Efficacy of Scaling and Root Planing with Photobiomodulation for Treating Periodontitis in Gutka Chewers: A Randomized Controlled Trial.

Objective: To explore the influence of photobiomodulation (PBMT) as an adjuvant to scaling and root planing (SRP) for treating periodontitis among gutka chewers. Materials and methods: Self-reported smokeless-tobacco (gutka) users were enrolled; and underwent SRP with (test group) and without (control group) PBMT. Full-mouth plaque index (P-I), bleeding upon probing (BUP), probing depth (P-D) clinical attachment loss (CAL), marginal bone loss (MBL) (on mesial and distal surfaces of the teeth), and number of missing teeth were recorded before treatment and at 3 and 6 months. Group comparisons were performed and p < 0.05 was referred significant. Results: In the control group, P-I (p < 0.013), BUP (p < 0.001), and P-D (p < 0.012) were high at baseline compared with 3 months follow-up. P-I, BUP, and P-D were higher in the test group, at baseline in comparison with the 3-month (p < 0.001) and 6-month (p < 0.01) follow-up. At 3 and 6 months, scores of P-I, BUP, and P-D were high in the control compared with the test group. No difference in CAL, and mesial and distal MBL was found among patients of both groups at 3 and 6 months. Conclusions: Among gutka chewers, SRP with PBMT is more efficient than SRP alone in the management of periodontitis.

Expression of Salivary S100A7 Levels in Stage I Oral Submucous Fibrosis: A Clinical and Laboratory Study.

BACKGROUND: Oral submucous fibrosis (OSF) is a chronic debilitating condition characterized by juxta-epithelial fibrosis. The main etiological agent associated with the high-risk precancerous condition is areca nut use. S100A7 is a member of the largest calcium-binding proteins exclusively found in vertebrates and are associated with the regulation of numerous intracellular and extracellular functions. The aim of this study was to investigate the expression of protein S100A7 in salivary samples of individuals with stage I OSF and healthy controls. METHODS: This study included 63 participants, 30 of whom had OSF stage I and 33 healthy controls. Nonprobability quota sampling technique was utilized for recruitment of the study participants. A structured baseline questionnaire was used to collect demographic data. Saliva samples were collected by passive droll technique in a sterile container. Salivary levels of S100A7 were quantified by enzyme-linked immunosorbent assay. For the normality of the data Shapiro Wilk test was performed. Student t-test was commuted to evaluate the expression of S100A7 protein expression between both the study groups. RESULTS: The mean salivary S100A7 value for stage I OSF group was 0.334 ng/ml, compared to 0.172 ng/ml for healthy controls. Student t-test reported a statistically significant difference, indicating higher levels of S100A7 in stage I OSF group than in healthy controls (p < 0.001). In the individual group analysis, a significant negative correlation was found between salivary S100A7 and duration of areca nut use (r = -0.45, p = 0.009) and gutka chewing (r = -0.20, p = 0.03), while a significant positive correlation was found between salivary S100A7 and mouth opening (r = 0.03, p = 0.04). CONCLUSIONS: Higher levels of S100A7 protein level was seen in stage I OSF group in comparison to the healthy individuals. Results of our study suggest that S100A7 could be used as a surrogate assessment to identify patients at risk of OSF development.
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Effect of Photodynamic Therapy, Er,Cr:YSGG, and Nd:YAG Laser on the Push-Out Bond Strength of Fiber Post to Root Dentin.

Objective: To evaluate the push-out bond strength and modes of failure of fiber post to root dentin by using photodynamic therapy (PDT), Er,Cr:YSGG, Nd:YAG laser, and conventional cleaning and shaping (CCS). Materials and methods: Eighty anterior teeth were sectioned in a horizontal manner being 2 mm incisal to the cementoenamel junction, and root canal was prepared for post space. After post space was made, fiber posts were placed inside the root canal system. The fiber posts were subjected to PDT, Er,Cr:YSGG laser, Nd:YAG laser, and conventional cleaning and shaping (CSS) with 20 specimens in each group. Cervical and apical sections were obtained from the specimens. For performing the push-out test, the universal testing machine was used. The formula used for calculating the push-out bond strength was σ = N/mm2. Results: PDT group (8.16 ± 2.19 MPa) achieved the highest mean push-out bond strength, whereas Er,Cr:YSGG (7.24 ± 1.27 MPa) reported the lowest value in the specimens. Among the experimental groups, the ANOVA test expressed statistical difference (p = 0.481). In the cervical segments, the mean push-out bond strength was found to be higher in all of the experimental groups. For the cervical segments, the independent t-test results showed higher mean push-out bond strength values than the apical segments in PDT, Er,Cr:YSGG, Nd:YAG, and CSS groups, respectively (p < 0.05). Twenty failures were observed at the interface level between the adhesive and surface of dentin. Seven failures were found at the interface between mixed and the adhesive and post, respectively. Conclusions: Push-out bond strength to root canal dentin was not affected by PDT, Er,Cr:YSGG, and Nd:YAG laser compared with CCS. However, PDT produced the smallest number of failure modes and slightly higher push-out bond strength to root dentin. Laser treatment using PDT and Er,Cr:YSGG appeared to be clinically efficient showing acceptable push-out bond strength of fiber post with less number of failures at different regions of the root dentin.

Clinical and microbiological outcomes of photodynamic and systemic antimicrobial therapy in smokers with peri-implant inflammation.

AIM: To compare the effectiveness of two protocols in the treatment of peri-implant mucositis (p-iM) among cigarette smokers. MATERIALS AND METHODS: Three groups were randomized into (i) single session of antimicrobial photodynamic therapy (aPDT) with mechanical debridement (MD) (Group-A), (ii) systemic AB with MD (Group-B), and (iii) MD alone (Group-C). Clinical peri-implant parameters including plaque scores (PS), bleeding on probing (BOP) and probing depth (PD) were measured at baseline, 6 weeks and 12 weeks. Microbiological parameters included the assessment of percentage level of Pseudomonas aeruginosa and Staphylococcus aureus at baseline and 12 weeks. All parameters were analyzed using Friedman test and multiple comparisons performed using Bonferroni tests. P-value less than 0.05 were considered statistically significant. RESULTS: At 6 weeks of follow-up, there was a statistically significant reduction in PS (p < 0.001), BOP (p < 0.01), and PD (p < 0.05) among patients in groups A and B on intragroup comparison. At 12 weeks of follow-up, there was a further significant reduction in PS (p < 0.001) and BOP (p < 0.01) among patients in groups A and B on intragroup comparison but this reduction was comparable with 6-week follow-up. On inter-group comparison, only Group-A showed statistically significant reduction in BOP compared to Group-B and C at 6 weeks (p < 0.05). The levels of both P. aeruginosa and S. aureus in Group-A and Group-B showed statistically significant reductions at 12 weeks compared with baseline (p < 0.01). On inter-group comparison, Group-A and B showed no significant differences at follow-up (p > 0.05). CONCLUSION: This short term clinical study suggests that aPDT as an adjunct to MD is as efficacious as adjunctive antibiotic therapy. However, additional benefits in the reduction of bleeding scores were observed for aPDT in peri-implant inflammation among cigarette smokers.

Survival of Titanium-Zirconium and Titanium Dental Implants in Cigarette-smokers and Never-smokers: A 5-Year Follow-up.

OBJECTIVE: To compare the peri-implant clinical and radiographic status around bone-level narrow-diameter titanium-zirconium (TiZr) implants and titanium (Ti) implants placed in cigarette-smokers (CS) and never-smokers (NS). METHODS: Partially edentulous CS and NS rehabilitated with TiZr and Ti implants were included. Demographic data and information regarding smoking habits were collected. Participants were divided into four groups: group-1, CS with TiZr implants; group-2, NS with TiZr implants; group-3, CS with Ti implants; and group-4, NS with Ti implants. 36, 30, 31 and 33 implants were placed in 24, 23, 24 and 25 male individuals in groups 1, 2, 3 and 4, respectively. Peri-implant plaque index (PI), bleeding on probing (BOP), probing depth (PD) and mesial and distal crestal bone loss (CBL) were measured. All patients were enrolled in biannual routine oral prophylaxis care at least until the fifth year of follow-up and oral hygiene instructions were reinforced at each recall appointment. P < 0.05 was considered statistically significant. RESULTS: At the 3- and 5-year follow-ups, there was no statistically significant difference in the peri-implant PI, BOP, PD and CBL between individuals in all groups. In all groups, the implant success and survival rates were 100% and 100%, respectively, at the 5-year follow-up. CONCLUSION: The TiZr and Ti dental implants can remain clinically and radiographically stable in CS in a manner similar to NS. Routine oral hygiene maintenance plays an essential role in this regard.

Current weight of evidence of viruses associated with peri-implantitis and peri-implant health: A systematic review and meta-analysis.

The pathological role of human herpesviruses (HHVs) (Epstein-Barr virus [EBV], Human cytomegalovirus [CMV], and Herpes simplex virus [HSV]) in peri-implant health needs clarification quantitatively. To determine the weight of evidence for HHVs in patients with peri-implantitis (PI) and substantiate the significance of HHVs in peri-implant inflammation, electronic databases including EMBASE, MEDLINE, Cochrane Oral Health Group Trials Register, and Cochrane Central Register of Controlled Trials were searched from 1964 up to and including November 2018. Meta-analyses were conducted for prevalence of HHVs in PI and healthy controls. Forest plots were generated that recorded risk difference (RD) of outcomes and 95% confidence intervals (CI). Five clinical studies were considered and included. Four clinical studies reported data on EBV while three clinical studies reported data on CMV. Considering the risk of these viruses in PI, significant heterogeneity for CMV (χ2  = 53.37, p < 0.0001, I2  = 96.25%) and EBV (χ2  = 14.14, p = 0.002, I2  = 78.79%) prevalence was noticed between PI and healthy control sites. The overall RD for only EBV (RD = 0.20, 95% CI, 0.01-0.40, p = 0.03) was statistically significant between both groups. Frequencies of the viruses were increased in patients with PI compared with healthy nondiseased sites. However, the findings of the present study should be interpreted with caution because of significant heterogeneity and small number of included studies.

Comparison of clinical peri-implant indices and crestal bone levels around narrow and regular diameter implants placed in diabetic and non-diabetic patients: A 3-year follow-up study.

BACKGROUND: Studies evaluating and comparing clinical and radiographic peri-implant indices around narrow diameter implants (NDIs; <3.3 mm) and regular diameter implants (RDIs) in type-2 diabetes mellitus (T2DM) and non-diabetic individuals are deficient. OBJECTIVE: To estimate and compare the clinical and radiographic indices around NDIs and RDIs placed in T2DM and non-diabetic patients. MATERIALS AND METHODS: Eighty-six patients requiring implant surgery in the posterior mandible were divided into two groups (42 T2DM and 44 non-diabetic individuals). Patients were further categorized into two subgroups on the basis of diameter of implants: (1) patients with NDIs (3.3 mm ø) and (2) patients with RDIs (4.1 mm ø). Clinical indices evaluating plaque index (PI), bleeding on probing (BOP), probing depth (PD), and crestal bone levels (CBL) were recorded around all dental implants at 18 and 36 months follow up. Serum hemoglobin A1c (HbA1c) test was carried out for both groups to assess the profile of glycosylated hemoglobin at baseline, 18 and 36 months of follow up. RESULTS: The mean age of patients in T2DM group and non-diabetic group was 45.2 and 41.6 years, respectively. At 18 and 36 months follow up, mean HbA1c levels were 6.5% and 4.5% and 6.7% and 4.5% in T2DM and non-diabetic individuals, respectively. A statistically significant reduction in mean HbA1c levels from the baseline to respective follow-up periods were seen in T2DM patients. There was no statistically significant difference in the overall mean scores of PI, BOP, PD, and CBL around NDIs and RDIs among T2DM and non-diabetic patients at 18 and 36 months of follow up. CONCLUSION: NDIs show reliable clinical stability and radiographic bone levels as RDIs placed in T2DM and non-diabetic individuals, provided oral hygiene and glycemic status are strictly maintained.

Peri-implant soft tissue status and crestal bone levels around adjacent implants placed in cigarette smokers and never smokers: Five-year follow-up results.

BACKGROUND: It is hypothesized that peri-implant soft tissue inflammation and crestal bone loss (CBL) are higher around adjacent implants placed in cigarette smokers compared with never smokers. The aim of the present 5-years follow-up retrospective clinical study was to compare the peri-implant soft tissue status and CBL around adjacent implants placed in cigarette smokers and never smokers. METHODS: Cigarette smokers (group 1) and never smokers (group 2) with adjacent dental implants were included. Demographic information regarding age, sex, duration of smoking (pack-years), daily frequency of toothbrushing and most recent visit to a dentist or dental hygienist were recorded using a questionnaire. Information regarding implant dimensions (length × diameter), duration of implants in function, loading protocol (and type of restoration was recorded. Peri-implant plaque index (PI), bleeding on probing (BOP), probing depth (PD), and mesial and distal CBL were measured. P <0.05 were considered statistically significant. RESULTS: Seventy-two male participants (37 in group 1 and 35 in group 2) were included. The mean age of individuals in groups 1 and 2 were 50.3 ± 5.4 and 48.5 ± 3.8 years, respectively. In group 1, the mean duration of cigarette smoking was 22.3 ± 1.6 pack years. A family history of smoking was more often reported by individuals in group 1 compared with group 2. In groups 1 and 2, 54 and 70 adjacent implants, respectively were placed in the regions of missing premolars and molars. All implants were delayed loaded and were fixed with non-splinted screw-retained restorations. In groups 1 and 2, toothbrushing twice daily was reported by 78.3% and 74.2% individuals, respectively. There was no statistically significant difference in peri-implant PI, BOP, PD, and mesial and distal CBL among individuals in groups 1 and 2. CONCLUSION: Peri-implant soft tissue status and crestal bone levels were comparable around adjacent dental implants placed in cigarette smokers and never smokers.

Proinflammatory cytokine levels and peri-implant parameters among cigarette smokers, individuals vaping electronic cigarettes, and non-smokers.

BACKGROUND: Tobacco smoking compromises the prognosis of dental implant treatment and is associated with increased risk of peri-implant bone loss and increased implant failure rate. There is a dearth of studies that have compared clinical, radiographic, and immunological peri-implant parameters among cigarette smokers (CS), individuals vaping e-cigarettes (e-cigs), and non-smokers (NS). This study aimed to compare clinical and radiographic peri-implant parameters and levels of matrix metalloproteinase (MMP)-9 and interleukin (IL)-1ß levels among CS, individuals' vaping e-cigs, and NS. METHODS: Thirty-two CS (group 1), 31 individuals vaping e-cigs (group 2), and 32 NS (group 3) were included. Demographic- and implant-related data were collected using a structured baseline questionnaire. Peri-implant plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were recorded and marginal bone loss (MBL) were assessed using standardized digital radiographs. Enzyme-linked immunosorbent assay was used to assess levels of MMP-9 and IL-1ß in peri-implant sulcular fluid. Pearson correlation coefficient was used to analyze for correlations of MMP-9 and IL-1ß levels with peri-implant parameters. RESULTS: BOP showed significantly higher values in group 3 as compared with groups 1 and 2 (P < 0.01). PI (P < 0.01), PD ≥ 4 mm (P < 0.01), and mean concentrations of MMP-9 (P < 0.001) and IL-1ß (P < 0.01) were significantly higher in groups 1 and 2 than group 3. MBL was significantly higher in group 1 as compared with group 2 and group 3 (P < 0.01). Significant positive correlations were found between MMP-9 (P = 0.0198) and IL-1ß (P = 0.0047) levels and MBL in group 1; and a significant positive correlation between IL-1ß and MBL in group 2 (P = 0.0031). CONCLUSIONS: Peri-implant health was compromised among CS than vaping individuals and NS. Increased levels of proinflammatory cytokines in CS and vaping individuals may suggest greater peri-implant inflammatory response.

Clinical indices and local levels of inflammatory biomarkers in per-implant health of obese and nonobese individuals.

BACKGROUND: Obesity seem to regulate peri-implant health. It is proposed that peri-implant crevicular fluid (PICF) levels of interleukin (IL)-1ß and IL-6 are higher in obese as compared to nonobese individuals. OBJECTIVE: The purpose of the present clinico-laboratory study is to estimate and compare the clinical and radiographic indices and PICF levels of IL-1ß and IL-6 among obese and nonobese patients. MATERIALS AND METHODS: Fifty patients were divided into two groups (25 obese with ≥27.5 kg/m2 and 25 nonobese with <27.5 kg/m2 individuals). Clinical indices for both periodontal and peri-implant evaluating plaque index (PI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), and crestal bone loss (CBL) were recorded around teeth and implants. PICF was collected and assessed for the levels of IL-1ß and IL-6 using enzyme-linked immunosorbent assay. RESULTS: A significant difference was observed in PI and BOP around natural teeth and implants in obese patients, respectively (P < .05). CBL was found to be significantly higher among obese as compared to nonobese patients (P = .022). Peri-implant and periodontal PD was higher in obese as compared to nonobese but did not reach statistical significance. Levels of IL-1ß and IL-6 were statistically significantly higher among obese patients as compared to nonobese (P = .001). Pearson correlation analysis showed IL-1ß was positively correlated with CBL (P = .0079), whereas IL-6 showed positive correlation with both BOP (P = .0019) and CBL (P = .015) among obese patients. CONCLUSIONS: Clinical peri-implant parameters were worse and proinflammatory biomarkers were significantly higher in obese patients compared with nonobese subjects. The findings of the present study suggests that increased proinflammatory biomarkers in PICF of obese patients may modulate peri-implant inflammation around dental implants.

Impact of jaw location on clinical and radiological status of dental implants placed in cigarette-smokers and never-smokers: 5-year follow-up results.

PURPOSE: The aim of this 60 months follow-up investigation was to investigate the impact of jaw location on clinical and radiological status of dental-implant therapy in cigarette-smokers and never-smokers. MATERIALS AND METHODS: Twenty-nine self-reported cigarette-smokers and 27 nonsmokers were assessed. All implants were categorized into three regions with reference to their location in the maxilla or mandible: (a) Anterior zone: implants located in anterior teeth; (b) Middle zone: Implants located in the premolar region; and (c) posterior zone: implants located in the molar region. Peri-implant crestal bone loss (CBL), bleeding-on-probing (BOP) and probing-depth (PD) ≥ 4 mm and were assessed. Level of statistical significance was set at P < .05. RESULTS: Mean age of cigarette-smokers (n = 29) and never-smokers (n = 27) was 44.5 years (39-51 years) and 43.6 years (35-49 years), respectively. The average duration of cigarette-smoking was 20.3 years (17-26 years). The mean periimplant PD (P < .05) and CBL (P < .05) were significantly higher in cigarette-smokers in contrast to never-smokers in all zones. No statistically significant differences in CBL, PD, and BOP were observed in the three zones of implant location among cigarette-smokers and never-smokers. CONCLUSION: Smoking enhanced PD and CBL around dental implants and this relationship was independent of site of implant placement and jaw location.

Assessment of matrix metalloproteinase-8 and -9 levels in the peri-implant sulcular fluid among waterpipe (narghile) smokers and never-smokers with peri-implantitis.

OBJECTIVES: It is hypothesized that levels of matrix metalloproteinase (MMP)-8 and MMP-9 are significantly higher in the peri-implant sulcular fluid (PISF) of waterpipe-smokers (WS) compared with never-smokers with peri-implantitis. The aim of the present convenience sample case-control study was to compare the levels of MMP-8 and MMP-9 in the PISF of WS and never-smokers with peri-implantitis. MATERIAL AND METHODS: Individuals smoking waterpipe (Group 1) and never-smokers (Group 2) were included. Demographic data was collected using a questionnaire. Peri-implant probing depth (PPD) was measured and crestal bone loss (CBL) was measured on digital bitewing radiographs. PISF samples were collected using paper strips and the collected PISF volume was determined. Levels of MMP-8 and MMP-9 were measured using enzyme-linked immunosorbent assay. Study sample-size was estimated and statistical analysis was performed. p values < .05 were considered statistically significant. RESULTS: Sixty-six individuals (33 individuals in Group 1 and 33 in Group 2) were included. In Groups 1 and 2, 41 and 44 implants, respectively were placed. The mean total PPD (p < .001) and peri-implant CBL (p < .001) was statistically significantly higher around implants affected by peri-implantitis in Group 1 compared with Group 2. The PISF volume (p < .05) collected and levels of MMP-8 (p < .01) and MMP-9 (p < .01) were statistically significantly higher among individuals in Group 1 compared with Group 2. CONCLUSION: PISF levels of MMP-8 and MMP-9 are significantly higher among WS compared with never-smokers with peri-implantitis.