Evaluation of periodontal status and cytokine levels in saliva and gingival crevicular fluid of patients with inflammatory bowel diseases.

BACKGROUND: Periodontal diseases and inflammatory bowel diseases (IBD, ulcerative colitis [UC] and Crohn disease [CD]) have been reported to present with increased salivary and gingival crevicular fluid (GCF) concentrations of cytokines. The aim of this study was to evaluate the salivary and GCF levels of TNF-α, IL-1ß, IL-10, and IL-17A and their associations with the periodontal statuses of UC, CD, and non-IBD patients, and to analyze the interrelationships among these cytokines, IBD conditions, and periodontal diseases. METHODS: This cross-sectional study was performed with a total of 131 patients (62 women and 69 men, mean age 42.96±13.02 years). Patients were divided into three groups: UC, CD, and non-IBD. Periodontal status was defined according to the 2017 World Workshop Disease Classification. Salivary and GCF cytokine levels were analyzed using ELISA. RESULTS: UC and CD patients diagnosed as having periodontitis and gingivitis presented with significantly higher levels of TNF-α and lower levels of IL-10 as compared with non-IBD patients (p<0.05). UC patients diagnosed with periodontitis exhibited significantly higher scores of bleeding on probing (p = 0.011) and increased salivary and GCF IL-1ß levels as compared with CD patients (p = 0.005, and 0.012, respectively). Considering the active and remission status of IBD, salivary IL-1ß was found to be correlated with the parameters representing the severity of periodontal diseases in active UC and CD patients. CONCLUSION: In the presence of periodontal diseases, UC and CD patients showed different expression levels of TNF-α, IL-1ß, and IL-10 in oral secretions as compared with non-IBD patients.

Histomorphometric and biomechanical evaluation of the osseointegration around micro- and nano-level boron-nitride coated titanium dental implants.

INTRODUCTION: Titanium dental implants has been coated with different materials such as polymers and biomimetic agents, bone morphogenetic protein, calcium phosphate to enhance surface properties of the titanium implants for osseointegration. The aim of this study was to evaluate the bone tissue healing around Boron Nitride-coated (BN-coated) titanium implants histomorphometrically and biomechanically and also observe the effect of different coating thicknesses on osseointegration. MATERIALS AND METHODS: BN was coated on dental titanium implants with two different coating thicknesses by using RF magnetron sputtering system. Totally fifty-four implants were inserted into the tibias' of 12 New Zealand rabbits bilaterally under general anesthesia. All animals were sacrificed after 4-weeks. Bone-implant contact (BIC) and new bone area/total area ratios (BATA) were calculated. Also, the removal torque (RT) test was performed. RESULTS: The highest new bone area in the medullary cavity was around the nano-BN-coated surface with 15.70%. In micro-BN-coated surface and control group, this ratio was determined as 10.48% and 8.23%, respectively. The BIC ratios in upper-side of implants and cortical-associated BIC ratios in lower-side were found significantly higher in control and micro-BN-coated group than nano-BN-coated group (p < 0.05). Similar BIC values were observed between control and micro-BN-coated groups (p > 0.05). BATA values did not show statistically significant differences between all three groups (p > 0.05). The RT values measured in all groups were found comparable and no statistically significant differences were found (p > 0.05). CONCLUSION: No inflammatory reaction developed around any implant. Relatively more new bone formation around nano-BN-coated titanium implants indicates the promising osseoinductive effect of BN coating. BN-coated implants showed similar biomechanical and histomorphometrical outcomes to that of the conventional titanium implants through a 4-week evaluation period.

Comparison of Radiofrequency and Electrocautery With Conventional Scalpel Incisions.

PURPOSE: The disadvantages of conventional scalpels, including insufficient control of bleeding, prompted us to search for new alternative methods such as electrosurgery and radiosurgery. In this study, the conventional scalpel was compared with radiosurgery and electrosurgery for wound healing with assessment of lateral heat production, inflammation, and instrument performance. MATERIALS AND METHODS: Incisions were made in the palatal mucosa of 42 Wistar rats using a scalpel, electrocautery instrument, or radiofrequency instrument. Postoperative hemostasis, tissue coagulation, and tissue sticking were measured, and pain evaluation through weight loss was recorded. Gingival biopsy specimens from the surgical area were obtained at the time of surgery and 2, 4, 7, and 14 days postoperatively and were evaluated immunohistochemically for inducible nitric oxide synthase and heat shock protein 70. Kruskal-Wallis, 1-way analysis of variance, and Mann-Whitney U tests were used for statistical evaluation. RESULTS: The rats in the electrosurgery and radiosurgery groups had aggressively greater weight loss when compared with the scalpel group in the first 7 days. Hemostasis was better in the electrocautery group, tissue coagulation was greater in the radiofrequency group (P < .001), and tissue sticking was lesser in the scalpel group (P < .001) compared with the other groups. Inducible nitric oxide synthase expression and heat shock protein 70 expression were similar in all 3 groups. CONCLUSIONS: Electrosurgery performed better regarding hemostasis, whereas a scalpel was superior in terms of tissue sticking and tissue coagulation. Radiosurgery was superior regarding hemostasis when compared with a conventional scalpel, but it was not as successful as electrosurgery.

Does laterally rotated flap design influence the short-term periodontal status of second molars and postoperative discomfort after partially impacted third molar surgery?

PURPOSE: To assess the influence of the surgical removal of partially impacted third molars (3Ms) and compare the effects of a 3-cornered laterally rotated flap (LRF) with primary closure (flap 1) and an envelope flap with secondary closure (flap 2) on the short-term periodontal status of the adjacent second molars (2Ms). We also assessed the postoperative complications after removal of the partially impacted 3M. MATERIALS AND METHODS: A split mouth, randomized clinical study was designed. The study sample included patients with bilateral partially impacted 3Ms. The primary predictor variable was the type of flap design (flaps 1 and 2). The primary outcome variable was periodontal status (gingival recession [GR], probing depth [PD], plaque index [PI], and gingival index) of the 2Ms measured preoperatively and 90 days postoperatively. The secondary outcome variables were postoperative complications, including pain, facial swelling, alveolitis, and local wound infection. The other variables included gender, position of the 3Ms, and surgical difficulty. We performed descriptive, comparative, correlation, and multivariate analyses. RESULTS: The sample included 28 patients aged 18 to 28 years. The GR, PD, and PI values with the flap 2 design were greater than those with the flap 1 design (P < .05). Facial swelling with the flap 1 design was significantly greater than with the flap 2 design on the second postoperative day (P < .05). The pain levels with the flap 1 design were significantly greater than those with the flap 2 design on the first and second postoperative days (P < .05). According to the multivariate regression analyses, flap design was closely related to the periodontal status of the 2Ms and postoperative discomfort. CONCLUSION: The results of the present clinical study have shown that the flap design in partially impacted 3M surgery considerably influences the early periodontal health of the 2Ms and postoperative discomfort. However, although the 3-cornered LRF design might cause more pain and swelling, it could be the method of choice for partially impacted 3M surgery because of the early periodontal healing.

The effect of light-emitting diode photobiomodulation on implant stability and biochemical markers in peri-implant crevicular fluid.

OBJECTIVE: The purpose of this study was to determine the effect of light-emitting diode photomodulation (LED PBM) on implant osseointegration by measuring implant stability changes by resonance frequency analysis (RFA) and measuring interleukin-1ß (IL-1ß), transforming growth factor-ß (TGF-ß), prostaglandin-E2 (PGE2), and nitric oxide (NO) levels in peri-implant crevicular fluid (PICF). BACKGROUND DATA: Light therapy modulates various biological events and allows improved wound healing in ischemic and wounded tissues. METHODS: Fifteen patients (8 control, 7 LED) participated in the study. In the LED group, LED device at a wavelength of 626 nm in the near-infrared (NIR) region (treatment array area: 4.80 cm2; average intensity: 38.5 mW/cm2; total power: 185 mW; total energy: 222 J; average density: 46.2 J/cm2) was applied for 20 min over the surgical area during 3 weeks, three times in a week, starting from the operation day. Implant stability quotient (ISQ) values were recorded at the time of operation, and 2, 4, 8, and 12 weeks postoperatively. PICF samples were collected in postoperative weeks 4 and 12 and IL-1ß, TGF-ß, PGE2, and NO levels were evaluated. Clinical indices were recorded around implants in postoperative weeks 4 and 12. RESULTS: In the control group, significant reduction of ISQ values from week 2 to week 12 were demonstrated. In the LED group, baseline ISQ values were maintained during the study and no significant changes were observed. Changes in biochemical parameters were found to be similar between groups over time. However, in the LED group, a negative correlation was found between PGE2 and ISQ values. CONCLUSIONS: LED application to surgical area has a positive effect on the osseointegration process, and implant stability can be maintained.

Receptor activator of NF-kappaB ligand (RANKL) and CD 31 expressions in chronic periodontitis patients before and after surgery.

AIM OF THE STUDY: The present study investigated the hypothesis that upregulation of receptor activator of NF-kappaB ligand (RANKL) expression may be associated with upregulation of endothelial cell activitiy, which is common for periods of periodontal bone loss in chronic periodontitis. MATERIAL AND METHODS: RANKL expression of activated cells in soft tissue biopsies with CD 31 activity and the presence of RANKL and osteoprotegerin (OPG) in gingival crevicular fluid (GCF) were assessed in chronic periodontitis patients. Biopsies from 17 patients and 10 healthy subjects were immunohistochemically analyzed. Clinical measurements [plaque index (PI), the gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL) and gingival bleeding index (GBI)] and GCF samples were obtained before and after periodontal therapy. RESULTS: CD31 staining did not support the assumption that endothelium-like cells were predominantly associated with RANKL expression. CONCLUSIONS: RANKL-positive cells were widely distributed in periodontitis patients giving only partial support to the hypothesis that RANKL expression is restricted to T- and B-cell activation.

Arginine-nitric oxide-polyamine metabolism in periodontal disease.

BACKGROUND: Arginine is converted to nitric oxide (NO) via NO synthase and to ornithine via arginase. Ornithine decarboxylase (ODC) catalyzes the conversion of ornithine to polyamines. Arginase can inhibit NO production, and NO can inhibit ODC activity as part of an early inflammatory response. This study examines the arginine-NO-polyamine pathway alteration in saliva and gingival biopsy samples of patients with gingivitis or periodontitis and healthy controls and evaluates the response to periodontal treatment. METHODS: This study includes nine gingivitis patients, 15 chronic periodontitis patients, and 11 healthy age-matched controls. Periodontal clinical measurements, gingival biopsies, and saliva samples were obtained before treatment (BT) and 1 month after periodontal treatment (AT). Arginase and ODC activities and NO levels were determined spectrophotometrically. RESULTS: The BT salivary and gingival NO levels were found to be highest in the gingivitis group, followed by the healthy and the periodontitis groups, respectively. Salivary NO levels significantly increased in the periodontitis group and decreased in the gingivitis group AT (P <0.05). Gingival NO levels decreased significantly in the periodontitis and the gingivitis groups AT (P <0.05). Arginase levels were detected highest in the gingivitis group and lowest in the periodontitis group, both in saliva and gingiva. Only gingival arginase levels significantly increased AT (P <0.05). ODC activity was highest in saliva, and lowest in the gingiva of the periodontitis patients BT. It was found to be significantly higher in the periodontitis group AT (P <0.05). CONCLUSIONS: In this study, regarding arginine-NO-polyamine metabolism, gingival tissue seems to be more informative about periodontal pathogenesis than saliva. At early phase of periodontal inflammation, NO arginase and ODC levels were measured as higher than at an established lesion of periodontitis.

Impact of chlorhexidine mouth rinse use on postextraction infection via nitric oxide pathway.

OBJECTIVE AND DESIGN: Nitric oxide (NO) has been linked to inflammatory reactions, tissue destruction, host defense, and wound healing in oral diseases. It is known that arginase enzyme controls the synthesis of NO through arginine depletion. This study evaluated the arginase-NO pathway alteration in response to tissue injury after dental extraction surgery and the effect of postoperative use of 0.2% chlorhexidine gluconate rinse (CHX). MATERIALS AND METHODS: This study included 28 individuals who had impacted mandibular third molars. They were randomly divided into two groups. Group A was comprised of 13 individuals who used postoperative CHX (0.2%) rinse, while group B included 15 individuals who did not use postoperative CHX rinse. For each patient, periodontal inflammatory status was evaluated. Salivary and gingival tissue samples were obtained before and 1 h and 1 week after the surgery to determine the NO level and arginase activity using spectrophotometric methods. RESULTS: NO level of tissue samples displayed an insignificant decrease in both groups postoperatively. However, arginase activity of tissue samples was significantly higher in group B compared to group A 1 week after surgery (p

The evaluation of cystatin C, IL-1beta, and TNF-alpha levels in total saliva and gingival crevicular fluid from 11- to 16-year-old children.

BACKGROUND: The aim of this study was to evaluate the levels of cystatin C, interleukin-1beta (IL-1beta), and tumor necrosis factor-alpha (TNF-alpha) in the total saliva and gingival crevicular fluid (GCF) of periodontally healthy children (PHC) and children with gingivitis (CG) who were between 11 and 16 years old. METHODS: The study was carried out with 10 PHC and 25 CG. Unstimulated total saliva and GCF samples were obtained. Clinical parameters, including probing depth (PD), clinical attachment loss (CAL), plaque index (PI), gingival index (GI), and gingival bleeding index (GBI), were assessed. GCF samples were collected from four maxillary upper incisors. After sampling, biochemical analyses were performed using latex particle-enhanced turbidimetric immunoassay for cystatin C and enzyme-linked immunosorbent assay for IL-1beta and TNF-alpha. The multivariate analysis of variance test was used for statistical evaluation. RESULTS: In total saliva, cystatin C and TNF-alpha levels were higher in PHC, and IL-1beta levels were higher in CG, but the differences were not statistically significant. In GCF, cystatin C levels were higher in PHC (P >0.05), whereas TNF-alpha and IL-1beta levels were higher in CG (P >0.05). In the CG group, there were positive correlations between the GCF cystatin C level and the PI of the sampled site (r = 0.488; P <0.05); also, GCF IL-1beta (r = 0.603; P <0.05) and TNF-alpha (r = 0.456; P <0.05) levels were positively correlated with PD and CAL. For the whole mouth and the sampled sites, PI, GI, GBI, PD, and CAL values were higher in CG (P <0.05), but no significant differences were detected between GCF volumes of the two groups. CONCLUSIONS: To the best of our knowledge, this study represents the first evaluation of cystatin C in the gingival disease mechanism in children. Our results showed that total saliva and GCF cystatin C levels were higher in PHC (P >0.05), but there was no correlation between cystatin C levels and IL-1beta or TNF-alpha levels in total saliva or GCF.

The Evaluation of Cystatin C, IL-1ß, and TNF-α Levels in Total Saliva and Gingival Crevicular Fluid From 11- to 16-Year-Old Children.

BACKGROUND: The aim of this study was to evaluate the levels of cystatin C, interleukin-1ß (IL-1ß), and tumor necrosis factor-alpha (TNF-α) in the total saliva and gingival crevicular fluid (GCF) of periodontally healthy children (PHC) and children with gingivitis (CG) who were between 11 and 16 years old. METHODS: The study was carried out with 10 PHC and 25 CG. Unstimulated total saliva and GCF samples were obtained. Clinical parameters, including probing depth (PD), clinical attachment loss (CAL), plaque index (PI), gingival index (GI), and gingival bleeding index (GBI), were assessed. GCF samples were collected from four maxillary upper incisors. After sampling, biochemical analyses were performed using latex particle-enhanced turbidimetric immunoassay for cystatin C and enzyme-linked immunosorbent assay for IL-1ß and TNF-α. The multivariate analysis of variance test was used for statistical evaluation. RESULTS: In total saliva, cystatin C and TNF-α levels were higher in PHC, and IL-1ß levels were higher in CG, but the differences were not statistically significant. In GCF, cystatin C levels were higher in PHC (P >0.05), whereas TNF-α and IL-1ß levels were higher in CG (P >0.05). In the CG group, there were positive correlations between the GCF cystatin C level and the PI of the sampled site (r = 0.488; P <0.05); also, GCF IL-1ß (r = 0.603; P <0.05) and TNF-α (r = 0.456; P <0.05) levels were positively correlated with PD and CAL. For the whole mouth and the sampled sites, PI, GI, GBI, PD, and CAL values were higher in CG (P <0.05), but no significant differences were detected between GCF volumes of the two groups. CONCLUSIONS: To the best of our knowledge, this study represents the first evaluation of cystatin C in the gingival disease mechanism in children. Our results showed that total saliva and GCF cystatin C levels were higher in PHC (P >0.05), but there was no correlation between cystatin C levels and IL-1ß or TNF-α levels in total saliva or GCF.

Comparison of different methods to detect Helicobacter pylori in the dental plaque of dyspeptic patients.

The aim of this study was to compare different methods of detection of Helicobacter pylori (H. pylori) in the dental plaque of dyspeptic patients. After recording the clinical indices, culture and polymerase chain reaction (PCR) methods were performed on plaque samples, while rapid urease test in addition to these tests was carried on gastric samples from 67 dyspeptic patients who attended for an upper gastrointestinal endoscopy. Forty-seven of 67 patients were H. pylori-positive in gastric biopsy material whereas the microbial dental plaque from 19 patients demonstrated H. pylori positivity detected by PCR. Among the patients, 25.4% harbored H. pylori both in the stomach and in microbial dental plaque. No significant correlations were found among the presence of H. pylori in the stomach, in plaque, and clinical variables (P > 0.05). Although oral hygiene was observed optimal and the mean of pocket depth was not found to be higher, the prevalence of H. pylori was observed to be higher in dental plaque. According to our results, PCR technique gave the highest detection rate both in gastric biopsy and in dental plaque compared to the other methods used.

A multifaceted molecule, nitric oxide in oral and periodontal diseases.

Nitric oxide (NO) is a molecule with multiple effects on different tissues. NO takes important roles in vasodilatation, bacterial challenge and cytokine stimulation, regulation of mineralized tissue function, neurotransmission, and platelet aggregation, etc. However, under pathological conditions, NO has damaging effects. NO is synthesized by NO synthases (NOS) and inducible isoform of NOS (iNOS) is closely related to the pathophysiological characteristics of inflammatory diseases such as periodontal diseases. The expression of iNOS has been investigated in salivary gland-related diseases, temporomandibular joint disorders and oral cancer as well. The beneficial and damaging effects of NO in diseases related with periodontal, dental and maxillofacial area are discussed in this review. The biological pathways involved with NO and NO inhibitors may be good drug targets to have a role in the future management of patients with diseases in orofacial region.

Periodontal regenerative potential of autogenous periodontal ligament grafts in Class II furcation defects.

BACKGROUND: The aim of the present study was to evaluate the regenerative potential of autogenous periodontal ligament (PDL) grafts in the treatment of Class II furcation defects. METHODS: Twenty mandibular Class II furcation defects from 10 systemically healthy patients with chronic periodontitis were selected. In experimental defects, flaps were coronally positioned following placing autogenous PDL grafts that were obtained from third molars; in controls, coronally advanced flap procedure without graft was applied. Clinical measurements including plaque index, gingival index, probing depth (PD), vertical and horizontal clinical attachment level (CAL), and gingival recession (GR) were obtained at baseline and after 3 and 6 months postoperatively. Vertical and horizontal defect fill was evaluated with open clinical measurements at initial surgery and reentry after 6 months. Gingival biopsies from the experimental and control defects were obtained at reentry and evaluated histopathologically in order to examine the soft tissue response towards PDL grafts. RESULTS: Sites treated with PDL grafts demonstrated significant improvement in vertical and horizontal defect fill, PD, and CAL at 3 and 6 months compared to presurgical values. The difference determined for the PD values of both groups at a statistically significant degree in favor of grafted sites was maintained at all observation periods. No foreign body reaction was observed in PDL grafts. CONCLUSIONS: These short-term results point to the potential of PDL grafts in promoting healing of furcation lesions. This preliminary study suggests that the use of PDL grafts may have beneficial effects in the treatment of furcation defects.

Monitoring of buccal epithelial cells by alkaline comet assay (single cell gel electrophoresis technique) in cytogenetic evaluation of chlorhexidine.

During the last few years, there has been increasing interest in buccal epithelial cells for cytogenetic evaluation of different materials. In the present study, the use of these cells and peripheral lymphocytes for cytogenetic evaluation of chlorhexidine digluconate (CHX) with comet assay (single cell gel electrophoresis, or SCGE) is reported. This technique detects DNA strand breaks in individual cells in alkaline conditions. Thirteen volunteers were requested to rinse their mouths with 0.12% CHX solution for 18 days. Buccal epithelial cells and peripheral blood lymphocytes were obtained from all participants at baseline and the end of the experimental period. One hundred cells per subject were analysed for the DNA damage. A statistical increase was observed in the damaged buccal and blood cells after the CHX application. The mean grade of damage in buccal cells was statistically different from that in blood cells. Due to minimal absorption of chlorhexidine into the tissues and low concentrations of free chlorhexidine in the oral cavity, the DNA damage produced by chlorhexidine in lymphocytes was lower than in buccal epithelial cells. As chlorhexidine does not accumulate in the body, the frequencies of DNA damage could be transient. Detected DNA damage after CHX use might be the indication of an earlier effect, before DNA repair begins, and could be reversible.