Evaluating the effect of mechanical debridement with adjunctive antimicrobial photodynamic therapy in comparison with mechanical debridement alone on the peri-implant parameters in type 2 diabetic mellitus patients with peri-implantitis: a systematic review and meta-analysis.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a major risk factor for localized diseases such as peri-implantitis that may affect ideal implant treatment. This study was aimed to evaluate the effect of mechanical debridement (MD) + antimicrobial photodynamic therapy (a-PDT) in patients with peri-implantitis who have T2DM in terms of bleeding on probing (BOP) and probing depth (PD) as primary outcomes and plaque index (PI) and crestal bone loss (CBL) as secondary outcomes. METHODS: Publications compared outcomes between MD + aPDT and MD alone in T2DM patients with peri-implantitis, containing more than 3-month follow-up duration, were involved in the systematic review and meta-analysis. Literature until July 2023 using MEDLINE (through PubMed), Scopus, Cochrane Library, Embase, Web of Science, and Google Scholar were collected. RESULTS: Two randomized controlled trials (RCTs, 88 individuals) and one controlled clinical trial (CCT, 67 individuals) with follow-up periods ranged from 3 to 12 months were recruited. All studies used diode laser with wavelengths ranged from 660 to 810 nm. The results demonstrated that the MD + aPDT group showed significant benefits for BOP reduction after 6 months (SMD = -2.15, 95% CI: -3.78 to -0.51, p = 0.01). However, a great amount of heterogeneity was observed (I2 = 91.52%, p < 0.001). Moreover, there was a significant difference between MD + aPDT and MD alone groups in CBL (SMD = -0.69, 95% CI: -1.07 to -0.30, p < 0.001). In addition, homogeneity assumption was satisfied (I2 = 22.49%, p = 0.28). Significant differences in PD and PI reduction were not found except for PI reduction after 3 months (SMD = -0.79, 95% CI: -1.24 to -0.33, p < 0.001. Also, no heterogeneity was observed (I2 = 0.00%, p = 0.47). CONCLUSION: Given that high heterogeneity in BOP and PD outcome was found in this systematic review, future long-term CTs with MD + aPDT should be examined to arrive at a firm conclusion.

A tangible prospect for the treatment of gingivitis using a potentially probiotic strain Lactobacillus plantarum MK06 isolated from traditional dairy products: a triple blind randomized clinical trial.

BACKGROUND: Frequent bacterial plaque buildup at the gingival margin and crevice can provoke an inflammatory reaction in gingival tissues which manifests as gingivitis. Probiotics could serve as a beneficial complementary therapy for treating gingival inflammation. The main aim of this research was to investigate the effect of the Lactobacillus plantarum MK06 probiotic strain on the treatment of gingivitis. METHODS: Patients with gingivitis, who were referred to a private clinic and were systematically healthy, were included in this randomized, triple-blind, placebo-controlled trial. They were instructed to use either placebo or Lactobacillus plantarum suspensions for one minute two times a day after tooth-brushing for four weeks. Then, the clinical parameters of gingivitis, including plaque index (PI), gingival index (GI), bleeding on probing (BOP), and oral hygiene index (OHI-s), were measured in the first, second, and fourth weeks. A total of forty-two patients were randomly assigned to the experimental (n = 21) and control (n = 21) groups. The mean age of the experimental and control groups was 29.10 and 28.48, respectively. RESULTS: The mean scores of BOP, GI, PI, and OHI-s reduced over time in both the control and test groups. However, according to the Mann-Whitney test, the difference between the two groups was not significant at the same time intervals (P ≥ 0.05) and only GI showed a significant difference in the fourth week (GI-3, P = 0.006). Nevertheless, the experimental group experienced a higher overall reduction rate than the control group. The BOP, GI, PI, and OHI-s scores decreased by 0.081, 0.204, 0.186, and 0.172 times in the second week, respectively, resulting from the interaction of time and the intervention, which considerably diminished these indices. CONCLUSION: This study shows the potential of the probiotic Lactobacillus plantarum MK06 suspension as a promoting therapeutic adjuvant in the treatment of gingivitis.

Evaluating the effect of photobiomodulation with a 940-nm diode laser on post-operative pain in periodontal flap surgery.

The aim of this study was to evaluate the efficacy of low-power of 940-nm diode laser on post-operative pain after undisplaced flap surgery. This randomized clinical trial study was conducted using a split-mouth design. The study participants comprised 30 patients who needed periodontal flap surgery for periodontal pockets on the same tooth on both sides of the mandible. One side of the mandible was subjected to undisplaced flap surgery plus treatment with a 940-nm diode laser, and on the contralateral side, the surgery was conducted without applying the laser. Patients received anti-inflammatory medication and analgesics after surgery. The patients were asked to report the number of analgesics they took and the pain they experienced each night for 1 week using a visual analogue scale. An independent-sample t test was used to compare the results between the two groups. Patients reported less pain on days 2, 3, 4, 5, 6, and 7 after surgery in the laser-treated group (p < 0.05). Furthermore, fewer analgesics were used in this group on days 3, 4, 5, 6, and 7 following the surgery (p < 0.05). The 940-nm diode laser with the settings used in this study could significantly reduce pain and the number of analgesics taken by patients after undisplaced flap surgery.

In Vitro Comparative Evaluation of the Efficacy of Antimicrobial Photodynamic Therapy, Chlorhexidine, Sodium Fluoride, and Hydrogen Peroxide for Acrylic Resin Disinfection.

Introduction: Plaque accumulation on the surface of removable orthodontic appliances could lead to dental caries, periodontitis, and fungal infections. This study evaluated the effectiveness of antimicrobial photodynamic therapy (aPDT), chlorhexidine (CHX), sodium fluoride (NaF), and hydrogen peroxide (H2O2) for the disinfection of acrylic resin. Methods: In this in vitro experimental study, 100 acrylic resin specimens were randomly divided into five groups (n=20 each): Enterococcus faecalis, Streptococcus mutans, Streptococcus salivarius, Streptococcus sanguinis, and Lactobacillus acidophilus. Each group was immersed separately in 5 mL of microbial suspension. They were then incubated until biofilm formation on their surface. Of each microorganism, one biofilm sample in phosphate-buffered saline was considered as negative control, and other biofilm samples (n=80) were subjected to aPDT with curcumin, 0.12% CHX (positive control), 1% H2O2, and 0.2% NaF. Finally, the number of colonies was counted. Data were analyzed by the Kruskal-Wallis and Mann-Whitney tests, two-way ANOVA, and Bonferroni adjustment at a significance level of 0.05. Results: The interaction effect of the treatment modality and type of microorganism was significant on the microbial count (effect size: 0.91, P<0.05). Maximum bacterial proliferation was noted in the following combinations: NaF/E. faecalis, H2O2/E. faecalis, and H2O2/S. salivarius. Microorganisms had no or insignificant growth and proliferation in the aPDT and CHX groups. Conclusion: The results supported the optimal antimicrobial efficacy of PDT which was comparable to that of CHX. aPDT showed superior antimicrobial efficacy to NaF and H2O2 for the disinfection of acrylic resin.

Efficacy of Adjunctive Antimicrobial Photodynamic Therapy to Mechanical Debridement in the Treatment of Peri-implantitis or Peri-implant Mucositis in Smokers: A Systematic Review and Meta-analysis.

This systematic review and meta-analysis aimed to determine whether adjunctive use of antimicrobial photodynamic therapy (a-PDT) in peri-implant diseases improves clinical outcomes in smokers. An electronic search was performed in MEDLINE (through PubMed), Scopus, Cochrane Library, Embase, Web of Science and Google Scholar. The primary outcome measures were bleeding on probing (BOP) and pocket depth (PD). Plaque index (PI) was the secondary outcome. Four RCTs, (188 participants) comprised of 118 cigarette smokers, 38 E-cig smokers and 32 water pipe smokers with follow-up periods ranged from 6 weeks to 6 months were recruited. All trials applied diode laser in one session with wavelengths ranged from 660 to 670 nm. There was a significant difference between mechanical debridement (MD)+a-PDT and MD alone groups in PD (WMD = -1.26 mm, 95% CI: -2.19 to -0.32, P = 0.01) and PI (WMD = -10.60%, 95% CI: -14.46 to -6.74, P < 0.001) at 3-month follow-up. However, a great amount of heterogeneity was observed (PD: χ2 = 199.19, I2 = 98%, P < 0.001 and PI: χ2 = 25.63, I2 = 84.4%, P < 0.001). Due to methodological heterogeneity and small number of studies, this systematic review was unable to reach conclusive evidence in regards of adjunctive a-PDT efficacy in improving clinical parameters in smokers.

Survival of Dyna Implants: A Retrospective Study with 1 to 6 Years of Follow up.

Objectives: Dental implants are a prominent scientific breakthrough and are frequently applied for replacement of the missing teeth. From the clinicians' point of view, long-term studies are essential to find out the predictability of dental implant systems. Materials and Methods: In this retrospective study, 1,626 patients who received 4,389 Dyna implants in a private office between 2013-2019 were evaluated. All statistical analyses were performed using SPSS 25 for Windows. P values less than 0.1 were considered significant for regression analysis. Results: Dyna implant ts (4389) placed from 2013 to 2019 were evaluated in this study. One-hundred and thirty-three (3.03%) implants failed during the healing period or recall visits. Eighty-nine implants (2.03%) failed immediately and 44 (1%) failed after 3 months. Conclusion: The present study showed that the Dyna dental implant system had high implant survival, and it had all the survival criteria similar to world-class dental implant systems.

Effects of probiotic and fluoride mouthrinses on Streptococcus mutans in dental plaque around orthodontic brackets: A preliminary explorative randomized placebo-controlled clinical trial.

BACKGROUND: Although it is shown that probiotic agents might reduce Streptococcus mutans, no study has evaluated this effect in the form of probiotic mouthrinse. The purpose of this study was to compare the effect of probiotic experimental mouthwash Lactobacillus plantarum versus sodium fluoride and placebo mouthwashes on the number of S. mutans present in dental plaque around orthodontic brackets in fixed orthodontic patients. MATERIALS AND METHODS: This study was a randomized clinical trial. The total of 38 patients participate consisting of 12 patients in the fluoride group, 13 in the probiotic, and 12 in the placebo group. They were given mouthwashes to use twice a day for 2 weeks. Plaque sampling was performed using the 4-pass technique in all three groups in two stages: before the intervention and after 2 weeks of using the mouthwash. The number of bacteria present in the dental plaque was then reported based on the number of colonies grown on agar medium. Data were analyzed using Kruskal-Wallis and Wilcoxon tests (α = 0.05). RESULTS: Gender distribution, mean age, and protocol adherence were not significantly different among all three groups. After the intervention, the number of S. mutans present in the dental plaque followed an increasing manner in the placebo (P = 0.005) and probiotic (P = 0.158) groups and decreased in fluoride group (P = 0.025). CONCLUSION: The L. plantarum probiotic mouthwash was ineffective in reduction of S. mutans in dental plaque. However, fluoride mouthwash is considerably effective against S. mutans and thus recommended.

A Newly Characterized Potentially Probiotic Strain, Lactobacillus brevis MK05, and the Toxicity Effects of its Secretory Proteins Against MCF-7 Breast Cancer Cells.

Among seven strains of lactic acid bacteria (LAB) isolated from traditional dairy products, a Lactobacillus strain was identified through 16S rRNA gene sequencing and tentatively designated as Lactobacillus brevis MK05. This strain demonstrated the highest probiotic potential through biochemical analysis, including acid and bile salt resistance, as well as antibacterial activity. The collected cell-free supernatant (CFC) of L. brevis MK05 culture, compared with MRS broth with pH equal to the pH for CFC, revealed antimicrobial activity against Escherichia coli (ATCC 25922) and Staphylococcus aureus subsp. aureus (ATCC 25923), possibly due to the presence of antibacterial metabolites other than organic acids. This strain was, therefore, selected to assess the biological activity of its partially purified secretory proteins against MCF-7 cancer cells and normal fibroblast cells via the MTT assay. The partially purified cell-secreted proteins of this strain (hereafter referred to as Lb-PPSPs) showed a time and dose-dependent anti-cancer and apoptosis induction function. There was a remarkable decline in the survival rate of MCF-7 cells at doses equal to and higher than 0.5 mg/mL after 48 h. The changes in expression of the three genes involved in the apoptosis pathway (BAX, BCL-2, and BCL2L11) in MCF-7 cells treated with the Lb-PPSPs confirm its cytotoxic activity and apoptosis induction.

Effect of laser photobiomodulation on wound healing and postoperative pain following free gingival graft: A split-mouth triple-blind randomized controlled clinical trial.

BACKGROUND AND AIM: Free gingival graft (FGG) is one of the most predictable techniques for gingival augmentation. However, patient's discomfort and pain during healing period are significant concerns. The aim of this study was to assess if laser photobiomodulation (PBM) was effective in terms of enhancing wound healing and reducing postoperative pain. METHODS AND MATERIALS: Twelve patients participated in this split-mouth randomized controlled clinical trial. Each patient had a 30-day interval between the two procedures. In the test group, donor and recipient sites received diode laser (660nm, 200mW, continuous mode, time of irradiation:32s, energy density: 4J/cm2, spot size:0.5cm) immediately after FGG surgery, and 1,2,4 and 7days later. The control side received the same sequence of irradiation with the laser-off. Complete wound epithelialization of donor site and clinical wound healing and visual analogue scale (VAS) pain score of donor and recipient sites were evaluated after surgery. RESULTS: At 14 and 21days after surgery, the number of donor sites with complete epithelialization was greater in laser group compared to the placebo. After 21days, all donor sites in the test group were epithelialized completely, while at the same time, only eight donor sites in the control group showed complete epithelialization (P value=0.05). In terms of clinical healing of the recipient and donor sites, the test and control groups did not show any significant difference during the 45-day period, except at days 1 (for recipient site) and 14 (for donor site), when the test group showed better results (P values: 0.01 and 0.03, respectively). The VAS pain score did not show statistically significant difference between two groups during the study period, except for the first 3h after procedure when laser group showed greater VAS pain score (P values<0.05). CONCLUSION: PBM following FGG procedure with the parameters used in this study could accelerate the rate of epithelialization at the donor site. However, it did not reduce postoperative pain.

Histologic evaluation of bone healing capacity following application of inorganic bovine bone and a new allograft material in rabbit calvaria.

OBJECTIVES: Considering the importance of bone augmentation prior to implant placement in order to obtain adequate bone quality and quantity, many studies have been conducted to evaluate different techniques and materials regarding new bone formation. In this study, we investigated the bone healing capacity of two different materials deproteinized bovine bone mineral (DBBM with the trade name of Bio-Oss) and demineralized freeze-dried bone allograft (DFDBA with the trade name of DynaGraft). MATERIALS AND METHODS: This randomized blinded prospective study was conducted on twelve New Zealand white rabbits. Three cranial defects with an equal diameter were created on their calvarium. Subsequently, they were distributed into three groups: 1. The control group without any treatment; 2. The Bio-Oss group; 3. The DynaGraft group. After 30 days, the animals were sacrificed for histologic and histomorphometric analysis. RESULTS: Substantial new bone formation was observed in both groups. DynaGraft: 56/1 % ± 15/1 and Bio-Oss: 53/55 % ± 13/5 compared to the control group: 28/6 % ± 11/2. All groups showed slight inflammation and a small amount of residual biomaterial was observed. CONCLUSION: Considerable new bone formation was demonstrated in both DynaGraft and Bio-Oss groups in comparison with the control group. Both materials are considered biocompatible regarding the negligible foreign body reaction.

Application of an Acellular Dermal Matrix Allograft (CenoDerm) for Treatment of Multiple Gingival Recession Defects: A Case Report with One-year Follow-up.

Several techniques and materials have been introduced for the treatment of gingival recession defects. This article reports the case of a 43-year old female patient with chief complaint of esthetic problem, presenting multiple gingival recession defects in anterior maxilla. CenoDerm combined with coronally positioned flap was used for management of six teeth with gingival recession. Complete root coverage was achieved in 66.6% of treated sites in one-year follow-up and the patient was satisfied with the esthetic result. The mean root coverage was 86.0%±22.3. The mean recession depth reduction and clinical attachment gain were 1.8±0.8 mm and 2.5±0.6 mm, respectively. According to the results obtained in this case, CenoDerm can be applied successfully in treatment of multiple gingival recession defects.

Effects of two types of anorganic bovine bone on bone regeneration: a histological and histomorphometric study of rabbit calvaria.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of two types of bone substitutes, Bio-Oss and NuOss, for repair of bone defects. MATERIALS AND METHODS: This study was performed on the calvaria of 14 New Zealand rabbits. The 6mm critical size defect (CSD) models of bone regeneration were used. Three CSDs were created in each surgical site. The first defect was filled with NuOss, the second one with Bio-Oss and the third one remained unfilled as the control. After healing periods of one and two months (seven animal for each time point), histological and histomorphometric analyses were carried out to assess the amount of new bone formation, presence of inflammation, foreign body reaction and type of new bone. Qualitative variables were analyzed by multiple comparisons, Wilcoxon, Friedman and Mann Whitney tests. Quantitative variables were analyzed using the Mann-Whitney and Wilcoxon tests. Level of statistical significance was set at 0.05. RESULTS: The level of inflammation was not significantly different at four and eight weeks in the Bio-Oss (P=0.944), NuOss (P=1.000) and control groups (P=0.71). At four weeks, foreign body reaction was not observed in Bio-Oss, NuOss and control groups. There was no significant difference in the type of the newly formed bone at four and eight weeks in any group (P=0.141 for Bio-Oss, P=0.06 for NuOss and P=0.389 for the control group). CONCLUSION: Deproteinized bovine bone mineral can be used as a scaffold in bone defects to induce bone regeneration.