The effectiveness of photodynamic and antibiotic gel therapy as an adjunct to mechanical debridement in the treatment of peri-implantitis among diabetic patients.

AIM: The current clinical trial aimed to assess the effectiveness of adjunctive photodynamic therapy (aPDT) and adjunctive antibiotic gel therapy (aAGT) to treat peri-implantitis among patients with type 2 diabetes mellitus (T2DM). METHODS: Selected T2DM participants with peri-implantitis were distributed into 3 groups: Group-1: received a single session of adjunctive (aPDT); Group-2: received a single session of adjunctive (aAGT) (metronidazole 400 mg and amoxicillin 500 mg); and Group-3: received MD alone. Clinical (probing depth [PD], bleeding on probing [BOP], and plaque scores [PS]) and radiographic (crestal bone loss [CBL]) peri-implant variables were recorded. Levels of interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-α) were assessed after the collection of peri-implant sulcular fluid (PISF). All the evaluations were carried out at baseline, 3- and 6-months. The significance level was set to p < 0.05. RESULTS: At 3-and 6-months of follow-up, all the three groups showed significant alleviation in PS (p < 0.05), BOP (p < 0.05), and PD (p < 0.05) when compared with the baseline. At baseline, no significant variation was observed in all clinical and radiographic peri-implant parameters among all three research groups. At 3-months follow-up, a considerable alleviation of in PS, BOP, PD, and CBL was noticeable in group-1 patients when compared with the baseline. At 6-months follow-up, a comparable difference was observed in BOP, PD, and CBL between group-1 and group-2. At baseline, no significant variation was observed in the PISF levels of IL-6 and TNF-α among all three research groups. At 3- and 6-months follow-up, a considerable alleviation of TNF-α and IL-6 levels was observed in group-1 and group-2 patients, respectively, when compared with the baseline. CONCLUSION: The application of aPDT demonstrated improved clinical, radiographic, and immunological peri-implant parameters for the treatment of peri-implantitis among T2DM patients.

Influence of root debridement with adjunct photodynamic therapy on periodontal parameters and gingival crevicular fluid cortisol levels among patients with and without type-2 diabetes mellitus.

OBJECTIVE: The aim of the present study was to assess the influence of scaling and root planing (SRP) with adjunct antimicrobial photodynamic therapy (aPDT) on periodontal parameters and gingival crevicular fluid (GCF) cortisol levels in type-2 diabetic and non-diabetic patients with periodontitis. METHODS: One hundred and twenty-eight patients with periodontitis (64 with and 64 without type-2 diabetes mellitus, respectively) were included. In the test- and control-groups, patients underwent SRP with and without aPDT, respectivey. In both groups, plaque and gingival indices (PI and GI), probing depth (PD), clinical attachment loss (CAL), marginal bone loss (MBL) and GCF volume and cortisol levels were assessed at baseline and three and six-months after SRP with or without aPDT. The aPDT was performed at baseline using methylene blue and photobiomodulation. The Kruskall-Wallis test was used to assess data normality; and group-comparisons were done. P-values, which were below 0.01 indicated statistical significance. RESULTS: Sixty-four type-2 diabetic patients with and 64 non-diabetic patients with periodontitis were included. All individuals had Stage-III/Grade-C periodontitis. Among patients with type-2 diabetes mellitus (DM), there was no statistically significant difference in hemoblobin A1c, PI, GI, PD, CAL and MBL at baseline and at 3- and 6-months intervals. Amongst diabetic patietns, there was no difference in the GCF volume and cortisol levels in the test- and control-groups at all time intervals. In non-diabetic patients, there was a significqnt reductionin GCF volume and cortisol levels when SRP was done with aPDT than when SRP was carried out as the sole treatment strategy CONCLUSION: Among non-diabetic patients, SRP with aPDT helps reduce periodontal inflammation and GCF cortisol levels for up to 6-months; however poorly-controlled DM compromises the beneficial effects of this treatment strategy.

Photodynamic activation of irrigation (using different laser prototypes) on push out bond strength of fiber posts.

BACKGROUND: To evaluate the influence of photodynamic therapy (PDT) and light activated irrigation (LAI) using different laser prototypes Er,Cr:YSGG (ECYL), Er:Yag (EYL), Nd-Yag (NYL) on pushout bond strength of Pre-fabricated fiber reinforced composite (PFRC) post to radicular dentin. MATERIAL AND METHOD: Fifty maxillary and mandibular teeth were collected, cleaned and decoronated. Canals were instrumented using crown-down technique. Flaring of canals was performed using protaper S1, SX files. F1, F2 and F3 files were utilized for finishing of canal preparations. Prepared root canals were dried and obturated with gutta percha. Teeth were placed vertically within the section of polyvinyl pipes using acrylic resin. Post space preparation was completed using peso-reamers. Based on the PDT and laser activated irrigation (LAI) with different laser prototypes, samples were divided into five groups of 10 specimens each. Group 1- PDT, group 2-5.25 % NaOCl (sodium hypochlorite) and 17 % EDTA (ethylene diamine tetra acetic acid), group 3-5.25 % NaOCl with 17 % EDTA and NYL, group 4-5.25 % NaOCl with 17 % EDTA and EYL ; and group 5-5.25 % NaOCl +17 % EDTA and ECYL. Fiber post were luted in root canals with self-etch dual cure cement and teeth were sectioned at three levels (apical, middle and coronal). Push-out test was performed by placing the specimens in universal testing machine. Failure analysis of debonded surfaces was evaluated using stereomicroscope at 40× magnification. Means and standard deviations of push out bond strength were assessed by one-way analysis of variance (ANOVA). Comparison between means of push out bond strength was evaluated using Tukey multiple comparison tests (p = 0.05). RESULT: The highest push out bond strength was observed in group 5 at all three levels, coronal (10.08 ± 0.74 MPa), middle (8.95 ± 0.94 MPa) and apical (6.00 ± 0.88 MPa). The lowest push out bond strength was demonstrated by group 2 at all levels, coronal (6.15 ± 1.22 MPa), middle (5.65 ± 0.95 MPa) and apical (2.25 ± 0.55 MPa). Intra-group comparison showed decrease in push out bond strength in the coronal to apical direction among all investigated groups. Inter-group comparison exhibited comparable push out bond strength at all three levels of root for group 1 and group 2 specimens (p > 0.05). CONCLUSION: LAI with different laser prototypes improved push out bond values of PFRC post to root dentin as an adjunct to NaOCl and EDTA treatment. PDT improved push out strength compared to conventional canal cleaning regime.

Effectiveness of scaling and root planing with and without adjunct probiotic therapy in the treatment of chronic periodontitis among shamma users and non-users: A randomized controlled trial.

BACKGROUND: Effectiveness of scaling and root planing (SRP) with/without adjunct probiotic (Lactobacillus reuteri) treatment towards the reduction in periodontal inflammatory parameters (clinical attachment loss [AL], marginal bone loss [MBL], plaque index [PI], and bleeding on probing [BOP] in shamma users and non-users [controls] with chronic periodontitis [CP]) remains uninvestigated. The aim of the present randomized controlled trial was to compare the efficacy of SRP with and without adjunct probiotic therapy (PT) in the treatment of CP among shamma users and controls (individuals not using tobacco in any form). METHODS: The study was conducted in accordance with the Consolidated Standards of Reporting Trials guidelines. Patient demographics were recorded using a questionnaire. Therapeutically, patients were allotted into four groups as follows: 1) group 1: Shamma chewers that underwent SRP alone; 2) group 2: Shamma-chewers that underwent SRP + PT; 3) group 3: Non-chewers that underwent SRP alone; and 4) group 4: Non-chewers that underwent SRP + PT. Periodontal parameters (PI, BOP, PD, clinical AL and mesial and distal MBL) were measured on all teeth except third molars at baseline and at 3- and 6-month follow-ups. Level of significance was set at P < 0.05. RESULTS: In total, 31, 32, 31, and 33 individuals were included in groups 1, 2, 3, and 4, respectively. Among shamma users, there was no significant difference in the scores of PI, BOP, PD, clinical AL and MBL when SRP was performed with/without adjunct PT. Amongst controls, SRP with adjunct PT was more effective in reducing PI (P < 0.05), BOP (P < 0.05) and PD (P < 0.05) at 3-month follow-up. There was no significant difference in periodontal parameters at 3- and 6-month follow-ups in patients that underwent SRP with and without adjunct PT. CONCLUSIONS: Habitual shamma use compromises the outcome of SRP in patients with CP. Among patients that do not use any form of ST product, SRP is an effective treatment modality for the treatment of CP, and this relationship is independent of use of adjunct PT.

Comparison of self-rated oral symptoms and periodontal status among cigarette smokers and individuals using electronic nicotine delivery systems.

Objective: The aim was to compare the self-rated oral symptoms (OS) and clinical and radiographic periodontal status among cigarette smokers and electronic nicotine delivery systems (ENDS) users.Participants: Self-reported cigarette smokers and electronic cigarette and JUUL users were included.Methods: Self-rated OS and demographic data were recorded. Clinical attachment loss (AL), plaque index (PI), probing depth (PD), number of missing teeth, and bleeding on probing (BOP) were determined. p Values<.05 were deemed significant.Results: Bad breath (p<.001) and pain in gums (p<.001) were more often reported by cigarette-smokers than ENDS users. Compared with never-smokers, pain in teeth (p<.001), bad-breath (p<.001), and pain in gums (p<.001) were higher among cigarette smokers. There was no significant difference in pain in teeth, bleeding gums, bad breath, and pain in gums when JUUL users were compared with never-smokers and electronic cigarette users. PI (p<.05) and PD (p<.05) were increased in cigarette smokers than ENDS users and never-smokers.Conclusions: Pain in teeth and gums are more often perceived by cigarette smokers than electronic cigarette and JUUL users and never-smokers.

Prevalence of Type 2 Diabetes Mellitus Among Men in the Middle East: A Retrospective Study.

The rising prevalence of diabetes mellitus (DM) is a serious global health concern. The world is experiencing type 2 diabetes epidemics and prevalence differs by gender, regions, and level of socioeconomic development. Type 2 diabetes mellitus (T2DM) in men increased at a faster rate and numbers are continuing to rise in some regions of the world. This study aimed to estimate the prevalence of T2DM among men in the Middle East countries. Seventy-four research articles were identified through search engines including Web of Science, Medline, PubMed, EMBASE, Scopus, and Ovid databases by using keywords "epidemiology," "prevalence," "diabetes mellitus," and individual names of the Middle East states. Finally, 17 studies were included for the assessment of prevalence of T2DM among men in the Middle East. In the Middle East, high prevalence of T2DM among men was identified in Bahrain (33.60%), Saudi Arabia (29.10%), United Arab Emirates (UAE; 25.83%), and Kuwait (25.40%), whereas low prevalence was reported in Iran (9.90%) and Yemen (9.80%). The random pooled prevalence in the Gulf Cooperation Council (GCC) states was (24.0%) compared to non-GCC states (16.0%), and in both GCC and non-GCC countries combined, it was 19%. The prevalence was significantly associated with the gross domestic product of these states ( p = .0005). Despite different socioeconomic and cultural settings in the Middle East, the rising T2DM prevalence among men was identified in Bahrain, Saudi Arabia, UAE, and Kuwait. These states must incorporate future diabetes defensive strategies targeting the Middle East population to minimize the burden of DM from the region.

Clinical and radiographic peri-implant outcomes of short dental implants placed in posterior jaws of patients with treated generalized aggressive periodontitis: A 3-year follow-up study.

BACKGROUND: Studies assessing clinical and radiographic peri-implant parameters around short dental implants (SDIs) in treated generalized aggressive periodontitis (GAgP) patients are scant. OBJECTIVES: This 3-year follow-up study aimed to compare the clinical peri-implant and radiographic bone status around SDIs placed in partially edentulous patients treated for GAgP and periodontally healthy patients and to assess the implant success rate between both the groups. MATERIALS AND METHODS: A total of seven patients clinically diagnosed with GAgP and seven periodontally healthy patients was included in the clinical study. Forty-eight (29 maxilla; 19 mandible) and 11 (8 maxilla; 3 mandible) SDIs were placed in the GAgP group and healthy group, respectively. Plaque index (PI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were recorded at six sites around all teeth and implants. Marginal bone loss (MBL) was studied incorporating in a specialized software and examined on a calibrated computer display screen with the help of an image analyzer. Patient satisfaction was recorded using a questionnaire sheet that contained questions regarding esthetics and function of the restorations. RESULTS: The implant survival rate after 3 years was 81.25%. BOP and CAL around SDIs of GAgP patients were significantly higher than in periodontally healthy subjects (P = .01) throughout the follow-up. CAL around the teeth of GAgP patients was significantly greater during the follow-up than around the teeth of periodontal healthy subjects (P = .02). The PI and BOP between the teeth and implants showed no statistical significant difference. The mean PD at teeth was 0.4 mm greater than at implants. Implants showed significantly increased attachment loss than teeth (P = .01). The overall mean satisfaction of visual analogue scale was 12.8 ± 1.45. CONCLUSION: This short-term follow-up study indicates SDIs remain functionally stable in the posterior jaws of treated GAgP patients.

Comparison of Periodontal Inflammatory Parameters and Whole Salivary Cytokine Profile Among Saudi Patients with Different Obesity Levels.

The aim of the present study was to compare clinical periodontal parameters and salivary interleukin (IL)-1ß and IL-6 levels in patients with different obesity levels. A total of 419 individuals with class I, II, and III obesity and nonobese with chronic periodontitis were included. Clinical periodontal parameters were recorded, and whole salivary IL-1ß and IL-6 were quantified using enzyme-linked immunosorbent assay. Clinical parameters and salivary cytokine concentrations were analyzed using one-way analysis of variance. For multiple comparisons, Bonferroni post hoc adjustment test was used. Clinical periodontal parameters and salivary IL-1ß and IL-6 levels were statistically significant in class II and class III obese as compared to class I obese patients (P < .01) but were comparable between class II and class III obese individuals. These findings should be interpreted with caution due to the inclusion of hyperglycemic patients.

Protective effect of fenofibrate against ischemia-/reperfusion-induced cardiac arrhythmias in isolated rat hearts.

Fenofibrate is a peroxisome proliferator-activated receptor (PPAR)-α activator that lowers triglycerides and influences cytochrome P-450 (CYP-450) epoxygenase-dependent arachidonic acid (AA) metabolism. CYP-450 epoxygenase metabolizes AA to epoxyeicosatrienoic acids (EETs). EETs have coronary dilating and cardiac and renal protective properties. Fibrates possess similar properties due to their CYP-450 epoxygenase-inducing properties that lead to increase in endogenous EET production. In the current investigations, fenofibrate (100 mg/kg, orally) for 2 weeks decreased ischemia-/reperfusion (I/R)-induced premature ventricular contractions (PVCs), ventricular tachycardia (VT), and ventricular fibrillation (VF) in the isolated rat hearts. Fenofibrate caused marked inhibition of the reperfusion-induced cardiac arrhythmias. The incidence of reperfusion-induced VF decreased from 80% in the control vehicle-treated animals to 33% in the fenofibrate-treated animals (P < 0.001). PVCs were also significantly (P < 0.01) decreased from 223.2 ± 51 in control vehicle-treated animals to 136.8 ± 22 in fenofibrate-treated animals. Total duration of reperfusion-induced VT decreased from 29.2 ± 6.3 s in control, vehicle-treated animals to 4.8 ± 1.3 s in fenofibrate-treated animals, P < 0.001. Heart rate and perfusion pressure were not significantly affected by fenofibrate pretreatment. Diltiazem, a clinically used anti-arrhythmic agent, produced complete protection against I/R-induced cardiac arrhythmias in this model reducing the incidence of VF from 80% in control, vehicle-treated animals to 10% in diltiazem-treated hearts. These findings indicate that fenofibrate suppresses arrhythmias in isolated rat hearts subjected to I/R-induced injury.

Short-term effects of adjunctive antimicrobial photodynamic therapy in obese patients with chronic periodontitis: A randomized controlled clinical trial.

BACKGROUND: The aim of the present study was to assess the effect of antimicrobial photodynamic therapy (aPDT) as an adjunct to scaling and root planing (SRP) on clinical periodontal and immunological parameters in obese patients with chronic periodontitis (CP). METHODS: Fifty-three obese with CP patients were divided into 2 groups receiving aPDT with SRP and SRP only respectively. Full-mouth plaque index (PI), bleeding on probing (BOP), pocket depth (PD) and clinical attachment level (CAL) were assessed at baseline, 6 and 12 weeks post-therapy. Gingival crevicular fluid (GCF) levels of tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-6 were evaluated using enzyme linked immunosorbent assay at baseline and 12 weeks. RESULTS: There was a significant improvement in all periodontal variables in both study groups at 6 weeks and 12 weeks with respect to the baseline visit (p<0.001). Significant reduction in PD of 4-6mm and ≥7mm was observed for aPDT group as compared to SRP group (p<0.01) at both 6 weeks and 12 weeks of follow-up. At 6 weeks, a significant (p<0.001) gain in CAL was observed in both groups, which remained stable at 12 weeks. IL-6 and TNF-α levels decreased significantly (p=0.001) at 12 weeks after therapy in both the groups. Inter-group comparison showed significant difference for TNF-α (p=0.024) and IL-6 (p=0.044) levels for aPDT group at 12 week follow-up. CONCLUSION: Within the limits of this clinical trial, adjunctive aPDT showed improvement in clinical and immunological parameters in obese patients with CP. Antimicrobial PDT showed additional benefit in moderate and deep periodontal pockets in obese patients with CP.

Clinical and radiographic peri-implant parameters and proinflammatory cytokine levels among cigarette smokers, smokeless tobacco users, and nontobacco users.

BACKGROUND: It is postulated that clinical and radiographic peri-implant parameters are worse and levels of interleukin (IL)-1ß and matrix metalloproteinase (MMP)-9 in the peri-implant sulcular fluid (PISF) are higher in cigarette-smokers (CS) and smokeless-tobacco users (STU) compared with nontobacco user (NTU). PURPOSE: The present study aimed to compare clinical and radiographic peri-implant inflammatory parameters and levels of IL-1ß and MMP-9 levels among CS, STU, and NTU. MATERIALS AND METHODS: Forty-five CS (Group-1), 42 STU (Group-2), and 44 NTU (Group-3) were included. Demographic data was collected using a structured baseline questionnaire. Peri-implant plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were recorded and crestal bone loss (CBL) were assessed using standardized digital radiographs. PISF volume and levels of IL-1ß and MMP-9 in PISF were quantified using enzyme-linked immunosorbent assay. Clinical peri-implant parameters and PISF IL-1ß and MMP-9 concentrations were analyzed with Kruskal-Wallis test. Bonferroni post hoc adjustment test was used for multiple comparisons. P-value was set at .05. RESULTS: Peri-implant PI and PD were significantly worse in group-1 and group-2 patients as compared to group-3 individuals (P < .05). Peri-implant CBL was also significantly higher in group-1 and group-2 compared with group-3 (P < .05). Peri-implant BOP was significantly higher in group-2 and group-3 as compared to group-1 individuals (P < .05). The PISF volume (P < .05) collected and levels of IL-1ß and MMP-9 were statistically significantly elevated among individuals in group-1 and group-2 compared with group-3 (P < .01). There was no significant difference in PI, PD, CBL, and PISF levels of IL-1ß and MMP-9 among participants in groups 1 and 2. CONCLUSION: Clinical and radiographic peri-implant parameters were compromised among CS and STU as compared to NTU. Increased expression of local proinflammatory cytokines may explain greater susceptibility of CS and STU to peri-implant breakdown.

Knowledge, behavior and attitudes of dental practitioners towards photodynamic therapy use in dental practice.

BACKGROUND: The aim of the present study was to assess knowledge, behavior and attitudes of dental practitioners (DPs) towards photodynamic therapy (PDT) in dental clinical practice. METHODS: A cross-sectional study was performed and a 13-item survey questionnaire was given to DPs practicing in 13 different teaching hospitals in Karachi, Pakistan. Questions were aimed at exploring the knowledge of DPs regarding PDT and their attitude towards PDT and perceptions that may influence clinical practices. Chi-square and spearman coefficient were conducted to compare subgroups and correlate factors with the knowledge score of DPs. RESULTS: A total of 509 questionnaires were completed (response rate=82%). Median age of participants was 34 years and 70% were females. Most DPs demonstrated good knowledge related to PDT, and nearly 77%, 69% and 62% were aware of the mechanism of action and the role of photosensitizers in PDT respectively. It was reported that 74% of the respondents expressed that they are comfortable to know about PDT in detail for their clinical practice. A cumulative 54% disagreed that discussing the option for PDT with their patients was peripheral to their role as clinicians. A striking 82% would like to attend seminars and workshops on PDT. Significant difference was found among senior lecturers and assistant professors for the knowledge items (p <0.05). No statistical correlation was found between the knowledge items score of DPs and their behavior (r=0.18; p=0.762), attitude (r=0.04; p=0.594) and self-rated knowledge (r=0.42; p=0.854). CONCLUSION: Dental practitioners showed adequate knowledge regarding PDT and its use in dentistry. However, expertise with regards to handling and training is warranted so that DPs could use PDT in their dental practice.