Morphological Changes Caused by Streptozotocin-Induced Diabetes in the Healthy Gingiva of Rats.

BACKGROUND AND OBJECTIVE: Epidemiologic and clinical studies have indicated that diabetes is a risk factor for periodontal disease progression. The aim of the present study was to evaluate the morphological changes of gingiva in streptozotocin diabetic rats. MATERIAL AND METHODS: 30 male Wistar rats that weighed 250-300 g were used in this study. The animals were randomly divided into 2 groups, one with streptozotocin-induced diabetes and another one with healthy (non-diabetic) animals. All rats were sacrificed after 21 days, and their maxillary first molars with surrounding tissues were observed morphological analyses. RESULTS: In this study, it was observed that the epithelial thickness was greater in the diabetes group, compared to the control group. The statistical comparison of the diabetes and control groups for the thickness of each of the layers of the epithelium demonstrated that the thickness of the keratinized (corneum), granular and basal layers had significantly increased in the diabetic animals. Furthermore, the diabetes group displayed a decrease in the height of the connective tissue papillae, which was found to be statistically insignificant. Another important finding detected in the diabetes group was the congestion of the gingival capillaries, which showed that blood circulation is impaired in diabetes cases. CONCLUSION: On the basis of the results obtained in this study, it was concluded that streptozotocin-induced diabetes may increase predisposition to periodontal disease by causing morphological changes in the periodontal tissues.

A 48-month clinical evaluation of fissure sealants placed with different adhesive systems.

AIM: To compare the retention rates of a nanofilled occlusal fissure sealant placed with the use of an etch-and-rinse or a self-etch adhesive over 48 months. MATERIALS AND METHODS: The authors enrolled 244 teeth, each with no restoration or sealant and no detectable caries, from 16 patients. The sealants were placed with Solobond M two-step etch-and-rinse adhesive or Futurabond NR one-step self-etch adhesive by four previously calibrated dentists using a table of random numbers. After completion of the adhesive application, a nanofilled sealant, Grandio Seal, was applied and light-cured. Two other calibrated examiners, who were unaware of which adhesive had been used, independently evaluated the sealants at baseline and at 12-, 24-, 36-, and 48-month recalls. Each sealant was evaluated in terms of caries formation being present or absent and retention using the following criteria: 1 = completely retained, 2 = partial loss, and 3 = total loss. The Pearson χ (2) test was used to evaluate differences in retention rates among the sealants used with different adhesives for each evaluation period. RESULTS: The retention rates for sealants in the Solobond M group were significantly higher than those in the Futurabond NR group in all periods of evaluation (p<0.05). No statistically significant difference between the retention rates for premolars and molars was found at each evaluation period (p>0.05). There was no new caries formation throughout the 48-month recall period. CONCLUSION: Fissure sealants placed with etch-and-rinse adhesive showed better retention rates than those placed with self-etch adhesive.

The effect of bleaching systems on the gingiva and the levels of IL-1ß and IL-10 in gingival crevicular fluid.

OBJECTIVE: This study aimed to evaluate the color change and clinical periodontal parameters and to analyze the interleukin­1 beta (IL-1ß) and interleukin-10 (IL-10) levels in gingival crevicular fluid (GCF) of patients treated with different bleaching systems. MATERIALS AND METHODS: According to pre-established criteria, 30 healthy volunteers were selected and randomly divided into three groups (n=10): G1, home bleaching (Opalescence 35% Carbamide Peroxide, CP); G2, chemically activated office bleaching (Opalescence Xtra Boost 38% Hydrogen Peroxide, HP); G3, light-activated office bleaching (Opalescence Xtra 35% HP). Treatments were applied according to the manufacturer's recommendations. After shade evaluation, clinical periodontal parameters were evaluated as follows: gingival index (GI), plaque index (PI), and bleeding on probing (BOP). GCF were collected from six maxillary sites per patient at baseline (T0), one day (T1) after bleaching treatments, and 15 days (T2) after bleaching treatments and analyzed for IL-1ß and IL-10 by enzyme-linked immunosorbent assay. Data were subjected to statistical analysis (p<0.05). RESULTS: Spectrophotometer readings exhibited significant differences among the groups (p<0.05). The ΔE values (color change) of G3 were statistically higher than the other groups (p<0.05). The PI of G3 after 15 days was significantly higher than the PI of G2 after 15 days (p<0.05). The GI of G2 was lower than that of G1 and G3 before bleaching (p<0.05). According to BOP, no significant differences were found among the groups at any time intervals (p>0.05). In G3, the total amount of IL-1ß after 15 days was higher than the amount before bleaching (p<0.05). The IL-10 total amount and concentration levels did not exhibit any significant differences among the groups or by time (p>0.05). CONCLUSION: Home and chemically activated bleaching systems could be considered as safer in tooth whitening and maintaining gingival health when compared with a light-activated bleaching system, which might lead to increased proinflammatory cytokine (IL-1ß).

Chemical analysis of enamel and dentin following the application of three different at-home bleaching systems.

PURPOSE: To determine the change in the chemical composition of enamel and dentin as well as to evaluate the differences in surface texture of the same dental hard tissues following three at-home bleaching systems in vitro. METHODS: Sixty extracted intact human anterior teeth were used in this study. Thirty teeth were used as samples for enamel, and the buccal surfaces of the remaining 30 teeth were abraded and used as dentin samples. Prior to bleaching treatments, calcium (Ca), phosphorus (P), potassium (K), sodium (Na), magnesium (Mg), fluoride (F), and oxygen (O) levels of each sample were measured using an energy dispersive spectrometer. The teeth were then randomly allocated into three groups according to the bleaching system used, as follows: GI, 10% carbamide peroxide (CP); GII, 20% CP; GIII, and 35% CP. Following the bleaching treatments, Ca, P, K, Na, Mg, F, and O measurements were repeated. The surface configurations were examined using scanning electron microscopy (SEM). The data were analyzed using Wilcoxon signed rank and Kruskal-Wallis tests followed by the Dunn test. RESULTS: All three bleaching systems tested caused similar changes in the chemical composition of enamel and dentin. Bleaching systems decreased Ca and K, while F and O levels increased in enamel. In dentin, Ca, P, and K levels decreased; however, Na, F, and O levels increased. SEM observations revealed no deleterious effect on enamel and dentin. CONCLUSION: The use of home bleaching agents could affect the chemical composition of dental hard tissues, whereas the change in the chemical composition of enamel and dentin was not affected by the CP concentration of the bleaching systems used.

Significance of elevated gingival crevicular fluid tumor necrosis factor-alpha and interleukin-8 levels in chronic hemodialysis patients with periodontal disease.

BACKGROUND AND OBJECTIVE: The prevalence of chronic renal disease in industrialized countries is increasing, and chronic renal disease and periodontitis can have significant, reciprocal effects. The aim of this study was to evaluate the associations between specific clinical parameters and the levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-8 (IL-8) in the gingival crevicular fluid of hemodialysis (HD) patients with periodontal disease. MATERIAL AND METHODS: Forty-three HD patients and 43 systemically healthy subjects were enrolled in this study. Plaque index (PI), gingival index (GI) and pocket depth were used to determine periodontal status. Venous blood samples were obtained from each patient in the morning before the dialysis session and analyzed to determine the levels of inflammatory, biochemical and hematological parameters. Gingival crevicular fluid was collected from all subjects, and the levels of TNF-alpha and IL-8 were determined in the gingival crevicular fluid samples. RESULTS: The following results were obtained from HD patients and controls: TNF-alpha (pg/mL), 31.40 +/- 1.46 and 3.06 +/- 0.15 (p < 0.001); IL-8 (pg/mL), 90.98 +/- 94.03 and 35.05 +/- 16.86 (p < 0.001); PI, 1.69 +/- 1.02 and 0.04 +/- 0.02 (p < 0.001); GI, 0.82 +/- 0.06 and 0.04 +/- 0.02 (p < 0.001); and pocket depth, 2.23 +/- 0.63 and 1.51 +/- 0.05 (p < 0.001), respectively. In addition, there were positive correlations between TNF-alpha and PI (r = 0.642, p < 0.001), between TNF-alpha and GI (r = 0.565, p < 0.001), between TNF-alpha and pocket depth (r = 0.522, p < 0.001), between IL-8 and PI (r = 0.402, p = 0.002), between IL-8 and GI (r = 0.396, p = 0.002), and between IL-8 and pocket depth (r = 0.326, p = 0.012). There were negative correlations between albumin and PI (r = -0.491, p < 0.001), albumin and GI (r = -0.406, p < 0.001), albumin and pocket depth (r = -0.464, p < 0.001) and albumin and CRP (r = -0.467, p = 0.002) and between the gingival crevicular fluid levels of TNF-alpha and IL-8, TNF-alpha and hemoglobin (r = -0.745, p < 0.001; r = -0.285, p < 0.05) (respectively). CONCLUSION: The levels of TNF-alpha and IL-8 in gingival crevicular fluid were significantly higher in HD patients than in controls. There were strong, positive correlations between clinical periodontal parameters and the levels of inflammatory cytokines in gingival crevicular fluid from the HD patients.

The effect of periodontal therapy on serum TNF-alpha and HbA1c levels in type 2 diabetic patients.

BACKGROUND: To determine the effect of non-surgical periodontal therapy on serum TNF-alpha and HbA1c levels in poorly and well-controlled type 2 diabetic patients. METHODS: In total, 45 patients were enrolled in the study; 30 patients with type 2 diabetes mellitus with periodontitis (15 with poorly controlled diabetes, HbA1c >or= 7%, group 1A and 15 with well-controlled diabetes, HbA1c < 7%, group 1B) and 15 patients that were systemically healthy with periodontitis (group 2). The plaque index, gingival index, probing depth, clinical attachment loss, gingival bleeding index, HbA1c value, and circulating TNF-alpha concentration were measured at baseline and three months after the non-surgical periodontal therapy. RESULTS: All periodontal parameters and serum TNF-alpha levels were significantly decreased three months after the non-surgical periodontal therapy compared to the baseline values in all groups. The HbA1c values were significantly decreased only in well-controlled diabetic patients. We found no significant differences in the periodontal parameters or TNF-alpha levels at baseline and after three months between the two groups. CONCLUSIONS: Although non-surgical periodontal therapy eliminates local/systemic infection and inflammation via decreases in TNF-alpha, it is insufficient for significantly reducing HbA1c levels without strict glycaemic control in poorly controlled diabetic patients in a short time period.

Resolution in partially accomodative esotropia during occlusion treatment for amblyopia.

PURPOSE: To evaluate alignment changes in partially accommodative esotropia during occlusion treatment for amblyopia. METHOD: Changes at the deviation angles of 63 partially accommodative esotropia patients, who had occlusion treatment for amblyopia, were evaluated retrospectively. RESULTS: Mean deviation angle at the start of therapy without glasses was 45 PD (10-90 PD) and became 27 PD (5-70 PD) after at least 2 months with glasses. During 12 (2-36) months of occlusion period, mean manifest deviation angle with glasses decreased to 11 PD (0-50) (P < 0.001) and amblyopia resolved in 71.5% of the cases. After termination of amblyopia treatment 24 (38%) cases had surgery for the residual deviation but if we had planned surgery before amblyopia treatment, 81% of the patients would have had surgery. DISCUSSION: Should amblyopia be treated initially or should we operate first in patients with strabismus and amblyopia together? Our research suggests that we should not hurry to operate in high hypermetropic partially accommodative cases, which have amblyopia and a long-term history of strabismus. Initial amblyopia treatment in these cases allows time for resolution of the nonaccomodative component in strabismus and can significantly decrease the necessity for surgery.

The sensitivity and specificity of 0.5% apraclonidine in the diagnosis of oculosympathetic paresis.

AIMS: To evaluate the sensitivity and specificity of 0.5% apraclonidine test in the diagnosis of oculosympathetic paresis (OSP). METHOD: Apraclonidine (0.5%) was administered to 31 eyes, nine with a diagnosis of Horner syndrome (HS), 22 with bilateral OSP caused by diabetes, and to 54 control eyes. All were confirmed with the cocaine test. The effects on pupil diameter and upper eyelid level were observed 1 hour later. RESULTS: Apraclonidine caused a mean dilation of 2.04 mm (range 1--4.5) (p<0.001) in the pupils with OSP and it caused pupillary constriction in the control eyes with a mean change of -0.14 mm (range 0.5 to --1) (p<0.05). It caused reversal of anisocoria in all HS cases. Its effects on both pupil diameters and upper lid levels differed significantly between the groups (p<0.001). The mean elevation in the upper lid was 1.75 mm (range 1--4) in the OSP group (p<0.001) and 0.61 mm (range 0--3) in the control group (p<0.001). CONCLUSION: The effect of the apraclonidine (0.5%) test on the pupil diameter was diagnostic for OSP and had at least the same sensitivity and specificity as the cocaine test for the diagnosis of OSP.

Is it possible to differentiate early-onset accommodative esotropia from early-onset essential esotropia?

PURPOSE: To determine the frequency of > or =2.50 diopter (D) hyperopia in infantile esotropia with onset up to the age of 6 months and by evaluating the treatment results of these cases retrospectively, to find the factors that may help to differentiate early-onset accommodative esotropia from early-onset essential esotropia. METHODS: The charts of 256 patients with infantile esotropia were reviewed. Thirtyseven cases, with hyperopia of > or =2.50 D, no other systemic and neurologic disease, and at least 1 year of follow-up, were included in this study. The age at the start of therapy, refractive error, deviation angle, type of therapy (antiaccommodative therapy, surgery) and the presence of amblyopia, latent nystagmus, inferior oblique overaction, dissociated vertical deviation and cross-fixation were recorded for each case. RESULTS: The prevalence of high hyperopia was found to be 14.4% (37/256) in infantile esotropia. In 18 of the cases (48.6%), antiaccommodative therapy alone was found to be adequate (Group I). In the remaining 19, although antiaccommodative therapy was found to decrease the deviation angle significantly (P<0.001), surgery was also required (Group II). Groups were compared with respect to age at the initial examination, refractive error, deviation angle, presence of amblyopia, anisometropia, and inferior oblique overaction, but no factor could be determined to predict the pure refractive ones (P>0.05). Essential infantile esotropia-associated findings did not help because they are rarely evident at the time of initial diagnosis. CONCLUSIONS: Half of the high hyperopic infantile esotropes could be corrected fully by antiaccommodative therapy alone, while the remaining ones could also benefit significantly. It is strongly recommended to try spectacles at first in the treatment of infantile esotropia with hyperopia > or =2.5 D.

Posterior segment involvement in ocular Behçet's disease.

PURPOSE: Posterior segment involvement, which can lead to blindness with recurrent inflammatory attacks, has a very important prognostic value in ocular Behçet's disease (BD). This study evaluated the frequency and characteristics of posterior segment involvement and the causes of visual impairment in patients with ocular BD. METHODS: We retrospectively evaluated 257 eyes of the 131 patients who were followed from 1993 to 2001 in the Uveitis and BD division of SSK Ankara Eye Hospital, Turkey. RESULTS: The mean follow-up was 49.2 +/- 27.4 months. Thirty-one of the palents were female (23.6%) and 100 male (76.4%). The mean age was 25.1 +/- 7.9. Fundus changes were observed in 213 (82.9%) eyes and were bilateral in 87%, and vitritis was present in 239 (93%) eyes. The most frequent fundus changes were vascular sheathing in 61 eyes (23.7%), optic atrophy in 46 (17.9%), macular edema in 29 (11.3%), retinal hemorrhage in 23 (9%), macular scar in 21 (8.2%), optic disc paleness in 19 (7.4%), retinal edema in 17 (6.6%), branch retinal vein occlusion in 15 (5.8%). The most common fluorescein angiography findings were diffuse vascular leakage in 98 (38%), hyperfluorescence of the optic disc in 38 (14.8%) and hyperfluorescence of the macula in 29 eyes (11.3%). Visual acuity was <1/10 in 85 (33%) of the eyes. Optic atrophy was the main cause (54.1%) of permanent visual impairment. CONCLUSIONS: Posterior segment involvement is the most serious ocular complication of BD, leading to blindness with recurrent attacks. Following patients closely, performing fluorescein angiography in all patients diagnosed as BD even they have no clinical ocular involvement, and early treatment are very important in the prognosis of the disease.

Central retinal artery occlusion associated with ocular Behçet's disease.

PURPOSE: To report a case of central retinal artery occlusion associated with ocular Behçet's disease (BD) and briefly discuss retinal vasculitis due to BD. CASE REPORT: A 52-year-old man, diagnosed as BD 22 years ago and followed up with ocular involvement for six years presented with sudden loss of vision. The clinical diagnosis was central retinal artery occlusion. RESULTS: No other associated systemic diseases were found and the case was classified as a complication of retinal vasculitis due to BD. CONCLUSIONS: Although the arteries are rarely affected in retinal vasculitis due to BD, it has to be considered in the differential diagnosis of retinal arterial occlusions especially in countries where the disease is prevalent. To our knowledge, this is the first reported case of ocular BD complicated with central retinal artery occlusion.

Factors influencing treatment results in pseudophakic endophthalmitis.

PURPOSE: To evaluate risk factors, therapeutic approaches and factors associated with the poor visual outcome in pseudophakic endophthalmitis. METHODS: Data related to 28 cases with the diagnosis of endophthalmitis after cataract surgery and IOL implantation were gathered retrospectively. RESULTS: Preceding surgery was extracapsular cataract extraction (ECCE) in 18, phacoemulsification in 8 and scleral fixated intraocular lens implantation in two cases. Posterior capsule rupture and diabetes mellitus were considered to contribute to the development of endophthalmitis because of their high incidences (50% and 25%) in the study group. Microbiological studies from aqueous and vitreous humour were done in 85% of the cases and 58% were positive. S. Epidermidis was the most common organism, accounting for 50% of the isolates. All cases were given topical and systemic antibiotics. Inflammation was controlled by addition of subconjunctival antibiotics to this regimen in two, intravitreal antibiotic injection in 14, pars plana vitrectomy, total capsular and lens extraction and intravitreal antibiotic injection in three, lens exchange, intracapsular and intravitreal antibiotic injection in three cases. Six (21%) cases eventually needed evisceration. Visual acuity of 20/40 or better was achieved in 25%, and 20/100 or better in 64%. CONCLUSIONS: Treatment delay (p=0.039), capsular rupture complicating cataract surgery, especially with extracapsular cataract extraction (p=0.015), and initial visual acuity worse than hand motion (p=0.003) were strong predictors of poor visual outcome. The risk of endophthalmitis was not different forplanned ECCCE (0.26%) andphacoemulsification (0.27%) but the prognosis was better with the latter.

Bilateral abortive cryptophthalmos associated with oculocutaneous albinism.

PURPOSE: To document a case of bilateral abortive cryptophthalmos associated with oculocutaneous albinism. METHODS: We describe a 13-year-old female patient with blond skin and hair who had anomalous face and eyes first noted at birth. RESULTS: The patient had fair hair and complexion, bilateral anomalous wedge of scalp hair, upper eyebrow and eyelid deformities, cup-shaped ears, broad based nose with depressed bridge and midline groove, iris transillumination and diffuse hypopigmentation and foveal hypoplasia in fundus examination. CONCLUSION: Based on the clinical and laboratory findings, the reported case represents tyrosinase-positive oculocutaneous albinism together with bilateral abortive cryptophthalmos. The oculocutaneous albinism can either be an entirely new criterion to the whole syndrome of cryptophthalmos, or, more probably, the condition can be due to a double affliction which is primarily related with consanguinity of the parents. The importance of ante-natal diagnosis and genetic counseling are emphasized in such cases where the two recessive genes for two different conditions coexist.

Ultrastructure of the cornea epithelium in keratoconus.

In this study, 20 keratoconus corneal tissue were examined. In TEM examination of the cornea, the epithelium was irregular in thickness. In these epithelial cells, the number of microvilli were decreased and they showed an irregular arrangement. Vesicular degeneration and swelling of the mitochondria were observed in the cytoplasm of these cells. Interepithelial relation was normal and the desmosomes did not show any pathology. In the electron microscopic examination of the stroma, focal degeneration was observed in the collagen fibers. In SEM examination of the cornea, depressions and elevations were found on the epithelial surface. Additionally, degenerated epithelial cells were observed on focal areas. To our knowledge, the decreased number of microvilli and their irregular arrangement which we observed in TEM examination of the cornea epithelium were not reported in the literature.