Assessment of the half-life of cationic periodontal pocket irrigation.

BACKGROUND: The concentration and persisting time of antimicrobial agents in the periodontal pockets are important factors for their antimicrobial efficacy. Increased clearance time in the periodontal pocket is a significant criterion for the selection of intrapocket irrigants. The aim of this study was to estimate the clearance time of a cationic agent from the periodontal pocket. METHODS: Thallium-201(Tl-201) was chosen as a tracer to simulate the clearance of cationic substance because of its electrical activity. Twenty patients with periodontitis and probing depths 6 to 9 mm were included in this study. In each patient, 3 Mega Becquerel (MBq) of Tl-201 were inserted into the periodontal pocket. Dynamic imaging was performed and clearance of radioactivity was measured. RESULTS: Clearance of radioactivity was 67.1 ± 16.9, 83.1 ± 13.9, 90.4 ± 10.4, 93.39 ± 8.0% at 30, 60, 90 and 120 min, respectively. Half-life of wash-out was determined as 20.3 ± 10.2 min. CONCLUSION: The results of this study demonstrate that the half-life of the cationic solution applied subgingivally was approximately 20 min and labelling of oral irrigants with radiotracers may be used to determine their clearance in further research.

Vitamin D deficiency in patients with aggressive periodontitis.

OBJECTIVES: Vitamin D deficiency is a frequent health problem worldwide, especially as fewer people spend much time in the sun. Vitamin D deficiency is linked to several infectious and inflammatory conditions, including periodontal disease. However, its role in aggressive periodontitis (AgP) has not been well studied. We evaluated the association between vitamin D concentration and periodontal disease, both AgP and chronic (CP) periodontitis. METHOD AND MATERIALS: Forty-seven AgP 55 CP and 27 control subjects participated. All patients were tested for serum vitamin D concentration (25(OH)D), parathyroid hormone, and serum bone-related biomarkers (alkaline phosphatases, calcium, and phosphorus) regulated by vitamin D. RESULTS: The patients with AgP had lower serum 25(OH)D concentration (11.22 ± 4.8 ng/ml) than controls (16.9 ± 6.4 ng/ml) and patients with CP (16.13 ± 8.3 ng/ml; overall p value 0.0002). These associations remained significant after adjustment for age and gender (p = 0.002). No significant differences were observed in any bone-related biomarker among the three groups, and no association was observed with periodontal disease indices. CONCLUSIONS: Our results suggest that vitamin D deficiency may be a potential risk factor for AgP. Given the high prevalence of vitamin D deficiency in AgP patients, routine screening for vitamin D status may be advisable in these subjects.

A comparison of gingival depigmentation by Er:YAG laser and Kirkland knife: osmotic pressure and visual analog scale.

Background: The aim of this study was to compare osmotic pressure (OP) 1 week after the gingival depigmentation in two diffeent methods: Er: YAG laser and Kirkland knife. Methods: This study included 20 patients, 13 women, and 7 men who had esthetic complaints of gingival melanin hyperpigmentation. The left side of the maxilla and mandible were depigmented with Er:YAG laser using air and water spray and the right side was removed with a Kirkland knife. Gingival biopsies were obtained from attached gingiva of operation sides with approximate dimensions of 2 mm × 2 mm before and 1 week after the depigmentation. The visual analog scale (VAS) was used to evaluate the pain level experienced by each patient. Results: Patients reported no pain at the gingivoplasty sides after 4 days and at the laser sides after 3 days. There were not statistical differences between laser and gingivoplasty groups according to values of OP (P > 0.05). Conclusion: According to results of wound healing, OP and VAS, two depigmentation procedures can be used safely and effectively.

Evaluation of the effects of Er:YAG laser, Nd:YAG laser, and two different desensitizers on dentin permeability: in vitro study.

The purpose of this in vitro study was to evaluate and compare the efficacy of erbium-doped yttrium aluminum garnet (Er:YAG) laser, neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, PrevDent nano-hydroxyapatite toothpaste plus Repairing Serum Kit (PNH), and NUPRO Sensodyne Prophylaxis Paste with NovaMin (NPP) on dentin permeability reduction. Forty dentin discs obtained from bovine incisors were divided into four study groups: Er:YAG laser-treated (2940 nm; 0.2 W, 80 mJ/pulse, 3 Hz); Nd:YAG laser-treated (1064 nm; 1 W, 10 Hz); PNH-treated; and NPP-treated groups. The quantitative changes in permeability of each dentin disc were measured using a computerized fluid filtration method (CFFM) before and after desensitizer treatments. The data were analyzed using the Wilcoxon, paired-samples t, Kruskal-Wallis, and Mann-Whitney U tests. The dentin surfaces and tubules were also morphologically detected by scanning electron microscopy (SEM). In all groups, dentin permeability was significantly reduced after the desensitizer and laser treatments (p < 0.05). Among the groups, we detected a significant difference in only when comparing the Er:YAG laser- and NPP-treated groups (p = 0.034). SEM analysis revealed physical changes in the dentin surface in all groups. This in vitro study shows that all tested desensitizers and laser treatments reduced dentin permeability. Also, surface changes, such as complete or partial occlusion or shrinkage of dentin tubules, were observed in all groups. Although the laser groups performed best, the PNH protocol can be considered as an alternative therapeutic product. In addition, clinical and laboratory studies should be performed for this product, and their efficacy should be assessed by combined therapy with lasers.

Dimensional changes in free gingival grafts: scalpel versus Er:YAG laser--a preliminary study.

The aim of this clinical study was to compare dimensional changes of the transplanted grafts when the recipient area was prepared with either erbium:yttrium, aluminum, and garnet (Er:YAG) laser or scalpel in free gingival grafts (FGGs). In the first and second groups of ten patients, the recipient area was prepared with an Er:YAG laser and a scalpel, respectively. All grafts were harvested from the palate at standard dimensions (horizontal, 14 mm; vertical, 8 mm). Probing depth, clinical attachment level, and keratinized tissue width were measured before surgery. FGG dimensions (width, length, and area) were measured using the University of North Carolina-15 manual probe (N15) (Nordent Manufacturing, Inc., IL, USA) during surgery and at 10, 21, and 90 days postoperatively. Differences between the two groups were statistically analyzed. In both groups, there was a statistically significant reduction in vertical and horizontal dimensions (p < 0.05) and graft area (p < 0.05) at all time points compared to the baseline measurements. There were no significant differences between the two groups with respect to vertical and horizontal dimensions and graft area at day 90 (p > 0.05). The Er:YAG laser may be used with similar effectiveness as the scalpel in the preparation of the recipient site for free gingival grafts.

Effects of Er:YAG laser treatments on surface roughness of base metal alloys.

We investigated the effects of different Er:YAG laser treatments on the surface roughness of base metal alloys. A total of 36 specimens were prepared of two base metal alloys (Wiron 99, Bellabond plus). The surfaces of the specimens were standardized by gradual wet grinding with 320-, 600-, 800- and 1,000-grit silicon carbide paper for 10 s each on a grinding machine at 300 rpm. Specimens of each alloy were randomly divided into six groups (n = 6) comprising a control group (group C), a group sandblasted with Al(2)O(3) powder at 60 psi for 10 s through a nozzle at a distance of 10 mm (group S), and four Er:YAG laser (Fotona AT) treatment groups. The laser treatment groups were as follows: 500 mJ, 10 Hz, 100 µs (group 500MSP); 500 mJ, 10 Hz, 300 µs (group 500SP); 400 mJ, 10 Hz, 100 µs (group 400MSP); and 400 mJ, 10 Hz, 300 µs (group 400SP). Surface roughness measurements (Ra) were performed using a profilometer. The data were analysed by two-way ANOVA, and mean values were compared using Tukey's HSD test (α = 0.05). According to the two-way ANOVA results, the base metal alloys and interaction between base metal alloy and surface treatment were not statistically significant different (p > 0.05), the surface treatments were significantly different (p < 0.0001). For the two base metal alloy groups, no significant differences were observed among the control, 400MSP, and 400SP groups (p = 0.912), and these groups demonstrated the lowest Ra values. The highest Ra value was observed in group S (p < 0.05). Er:YAG laser treatment at 400 and 500 mJ/10 Hz is not an alternative method for surface roughening of base metal alloys.

Effect of defective collagen synthesis on epithelial implant interface: lathyritic model in dogs. An experimental preliminary study.

Peri-implant mucosa is composed of 2 compartments: a marginal junctional epithelium and a zone of connective tissue attachment. Both structures consist mainly of collagen. Lathyrism is characterized by defective collagen synthesis due to inhibition of lysyl oxidase, an enzyme that is essential for interfibrillar collagen cross-linking. The lathyritic agent beta-aminoproprionitrile (ß-APN) is considered a suitable agent to disrupt the connective tissue metabolism. Therefore, the purpose of this study was to assess the effect of defective connective tissue metabolism on epithelial implant interface by using ß-APN created chronic lathyrism in the canine model. Two 1-year-old male dogs were included in this study. A ß-APN dosage of 5 mg/0.4 mL/volume 100 g/body weight was given to the test dog for 10 months, until lathyritic symptoms developed. After this, the mandibular premolar teeth (p2, p3, p4) of both dogs were atraumatically extracted, and the investigators waited 3 months before implants were placed. In the test dog, 3 implants were placed in the left mandible, and 2 implants were placed in the right mandible. In the control dog, 2 implants were placed in the left mandibular premolar site. The dogs were sacrificed 10 months after healing. Peri-implant tissues obtained from the dogs were examined histomorphologically and histopathologically. Bone to implant contact (BIC) values and bone volumes (BV) were lower in the lathyritic group compared to the control group; however, no statistical significance was found. Significant histologic and histomorphometric changes were observed in peri-implant bone, connective tissue, and peri-implant mucosal width between test and control implants. Defective collagen metabolism such as lathyrism may negatively influence the interface between implant and surrounding soft tissue attachment.

Bone response to early orthodontic loading of endosseous implants.

This study evaluated the clinical, radiographic, and histologic responses of tissues surrounding implants loaded with a heavy force of 500g for 20 weeks after a 1-week healing period. Unilateral mandibular and maxillary alveolar ridges in the premolar areas of a male dog and the bilateral mandibular alveolar ridges of a female dog were chosen for implant placement. The control implants (1 in the maxilla, 3 in the mandible) were placed in these quadrants after a 12-week healing period following extraction. The test implants (1 in the maxilla, 3 in the mandible) were implanted in the same quadrants after a 4-month osseointegration period of the control implants. Abutments were attached to the control and test implants after a 1-week healing period for the test implants. Superelastic nickel-titanium coil springs, producing a force of 500g (≈5 N), were activated between control and test implants for 20 weeks. Light microscopic assessment revealed that all implants were well integrated with the bone. Histologic analysis showed no definitive differences between test and control implants in the corticalization of bone trabeculae. The mean bone-implant contact values of the control implants for compression and tension sides were 55.99% and 64.04%, respectively. In the test implants, the bone-implant contact value was 57.27% for the compression side and 62.96% for the tension side. Potential clinical applications of these radiologic and histologic results include the possibility of minimizing the healing duration, even for high orthodontic forces, and the possibility of postorthodontic use of these implants as abutments for supporting prosthetic reconstruction.

Peripheral ameloblastoma: A case report.

BACKGROUND: Ameloblastoma is a rare tumor which develops from odontogenic epithelium and its remnants and it occurs in the jaws. Peripheral ameloblastomas are rare and benign extraooseous ameloblastomas which effects soft tissues. This case report declares a peripheral ameloblastoma which is a rare type of ameloblastoma. MATERIAL AND METHODS: 34 year old female patient referred with a complaint of a gingival growth at right lower premolar area. A firm and granular surfaced gingival growth with the color of pink and red and having 1.5x1 cm sizes was observed at the mentioned area. With an incision from lower right second incisor tooth to lower right second molar tooth a flap from bone was made and lesion was excised. After then specimen was submitted to histopathologic examination. After clinical, radiological and pathological examinations lesion was described as peripheral ameloblastoma. RESULTS: At the control examination after three months of excision there was no recurrence and patieant has no complaint. CONCLUSIONS: Although reccurens rate of peripheral ameloblastomas are low, long-term follow-ups are suggested Patient was informed about the importance of regular controls for early diagnosis of possible reccurenses and regular controls were made during one year after excision. Key words:Peripheral ameloblastoma, gingiva, gingival hyperplasia, gingival lesion, alveolar mucosa, extraosseous.

Healing of periodontal defects treated with enamel matrix proteins and root surface conditioning--an experimental study in dogs.

Application of enamel matrix proteins has been introduced as an alternative method for periodontal regenerative therapy. It is claimed that this approach provides periodontal regeneration by a biological approach, i.e. creating a matrix on the root surfaces that promotes cementum, periodontal ligament (PDL) and alveolar bone regeneration, thus mimicking the events occurring during tooth development. Although there have been numerous in vitro and in vivo studies demonstrating periodontal regeneration, acellular cementum formation and clinical outcomes via enamel matrix proteins usage, their effects on the healing pattern of soft and hard periodontal tissues are not well-established and compared with root conditioning alone. In the present study, the effects of Emdogain (Biora, Malmö, Sweden), an enamel matrix derivative mainly composed of enamel matrix proteins (test), on periodontal wound healing were evaluated and compared with root surface conditioning (performed with 36% orthophosphoric acid) alone (control) histopathologically and histomorphometrically by means of the soft and hard tissue profile of periodontium. An experimental periodontitis model performed at premolar teeth of four dogs were used in the study and the healing pattern of periodontal tissues was evaluated at days 7, 14, 21, 28 (one dog at each day), respectively. At day 7, soft tissue attachment evaluated by means of connective tissue and/or epithelial attachment to the root surfaces revealed higher connective tissue attachment rate in the test group and the amount of new connective tissue proliferation in the test group was significantly greater than the control group (p<0.01). New bone formation by osteoconduction initiated at day 14 in the test and control group. At day 21, the orientation of supra-alveolar and PDL fibers established, and new cementum formation observed in both groups. At day 28, although regenerated cementum was cellular in all of the roots in the control samples, an acellular type of cementum (1.32+/-0.83 mm in length and 3.16+/-0.23 microm in width) was also noted in six roots of test samples with an inconsistent distribution on the root surfaces. The amount of new cementum was significantly higher in the test group than the control group samples (p<0.01). The width of the cellular cementum in the control group was more than the cellular cementum in the test group, but the difference was not statistically significant (p>0.05). A firm attachment of acellular cementum to the root dentin with functional organization of its collagen fibers was noted, and, the accumulation and organization of cellular cementum in the control group was more irregular than the cellular cementum formed in the test group. The amount of new bone was 2.41+/-0.75 mm in the test and 1.09+/-0.46 mm in the control group at day 28. The rate of bone maturation (the number of osteons) was found higher in the test group (10.75+/-0.85) than the control group (5.50+/-0.86). Under the limitations of the study, our results reveal that when compared with root surface conditioning, enamel matrix proteins have more capacity for stimulating periodontal regeneration via their positive effects on root surfaces, i.e. inhibition of gingival epithelium down growth and stimulation of connective tissue proliferation and attachment to the root surfaces during wound healing. An acellular type of cementum regeneration and new alveolar bone formation by an accelerated osteoconductive mechanism are also achieved with application of enamel matrix proteins.

Rare lesions of the oral cavity: case report of an actinomycotic lesion limited to the gingiva.

Actinomycosis is an infectious disease that frequently has chronic granulomatous and suppurative lesions caused by saprophytic Actinomyces species. Although cervicofacial actinomycosis is known to be the most common type, intraorally and periodontally types occur rarely in a localized fashion. The present case reports on an adult periodontitis patient with a diffuse and atypic actinomycotic lesion which was limited to the gingiva and had an abscess formation, a large desquamation and subsequent exposure of the alveolar bone in the involved region. Diagnosis was based on histopathological examination, the history of the case and clinical nature of the lesion. The patient responded to daily administration of 100 g doxcycycline (first day-bid) for 3 weeks and 0.2% chlorhexidine gluconate irrigation (following tooth brushing) performed with oral hygiene reinforcement and periodontal debridement procedures. Complete improvement of the lesion was observed after 5 weeks. Due to the opportunistic characteristics of the actinomycotic infection, early and adequate differential diagnosis of actinomycosis prior to therapeutic attempts, as well as management steps, are of great importance in the oral cavity to prevent the spread of the disease.

Multiple pulp stones: a case report.

Pulp stones are usually found in the pulp chamber. Radiographically, they appear as radiopaque structures in the pulp chambers or root canals of individual teeth. Generalized pulp stones throughout the dentition are usually associated with systemic or genetic disorders of the dentine. This report presents an unusual case of a 13-year-old girl with generalized pulp stones with clinically normal crowns. The patient's main complaint was a crossbite affecting all permanent canines. Radiographic examination revealed multiple pulp stones and several teeth with atypically shaped roots. Orthodontic treatment, gingivoplasty, and esthetic restorations were performed, thus using a multidisciplinary approach to establish functionally and esthetically sound dentition.

Comparison of 2 flap designs in the periodontal healing of second molars after fully impacted mandibular third molar extractions.

PURPOSE: This investigation compared the effects of different flap designs on the periodontal health status of the mandibular second molar after the extraction of the adjacent impacted third molar. PATIENTS AND METHODS: Eighteen patients aged 16 to 32 years who required removal of bilateral impacted mandibular third molars were included in this study. The periodontal health of the second molar was evaluated preoperatively and at 1 week, 2 weeks, 4 weeks, and 12 months postoperatively. The third molars were removed by using the 3-cornered flap on the left side of the jaw and modified Szmyd flap on the right side. RESULTS: The mean probing depth (PD) at distal and buccal sites was significantly different between the flaps at 1 week, 2 weeks, and 4 weeks postoperatively (P < .05). There were no significant differences in preoperative and 1 year postoperative mean PD between the 2 flaps (P > .05). There was no significant difference in mean clinical attachment level between the flap sites at 1 year (P > .05). CONCLUSION: The modified Szmyd flap, which leaves intact gingiva around the second molar, has better primary periodontal healing than the 3-cornered flap after surgical removal of the fully impacted mandibular third molar.

Comparison of the proliferative activity in gingival epithelium after surgical treatments of intrabony defects with bioactive glass and bioabsorbable membrane.

Guided tissue regeneration is based on preventing the more rapidly proliferating epithelium from growing into the periodontal defect after surgical procedures incorporating barrier membranes. The aim of this study was to compare the proliferative activity of gingival epithelium using proliferating cell nuclear antigen (PCNA) as a marker of cell proliferation after surgical treatments with bioactive glass graft material and bioabsorbable membrane. Using split mouth design, 20 intrabony defects were randomly assigned treatments with bioactive glass (BG group) or bioabsorbable membrane (BM group). Gingival biopsies were taken at preoperative and postoperative 12 weeks. After histological processing, the number of the inflammatory cells was measured in hematoxylin and eosin-stained sections; PCNA expression was determined in immunohistochemically-stained sections. At postoperative 12 weeks, the number of the inflammatory cells was significantly decreased (p < 0.01), PCNA expression was significantly increased (p < 0.001) in both treatment groups compared to baseline data. There was no significant difference in PCNA expression between baseline values of two groups (p > 0.05), while at postoperative 12 weeks, increase in BG group was significantly greater than that in BM group (p < 0.001). These results suggest that epithelial cell proliferation is more prominent after treatment of intrabony defects with bioactive glass compared to the treatment with bioabsorbable membrane.

An assessment of oral self-care in the student population of a Turkish university.

OBJECTIVES: The aim of this study was to determine the oral health behavior of Turkish non-dental university students. STUDY DESIGN AND METHODS: A sample of 610 non-dental university students attending the University of Ondokuz Mayis in Samsun were randomly selected from the whole student population (n=12604) via the random number method. The students were asked to fill out a standardized self-completion questionnaire about daily frequency of toothbrushing, kind of toothbrush, frequency of toothbrush replacement, frequency of dental flossing, use of antibacterial rinse, or any other oral hygiene aid, receiving of oral hygiene instruction and frequency of oral check-up. The data were analysed using the SPSS version 12.0.1 statistical software package. RESULTS: Sixty-eight per cent of the students brushed their teeth two or more times per day. Two or more times a day toothbrushing was more common among females than males (P<0.001). Few subjects (3%) used dental floss daily. Forty per cent of students used only the toothpick as an interdental oral hygiene device. Thirty per cent of the students visited a dentist for preventive treatment at least once a year. There was no significant difference in regularity of visits to the dentist between females and males (P>0.05). CONCLUSION: This study indicated that self-preventive oral behaviour of the Turkish university student is at a lower level than in industrialized countries.