Effectiveness of an erbium-doped: yttrium, aluminum and garnet laser for treatment of peri-implant disease: Clinical, microbiological, and biochemical marker analyses.

BACKGROUND: The effectiveness of an erbium-doped: yttrium, aluminum and garnet (Er: YAG) laser (EYL) for the treatment of peri-implant disease (PID) remains unclear. The aim of this study was to compare non-surgical EYL therapy for PID with locally delivered minocycline hydrochloride (MC) ointment therapy by evaluating clinical, microbiological, and biochemical markers. MATERIAL AND METHODS: Thirty-seven patients with PID were randomly assigned to either the EYL group (n = 18) or the MC group (n = 19). The clinical, microbiological, and biochemical markers at baseline and at 1 and 3 months after treatment were compared between the two groups. Subgingival plaque and peri-implant crevicular fluid (PICF) were collected from the diseased pockets. RESULTS: In the EYL group, probing pocket depth (PPD) was significantly decreased after treatment when compared with baseline. On the other hand, in the MC group, there was no significant decrease in PPD after treatment. Specific bacteria associated with PID were not determined. The counts of both Gram-positive and -negative species did not significantly decrease in the EYL group at 3 months after treatment. In the MC group, the counts of almost all bacterial species were significantly decreased after treatment. Biochemical marker analysis of PICF revealed significantly lower levels of metalloproteinase (MMP)-9 in the EYL group, as compared with the MC group at 3 months after treatment (p= 0.009). CONCLUSIONS: Non-surgical therapy with an EYL for PID was clinically effective, with decreased MMP-9 levels in PICF, which may lead to reduced peri-implant tissue destruction. Key words:Er: YAG laser; peri-implant disease; biomarker; peri-implant crevicular fluid.

Site-level progression of periodontal disease during a follow-up period.

Periodontal disease is assessed and its progression is determined via observations on a site-by-site basis. Periodontal data are complex and structured in multiple levels; thus, applying a summary statistical approach (i.e., the mean) for site-level evaluations results in loss of information. Previous studies have shown the availability of mixed effects modeling. However, clinically beneficial information on the progression of periodontal disease during the follow-up period is not available. We conducted a multicenter prospective cohort study. Using mixed effects modeling, we analyzed 18,834 sites distributed on 3,139 teeth in 124 patients, and data were collected 5 times over a 24-month follow-up period. The change in the clinical attachment level (CAL) was used as the outcome variable. The CAL at baseline was an important determinant of the CAL changes, which varied widely according to the tooth surface. The salivary levels of periodontal pathogens, such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, were affected by CAL progression. "Linear"- and "burst"-type patterns of CAL progression occurred simultaneously within the same patient. More than half of the teeth that presented burst-type progression sites also presented linear-type progression sites, and most of the progressions were of the linear type. Maxillary premolars and anterior teeth tended to show burst-type progression. The parameters identified in this study may guide practitioners in determining the type and extent of treatment needed at the site and patient levels. In addition, these results show that prior hypotheses concerning "burst" and "linear" theories are not valid.

Cementogenesis examined from the viewpoint of microcirculation.

The purpose of this study was to perform a three-dimensional observation, via microvascular corrosion casts, of the microcirculation system during deposition of cementum after flap surgery and to investigate the permeable structure of the vascular endothelium. Two stages of wound healing after flap surgery were confirmed based on successive vascular changes. The transition between these stages occurred 3 weeks after surgery, at which time new blood vessels disappeared and an early stage of accumulation of new cementum was apparent. Hence, fibrous repair occurred during the first stage, and repair of hard tissue (ie, formation of cementum) occurred during the second stage. These findings suggest that metabolic activity in cementogenesis is low, based on the condition of the blood vessels, and therefore new cementum is not easily formed.

Microvascular response in the periosteum following mucoperiosteal flap surgery in dogs: 3-dimensional observation of an angiogenic process.

BACKGROUND: An increase in blood flow from the periosteum after mucoperiosteal flap surgery is essential for healing and angiogenesis and repair may work in close cooperation to facilitate this process. To investigate the role of the periosteal vascular plexus in the healing process, we used 3-dimensional (3-D) and ultrastructural monitoring of the angiogenic process after elevation of the mucoperiosteal flap. METHODS: Mucoperiosteal flap surgery was performed on nine adult beagle dogs. The periosteal vascular plexus was observed 3, 5, and 7 days after surgery in histological specimens in which blood vessels were injected with India ink under a light microscope, in ultrathin sections under a transmission electron microscope, and in acryl plastic vascular cast specimens under a scanning electron microscope. RESULTS: On day 3 after surgery, new blood vessels, formed through sprouting, bridging, and intussusception, were observed in ultrathin sections and vascular casts. In addition, blood island-like structures consisting of clustered immature endothelial cells were noted in the repaired tissue. On days 5 to 7 after surgery, 3-D observation of vascular casts clarified that these new blood vessels had a sinus-like morphology in the interstitium of the periosteal vascular plexus. These new sinusoidal vessels exhibited a stereoscopic structure with increased continuity as the blood vessels matured and ultrastructurally the vascular endothelium was thinned. CONCLUSIONS: After mucoperiosteal flap elevation, the periosteal vasculature exhibited potent blood vessel-forming activity through various angiogenic mechanisms and through repair activity. Our results provide a 3-dimensional clarification that the periosteal vascular plexus has an important role in the healing process after flap surgery.

Microvascular response in the periosteum following mucoperiosteal flap surgery in dogs: angiogenesis and bone resorption and formation.

BACKGROUND: When surgical stress reaches the periosteum, bone resorption and formation that occur as a periosteal response are closely related to angiogenesis and hemodynamics. Thus, we investigated bone remodeling in the healing process after mucoperiosteal flap surgery, focusing our attention on the microcirculation. METHODS: Mucoperiosteal flap surgery was performed on 12 adult beagle dogs. The periosteal vascular plexus was observed on days 7, 14, 21, and 28 after surgery, using three different techniques: in histological specimens into which India ink was injected into blood vessels, under a light microscope; in ultrathin sections, using a transmission electron microscope; and in acryl plastic-injected vascular corrosion cast specimens, under a scanning electron microscope. RESULTS: On day 7 after surgery, the interstitum of the elevated mucoperiosteal vascular plexus was filled with sinusoidal new blood vessels. Bone resorption by osteoclasts was observed around these new blood vessels and many highly permeable fenestrations were present in the vascular endothelium. On day 14 after surgery, sinusoidal new blood vessels were more markedly developed and some regions exhibited glomeruluslike morphology consistent with bone resorption cavities. Activated osteoblasts were present around these new blood vessels and highly permeable vesicles, which were considered to be possible vesiclo-vacuolar organelles (VVOs) and caveolae, were noted in the vascular endothelium. On days 21 and 28 after surgery, the mucoperiosteal vascular plexus was dissected through regression of endothelial cells and fibroblasts and reconstructed into a rough mesh structure, and simultaneously the bone surface became smooth. CONCLUSION: The morphology of the mucoperiosteal vascular plexus changed with bone metabolism and these changes contributed to transport of substances involved in periodontal repair.

Microvascular response in the periodontal ligament following mucoperiosteal flap surgery.

BACKGROUND: When the mucoperiosteal flap is elevated, the gingivo-periosteal vascular plexus and periodontal ligament (PDL) vascular plexus sever their connection with the circulatory tracts that pass through alveolar bone. We studied the effect exerted on the PDL vascular plexus during restoration of the circulatory tract. METHODS: We performed experimental mucoperiosteal flap surgery in adult beagle dogs. Histological specimens, prepared after injecting India ink into the blood vessels on postoperative days 5, 7, 14, 21, 28, and 42, were examined under a light microscope. In addition, vascular corrosion cast specimens of the PDL, into which acrylic resin was injected, were observed using a scanning electron microscope. RESULTS: On postoperative day 5, the PDL vascular plexus had formed new blood vessels toward the bone side and root side, and bone resorption of the alveolar bone proper had initiated primarily around the opening of the Volkmann's canal. From postoperative day 7 to 14, the PDL vascular plexus formed new vessels on the bone side and root side accompanied by bone resorption of the alveolus, and demonstrated a complicated vascular architecture, which gradually organized and transformed into a mesh structure from postoperative day 21. Osteogenesis was initiated and encircled the newly formed vessels, and the alveolar bone proper recovered to a flat morphology. Judging from the quantity of new vessels and bone resorption, the width of the PDL space seemed to be the greatest on postoperative day 14. CONCLUSIONS: When the mucoperiosteal flap was elevated, active wound healing was activated because of angiogenesis from the PDL, which possesses a microcirculatory system. Moreover, it was suggested that angiogenesis of the PDL vascular plexus and subsequent bone resorption of alveolar bone might temporarily reduce the tooth-supporting function and cause postoperative mobility.