Assessment of palatal mucosal thickness and location of the greater palatine foramen using cone-beam computed tomography: a retrospective study.

OBJECTIVES: This study aimed to measure the palatal mucosal thickness and examine the location of the greater palatine foramen using cone-beam computerized tomography (CBCT). METHODS: In this study, cone-beam computed tomography (CBCT) images of the maxillary posterior region of 120 subjects were evaluated. The palatal mucosal thickness (PMT), palatal width and depth, and location of the greater palatine foramen (GPF) were determined on CBCT. The differences in the palatal mucosal thickness according to gender and palatal width/palatal depth were analyzed. The location of the GPF related to the maxillary molars was noted. RESULTS: The mean palatal mucosal thicknesses from the canine to the second molar teeth were 3.66, 3.90, 4.06, 3.76, and 3.92 mm, respectively. The mean PMT at the second premolar was statistically thicker than at other regions (p < 0,001). There was no relationship between PMT and gender. However, the palatal depth and width of the males were greater than females. (p = 0.004 and p = 0.014, respectively) PMT in the low palatal vault group had statistically higher compared to the high palatal vault group. (p = 0.023) Greater palatine foramen was mostly observed between second and third molar teeth. (48%). CONCLUSIONS: According to our results, first and second premolar regions can be preferable in soft tissue grafting procedures for safe and successful treatment outcomes. The measurement of the thickness of the palatal mucosa and the evaluation of the greater palatine foramen location before the surgical procedures are essential steps to harvest from the ideal donor site and to achieve optimal surgical outcomes.

The evaluation of gingival phenotype by clinicians using the visual inspection method.

OBJECTIVES: Evaluating gingival thickness is an essential factor for esthetics, function, and the maintenance of soft tissue health around natural teeth and dental implants. This study aimed to evaluate the accuracy of visual inspection procedures used to identify gingival phenotype by clinicians with different expertise and level of experience. METHOD AND MATERIALS: The gingival phenotypes of a total of 200 cases were identified as either thick or thin via visual assessment with clinical photographs by eight clinicians. One periodontist examined the gingival phenotype of all subjects based on the translucency of the periodontal probe through the gingival sulcus. The accuracy between these two methods was evaluated using percentile agreement and k statistics. RESULTS: The mean percentage of accurately identified cases was 75% irrespective of the clinician's experience and expertise. Almost half of the thin phenotype cases were misclassified by clinicians. Inter-examiner agreement was generally fair to moderate and intra-examiner agreement was generally moderate. CONCLUSION: Within the limits of this study, the present findings demonstrated that the visual inspection method misclassified the cases, especially thin gingival phenotype, compared to the probe translucency method. Therefore, there is a need to identify a universally accepted, accurate method and clear clinical definitions.

Assessment of gingival thickness in the maxillary anterior region using different techniques.

OBJECTIVES: Gingival phenotype is closely related to treatment success and aesthetic results in the maxillary anterior region. Several methods were proposed to measure the dimensions of the gingival tissue. This study aimed to evaluate the gingival thickness using clinical and radiographic techniques and to explore the association between gingival thickness and gingival phenotypes classified by color-coded phenotype probes. MATERIALS AND METHODS: The gingival thickness of 86 periodontally healthy maxillary anterior teeth was assessed using transgingival probing (TGP) and cone-beam computed tomography (CBCT). The gingival phenotype was classified as thin, medium, thick, or very thick by transparency of the color-coded probes through the gingival sulcus. The labial alveolar bone thickness was measured on CBCT images. The keratinized tissue width (KTW) was recorded. RESULTS: Good to excellent agreement was found between TGP and CBCT regarding the thickness of the gingiva (p<0.001). There was a very high correlation between the phenotypes determined by color-coded probes and the gingival thickness measured by TGP (r=0.953, p<0.001). KTW was significantly higher in thick and very thick phenotype groups compared with thin phenotype group. CONCLUSION: Cone-beam computed tomography images and the probe transparency method with color-coded probes are reliable for identifying the gingival phenotype in the maxillary anterior region, based on comparisons to direct transgingival probing. CLINICAL RELEVANCE: The assessment of the gingival phenotype is essential, especially in the aesthetic zone, to obtain predictable and favorable clinical outcomes in various dental procedures. The newly introduced color-coded probes comprise a non-invasive and reliable method for this.

Prevalence of Carotid Artery Calcification on Digital Panoramic Radiographs in Hemodialysis Patients on Kidney Transplant Waiting List.

OBJECTIVES: The detection of carotid artery calcification at an early stage is important to reduce the effects of cardiovascular disease in patients undergoing hemodialysis. This study sought to evaluate the prevalence of carotid artery calcification from panoramic radiographs of patients who were undergoing hemodialysis and to assess the relationship between such calcification and certain medical and periodontal parameters. MATERIALS AND METHODS: We evaluated 120 panoramic radiographs from patients who were undergoing hemodialysis for the presence of carotid artery calcification. Full-mouth periodontal clinical and medical parameters were recorded, and patients were diagnosed on the basis of the new periodontal disease classification. Patient medical records from the same period (the same week) during which the panoramic radiographs were taken were also assessed. RESULTS: Among the 120 participating patients, pano - ramic radiographs from 27 patients (22.5%) showed a uni- or bilaterally radiopaque mass. Of the periodontal clinical parameters investigated for associations between patients with and without carotid artery calcification, there was only a significant difference shown for probing pocket depth (P = .017). No significant differences were found between the groups with and without carotid artery calcification with regard to any other medical or periodontal parameter. CONCLUSIONS: In our study group, suspected carotid artery calcifications were detected on panoramic radiographs in about one-fourth of total patients receiving hemodialysis. Because of the significant relationship found between probing pocket depth and carotid artery calcification, the presence of periodontal disease may be associated with calcifications in these patients. Dentists should maintain awareness in detecting these lesions when evaluating panoramic radiographs of patients undergoing hemodialysis.

Salivary Del-1, IL-17, and LFA-1 levels in periodontal health and disease.

OBJECTIVE AND BACKGROUND: Developmental endothelial locus-1 (Del-1), lymphocyte function-associated antigen-1 (LFA-1), and interleukin 17 (IL-17) play critical roles in transendothelial migration of neutrophils in periodontal diseases. The aim of this study was to evaluate salivary Del-1, IL-17, and LFA-1 protein levels in patients with gingivitis (G), chronic periodontitis (CP), and generalized aggressive periodontitis (GAP). METHODS: A total of 180 systemically healthy, non-smoking patients (45 periodontally healthy (H) and 45 G, 50 CP, and 40 GAP) individuals (between March 2014 and February 2016) were included in this study according to Armitage's (1999) classification. Clinical periodontal parameters, including clinical attachment level, probing depth, plaque index, and gingival index, were recorded. Del-1, IL-17, and LFA-1 protein expression levels were measured in unstimulated saliva samples collected from patients by using enzyme-linked immunosorbent assays. Kruskal-Wallis and Mann-Whitney U tests were used for multiple comparisons and post hoc statistical analyses, respectively. ROC curve analysis was used to evaluate the sensitivity and specificity of Del-1, IL-17, and LFA-1 in distinguishing periodontal disease from health and gingivitis. RESULTS: It was found a high level of IL-17 and a low level of Del-1 in the CP and GAP, as compared to the G and H groups (P < .001). Nevertheless, we found LFA-1 levels were higher in the GAP than in the CP or G groups (P = .00). Consistently, LFA-1 levels were lower in the H and G groups than in the CP and GAP groups (P = .00). The combination of three biomarkers was found as the best predictor yielded exhibited the highest AUC [0.893, 0.845-0.94 (%95 CI) P < .001] in discriminating periodontal disease from health and gingivitis. CONCLUSION: Salivary Del-1, LFA-1, and IL-17 levels might be useful markers for determining the clinical health and disease status of patients with periodontitis. However, further studies that evaluate the level of salivary Del-1, LFA-1, and IL-17 before and after periodontal therapy are required to understand the exact roles of these cytokines during the periodontal healing period.

The Association Between Some Macro and Trace Elements in Saliva and Periodontal Status.

Changes in the macro and trace element composition of saliva might be indicative for pathological changes in periodontal tissues. However, there is a lack of evidence in the literature showing associations between mineral elements and periodontal status. The aim of this study was to determine whether such associations occur. Totally, 190 systemically healthy non-smoker participants (mean age 32.2 ± 6.02; 50 periodontally healthy, 50 gingivitis, 50 chronic periodontitis, and 40 aggressive periodontitis individuals) were included in this cross-sectional study. Salivary levels of some macro and trace elements were measured by using inductively coupled plasma mass spectrometry (ICP-MS). Kruskal-Wallis's test was used for statistical analysis. Statistically significant differences were found in sodium (Na), magnesium (Mg), potassium (K), calcium (Ca), vanadium (V), chromium Cr), manganese (Mn), iron (Fe), rubidium (Rb), strontium (Sr), and selenium (Se) concentrations among the groups. Significant increases in the essential minerals Na, Mg, K, Ca, Fe, and Se occurred in both periodontitis groups when compared to the gingivitis and periodontally healthy groups. Lower Se, Sr, Fe, Mn, and V concentrations were found in the aggressive periodontitis group than in the chronic periodontitis group. The results of this study demonstrated that assessment of mineral element concentrations in saliva might be useful in assessing periodontal health and disease. However, further studies are required to determine whether the change in a specific mineral element is the result of periodontal disease or is involved in its pathogenesis.