Alveolar ridge splitting and simvastatin loaded xenograft for guided bone regeneration and simultaneous implant placement: randomized controlled clinical trial.

OBJECTIVES: The present study goal was to assess clinically and radiographically using simvastatin (SMV) loaded xenograft for guided bone regeneration (GBR) around simultaneously placed implants with alveolar ridge splitting in patients with horizontally atrophic jaw defect. MATERIALS AND METHODS: Randomized distribution of the twenty-two patients into two groups (11 patients each) was performed. Group I participants received alveolar ride splitting (ARS) with GBR using SMV gel mixed bone graft and a barrier membrane with simultaneous implant placement. Group II received the same treatment protocol without SMV gel. At the baseline, 6- and 9-months post-surgery, clinical and radiological alterations were assessed. RESULTS: Six months after therapy, PES records of group I were statistically significantly improved than those of group II (P < .001). Group I exhibited statistically significant expansion of the alveolar ridge over group II after 6 and 9 months (P < .001). When compared to group II over the evaluation interval between 6 and 9 months, group I demonstrated statistically substantially minimal loss of the mean marginal bone level (P < .001). At the 6- and 9-month observation periods, bone density gain was considerably higher in group I than that in group II (P < .001). CONCLUSION: Alveolar ridge splitting along with GBR-augmented SMV improve the clinical and radiographical outcomes around dental implant over GBR alone. CLINICAL RELEVANCE: Augmenting GBR with SMV in alveolar ridge splitting could boost implant osseointegration and enhance peri-implant tissue changes. CLINICAL TRIAL REGISTRATION: NCT05020405.

The impact of membrane perforation and L-PRF for vertical ridge augmentation with a xenogeneic block graft: an experimental study in a canine model.

OBJECTIVES: This study evaluated clinically and histologically the efficacy of modified perforated collagen membrane (PCM) and/or leukocyte- and platelet-rich fibrin (L-PRF) in combination with xenogeneic block bone graft in the vertical alveolar ridge augmentation. MATERIALS AND METHODS: Six adult mongrel dogs were enrolled in this randomized blinded study. After defect preparation, xenogeneic screw-fixed block graft was covered by an occlusive collagen membrane in group 1 that represented the control group (Block + CM). In group 2, L-PRF membrane was added first before top coverage by occlusive collagen membrane (Block + L-PRF + CM). Groups 3 (Block + PCM) and 4 (Block + L-PRF + PCM) were identical to the first two groups except that the occlusive collagen membrane was replaced by a perforated one. Following a healing period of 2 months, the dogs were submitted to the surgical reentry phase for clinical and histological evaluation. RESULTS: Clinically, no significant differences were found among all groups regarding vertical and horizontal ridge dimensions (p = 0.155, 0.492, respectively). Histomorphometric analysis revealed that the percentage of the total bone area and mature bone was significantly higher in group 4 (69.36 ± 2.72, 33.11 ± 5.18) compared to the control group (59.17 ± 4.27, 21.94 ± 2.86) (p = 0. 027, p = 0.029). CONCLUSION: The use of xenogenic block grafts in combination with a double-layered perforated collagen L-PRF membrane in vertical ridge augmentation appeared to improve the inductive power of this challenging defect type. CLINICAL RELEVANCE: Size and number of perforations may affect the mechanical and handling properties of the membrane.

Silver nanoparticles as a viricidal agent to inhibit plant-infecting viruses and disrupt their acquisition and transmission by their aphid vector.

Silver nanoparticles (AgNPs) are a potentially effective tool for preventing viral plant diseases. This study was carried out to evaluate the effectiveness of AgNPs for managing bean yellow mosaic virus (BYMV) disease in faba bean plants from the plant-virus-vector interaction side. AgNPs were evaluated as foliar protective and curative agents. In addition, the effect of AgNPs on virus acquisition and transmission by its vector aphid was investigated. The results indicated that AgNPs exhibited curative viricidal activity and were able to inactivate BYMV when applied 48 hours after virus inoculation. The occurrence of disease was prevented using an AgNP concentration as low as 100 mg L-1, whereas virus infection was completely inhibited when plants were preventatively treated with AgNPs at a concentration of to 200 mg L-1 24 h before virus inoculation. AgNPs proved to be highly bio-reactive, binding to viral particles and suppressing their replication and accumulation within plant tissues. Moreover, AgNPs, at all concentrations tested, were found to upregulate the pathogenesis-related gene PR-1 and induce the production of defense-related oxidizing enzymes in treated plants. Exposure of aphids to AgNPs-treated plants before virus acquisition reduced BYMV acquisition and transmission efficiency by 40.65 to 100% at 24 h post-application, depending on the AgNP dosage. At 10 days after treatment, virus acquisition was reduced by 36.82% and 79.64% upon exposure to AgNPs at a concentration of 250 and 300 mg L-1, respectively. These results suggest that AgNPs have curative viricidal activity due to targeting the virus coat protein and affecting virus-vector interactions. Accordingly, AgNPs may contribute to alleviating the natural disease and virus transmission under field conditions. This is the first report on the activity of nanomaterials against plant virus acquisition and transmission by insects.

Guided tissue regeneration of intrabony defects with perforated barrier membranes, simvastatin, and EDTA root surface modification: A clinical and biochemical study.

BACKGROUND: Perforated barrier membranes (PBM) were suggested to enhance periodontal regeneration by allowing positive charity of wanted elements from the gingival tissue side. The present study was designed to evaluate clinically and biochemically the use of PBM combined with simvastatin (SMV) gel with and without an associated EDTA gel root surface etching as a suggested option that could improve SMV availability and clinical outcomes of PBM. METHODS: Forty patients having moderate-to-severe chronic periodontitis with 40 intrabony defects were randomly divided into four treatment groups (10 sites each). Patients in group 1 received 1.2% SMV gel and covering the defect with occlusive membrane (OM). Patients in group 2 received 1.2% SMV gel and covering the defect with PBM. Group 3 received 24% EDTA root surface etching, 1.2% SMV gel, and defect coverage with OM (eOM). Patients in group 4 were treated as in group 3 but the defect was covered with PBM (ePBM). Clinical parameters were recorded at baseline before surgical procedures and were reassessed at 6 and 9 months after therapy. The mean concentration of SMV in gingival crevicular fluid (GCF) was estimated by reverse-phase high-performance liquid chromatography at days 1, 7, 14, 21, and 30. RESULTS: At 6- and 9-month observation periods, groups 3 and 4 showed a statistically significant improvement in PD reduction and CAL gain compared with groups 1 and 2. Group 4 showed a statistically significant more defect fill compared with groups 1, 2, and 3 (P ≤ .05). Group 2 showed statistically significant higher defect fill compared with group 1 and group 3 (P < .05). Bone density was significantly increased with no significant difference between the four groups at 6- and 9-month observation periods. SMV-GCF concentration in group 4 showed the highest mean concentration with no significant difference than that of group 3. CONCLUSION: The use of perforated barrier membranes in association with SMV enhances the clinical hard tissue parameters compared with occlusive ones in treating intrabony periodontal defects. Moreover, EDTA root surface treatment could enhance SMV availability in the defect area.

Regenerative potential of cultured gingival fibroblasts in treatment of periodontal intrabony defects (randomized clinical and biochemical trial).

BACKGROUND: Defective cellular elements constitute an important challenge to achieve predictable periodontal regeneration. In an attempt to improve the cellularity of periodontal defects, gingival fibroblasts were implanted without their associated extracellular elements in periodontal defects to expose them to periodontal tissue mediators. In order to investigate the regenerative potential of gingival fibroblasts translocated into periodontal defects, the present study was designed to clinically and biochemically investigate the use of gingival fibroblasts (GF) and their associated mesenchymal stem cells (GMSC) in the treatment of intrabony periodontal defects. METHODS: A total of 20 subjects were randomly divided into two groups (n = 20). Group I: ten patients were included with ten intrabony periodontal defects that received ß-calcium triphosphate (ß-TCP) followed by collagen membrane defect coverage, while group II: (10 patients) ten periodontal defects received cultured gingival fibroblasts (GF) on the ß-TCP scaffold and covered by a collagen membrane. The clinical evaluation was carried out at the beginning and at 6 months. Gingival crevicular fluid (GCF) samples were collected directly from the test sites for the quantitative measurement of PDGF-BB and BMP-2 using the ELISA kit at 1, 7, 14, and 21 days after surgery. RESULTS: Group II reported a significantly greater reduction in vertical pocket depth (VPD) and CAL gain compared with group I after 6 months. Radiographic bone gain was statistically higher in group II compared with group I. A significantly higher concentration of PDGF-BB was observed in group II on days 1, 3, and 7 compared with group I. CONCLUSIONS: Translocation of gingival fibroblasts from gingival tissue to periodontal defects could be a promising option that increases cellular elements with regeneration potential. The concept of total isolation of gingival fibroblasts using occlusive membranes must be re-evaluated.

Lycopene solid lipid microparticles with enhanced effect on gingival crevicular fluid protein carbonyl as a biomarker of oxidative stress in patients with chronic periodontitis.

Lycopene (LP), a naturally occurring carotenoid in red-coloured fruits, especially tomatoes, has a pivotal role in counteracting the deleterious effect of oxidative stress on periodontal tissues. The aim of this study is to prepare solid lipid microparticles (SLMs) encapsulating LP and to assess their biochemical and clinical effects in the management of chronic periodontitis. Optimization of SLMs was performed by assessing particle size and LP entrapment efficiency. Clinical study included 16 chronic periodontitis patients allocated into two groups, Group I was managed by scaling and root planing (SRP) and local delivery of LP loaded SLMs, while Group II was managed by SRP only. Protein carbonyl (PC) levels as a biomarker of oxidative stress and drug concentration in gingival crevicular fluid (GCF) were assessed at different time intervals. Results revealed that optimum formula of SLMs had a particle size of 77.28 µm and entrapped 98.03% of LP. SLMs recorded 30 d of drug release with no burst effect. Patients treated with LP SLMs showed significantly lower levels of PC after SRP compared to those treated with SRP only, in addition to improvement in the measured clinical parameters. In conclusion, locally delivered LP SLMs along with SRP could have a protective effect over periodontal tissues and it has the ability to decrease oxidative damage of proteins in diseased periodontium.

Gingival crevicular fluid bone morphogenetic protein-2 release profile following the use of modified perforated membrane barriers in localized intrabony defects: a randomized clinical trial.

BACKGROUND: In guided tissue regenerative surgery, membrane perforations may serve as a mechanism for the passage of cells and biologic mediators from the periosteum and overlying gingival connective tissue into the periodontal defects. To test this assumption, this study was designed to evaluate levels of bone morphogenetic protein-2 (BMP-2) in gingival crevicular fluid (GCF) during the early stages of healing for sites treated with modified perforated membranes (MPMs) as compared with occlusive membranes (OMs). METHODS: Fifteen non-smoking patients with severe chronic periodontitis participated in this prospective, randomized and single-blinded clinical trial. Each patient contributed two interproximal contralateral defects that were randomly assigned to either an experimental modified perforated membrane group (15 sites) or a control occlusive membrane group (15 sites). Plaque index, gingival index, probing depth(PD), clinical attachment level (CAL) and the relative intrabony depth of the defect (rIBD) were measured at baseline and reassessed at three, six and nine months after therapy. Gingival crevicular fluid samples were collected on day 1 and 3, 7, 14, 21, and 30 days after therapy. RESULTS: The MPM-treated group showed a statistically significant improvement in PD reduction and clinical attachment gain compared to the OM control group. Similarly, rIBD was significantly reduced in MPM-treated sites as compared with those of the OM group. BMP-2 concentrations peaked in the MPM samples obtained during the early postoperative period (days 1, 3 and 7) with a statistically significant difference compared with OM-treated groups. BMP-2 levels decreased sharply in the samples obtained at days 14, 21 and 30 with non-significant higher levels in MPM samples as compared with those of OM sites. CONCLUSION: Within the limits of the present study, one can conclude that MPM coverage of periodontal defects is associated with a significant initial increase in GCF levels of BMP-2, a factor that could improve the clinical outcomes of guided tissue regenerative surgery.

Human periodontal ligament fibroblast responses to compression in chronic periodontitis.

AIM: Test whether human periodontal ligament fibroblasts (PDLFs) retain homeostatic responses to a physiological compressive force during chronic periodontitis. MATERIAL AND METHODS: Six cell lines were established from periodontally healthy individuals (H-PDLFs) and another six were cultured from patients diagnosed with chronic periodontitis (D-PDLFs). Compressive force at 150 psi was applied to H-and D-PDLFs for 3 h on 2 consecutive days. After compression, comparisons between H-and D-PDLFs were performed by gene expression analysis of IL-6, proteases and 84 inflammation-related targets using real-time PCR. RESULTS: Compression of H-PDLFs resulted in a significant increase only in MMP-1 mRNA. In contrast, the same compressive force on D-PDLFs produced significant increases in the expression of MMPs-1,-7,-9 and -16. Moreover, compression of H-PDLFs resulted in down-regulation of IL-6, while IL-6 was significantly up-regulated in compressed D-PDLFs. Compression of H-PDLFs slightly up-regulated 3 and significantly down-regulated 15 inflammation-related genes, while the same treatment strongly up-regulated 21 inflammation-related genes in D-PDLFs. CONCLUSION: These results suggest a fundamental difference in the inflammatory response of healthy versus diseased PDLFs under physiological compression. Maintenance of these characteristics in vitro suggests that these cells may be at least partly responsible for the persistence of inflammation and localized susceptibility in chronic periodontitis.

The use of integrin binding domain loaded hydrogel (RGD) with minimally invasive surgical technique in treatment of periodontal intrabony defect: a randomized clinical and biochemical study.

BACKGROUND: Periodontal regeneration faces multiple challenges, the most important being cellular insufficiency. In an attempt to improve defect cellularity, we aimed to demonstrate enhancing cellular attraction using arginine-glycine-aspartic acid (RGD) adhesion molecule legend blended hydrogel within the intrabony defects. METHODOLOGY: Forty-five intrabony defects were selected from patients with stage III or IV - grade A or B periodontitis and divided randomly into three equal groups of 15 each: group1 (G1): received minimally invasive surgical technique (MIST) alone, group2 (G2): received MIST and placebo hydrogel injection, and group3 (G3): were treated with MIST and RGD hydrogel injection. Primary outcomes 6 months following therapy were; defect base fill (DBF) and defect width measurement (DW); secondary outcomes were clinical attachment level (CAL), pocket depth (PD), plaque index (PI), gingival index (GI), and biochemical analysis of bone morphogenetic protein (BMP-2) evaluated at 1,7,14 and 21 days following therapy. RESULTS: Significant improvements in DBF, CAL, and PD were observed in the three studied groups 6 months following therapy compared to baseline (p<0.05). A significant improvement in DBF was reported in G3 compared to G1 and 2 (p=0.005). Additionally, a significantly higher CAL gain was reported in G3 compared to that of G1 (p=0.02). Group 3 was associated with a significantly higher level of BMP-2 compared to G1 and G2 in all reported periods. CONCLUSION: RGD peptide carried on a hydrogel delivery agent and contained with a minimally invasive flap could be a reliable option in improving the outcomes of periodontal therapy.

Erbium, Chromium:Yttrium-Scandium-Gallium-Garnet Laser for Root Conditioning and Reduction of Postoperative Morbidity in the Treatment of Gingival Recession Defects: A Randomized Controlled Clinical Trial.

Objective: This clinical trial evaluates the effect of erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) root surface biomodification and laser harvesting of de-epithelialized gingival graft (DGG) on root coverage clinical outcomes and postoperative morbidity, and compares this to the conventional blade-harvested DGG method without Er,Cr:YSGG root surface biomodification in treatment of Miller's class I, II gingival recessions (GR). Background: The application of laser technology to enhance tooth root coverage clinical outcomes as well as the impact of laser on postoperative morbidity after harvesting autogenous soft tissue grafts requires further research. Methods: This study is a randomized, single-blinded controlled trial, including 24 volunteers with isolated GR defects. They were allocated into three treatment groups to receive one of the following three interventions: blade-harvested DGG (control group: B-DGG); Er,Cr:YSGG-harvested DGG and root surface biomodified [test 1 group: L-laser-harvested DGG (L-DGG)/laser root biomodification (LRB)]; and B-DGG and Er,Cr:YSGG root surface biomodification (test 2 group: B-DGG/LRB). Clinical and radiographic parameters were recorded at baseline (1 week before surgery) and 3, 6, and 9 months postoperatively. Results: Root coverage did not show a statistically significant difference between control and test groups. Statistically significant differences were found for Visual Analog Scale on the day of surgery and day 3 and 4 postoperatively, as well as pain medication on the day of surgery favoring the L-DGG group. Conclusions: The use of Er,Cr:YSGG laser in root surface biomodification improved root coverage outcomes at 9 months. Even these changes were not statistically significant from the control group; the L-DGG technique was associated with decreased postoperative morbidity in the palatal donor site.

The clinical and laboratory manifestations profile of antiphospholipid syndrome among Saudi Arabia population: Examining the applicability of Sapporo criteria.

Antiphospholipid syndrome is a organized autoimmune disease presented with vascular thrombosis and pregnancy morbidity. The Sapporo classification criteria of APS were revised in 2006 and are used as the main diagnosis guideline, which validity as standard measurements is still in debate. This study observe the clinical and laboratory indices of APS among Saudi patients. This is a retrospective study hospital-based population. The clinical and Laboratory manifestations of diagnosed APS patients from electronical medical records identifies by ICD-9 code 795.79 in the King Saud University Medical City, Riyadh, Saudi Arabia, between 1990 and 2012. We selected patients with ICD-9 code 795.79 as. Sapporo criteria applied to all patients, then divided into cases fulfilled criteria and cases failed the criteria. To notice the difference in clinical and laboratory indices and comorbidities between the two groups, the T-test was performed and Logistic regression for the fulfilled criteria and clinical indices of vascular thrombosis, DVT/PE, recurrent, and pregnancy morbidity. A total of 72 (90%) females and 8 (10%) males, with the female-to-male ratio 9:1. The mean (±SD) age at diagnosis was 28.1 (±8.7) years (range 11-63 years). There were 22 patients (27.5%) attained the revised criteria (APS confirmed) and no significant difference between the two groups was observed (p > 0.2). However, we found Sapporo confirmed APS cases had significantly higher percentage of serological manifestation presence than clinically diagnosed APS cases. Though there is no statistically significance, Sapporo confirmed APS cases had advanced odds of undergoing vascular thrombosis (OR = 1.61, 95%CI) and DVT/PE (OR = 1.53, 95%CI) and lesser odds of undergoing recurrent DVT/PE (OR = 0.67, 95%CI) and pregnancy morbidity (OR = 0.63, 95%CI) than the clinically diagnosed APS cases. Over 70% of the study population with diagnosed APS did not accomplish the revised Sapporo criteria due to negative laboratory manifestations, which reflects heterogeneous but not degreed disease severity profiles.

A novel marginal periosteal pedicle graft as an autogenous guided tissue membrane for the treatment of intrabony periodontal defects.

OBJECTIVE: The aim of the present study was to clinically examine the effects of a novel marginal periosteal pedicle graft (MPP) as a guided tissue membrane for treating proximal intrabony defects in comparison to a an open flap debridement. MATERIAL AND METHODS: Fifteen patients with severe chronic periodontitis and no systemic diseases participated in this prospective, controlled clinical trial. Each subject contributed matched pairs of interproximal two- or three-walled intrabony defects. Baseline clinical examination included plaque index (PlI), gingival index (GI), bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL) of selected sites and were performed two weeks following completion of cause-related therapy. Radiographic measurements were also recorded to ascertain the radiographic depth of the defect. Each pair of periodontal defects were randomly assigned into the experimental group G1, marginal periosteal pedicle graft (MPP) guided tissue membrane or the control open flap debridement group, G2. In the MMP, partial thickness flaps were elevated at the vestibular surface of the tooth adjacent to the interproximal defect to harvest a 4 mm marginal pedicle periosteal graft. Exposed root surfaces were root planed and the remaining bony walls of the selected defect were degranulated prior to the periosteal pedicle barrier membrane being rotated to cover the intrabony defect. Sites representing the control group were treated with only open flap debridement. Clinical and radiographic parameters were recorded at 3, 6 and 9 months after surgery for treatment outcome evaluation. RESULTS: Baseline data showed no differences in any of the investigated parameters, suggesting parameters were balanced between the two groups. Both experimental and control groups showed significant improvements in all of the soft and hard tissue parameters when compared to baseline (p < 0.001). At nine months, the experimental MPP group showed significant improvement in PD reduction, CAL gain and intrabony defect reduction when compared to the control (p < 0.01). In the MPP group, the mean reduction in PD was 3.8 mm, mean CAL gain was 3.4 mm and mean reduction in intrabony defect was 2.2 mm. In sites treated with open flap DEBRIDEMENT, the mean PD reduction was 2.5 mm, CAL gain was 2.0 mm and mean reduction in intrabony defect was 0.6 mm. CONCLUSION: Within the limits of this study, it can be concluded that the placement of a marginal periosteal pedicle graft as a barrier membrane significantly improved clinical and radiographic parameters of deep intrabony defects and proved superior to OPEN FLAP DEBRIDEMENT alone.

Platelet-derived growth factor BB treated osteoprogenitors inhibit bone regeneration.

The study evaluates the ability of osteoprogenitors treated with platelet-derived growth factor BB (PDGF-BB) delivered on vinyl styrene microbeads (VSM) to regenerate rat calvarial critical-size defects (CSDs). Fetal rat calvarial cells were cultured and tested for their ability to attach to VSM using scanning electron microscopy. Twenty-five rats were equally divided into 5 groups; a negative control (GPI), vinyl styrene microbeads (GPII), PDGF-BB (GPIII), VSM plus osteoblastic progenitors (GPIV), and VSM plus PDGF-BB treated osteoblastic progenitors (GPV). CSDs were created and reconstructed according to the mentioned study design. After 16 weeks, animals were sacrificed and defect areas evaluated for bone regeneration. Cells attached to the microbeads; however, their morphology and topography were affected by the PDGF-BB. Transplanting the VSM/cells constructs to CSDs revealed significant reduction of bone regeneration upon pretreatment of the cells with PDGF-BB. However, short-term application of PDGF-BB to CSD stimulated bone regeneration. The ability of osteoprogenitor cells to regenerate bone was significantly reduced upon pretreatment with PDGF-BB in vitro. However, adding PDGF-BB at the time of surgery had stimulated bone regeneration.

Dimensional evaluation of blood clot gap distances within intrabony defects following grafting and EDTA root surface treatment-experimental study in dogs.

BACKGROUND: Because it is important to establish and maintain a firm blood clot to the surrounding tissues within the intrabony lesion; we have to investigate the potentials of different materials in resisting clot retraction that disrupt clot adhesion to the root surface. This study was designed to measure the gap distance created by clot retraction within the defect following intrabony defects grafting with and without root surface EDTA etching. METHODS: Eight mongrel dogs with surgically created acute-chronic bilateral mandibular interproximal intrabony defects in the premolar-molar areas were enrolled in this study (total 8 defects per dog). Intrabony defects were divided into four groups, the first group (OFD): control open flap debridement, the second group, (EDTA treated defects) in which debridement of the defects was followed by two minute root surface etching with a neutral 24% EDTA gel followed by two minute copious saline irrigation, the third group (only grafted defects): defects received closely packed ß-TCP of a particle size ranged from 150 to 500 mm, and the fourth group, (Graft + EDTA treated defects): defects were etched for 2 minutes with a neutral 24% EDTA gel and saline irrigation followed by intrabony defect fill of ß-TCP. Twenty four hours post treatment, animal euthanasia was carried out for histomorphometric analysis of the tooth and root side gap distances. RESULTS: EDTA treated group and EDTA + graft group showed statistically significant lower degree of clot shrinkage compared to both the control and only grafted group. Clot shrinkage in EDTA treated group showed no significant difference from that of the EDTA + graft group (p = 0.197). OFD and only grafted groups were found to show statistically higher clot retraction percnetage compared to both EDTA and EDTA+graft groups. CONCLUSION: following intrabony defect debridement, blood clot undergoes clot retraction creating a micro gap with the root surface. EDTA root surface etching before graft application into the defect area significantly reduced the amount of gap distance.

The use of integrin binding domain loaded hydrogel (RGD) with minimally invasive surgical technique in treatment of periodontal intrabony defect: a randomized clinical and biochemical study

Abstract Periodontal regeneration faces multiple challenges, the most important being cellular insufficiency. In an attempt to improve defect cellularity, we aimed to demonstrate enhancing cellular attraction using arginine-glycine-aspartic acid (RGD) adhesion molecule legend blended hydrogel within the intrabony defects. Methodology Forty-five intrabony defects were selected from patients with stage III or IV - grade A or B periodontitis and divided randomly into three equal groups of 15 each: group1 (G1): received minimally invasive surgical technique (MIST) alone, group2 (G2): received MIST and placebo hydrogel injection, and group3 (G3): were treated with MIST and RGD hydrogel injection. Primary outcomes 6 months following therapy were; defect base fill (DBF) and defect width measurement (DW); secondary outcomes were clinical attachment level (CAL), pocket depth (PD), plaque index (PI), gingival index (GI), and biochemical analysis of bone morphogenetic protein (BMP-2) evaluated at 1,7,14 and 21 days following therapy. Results Significant improvements in DBF, CAL, and PD were observed in the three studied groups 6 months following therapy compared to baseline (p<0.05). A significant improvement in DBF was reported in G3 compared to G1 and 2 (p=0.005). Additionally, a significantly higher CAL gain was reported in G3 compared to that of G1 (p=0.02). Group 3 was associated with a significantly higher level of BMP-2 compared to G1 and G2 in all reported periods. Conclusion RGD peptide carried on a hydrogel delivery agent and contained with a minimally invasive flap could be a reliable option in improving the outcomes of periodontal therapy.

Effects of EDTA gel preconditioning of periodontally affected human root surfaces on chlorhexidine substantivity - an SEM study.

BACKGROUND: Infection control is an important requirement during the early stages of periodontal healing. This study was performed to assess the preconditioning effect of EDTA gel on chlorhexidine (CHX) substantivity to periodontally involved root surfaces. METHODS: Eighty patients with severe chronic periodontitis were enrolled in this study. Following cause-related therapy, patients were divided randomly into four groups. Each group consisted of 20 subjects with one tooth that was diagnosed as hopeless and designated for extraction. In group 1 (G1), selected periodontal pockets were filled with a placebo gel in a silica base for 2 minutes. Exposed roots in group 2 (G2) were etched for 2 minutes with a neutral EDTA conditioning agent, followed by pocket fill with the placebo gel. Pockets in group 3 (G3) were filled with 0.12% CHX digluconate gel in a silica base. Exposed roots in group 4 (G4) were etched for 2 minutes with a neutral EDTA conditioning agent, followed by pocket fill with the CHX gel. Four teeth from each group were extracted immediately and at 3, 12, 24, and 48 hours for SEM evaluation. RESULTS: G1 and G2 specimens showed no evidence of silica adherent to any of the examined root surfaces. At 3 hours following CHX gel application, G3 specimens showed marked reduction in CHX-coated silica. At 24 and 48 hours following EDTA and CHX gel application, G4 specimens demonstrated adherent CHX-coated silica particles despite the reclogging of the tubule orifices. CONCLUSION: EDTA and CHX gel root conditioning is a valuable regimen that improves CHX substantivity to periodontally involved root surfaces.

Crevicular Fluid Growth Factors Release Profile Following the Use of Platelet-Rich Fibrin and Plasma Rich Growth Factors in Treating Periodontal Intrabony Defects: A Randomized Clinical Trial.

BACKGROUND: The open, usually contaminated nature of periodontal defects could negatively affect availability and activity of platelet concentrate-suggested growth factors (GF). The aim of this study is to test this hypothesis and investigate concentrations of: 1) vascular endothelial growth factor (VEGF) and 2) platelet-derived growth factor (PDGF-BB) in gingival crevicular fluid (GCF) from localized intrabony defects treated with platelets rich in growth factors (PRGF) or platelet-rich fibrin (PRF) compared with a control xenograft defect filling. METHODS: Thirty non-smoking patients suffering severe chronic periodontitis were allocated to this randomized, prospective, single-masked trial. Each patient had one interproximal defect randomly distributed to: 1) group 1: bone-substitute grafting control (n = 10); 2) group 2: experimental PRGF (n = 10); or 3) group 3: PRF (n = 10). Clinical parameters were measured at baseline and 6 and 9 months following therapy. GCF samples were obtained on days 1, 3, 7, 14, 21, and 30 after therapy for evaluation of VEGF and PDGF-BB levels. RESULTS: On days 1, 3, and 7 following surgery, mean levels of VEGF and PDGF-BB at sites treated with PRGF and PRF were not significantly different versus the control. Levels of PDGF-BB and VEGF were higher in the PRGF-treated group, but differences were not significant. Growth factor levels decreased significantly in samples collected on days 14, 21, and 30 with non-significant differences among the three groups. No significant clinical differences were reported among the three groups during the two observation periods (early period: days 1, 3, and 7; and later period: days 14, 21, and 30). CONCLUSIONS: Within the limits of the present study, it can be concluded that PRF and PRGF platelet concentrate failed to augment clinical effects achieved with the xenograft alone in treating intrabony defects. Periodontal defects could not retain extraphysiologic levels of GF suggested to be associated with platelet concentrate.

The effects of EDTA gel conditioning exposure time on periodontitis-affected human root surfaces: surface topography and PDL cell adhesion.

OBJECTIVE: The purpose of this investigation was to study the surface topography of periodontally-affected human roots following EDTA gel application at different time periods with and without scaling and root planing. In addition, to assess any correlations between root surface changes following EDTA gel conditioning and periodontal ligament fibroblast adhesion. METHODS: Forty-eight teeth that had a labial probing depth and clinical attachment loss of more than 7mm were used in this study. Periodontally-affected teeth were randomly divided into 4 groups of 12 teeth in each. Furthermore, a sample group of 6 teeth, which had a healthy periodontium, were used to serve as the healthy control (G1). The second group (G2) served as a diseased treated control in which sample teeth were only scaled and root planed prior to immediate extraction. Teeth in the third group (G3) were conditioned with a pH neutral, 24% Ethylenediaminetetraacetic acid (EDTA gel), for 2 minutes without any scaling or root planing and immediately extracted. The teeth in the fourth group (G4) were scaled, root planed, and then conditioned with the EDTA gel preparation for 2 minutes before immediate extraction. Finally the teeth in the fifth group (G5) were conditioned with EDTA gel for 4 minutes following scaling and root planing and immediately extracted. Half the samples in each group were randomly selected and processed for SEM evaluation of the surface topography. The other half were prepared to assess PDL cell adhesion with PDL fibroblasts being cultured and seeded on the root surface for 24 hours then processed for SEM evaluation of the adherent cells. RESULTS: SEM evaluation of the root planed surfaces in G2 revealed the typical appearance of a smear layer. The root surfaces of all samples in G3 exhibited a uniform coating of calculus that was covered by a considerable amount of loosely attached material including residual plaque and debris. In G4 EDTA gel exposure for 2-minutes following scaling and root planing resulted in removal of the smear layer and a marked exposure of round to oval dentinal tubule orifices. Areas of bacterial accumulation were observed in 4 out of the 6 samples examined in this group. The root surfaces after the 4-minute EDTA gel application (G5) had a fibrillar texture associated with a marked decrease in the number and an increased diameter of the exposed dentinal tubule openings. With regard to PDL cell adhesion, the majority of the 2-minute EDTA gel conditioning on the non-instrumented samples in G3, showed a failure of cells to adhere to the diseased root surface. The examined samples in G4 showed a significant increase in the number of flat and round adherent cells when compared to the diseased control samples (G2) (P > or = 0.01). The G5 samples showed a significant increase in the number of flat cells when compared to G4 (P > or = 0.01). CONCLUSION: The present study confirms the capability of EDTA gel to remove a root surface associated smear layer and to expose a collagen matrix when it was applied after scaling and root planing. In addition, a positive correlation was found between time of EDTA gel conditioning and the degree of PDL cell adhesion. It appears from the present investigation that EDTA gel conditioning for 4 minutes provides the most desirable root surface to which maximum PDL cells can adhere and on which they can grow.

Blood dendritic cells: "canary in the coal mine" to predict chronic inflammatory disease?

The majority of risk factors for chronic inflammatory diseases are unknown. This makes personalized medicine for assessment, prognosis, and choice of therapy very difficult. It is becoming increasingly clear, however, that low-grade subclinical infections may be an underlying cause of many chronic inflammatory diseases and thus may contribute to secondary outcomes (e.g., cancer). Many diseases are now categorized as inflammatory-mediated diseases that stem from a dysregulation in host immunity. There is a growing need to study the links between low-grade infections, the immune responses they elicit, and how this impacts overall health. One such link explored in detail here is the extreme sensitivity of myeloid dendritic cells (mDCs) in peripheral blood to chronic low-grade infections and the role that these mDCs play in arbitrating the resulting immune responses. We find that emerging evidence supports a role for pathogen-induced mDCs in chronic inflammation leading to increased risk of secondary clinical disease. The mDCs that are elevated in the blood as a result of low-grade bacteremia often do not trigger a productive immune response, but can disseminate the pathogen throughout the host. This aberrant trafficking of mDCs can accelerate systemic inflammatory disease progression. Conversely, restoration of dendritic cell homeostasis may aid in pathogen elimination and minimize dissemination. Thus it would seem prudent when assessing chronic inflammatory disease risk to consider blood mDC numbers, and the microbial content (microbiome) and activation state of these mDCs. These may provide important clues ("the canary in the coal mine") of high inflammatory disease risk. This will facilitate development of novel immunotherapies to eliminate such smoldering infections in atherosclerosis, cancer, rheumatoid arthritis, and pre-eclampsia.

Mixed nano/micro-sized calcium phosphate composite and EDTA root surface etching improve availability of graft material in intrabony defects: an in vivo scanning electron microscopy evaluation.

BACKGROUND: The use of nanoparticles of graft materials may lead to breakthrough applications for periodontal regeneration. However, due to their small particle size, nanoparticles may be eliminated from periodontal defects by phagocytosis. In an attempt to improve nanoparticle retention in periodontal defects, the present in vivo study uses scanning electron microscopy (SEM) to evaluate the potential of micrograft particles of ß-tricalcium phosphate (ß-TCP) to enhance the binding and retention of nanoparticles of hydroxyapatite (nHA) on EDTA-treated and non-treated root surfaces in periodontal defects after 14 days of healing. METHODS: Sixty patients having at least two hopeless periodontally affected teeth designated for extraction were randomly divided into four treatment groups (15 patients per group). Patients in group 1 had selected periodontal intrabony defects grafted with nHA of particle size 10 to 100 nm. Patients in group 2 were treated in a similar manner but had the affected roots etched for 2 minutes with a neutral 24% EDTA gel before grafting of the associated vertical defects with nHA. Patients in group 3 had the selected intrabony defects grafted with a composite graft consisting of equal volumes of nHA and ß-TCP (particle size 63 to 150 nm). Patients in group 4 were treated as in group 3 but the affected roots were etched with neutral 24% EDTA as in group 2. For each of the four groups, one tooth was extracted immediately, and the second tooth was extracted after 14 days of healing for SEM evaluation. RESULTS: Fourteen days after surgery, all group 1 samples were devoid of any nanoparticles adherent to the root surfaces. Group 2 showed root surface areas 44.7% covered by a single layer of clot-blended grafted particles 14 days following graft application. After 14 days, group 3 samples appeared to retain fibrin strands devoid of grafted particles. Immediately extracted root samples of group 4 had adherent graft particles that covered a considerable area of the root surfaces (88.6%). Grafted particles appeared to cover all samples in a multilayered pattern. After 14 days, the group 4 extracted samples showed multilayered fibrin-covered nano/micro-sized graft particles adherent to the root surfaces (78.5%). CONCLUSION: The use of a composite graft consisting of nHA and microsized ß-TCP after root surface treatment with 24% EDTA may be a suitable method to improve nHA retention in periodontal defects with subsequent graft bioreactivity.