Monophasic ß-TCP vs. biphasic HA/ß-TCP in two-stage sinus floor augmentation procedures - a prospective randomized clinical trial.

OBJECTIVES: To compare a monophasic (100% ß-TCP) and a biphasic (60% HA and 40% ß-TCP) bone substitute material (BSM) regarding biocompatibility, osteoconductivity and implant stability using histological, radiological and resonance frequency analysis. MATERIAL AND METHODS: Sixty-seven sinus floor elevations were performed in 60 patients. One patient group (monophasic bone substitute [MBS], 30 patients, 32 sinuses) was augmented by the use of the monophasic material (Bioresorb® , Sybron Implant Solutions, Bremen, Germany), while the second group (biphasic bone substitute (BBS), 30 patients, 35 sinuses) received a biphasic material (Maxresorb® , Botiss Biomaterials, Berlin, Germany). Cone beam CT images were taken immediately after augmentation and prior to implant placement after 6 months. Trephines were harvested, while the implant bed was prepared. Resonance frequency analysis was performed immediately after implant placement and 6 months later. Descriptive analysis was performed on all augmented sinus (n = 67). For statistical comparison of the groups, one sinus of each bilaterally treated patient was randomly excluded, resulting in 30 sinuses grafted with MBS and 30 sinuses grafted with BBS (n = 60). RESULTS: Histomorphometrical analysis of all sinuses displayed comparable results for both groups regarding new bone matrix (MBS 36.16 ± 19.37%, BBS 38.42 ± 12.61%), residual BSM (MBS 30.26 ± 11.7%, BBS 32.66 ± 12.57%) and non-mineralized tissue (MBS 34.29 ± 18.32%, BBS 28.92 ± 15.04) %) (P > 0.05, respectively). Radiological volume of BBS was significantly more stable (volume loss of 22.2% for MBS, 6.66% for BBS; P < 0.001), and homogeneity of the graft after 6 months was higher for BBS than that for MBS (P < 0.05). Resonance frequency analysis endorsed a higher implant stability quotient for BBS after 6 months than that for MBS (MBS 78.31 ± 5.81, BBS 80.42 ± 6.31; P < 0.05, Mann-Whitney U-test, respectively). CONCLUSION: Both monophasic and biphasic materials show good biocompatibility and osteoconductivity with satisfactory support on implant stability. BBS remains more stable in terms of volume maintenance and radiological graft homogeneity after a healing period of 6 months.

The incidence of satellite cysts in keratocystic odontogenic tumors.

Renaming of the Odontogenic Keratocyst as the Keratocystic Odontogenic Tumor by the World Health Organization (WHO) is based on the aggressive nature of this lesion. Satellite cysts founded in the walls of the original cysts may give rise to a new lesion formation. The aim of this retrospecitve study was to identify the existence of specific features according incidence of satellite cysts and the pallisading of the basal layer of the epithelium and to establish their mutual correlation. The histopathologic data of Keratocystic Odontogenic Tumor on the basis of new WHO's classification (2005) were analized. Prominent palisade basal cell layer was found in 415 (94.75%) and partially absent palisade basal cell layer in 23 (5.25%) cases. Satellite cysts were presented in prominent palisade basal cell layer in 85 specimens (20.5%) and in cases with partial absent of the palisade basal layer in 3 spicemens (13%). The higher the frequency of pallisading was the higher the frequency of satellite cysts was (p > 0.05).

Periodontal Disease in Patients with Ischemic Stroke - an Exploratory Study.

Objective: The aim of this study was to assess the periodontal disease parameters in patients with ischemic stroke. Materials and methods: The study included 21 patients with ischemic brain stroke and a control group that was matched in number, age, and gender. All participants underwent a standard periodontal examination. The inclusion criterion of this study was the presence of at least 15 teeth. Periodontal epithelial surface area, periodontal inflamed surface area (PISA), and periodontal disease stage were determined. All participants were given a questionnaire to determine oral health-related quality of life (OHQL). Stroke risk factors were assessed. Results: Stroke patients had a significantly higher OHQL score than the control group (20.81 vs. 12.57) and a full-mouth plaque score (FMPS, 27.57 vs. 16.83), while full-mouth bleeding score (FMBS) was significantly higher in the control group than in the hospital group (10.17 vs. 6.42). For PISA, statistically significant negative correlations were found for smoking, cholesterol levels, and LDL levels, while significant positive correlations were found for FMBS, clinical attachment level and probing depth. Conclusion: Although PISA does represent the amount of periodontal tissue that is inflamed, tooth loss due to advanced periodontal disease combined with oral hygiene limitations imposed by the hospital setting and the stroke recovery process remain the most significant obstacles for a more meaningful understanding of the data represented by specific clinical, laboratory and various demographic parameters that characterize the two diseases.

Periodontal disease increases risk for chronic obstructive pulmonary disease.

The aim of this study was to explore whether a periodontal disease could be a risk indicator for a chronic obstructive pulmonary disease (COPD). The examined group comprised 93 patients with COPD (mean age 65.8 years). The control group comprised 43 systemically healthy individuals (mean age 62.1 years). Respiratory and periodontal conditions were examined in both groups. COPB subjects had significantly worse periodontal conditions than controls (p < 0.05) with regard to each parameter of periodontal condition, except for gingival inflammation. COPD patients had higher Plaque Index than control patients (82.84 +/- 22.81 vs. 57.15 +/- 26.96; p < 0.001), higher periodontal depth (3.02 +/- 0.92 vs. 2.57 +/- 0.79 mm; p = 0.007), higher gingival recession (1.97 +/- 1.09 vs. 0.91 +/- 0.79 mm; p < 0.001), and higher mean clinical attachment loss (CAL) (4.12 +/- 1.74 vs. 2.91 +/- 1.27 mm; p < 0.001). Multiple logistic regression model, after controlling for other risk indicators, showed that periodontal disease, presented as CAL > or = 4 mm at > or = 60% sites, was associated with odds ratio of 3.2 (95% CI 1.0-9.8) for the COPB group. Data suggest that periodontal disease could be a risk indicator for COPD.

Diagnostic Accuracy of Salivary aMMP-8 Test in Infertile Women and Blood Finding Analysis.

Introduction: The literature reviewed in this paper suggests that infertile patients present worse periodontal status, which may be causative to conception complications. This study aimed to validate an aMMP-8 point-of-care mouth rinse test in the population of women with unexplained infertility and compare it to age-matched fertile women with and without periodontitis. Furthermore, blood sampled inflammatory parameters were analyzed and compared between the two groups. It was hypothesized that the infertile women would present worse periodontal status and a greater number of positive aMMP-8 tests than fertile women, and they would have increased inflammatory blood parameters. Material and methods: The study included 50 healthy norm-ovulatory females aged 25-45 years with strictly defined unexplained (idiopathic) infertility, and 50 healthy norm-ovulatory women of the same age who had conceived and delivered naturally. Results: The sensitivity and specificity of the test for detecting periodontitis was 84% and 72% in the group of infertile patients, 88% and 68% in the group of fertile patients and 86% and 70% in the overall patient population. Infertile patients with periodontitis had less advanced periodontitis than the control group although this difference was not statistically significant. Blood inflammatory markers were significantly higher in infertile than in fertile women. Conclusion: This study has shown that infertile patients had better periodontal status and less advanced periodontitis than fertile women of the same age. Therefore, when interpreting the results of aMMP-8 tests for diagnosis of periodontitis, one should keep in mind the periodontal status of the examined population.

Dental Students' Attitudes and Perspectives regarding Online Learning during the COVID-19 Pandemic: a Cross-sectional, Multi-university Study.

Objectives: The aim of the study was to evaluate the attitude and perspectives of dental students of four Croatian universities towards online learning during the COVID-19 pandemic. Material and methods: An anonymous internet-based survey was administered to undergraduate dental medicine students at the Universities of Zagreb, Rijeka, Split and Osijek. The 29-item questionnaire collected data on students' demographics, online learning organization and management, and perception of online classes. Results: Five hundred and four participants (85.1% female) took part in the survey. The majority of the participants (63.5%) were from the University of Zagreb. 39.6% of students reported agreement regarding online learning satisfaction. Individual university satisfaction ratings on overall online learning were: Osijek 3.69, Zagreb 3.22, Split 3.05 and Rijeka 2.64. Most students considered that lectures (82.9%) and seminars (78.9%) could be successfully delivered in an online learning format. The online learning format cannot successfully deliver laboratory, preclinical, clinical practicals or clinical clerkship, as agreed by more than 80% of the total student sample. 60% of students consider online learning a valuable alternative to face-to-face instruction. Conclusion: Online learning was highly praised for educational formats such as lectures and seminars, and was considered a useful substitute for conventional learning. Conventional practical courses cannot be substituted with online learning. Overall perspective about online learning was mixed among the students of four universities. The findings of the present study can serve to help individual universities address the shortcomings and reinforce the strengths of their OL programs.

Assessment of Health-Promoting Lifestyle among Dental Students in Zagreb, Croatia.

As future healthcare professionals, dental medicine students are expected to exhibit healthy lifestyle behaviors. This study aims to assess the health-promoting behaviors among undergraduate dental medicine students of all six academic study years at the University of Zagreb, and determine their predictors. Students were invited to complete a two-part survey, consisting of a self-reported sociodemographic questionnaire and the Health-Promoting Lifestyle Profile II (HPLP II). Three hundred and forty-nine students completed the survey; the response rate was 60.3%. The total mean HPLP II score was 2.64 ± 0.34. Students in the second academic study year scored the lowest (2.50 ± 0.33), and students in the sixth academic study year scored the highest (2.77 ± 0.32). Health responsibility was the overall lowest scored subcategory, while interpersonal relations was scored the highest. Female students reported lower spiritual growth and stress management than male students. Higher body mass index (BMI) was related to lower health responsibility. Smoking, place of residence and the age of participants did not seem to have an impact on health-promoting behaviors. Dental students at our faculty exhibit moderate health-promoting behaviors, even in the absence of a formal health-promoting course in the existing curriculum.

Relationship Between Halitosis and Periodontitis: a Pilot Study.

OBJECTIVE: Halitosis, or oral malodour, is an unpleasant smell emanating from the oral cavity. It is a common complaint among patients with periodontitis, however, their relationship is not fully elucidated. This study aimed to evaluate the association between halitosis measures, clinical indicators of periodontitis and tongue coating, as well as a novel measure, periodontal inflamed surface area (PISA). MATERIAL AND METHODS: Data of 10 patients with periodontitis and halitosis were included in this study. Halitosis was assessed by the organoleptic method and the portable sulphide monitor, measuring volatiles sulphur compounds. A comprehensive periodontal examination was conducted, and the parameters of probing depth, gingival recession, clinical attachment level, bleeding on probing, plaque and tongue coating were registered. The PISA was calculated using clinical attachment level, gingival recession and bleeding on probing. RESULTS: A correlation between organoleptic score and tongue coating (r=0.554) and plaque (r=0.614) could be observed. No correlation between measures of halitosis and probing depth or the PISA could be detected. A significant correlation was found between organoleptic scores and volatiles sulphur compounds values (r=0.931). CONCLUSION: This pilot study has shown and further reiterated a complex interplay between different factors causative to halitosis in patients affected by periodontitis. The results suggest that tongue coating and oral hygiene may have an important role in halitosis in patients with periodontitis.

A Comparison of Clinical and Radiological Parameters in the Evaluation of Molar Furcation Involvement in Periodontitis.

Objective: The aim of this study was to compare clinical, intra-surgical, 2D (panoramic) and 3D (CBCT)-based parameters in assessing molar furcation involvement (FI). Materials and Methods: Six patients with generalized periodontitis Stage II to IV, Grade B and C who were scheduled for the periodontal flap surgical treatment were recruited in the study. In total, 38 molar teeth with 93 furcation sites were analysed. All subjects had comprehensive periodontal examination, which included an assessment of molar FI using Naber's probe according to modified Glickman's classification. Periodontal surgery was performed in patients with at least one maxillary molar with probing depth of ≥6 mm. This probing demonstrated lower grade of FI compared with intra-surgical findings. Results: Periodontal probing, intra-surgical measurement and measurements based on CBCT significantly correlated with each other regarding the assessment of FI, with r values ranging between 0.81 to 1.00 (p<0.01). The correlation of panoramic radiograph with periodontal probing is 0.49, with CBCT 0.39 and with intra-surgical measurements 0.36. The results showed an excellent agreement and higher accuracy between intra-surgical measurements and CBCT (0.96), in contrast to clinical examination and panoramic radiography- 0.87 and 0.63 respectively. Different clinical and radiological modalities showed a correlation among each other. They are accurate and have their own benefits, which makes (renders) them useful in establishing periodontal diagnosis and treatment planning. Conclusion: However, CBCT offers significant advantages including excellent agreement and higher accuracy and can be used as justified as excellent diagnostic tool in detecting and locating FI to provide a more reliable diagnosis and basis for treatment decisions.

Syndecans and Enzymes for Heparan Sulfate Biosynthesis and Modification Differentially Correlate With Presence of Inflammatory Infiltrate in Periodontitis.

Periodontitis is a common degenerative disease initiated by the bacteria in subgingival biofilm. The exposure to bacterial biofilm triggers host inflammatory response whose dysregulation is ultimately responsible for the destruction of hard and soft periodontal tissues resulting in tooth loss. To date, significant effort has been invested in the research of the involvement of host cells and inflammatory mediators in regulation of inflammatory response in periodontitis. Syndecans (Sdcs) belong to a four-member family of heparan sulfate proteoglycans (HSPGs). Sdcs are compound molecules comprised of the core protein to which several heparan sulfate (HS) glycosaminoglycan (GAG) chains are attached. The role of Sdcs in pathogenesis of periodontitis is poorly investigated despite the numerous reports from experimental studies about the critical involvement of these factors in modulation of various aspects of inflammatory response, such as the formation of inflammatory mediators gradients, leukocyte recruitment and extracellular matrix remodeling in resolution of inflammation. Most of these functions of Sdcs are HS-related and, thus, dependent upon the structure of HS. This, in turn, is determined by the combinatorial action of enzymes for biosynthesis and modification of HS such as exostosis (EXTs), sulfotransferases (NDSTs), and heparanase 1 (HPSE1). The data presented in this study clearly indicate that some Sdcs display different expression profiles in healthy and diseased periodontal tissue. Additionally, the differences in expression profiles of HS GAG biosynthesis and modification enzymes (EXTs, NDSTs, and HPSE1) in healthy and diseased periodontal tissue imply that changes in HS GAG content and structure might also take place during periodontitis. Most notably, expression profiles of Sdcs, EXTs, NDSTs, and HPSE1 differentially correlate with the presence of inflammatory infiltrate in healthy and diseased periodontal tissue, which might imply that these factors could also be involved in modulation of inflammatory response in periodontitis.

The effect of local application of low-magnitude high-frequency vibration on the bone healing of rabbit calvarial defects-a pilot study.

BACKGROUND: The objective of this pilot study was to evaluate the effect of local application of low-magnitude high-frequency vibration (LMHFV) on the bone healing of rabbit calvarial defects that were augmented with different grafting materials and membranes. METHODS: Four calvarial defects were created in each of two New Zealand rabbits and filled with the following materials: biphasic calcium phosphate (BCP), deproteinized bovine bone mineral covered with a non-cross-linked collagen membrane (BO/BG), biphasic calcium phosphate covered with a strontium hydroxyapatite-containing collagen membrane (BCP/SR), and non-cross-linked collagen membrane (BG). Four defects in one rabbit served as a control, while the other was additionally subjected to the local LMHFV protocol of 40 Hz, 16 min per day. The rabbits were sacrificed 1 week after surgery. Histomorphometric analysis was performed to determine the percentages of different tissue compartments. RESULTS: Compared to the control defects, the higher percentage of osteoid tissue was found in LMHFV BG defects (35.3 vs. 19.3%), followed by BCP/SR (17.3 vs. 2.0%) and BO/BG (9.3 vs. 1.0%). The fraction occupied by the residual grafting material varied from 40.3% in BO/BG to 22.3% in BCP/SR LMHFV defects. Two-way models revealed that material type was only significant for the osteoid (P= 0.045) and grafting material (P = 0.001) percentages, while the vibration did not provide any statistical significance for all histomorphometric outcomes (P > 0.05). CONCLUSION: Local application of LMHFV did not appear to offer additional benefit in the initial healing phase of rabbit calvarial defects. Histomorphometric measurements after 1 week of healing demonstrated more pronounced signs of early bone formation in both rabbits that were related with material type and independent of LMHFV.

Quorum Sensing of Periodontal Pathogens.

The term 'quorum sensing' describes intercellular bacterial communication which regulates bacterial gene expression according to population cell density. Bacteria produce and secrete small molecules, named autoinducers, into the intercellular space. The concentration of these molecules increases as a function of population cell density. Once the concentration of the stimulatory threshold is reached, alteration in gene expression occurs. Gram-positive and Gram-negative bacteria possess different types of quorum sensing systems. Canonical LuxI/R-type/acyl homoserine lactone mediated quorum sensing system is the best studied quorum sensing circuit and is described in Gram-negative bacteria which employ it for inter-species communication mostly. Gram-positive bacteria possess a peptide-mediated quorum sensing system. Bacteria can communicate within their own species (intra-species) but also between species (inter-species), for which they employ an autoinducer-2 quorum sensing system which is called the universal language of the bacteria. Periodontal pathogenic bacteria possess AI-2 quorum sensing systems. It is known that they use it for regulation of biofilm formation, iron uptake, stress response and virulence factor expression. A better understanding of bacterial communication mechanisms will allow the targeting of quorum sensing with quorum sensing inhibitors to prevent and control disease.

Severe Generalized Periodontitis in a Patient with an Aplastic Anemia: a 5 Year Follow-up Case Report.

Aplastic anemia is a hematological disorder characterized by pancytopenia. This case report presents a young patient with untreated periodontitis associated with hematological disorders, and cyclosporine therapy. During 2 consecutive days, periodontal therapy which consisted of nonsurgical therapy supplemented with an antibiotic treatment and antifibrinolytic therapy was performed. Commercial microbiological PCR tests and periodontitis IL-1 polymorphism risk test were performed. Following the periodontal therapy, the inflammation was resolved and the patient's occlusion was restored by means of removable partial dentures. After the 5 year follow-up, the patient still remained with shallow probing depths although there was inadequate compliance during the maintenance phase. Aplastic anemia increases the risk of onset of severe forms of periodontitis that can be additionally complicated with cyclosporine therapy. In such patients, periodontal therapy must be supplemented with antibiotics.

Periodontal Disease and its Association with Angiographically Verified Coronary Artery Disease.

PURPOSE: The aim of this research was to investigate the association of chronic and aggressive periodontitis with the severity of coronary artery disease which was angiographically verified. MATERIAL AND METHODS: Subjects were selected among the hospitalized patients at the University Hospital Centre Zagreb who had coronary angiography done because of the chest pain. Thorough clinical examination included periodontal indices and clinical and socio-demographic characteristics of participants. Subjects were divided in two test groups, acute coronary syndrome (ACS) and stable coronary artery disease (CAD), and the control group with no significant CAD. Data were analyzed using Kruskal-Wallis and Pearson's Chi-Square test. RESULTS: From 106 subjects, 66 (62.3%) were hospitalized for ACS, 22 (20.7%) had stable CAD and only 18 (17.0%) had no significant CAD. Only 26 (24.5%) out of 106 patients were never smokers (p<0.05). Chronic periodontitis was the most common finding with 68.2% in ACS group and 54.5% in stable CAD group, while healthy patients without periodontitis (72.6%) were dominant in the control group (p<0.001). Stable CAD group had the highest mean probing depth (PD) 3.92±1.16, gingival recession (GR) 1.34±0.78, clinical attachment level (CAL) 4.60±1.41 and bleeding on probing (BOP) 45.98±26.19 values, whereas ACS group had mean PD value of 3.77±0.91, GR 1.11±0.66, CAL 4.32±1.08 and BOP 41.30±22.09, and no significant CAD group had mean PD value of 3.27±0.97, GR 0.69±0.37, CAL 3.62±1.04 and BOP 26.39±13.92 (p<0.05). CONCLUSION: Periodontitis was shown to be associated with angiographically verified coronary artery disease. Physical inactivity, poor oral hygiene and periodontal inflammation were observed in patients with ACS and stable CAD.

Assessment of implant stability following sinus lift procedures with different grafting materials.

OBJECTIVE: The objective of this research was to evaluate implant stability following sinus lift with two grafting materials, and to compare it with the results obtained for the implants placed in a pristine posterior maxilla. MATERIALS AND METHODS: The study included 44 healthy patients with an existing indication for sinus lift procedure (test group). 46 implants were placed following sinus lift with a pure-phase beta-tricalcium phosphate, while 39 implants were placed following augmentation with 60% hydroxyapatite with 40% beta-tricalcium phosphate material. The control group consisted of 48 healthy patients who were treated with 85 implants but without bone augmentation in posterior maxilla. Astra Tech OsseoSpeed implants were placed in all subjects. Resonance frequency analysis was used in both groups for determining implant stability 4 months after insertion. A mean implant stability quotient (ISQ) was calculated on the basis of 3 measurements. RESULTS: No statistical difference was observed in ISQ values of implants placed with and without augmentation procedure (p=0,789). Statistically significant difference was not found when ISQ values of implants placed following particular grafting material were compared with ISQ values of corresponding implants in a pristine bone (p=0.697 and p=0.402). CONCLUSIONS: This study demonstrated that the implant stability is comparable among implants placed in the posterior maxilla regardless of sinus lift and grafting procedure. Implants placed in the grafted posterior maxilla can be predictably loaded as the implants placed in a non-grafted, pristine maxilla.

Internal carotid occlusion in a patient with previous history of periodontitis: case report.

Although inflammatory periodontal disease has been proven to be related to carotid intima media thickness, it has been recently suggested that even an alteration of carotid hemodynamics might contribute to atherosclerosis in patients with periodontal disease. A 52-year-old female patient was referred to periodontology department due to painful alveolar mucosa. On the basis of dental history, we concluded that the patient had a severe form of generalized aggressive periodontitis that led to complete edentulism. The patient was advised to undergo ultrasonography of carotid arteries with arterial stiffness measurements at neurology department. A diagnosis of the right internal carotid artery occlusion was established. Inflammatory periodontal disease may affect arterial hemodynamics and even lead to artery occlusion. It is advisable that patients with a severe form of periodontitis should be referred for carotid artery ultrasonography.

Efficacy of electrical neuromuscular stimulation in the treatment of chronic periodontitis.

PURPOSE: The purpose of the present randomized controlled clinical study was to evaluate the short-term outcomes of microcurrent electrical neuromuscular stimulation (MENS) as an adjunct method to nonsurgical periodontal therapy. METHODS: Twenty patients with moderate to severe chronic periodontitis were recruited into the study and randomly treated with either nonsurgical periodontal therapy followed by 5 MENS treatments with a microcurrent device or by nonsurgical periodontal therapy alone. Periodontal parameters were measured at baseline and 6 weeks following therapy, and included the plaque index, bleeding on probing, probing depth, and clinical attachment level (CAL). RESULTS: All measured values were reduced at the time of re-evaluation. The amount of inflammation was significantly reduced in both the test (P=0.002) and control group (P=0.015). The test group demonstrated a significant CAL gain at 6 weeks following therapy, including non-molar (P=0.009) and molar teeth (P=0.028). In comparison with the control group, the test group showed statistically significant differences in the CAL on both molar (P=0.027) and non-molar teeth (P=0.031). CONCLUSIONS: In conclusion, the short-term results of the study indicate that MENS could be a suitable adjunctive method in the treatment of chronic periodontitis.