Evaluation of the relationship between periodontal bone destruction and mesial root concavity of the maxillary first premolar.

BACKGROUND: The purpose of this study was to investigate the morphology of maxillary first premolar mesial root concavity and to analyse its relation to periodontal bone loss (BL) using cone beam computed tomography (CBCT) and panoramic radiographs. METHODS: The mesial root concavity of maxillary premolar teeth was analysed via CBCT. The sex and age of the patients, starting position and depth of the root concavity, apicocoronal length of the concavity on the crown or root starting from the cementoenamel junction (CEJ), total apicocoronal length of the concavity, amount of bone loss both in CBCT images and panoramic radiographs, location of the furcation, length of the buccal and palatinal roots, and buccopalatinal cervical root width were measured. RESULTS: A total of 610 patients' CBCT images were examined, and 100 were included in the study. The total number of upper premolar teeth was 200. The patients were aged between 18 and 65 years, with a mean age of 45.21 ± 13.13 years. All the teeth in the study presented mesial root concavity (100%, n = 200). The starting point of concavity was mostly on the cervical third of the root (58.5%). The mean depth and buccolingual length measurements were 0.96 mm and 4.32 mm, respectively. Depth was significantly related to the amount of alveolar bone loss (F = 5.834, p = 0.001). The highest average concavity depth was 1.29 mm in the group with 50% bone loss. The data indicated a significant relationship between the location of the furcation and bone loss (X2 = 25.215, p = 0.003). Bone loss exceeded 50% in 100% of patients in whom the furcation was in the cervical third and in only 9.5% of patients in whom the furcation was in the apical third (p = 0.003). CONCLUSIONS: According to the results of this study, the depth of the mesial root concavity and the coronal position of the furcation may increase the amount of alveolar bone loss. Clinicians should be aware of these anatomical factors to ensure accurate treatment planning and successful patient management.

Evaluation of periodontal status and cytokine response in children with familial Mediterranean fever or systemic juvenile idiopathic arthritis.

OBJECTIVES: Familial Mediterranean fever (FMF) and systemic juvenile idiopathic arthritis (sJIA) are chronic inflammatory diseases and anti-inflammatory agents are used in their treatment. This study evaluates the periodontal status and cytokine response in pediatric patients with FMF or sJIA. MATERIALS AND METHODS: Forty-eight FMF/sJIA patients were under treatment/control and in attack-free period; 20 systemically healthy children participated in the study. FMF/sJIA patients were divided into two subgroups based on the treatment they received: receiving anti-IL-1 therapy (anti-IL-1 ( +)) and not receiving anti-IL-1 therapy (anti-IL-1 ( -)). The clinical periodontal indices were recorded. Gingival crevicular fluid (GCF) and serum samples were collected. Cytokine levels (IL-1ß, IL-1α, TNF-α, IL-6, IL-8, IL-10, IL-17, IL-33) in GCF and serum were measured using ELISA kits. RESULTS: There was no significant difference between the groups in terms of GCF IL-1ß and IL-1α levels although, BoP and GI were significantly lower in the anti-IL-1 ( +) group compared to the control group. GCF IL-10 level was higher in the anti-IL-1 ( -) group than in the control group; GCF IL-8 levels were lower in both FMF/sJIA subgroups versus controls. There was no significant difference between serum cytokine levels of FMF/sJIA subgroups. CONCLUSIONS: Considering the significant decrease in GI, BoP, and GCF IL-8 levels in the anti-IL-1 ( +) group, it can be concluded that anti-IL-1 medications may suppress periodontal inflammation clinically and immunologically. CLINICAL RELEVANCE: Anti-IL agents are not currently used in periodontal therapy. However, this study demonstrated the positive effect of anti-IL-1 medications on periodontal inflammation in pediatric patients with FMF or sJIA.

Evaluation of periodontal status and cytokine/chemokine profile of GCF in patients with severe congenital neutropenia.

Severe congenital neutropenia (SCN) is a primary immunodeficiency characterized by defect in neutrophil count. Increased risk of infections in addition to periodontal problems, such as ulcerations of oral mucosa, gingival inflammation, and rapid loss of attachment are common in the course of the disease. The aim of the present study is to define the causal relationship between the severity of periodontal inflammation and severe congenital neutropenia through identification of cytokine profile in gingival crevicular fluid (GCF). A case-control study was performed in patients diagnosed with SCN and healthy controls. Demographic data, the molecular defect, laboratory work-up were gathered from the hospital registry. Periodontal indices were recorded and GCF samples were analyzed using multiplex analysis for the simultaneous measurements of the particular cytokines and chemokines. The present study included 14 patients and 22 control subjects. Both groups were comparable in terms of age and sex. Severity of gingival inflammation measured by the criteria of Löe was higher in the SCN cases (p < 0.05). Moreover, GCF levels of IFN-α, TNF-α, IL-10, IL-13, IL-15, IL-17, IL-2, IL-7, IL-33, IP-10, MIG, MIP-1ß were significantly higher in the controls. Decreased cytokine secretion seems to correlate with the decrease in neutrophil counts. The severity of gingival inflammation in SCN patients may be due to the bacterial overgrowth and the change in the content of the oral flora due to the decreased neutrophil counts. Therefore, regular periodontal examinations, the motivation of oral hygiene as well as the compliance with therapy in SCN patients contribute to the periodontal health.

Effects of oral prophylaxis including tongue cleaning on halitosis and gingival inflammation in gingivitis patients-a randomized controlled clinical trial.

OBJECTIVE: The objective of this study was to assess the effect of oral prophylaxis including tongue scraping on level of halitosis, clinical periodontal parameters and local cytokine response in gingivitis patients. MATERIALS AND METHODS: In this randomized controlled clinical trial, 36 gingivitis patients were randomly assigned into two subgroups after scaling and polishing. Group 1 received oral hygiene instructions including the use of tongue scraper; group 2 received oral hygiene instructions alone without tongue cleaning. Levels of volatile sulfur compounds (VSC), organoleptic and tongue coating scores, clinical periodontal parameters and gingival crevicular fluid (GCF) samples were collected at baseline and 7 days after oral prophylaxis. GCF samples were analyzed using multiplexing analysis for the simultaneous measurements of cytokines. The Chi-square, Mann-Whitney U, Wilcoxon, and Student's paired and unpaired t tests were used for statistical analysis. RESULTS: Statistically significant reductions were found in terms of clinical periodontal parameters in both groups. However, significant improvements in VSC levels, organoleptic and tongue coating scores were observed just in tongue scraping group. Moreover, the GCF levels of IL-1ß and IL-8 significantly decreased after the treatment in group 1 according to the baseline values. CONCLUSION: The present study indicated that oral prophylaxis including tongue scraping was effective in improving intra-oral halitosis and pro-inflammatory cytokine response in GCF in gingivitis patients. CLINICAL RELEVANCE: The results suggest that tongue scraping can be taken into consideration in order to manage gingival inflammation as well as VSC levels in gingivitis patients but further clinical studies are required to judge the clinical relevance.

Morphological and volumetric evaluation of the nasopalatinal canal in a Turkish population using cone-beam computed tomography.

PURPOSE: To establish (nasopalatine canal) NPC morphology and obtain linear and volumetric measurements using CBCT images. METHODS: We evaluated CBCT scans of 252 patients. NPC shape was classified as belonging to six groups. Following measurements were recorded: M1, nasal foramen diameter; M2, incisive foramen diameter; M3, NPC length; M4, distance from the buccal border of the incisive foramen to the facial aspect of the buccal bone plate; M5, distance from the buccal bone wall of the NPC to the facial aspect of the buccal bone plate; and M6, distance from the buccal border in the middle of the NPC to the facial aspect of the buccal bone plate. Volume and surface area measurements of the NPC were also conducted. Sex, age and maxillary anterior teeth status (MCI) were recorded. Four-way repeated ANOVA was performed. Significance level was set at p < 0.05. RESULTS: With the exception of M4 and M5, the relationship between MCI and all linear measurements was statistically significant. Patient sex had a significant effect on all NPC measurements with the exception of nasal foramen diameter, with all measurements greater in males than females (p < 0.001). NPC volume was found to vary significantly by patient sex (p = 0.042), with mean NPC volume values of 55.171 mm(3) for females and 72.966 mm(3) for males. CONCLUSION: The measurements conducted around nasopalatine canal provided useful information prior to implant placement in the anterior maxilla.

CBCT quantitative evaluation of mandibular lingual concavities in dental implant patients.

PURPOSE: The purpose of this study was to evaluate the prevalence of mandibular lingual concavities and to measure them using CBCT (Cone-Beam Computerized Tomography). METHODS: In this study, CBCT scans of 200 patients requiring dental implants were assessed for lingual concavities. Reconstructed CBCT images were transferred as DICOM files to the 3D DOCTOR software program, and metric, volumetric, and surface area measurements were obtained. Two-way mixed ANOVA was used to model side (left/right, anterior), measurement type, and gender with side and type taken as within-subject variables, gender as between-subject variables, and age as a covariate. A comparison between the dentate and edentulous groups in the samples with lingual concavities was performed using an unpaired Student's t test. RESULTS: Submandibular concavity mean depth and volume were found to be 2.4 mm and 130.7 mm(3), whereas mean depth and volume of sublingual concavities were found to be 1.3 mm and 26.5 mm(3). Significant inverse ratios were found between age and volume and between age and surface area (p < 0.05). All measurements were higher in males than females, but the differences were not statistically significant. The differences between the presence of concavity (sublingual, right, and left submandibular) and dental status (dentate/edentulous) were statistically insignificant (p > 0.05). CONCLUSION: Mandibular lingual concavity dimensions were found to vary by age, location, and the presence/absence of teeth. Third party software can be used to generate 3-dimensional models that provide useful information about shape, size, and location of sublingual and submandibular concavities prior to implant placement.

Cytokine profile in serum and gingival crevicular fluid of children with inflammatory bowel disease: A case-control study.

BACKGROUND: To evaluate the cytokine profile in gingival crevicular fluid (GCF) and serum of pediatric inflammatory bowel disease (IBD) patients and determine the cluster patterns of cytokines. METHODS: Fifty IBD patients and 21 systemically healthy children were enrolled in the study. The GCF samples were collected from the participants during periodontal examination and periodontal indices were recorded. Based on activity indexes and response to conventional treatment, patients with IBD were further categorized into subgroups as: remission, active disease, and treatment-resistant. Serum samples were obtained from IBD patients to determine serum levels of cytokines. The levels of pro- (interleukin (IL)-1ß, IL-12, IL-21, IL-22, IL-23, IL-17A, IL-17F) and anti-inflammatory (IL-4, IL-10) cytokines in serum and GCF were measured using Enzyme-linked Immunosorbent Assay (ELISA) kits. RESULTS: Among 50 IBD patients, 58% were in remission, 20% had active disease, and 22% were defined as treatment-resistant. The severity of gingival inflammation measured by the criteria of Löe had increasing trends in IBD patients with active disease and treatment resistance. GCF IL-1ß level was lower and GCF IL-4 and GCF IL-23 levels were higher in IBD patients compared to healthy controls. In the active disease group, more cytokine clusters occurred compared to the control group and other IBD subgroups, as explained by increased cytokine-cytokine interactions. CONCLUSIONS: Considering the increased complexity of cytokine interactions and the increased severity of gingival inflammation in patients with active disease, it can be concluded that disease activity might have an impact on gingival inflammation in pediatric patients with IBD.

Actinomyces-associated Lesions Located in the Gingiva: Case Report of Rare Gingival Lesions.

Actinomyces spp. are located without displaying any pathogenic effect in the oral flora. However, the disruption of oral microenvironmental balance, mucosal tissue integrity, and defense system can cause microorganisms to settle on deep periodontal tissues and to induce pathologic reactions. The present case report describes erythematous and desquamative lesions with pseudomembrane limited to the gingiva. In the histopathologic examination, Actinomyces colonies were isolated from the gingiva. On the basis of histopathologic and laboratory findings, the lesions were diagnosed as Actinomyces- associated lesions of the gingiva. No condition that caused immuno suppression was present in the patient. Nevertheless, local effect of the chlorhexidine mouthwash usage for a period may induce irritation of the oral keratinized tissue. The localized form of actinomycotic lesions occurs seldom in the gingival tissues. In rare cases like this, the practice of differential diagnosis with a multi-disciplinary approach is very important for the accurate diagnosis and appropriate treatment planning.

Assessment of zygomatic bone using cone beam computed tomography in a Turkish population.

OBJECTIVE: To provide linear and volumetric measurements of zygomatic bone using cone beam computed tomography (CBCT) images. STUDY DESIGN: CBCT images were assessed for 198 patients. Posterior and anterior zygomatic bone widths (M1 and M2), zygomatic bone projection (M3), zygomatic bone height (M4), combined zygomatic arch diameter (M5), maximum cortical thickness (M6), gray value obtained from maximum cortical thickness region (M7), minimum cortical thickness (M8), and gray value obtained from minimum cortical thickness region (M9) were measured. Volume and surface area measurements of the zygomatic bone were also conducted. Sex, age, and side were recorded for each patient. General linear model analysis of variance (ANOVA) was performed (P < .05). RESULTS: Age (P < .001) and gender (P = .001) significantly affected M1. Gender significantly affected M3 (P = .003) and M4 (P = .000), with higher values for men. Gender (P = .000) and age (P = .000) significantly affected M5 variation. Only age had a significant effect on M6 variation, with an increase with age (P < .015). Only gender had a significant effect on M7 (P = .005), M8 (P = .000), and M9 (P = .004), with higher values for men. All the factors significantly affected zygomatic bone volume variation (gender, P = .000; age, P = .000; and side, P < .004). CONCLUSION: Detailed examination of the zygomatic bone region can be performed with CBCT images.

Comparison of micro-computerized tomography and cone-beam computerized tomography in the detection of accessory canals in primary molars.

PURPOSE: This study was performed to compare the accuracy of micro-computed tomography (CT) and cone-beam computed tomography (CBCT) in detecting accessory canals in primary molars. MATERIALS AND METHODS: Forty-one extracted human primary first and second molars were embedded in wax blocks and scanned using micro-CT and CBCT. After the images were taken, the samples were processed using a clearing technique and examined under a stereomicroscope in order to establish the gold standard for this study. The specimens were classified into three groups: maxillary molars, mandibular molars with three canals, and mandibular molars with four canals. Differences between the gold standard and the observations made using the imaging methods were calculated using Spearman's rho correlation coefficient test. RESULTS: The presence of accessory canals in micro-CT images of maxillary and mandibular root canals showed a statistically significant correlation with the stereomicroscopic images used as a gold standard. No statistically significant correlation was found between the CBCT findings and the stereomicroscopic images. CONCLUSION: Although micro-CT is not suitable for clinical use, it provides more detailed information about minor anatomical structures. However, CBCT is convenient for clinical use but may not be capable of adequately analyzing the internal anatomy of primary teeth.

Use of cone beam computed tomography in periodontology.

Diagnosis of periodontal disease mainly depends on clinical signs and symptoms. However, in the case of bone destruction, radiographs are valuable diagnostic tools as an adjunct to the clinical examination. Two dimensional periapical and panoramic radiographs are routinely used for diagnosing periodontal bone levels. In two dimensional imaging, evaluation of bone craters, lamina dura and periodontal bone level is limited by projection geometry and superpositions of adjacent anatomical structures. Those limitations of 2D radiographs can be eliminated by three-dimensional imaging techniques such as computed tomography. Cone beam computed tomography (CBCT) generates 3D volumetric images and is also commonly used in dentistry. All CBCT units provide axial, coronal and sagittal multi-planar reconstructed images without magnification. Also, panoramic images without distortion and magnification can be generated with curved planar reformation. CBCT displays 3D images that are necessary for the diagnosis of intra bony defects, furcation involvements and buccal/lingual bone destructions. CBCT applications provide obvious benefits in periodontics, however; it should be used only in correct indications considering the necessity and the potential hazards of the examination.