oral microbes is currently unclear. Using macrophages derived from human blood monocytes with either the canonical cytokine colony-stimulating factor (CSF)1 or IL-34, we compared the ability of the macrophages to phagocytose, kill, and respond through the production of cytokines to the periodontal keystone pathogen Porphyromonas gingivalis. While macrophages derived from both cytokines were able to engulf the bacterium equally, IL-34-derived macrophages were much less capable of killing internalized P. gingivalis. Of the macrophage cell surface receptors known to interact with P. gingivalis, dendritic cell-specific intercellular adhesion molecule-grabbing nonintegrin was found to have the largest variation between IL-34- and CSF1-derived macrophages. We also found that upon interaction with P. gingivalis, IL-34-derived macrophages produced significantly less of the neutrophil chemotactic factor IL-8 than macrophages derived in the presence of CSF1. Mechanistically, we identified that the levels of IL-8 corresponded with P. gingivalis survival and dephosphorylation of the major transcription factor NF-κB p65. Overall, we found that macrophages differentiated in the presence of IL-34, a dominant cytokine in the oral gingiva, have a reduced ability to kill the keystone pathogen P. gingivalis and may be susceptible to specific bacteria-mediated cytokine modification.

The Relationship Between Low Serum Vitamin D Level and Early Dental Implant Failure: A Systematic Review.

The variety in shape and type of dental implants in the present time is considered one of the most successful evolutions in dentistry. This facilitates dental treatment options to restore patient function and appearance. However, numerous significant factors influence the predictability of survival or the success rates of dental implants, some of which, such as vitamin D levels, have not been included in many studies. The main purpose of this systematic review was to investigate whether there is a relationship between low serum levels of vitamin D and early dental implant failures (EDIFs). Our literature search involved international databases including PubMed, Directory of Open Access Journals (DOAJ), and Web of Science. Initially, according to our search criteria, 1200 studies were found. After excluding duplicates, incomplete studies, and studies not meeting our inclusion criteria, only six human studies were included in this research and analyzed. Finally, upon meticulous analysis of included studies, this systematic review revealed inconsistent results in articles with respect to the association between vitamin D deficiency and implant failures. Large-scale studies, especially clinically relevant studies, on this subject is recommended.

Gingival health and oral hygiene practices among high school children in Saudi Arabia.

BACKGROUND: Gingivitis is a site-specific inflammatory condition initiated by dental biofilm accumulation. The accumulation of dental plaque on the gingival margin triggers inflammatory effects that can become chronic. In addition to its local effect, gingival inflammation has recently been suggested to have an impact on general health. OBJECTIVE: Determine the prevalence of gingivitis and its relationship to oral hygiene practices in high school children in Saudi Arabia. DESIGN: Cross-sectional. SETTING: High schools from different regions in Saudi Arabia. PATIENTS AND METHODS: Periodontal examinations were conducted on a randomly selected sample of high school children between the ages of 15 and 19 years. Gingival and plaque indices, probing depth, clinical attachment level, oral hygiene practices and sociodemographic characteristics were recorded. Data were analyzed using descriptive statistics, chi-square and the independent t test. MAIN OUTCOME MEASURE: Prevalence of gingivitis as defined by mean gingival index. SAMPLE SIZE: 2435 high school students. RESULTS: Twenty-one percent of the sample had slight gingivitis, 42.3% had moderate, and 1.8% had severe. Gender, toothbrushing, tongue brushing, plaque index, and the percentage of pocket depth (PD) ≥4 mm showed a significant relationship with the severity of gingivitis. Almost 39.3% of females had a healthy periodontal status when compared to males (30.7%). Thirty-five percent (35.5%) of students who brushed their teeth had a healthy periodontium compared to 26.9% who did not brush. The mean plaque index was significantly higher in students with severe gingivitis when compared to students with healthy periodontium (2.4 vs. 0.79, respectively). CONCLUSION: Gingivitis prevalence was high compared with Western countries in a nationally representative sample of high school students in Saudi Arabia and was influenced by oral hygiene practices. LIMITATIONS: The half-mouth study design may underestimate disease prevalence. Data on oral hygiene practices was self-reported and may thus have been affected by social desirability bias. CONFLICT OF INTEREST: None.

Prevalence of periodontitis in high school children in Saudi Arabia: a national study.

BACKGROUND: The occurrence of periodontitis is rather infrequent in children and adolescence and increases with age. We conducted this study because there have been few epidemiological studies on prevalence of periodontitis in children in Saudi Arabia. OBJECTIVE: Determine the prevalence of periodontitis in high school children in Saudi Arabia. DESIGN: Cross-sectional, using cluster and multistage sampling. SETTING: High school children in Saudi Arabia. PARTICIPANTS AND METHODS: Periodontal examinations were conducted on a randomized sample of high school children between the ages 15 to 19 in Saudi Arabia. The study spanned from September 2012 to January 2016. Clinical examinations included measurements of the probing depth (PD) percentage of PD ≥4 mm per patient. MAIN OUTCOME MEASURES: The prevalence of periodontitis (PD ≥4 mm and CAL ≥1 mm), the mean percentage PD ≥4 mm, the mean percentage CAL ≥1 mm, plaque index (PI) and gingival index (GI). SAMPLE SIZE: 2435 high school students. RESULTS: Of 2435 high school children in the sample, 209 students (8.6%) had periodontitis. The mean (standard deviation) for the PD was 0.59 (0.17) mm. Differences in percentage PD ≥4 mm and CAL ≥1 mm were greater in students with periodontitis ( P<.001). The prevalence of periodontitis was higher among non-Saudis, students who did not brush their teeth and did not visit their dentist regularly. In the bivariate analysis, periodontitis was positively associated with GI, PI, number of teeth extracted, mean percentage PD ≥4 mm, and mean PD. However, in the multivariate analysis, tooth brushing was the main factor protective against periodontitis (odds ratio: 0.62, 95% CI 0.42-0.92, P=.017). CONCLUSION: Periodontitis prevalence was high compared with Western countries in a nationally representative sample of high school students in Saudi Arabia. LIMITATIONS: Partial mouth study design, which may underestimate the disease prevalence. CONFLICT OF INTEREST: None.

Periodontal pathogenic bacteria among high school children in Saudi Arabia.

BACKGROUND: The periodontal tissues are continuously exposed to specific bacterial components that have the ability to alter many local functions. Normal endogenous infections in healthy mouths cause disease when their numbers increase significantly. OBJECTIVE: Determine the percentage of different periodontal pathogenic bacteria and their association with periodontal status. DESIGN: Cross-sectional, analytical. SETTINGS: School children of both genders in Saudi Arabia. PATIENTS AND METHODS: Clinical examination consisted of measurement of the gingival and periodontal supporting tissue including attachment loss, probing pocket depth and furcation involvement following the National Health and Nutrition Examination Survey (NHANES) and taking samples of the subgingival bacterial flora. MAIN OUTCOME MEASURES: The percentage of periodontal pathogenic bacteria and its association with periodontal status in Saudi Arabia. SAMPLE SIZE: Bacterial samples were collected from 277 subjects. RESULTS: Aggregatibacter actinomycetemcomitans was present in 21.7% of the subjects, Porphyromonas gingivalis in 21.3%; Tannerella forsythia in 10.1%; Treponema denticola in 34.7% and Prevotella inter-media in 12.3%. The red complex bacteria were found in 2.9% of the subjects. CONCLUSIONS: The percentages of bacteria varied but only T denticola was significantly associated with periodontal breakdown. In addition, the presence of more than 2 of the 5 species tested were significantly associated with tissue damage. LIMITATIONS: Cannot be generalized to all of Saudi Arabia. Larger controlled studies are needed. CONFLICT OF INTEREST: None.