Effects of enamel matrix derivative on non-surgical management of peri-implant mucositis: a double-blind randomized clinical trial.

BACKGROUND: Peri-implant diseases have been recognized as being among the ever-increasing complications related to dental implants. The aim of this study was to evaluate the adjunctive use of enamel matrix derivative (EMD) to mechanical debridement (MD) in patients with these conditions in terms of clinical parameters and cytokine levels of peri-implant crevicular fluid (PICF). METHODS: In the present double-blind clinical trial, 46 patients with peri-implant mucositis (PM) were randomly divided into control and test groups. Two different therapeutic protocols, consisting of non-surgical MD alone (control group) and MD with the application of EMD (test group), were considered for the two groups. Clinical parameters [bleeding on probing (BOP) and probing depth (PD)] and sampling from PICF were carried out before treatment and 3 months postoperatively. The levels of IL-6 and IL-17 cytokines in PICF were evaluated by enzyme-linked immunosorbent (ELISA). RESULTS: Three-month post-interventional assay revealed significant improvements in BOP and PD in the test group in comparison to the control group (P < 0.0001). Relative to control, IL-6 and IL-17 levels were reduced significantly (p < 0.05) in the test group compared to the control group. CONCLUSION: Application of EMD can be considered an adjunct to MD in the non-surgical treatment of PM. However, complete recovery was not observed using either treatment approach showing that management of implant-associated disease is still a significant clinical problem.

Effect of photodynamic therapy as an adjunctive to mechanical debridement on the nonsurgical treatment of peri-implant mucositis: A randomized controlled clinical trial.

Background: The use of photodynamic therapy (PDT) has been evaluated as an adjunctive technique for bacterial decontamination of implants with peri-implantitis. Given the controversies over the efficacy of the application of PDT to treat peri-implant diseases, the present clinical study aimed to evaluate the posttherapeutic clinical parameters and cytokine levels in peri-implant crevicular fluid in patients with peri-implant mucosal inflammation, receiving mechanical debridement (MD) alone or in association with PDT. Materials and Methods: In this double-blinded randomized clinical trial, 52 patients with peri-implant mucosal inflammation were selected and they were randomly assigned to 2 treatment groups: a MD group and an MD + PDT group using an 805 nm laser and indocyanine green (ICG). Although the decrease in bleeding on probing was the primary outcome, pocket depth, PUS, pain on probing, clinical attachment level, gingival recession, tumor necrosis factor-α, interleukin (IL)-1ß, IL-6 and matrix metalloproteinase-8 were also evaluated at baseline, 2-week, and 3-month postintervention. Repeated measure analysis of variance was used to analyze inter-group differences and a P ≤ 0.05 was considered for significant differences between tested parameters. Results: Statistically significant improvements (P < 0.001) were detected for all variables after comparison of baseline data with those collected at each time interval of the study. Nevertheless, the inter-group comparisons of these variables between the baseline, 2-week, and 3-month intervals did not reveal any significant decrease in sites treated with either MD alone or MD + PDT. Conclusion: The application of PDT using 805-nm laser and ICG as an adjunct therapy to MD did not provide any additional improvements in the clinical or biologic parameters of peri-implant mucosal inflammation.

Effect of Light Emitting Diode Photobiomodulation on the Stability of Dental Implants in Bone Grafted Cases: a Split-Mouth Randomized Clinical Trial.

Introduction: The high success rate of implants has made implant-based prostheses attractive to edentulous patients. Osseointegration lasts 4-6 months, increasing to 6-8 months in cases requiring bone grafts and guided bone regeneration. Many efforts have been made to accelerate osseointegration, including low level laser (LLL) and light emitting diode (LED) photobiomodulation. Material and methods:Twelve patients underwent bimaxillary immediate implant surgery with particulate bone grafts between the socket wall and the implant, and the transmucosal abutment was attached on implants at the same time. The intervention side was exposed to LED radiation for 20 minutes a day one day preoperatively and 10 consecutive sessions, starting from the day of surgery. A trained operator measured and recorded the implant stability quotient (ISQ) value on both sides immediately after surgery as well as one month and three months postoperatively. Results: The ISQ value was 37.54 on the non-irradiated side immediately after surgery; it decreased to 35.09 one month postoperatively and increased to 46.45 at three months after the operation. The ISQ value was 36.73 on the irradiated side immediately after surgery and it increased to 47.36 and 71.18 at one month and three months postoperatively, respectively. There were significant differences between the ISQ values on the irradiated side at all the three time intervals, but also a significant difference on the non-irradiated side, except for two other two time intervals of immediately and one month after surgery. Although there was no significant difference between the two sides in terms of the ISQ value immediately after surgery, the ISQ value was significantly higher on the irradiated versus non-irradiated side at one month and three months postoperatively. Conclusion:Low level laser radiation resulted in a favorable increase in the ISQ value in three months. Light emitting diode has lso led to a clinically significant increase in the ISQ value after three months because implants with ISQ values >54 could be loaded.

Corrigendum: Microbiological and clinical effects of enamel matrix derivative and sustained-release micro-spherical minocycline application as an adjunct to non-surgical therapy in peri-implant mucosal inflammation.

[This corrects the article on p. 181 in vol. 41, PMID: 26339576.].

Microbiological and clinical effects of enamel matrix derivative and sustained-release micro-spherical minocycline application as an adjunct to non-surgical therapy in peri-implant mucosal inflammation.

OBJECTIVES: The purpose of this study was to compare the microbial and clinical effects of mechanical debridement (MD) alone or in combination with the application of enamel matrix derivative (EMD) and sustained-release micro-spherical minocycline (MSM) for treatment of peri-implant mucosal infl ammation (PIMI). MATERIALS AND METHODS: Subjects with at least one implant with PIMI were included and divided into control and two different test groups. In all three groups, MD was performed. In the MSM group, following MD, MSM was placed subgingivally around the implants. In the EMD group, after MD, EMD was placed in the sulcus around the implants. Sampling of peri-implant crevicular fl uid for microbial analysis with real-time polymerase chain reaction and recording of probing depth (PD) and bleeding on probing (BOP) were performed prior to as well as two weeks and three months after treatment. Median values and interquartile range were estimated for each variable during the various assessment intervals of the study. RESULTS: In all groups, at two weeks and three months, the counts of Porphyromonas gingivalis decreased significantly compared to baseline. Levels of P. gingivalis were significantly reduced in MSM (P<0.001) and EMD (P=0.026) groups compared to the control group. Also, clinical parameters improved significantly at two weeks and three months. Reduction of PD was significant in MSM (P<0.001) and EMD (P<0.001) groups. The decrease in BOP in the MSM, EMD, and control groups was 60%, 50%, and 20%, respectively. CONCLUSION: The use of MSM and EMD can be an adjunctive treatment for management of PIMI and improves clinical parameters and reduces P. gingivalis burden three months after treatment.

Effects of photodynamic therapy on clinical and gingival crevicular fluid inflammatory biomarkers in chronic periodontitis: a split-mouth randomized clinical trial.

BACKGROUND: There are limited clinical experiments addressing the effects of photodynamic therapy (PDT) as an adjunct to conventional scaling and root planing (SRP) on clinical and biologic features of periodontitis. This trial compares the clinical parameters and cytokine profiles in gingival crevicular fluid of patients with moderate-to-severe chronic periodontitis (CP) who have been treated using SRP alone or SRP + PDT. METHODS: Twenty-two patients with two contralateral teeth affected with moderate-to-severe CP were selected. After SRP, the participants' teeth were randomized to receive either no further treatment or a single application of PDT using a 638-nm laser and toluidine blue. Although the change in probing depth was the primary outcome, bleeding on probing, clinical attachment level, gingival recession, interleukin-1ß, tumor necrosis factor (TNF)-α, and matrix metalloproteinase 8 and 9 were also evaluated at baseline and 3 months postintervention. An oral rinse assay was also performed to determine the total levels of oral polymorphonuclear cells (PMNs) before and 3 months after the treatments. RESULTS: Within each group, significant improvements (P <0.001) were found for all variables in 3-month follow-up compared with baseline. Only TNF-α was significantly improved in the PDT + SRP versus SRP group. Total levels of PMNs were reduced for all patients compared with baseline levels (P <0.001). CONCLUSION: In patients with CP, a single application of PDT (using a 638-nm laser and toluidine blue) did not provide any additional benefit to SRP in terms of clinical parameters or inflammatory markers 3 months following the intervention.

The effect of interleukin 36 gene therapy in the regression of tumor.

BACKGROUND: Cancer immunotherapy attempts to stimulate the immune system to reject and destroy tumors and is one of the cancer treatment strategies. Recently, interluekin36 (IL36) has been used as immunotherapeutic agents in cancer gene therapy. Present study investigated that the IL36 gene therapy effects on the regression of tumor masses in mouse model. Aim of this study is determination of the gene therapy effects by IL36 in the regression of tumor masses in mouse model. METHODS: To study the therapeutic efficacy of this cytokine, WEHI-164 tumor cells were transected with mIL36 plasmids. ELISA test was used to check cytokine production by transected cells. To establish fibro sarcoma mouse model, Tumoral transfected cells were injected subcutaneously to inoculate tumor in BALB/C mice. Tumor volumes were measured by caliper. Mice were sacrificed and tumors were extracted. The expression of IL36 and IFN-γ was studied with Real-time PCR and immunoblotting. The expression of Ki-67 (a tumor proliferation marker) in tumor masses was studied by immunohistochemistry staining. In this study we had 2 groups which are treated with IL-36 and Untreated with IL-36 as a blank. RESULTS: The group treated with IL36 indicated decrease of tumor mass volume (p<0.001). The results of western blotting and real-time PCR showed the IL36 expression increased in the group treated with IL36 (with relative expression of 1.9). CONCLUSION: Immunohistochemistry staining indicated that the Ki-67expression has been reduced in the group interfered with IL36. IL36 gene therapy has therapeutic effects on the regression of tumor masses in fibro sarcoma mouse model.

Efficacy of Subgingival Application of Xanthan-based Chlorhexidine Gel Adjunctive to Full-mouth Root Planing Assessed by Real-time PCR: A Microbiologic and Clinical Study.

BACKGROUND AND AIMS: The aim of this clinical investigation was to compare clinical and microbiological effectiveness of adjunctive CHX gel in the treatment of periodontitis. MATERIALS AND METHODS: Twenty-four subjects with localized or generalized moderate-to-severe chronic periodontitis underwent scaling and root planing. One tooth in each quadrant with a probing depth of >4 mm was chosen for combined gel and SRP, with contralateral tooth as control (SRP treated site). Clinical assessment was carried out at baseline and 1 and 3 months later; microbial assessment was performed by real-time PCR. Periodontal probing depth (PPD) was considered as primary outcome. RESULTS: Twenty patients completed the study. Baseline PPDs were 4.90±0.78 and 5.05±0.79 in the SRP and gel groups, respectively (P>0.05), which decreased to 3.67±0.59 and 3.7±0.83 one month after treatment and 3.25±0.65 and 3.38±0.79 three months after treatment. Although values decreased significantly in both groups after one and three months (P=0.001 in the SRP and P=0.001 in the gel group), the inter-group difference was not significant neither at one-month (P=0.47) nor at three-month (P=0.77) intervals. The only clinical parameters exhibiting statistically significant inter-group differences was BOP in both one-month (P=0.004) and three-month (P=0.0001) intervals. All the other clinical measurements showed significant decreases after one and three months in both sites but without inter-group differences. CONCLUSION: Subgingival application of xanthan chlorhexidine gel combined with scaling and root planing reduced bleed-ing of periodontal pockets. Clinical trials to evaluate effectiveness of this gel in aggressive and severe periodontitis modified by systemic factors are suggested.

Comparison of pain intensity of anterior middle superior alveolar injection with infiltration anesthetic technique in maxillary periodontal surgery.

PURPOSE: The aim of the present clinical trial was to compare pain during injection of anterior middle superior alveolar (AMSA) technique with that of infiltration injection technique in the maxilla in periodontal flap surgeries of patients referring to the Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Sciences. METHODS: Twenty subjects with an age range of 20 to 40 years were selected for the present study. One side of the maxilla was randomly selected as the test side and the other as the control side using a flip of a coin. AMSA technique was used on the test side and infiltration technique was used on the control side for anesthesia. On both sides 2% lidocaine containing 1:80,000 epinephrine was used for anesthesia. The operator obtained the visual analogue scale for each patient immediately after the injection and immediately after surgery. Data was analyzed using descriptive statistical methods (frequency percentages, means and standard deviations) and Wilcoxon's test using SPSS ver. 13 (SPSS Inc.). Statistical significance was defined at P<0.05. RESULTS: There were no statistically significant differences in pain during injection between the two techniques (P=0.856). There were statistically significant differences in postoperative pain between the two injection techniques (P=0.024). CONCLUSIONS: Postoperative pain in AMSA injection technique was less than that in the infiltration technique. Therefore, the AMSA technique is preferable in the periodontal surgeries for the anesthesia of palatal tissues given the fact that it has other advantages, too.

Subepithelial connective tissue graft with and without the use of plasma rich in growth factors for treating root exposure.

PURPOSE: The aim of this study was to evaluate the clinical efficiency of the subepithelial connective tissue graft (SCTG) with and without plasma rich in growth factor (PRGF) in the treatment of gingival recessions. METHODS: Twenty bilateral buccal gingival Miller's Class I and II recessions were selected. Ten of the recessions were treated with SCTG and PRGF (test group). The rest ten of the recessions were treated with SCTG (control group). The clinical parameters including recession depth (RD), percentage of root coverage (RC), mucogingival junction (MGJ) position, clinical attachment level (CAL), and probing depth (PD) were measured at the baseline, and 1 and 3 months later. The data were analyzed using the Wilcoxon signed rank and Mann-Whitney U tests. RESULTS: After 3 months, both groups showed a significant improvement in all of the mentioned criteria except PD. Although the amount of improvement was better in the SCTG+PRGF group than the SCTG only group, this difference was not statistically significant. The mean RC was 70.85±12.57 in the test group and 75.83±24.68 in the control group. CONCLUSIONS: Both SCTG+PRGF and SCTG only result in favorable clinical outcomes, but the added benefit of PRGF is not evident.

Evaluation of gram negative bacterial contamination in dental unit water supplies in a university clinic in tabriz, iran.

BACKGROUND AND AIMS: Bacterial contamination of dental unit water supplies (DUWS) has attracted a lot of attention in recent years due to the emergence of serious infectionsin susceptible dental patients. The aim of the present study was to evaluate the presence of gram-negative bacterial contamination in DUWS at Tabriz University of Medical Sciences Faculty of Dentistry. MATERIALS AND METHODS: This descriptive study was carried out on 51 active dental units in different departments. Con-tamination was determined by taking samples from the unit's water supply before dental procedures and the use of specific culture media. The cultures were evaluated after 48 hours. RESULTS: Gram-negative bacterial contamination was identical in all the departments. In the departments on the ground floor, namely Departments of Periodontics and Oral and Maxillofacial Surgery, Pseudomonas contamination was observed in 71% of units; in the departments on the first floor, namely Departments of Prosthodontics, Orthodontics and Pedodon-tics, 46.8% of the units had Pseudomonas contamination; and in the departments on the second floor, namely Departments of Operative Dentistry and Endodontics, 37.7% of the units demonstrated Pseudomonas contamination. CONCLUSION: Gram-negative bacterial contamination was evident in the evaluated DUWS. The contamination type was identical but the number of contaminated units decreased with the increase in the height of the floors.

Clinical evaluation of reasons for replacement of amalgam restorations in patients referring to a dental school in iran.

BACKGROUND AND AIMS: The present study evaluated the most common reasons for replacing amalgam restorations in a university clinic. MATERIALS AND METHODS: A total of 217 restorations which needed to be replaced were clinically and radiographically evaluated in a period of 4 months. The frequencies of reasons for replacing amalgam restorations were calculated: The assessed items included recurrent caries, tooth structure fracture (functional or non-functional cusps), amalgam bulk fracture, amalgam marginal fracture, proximal overhangs, and esthetics. Data were analyzed using Fischer's exact test. RESULTS: Both in vital teeth and teeth which had undergone root canal therapy, the most common reason for amalgam replacement was cusp fracture, with the fracture of non-functional cusps being statistically significant. Recurrent caries was the second most common reason for amalgam replacement. In Class I restorations, the most common reasons were recurrent caries and esthetics, with no statistical significance. The most frequent problem in Class II restorations was fracture of non-functional cusps, with a statistical significance in three-surface restorations. CONCLUSION: According to the results, failing to reduce undermined cusps and neglectful caries removal are the reasons for majority of amalgam restoration replacements. These issues should be emphasized in the curriculum for dental students and continuing education courses.

Influence of the display monitor on observer performance in detection of dental caries.

BACKGROUND AND AIMS: Digital imaging continues to gain acceptance in dentistry and video display used for this becomes important. The aim of this study was to assess the influence of the display monitor on observer performance on caries detection. MATERIALS AND METHODS: Artificial enamel lesions were created in 40 extracted teeth at random using 1/4 and 1/2 round burs. Teeth were mounted in dental stone blocks to simulate a hemi-dentition. Approximate exposures were recorded at 70 kVp using a Planmeca (Planmeca Co, Helsinki, Finland) digital imaging system. Three oral and maxillofacial radiologists rated each image on a five-point scale for the presence or absence of lesion. Radiographic images were viewed on the following monitors: (1) LG Flatron 700p (LG Electronics Co., South Korea); (2) Samsung Magicgreen (Samsung Electronics Corp., South Korea); (3) Hansol 710p (Hansol Electronics Corp., South Korea) and (4) Toshiba satellite laptop (Toshiba Computer Corp., Philippines). Examiners were allowed to magnify and adjust density and contrast of each image at will. Receiver Operating Characteristic (ROC) analysis was performed. Data was subjected to repeated measures analysis of variance and ordinal logistic regression to test for significance between variables and to determine odds ratios. RESULTS: Mean ROC curve areas ranged from 0.8728 for the LG monitor to 0.8395 for the Samsung. Repeated measures analysis of variance showed significant differences between observers (P<0.0001), lesion size (P<0.0001), examiner/monitor interaction (P<0.033) and examiner/block interaction (P<0.013). However, no significant difference was found between monitors. CONCLUSION: This study suggests that observer performance is independent of the visual characteristics of the display monitor.