Evaluation of Oromucosal Natural Gum-Based Emulgels as Novel Strategy for Photodynamic Therapy of Oral Premalignant Lesions.

Photodynamic therapy (PDT) recently has been shown as a promising option in the treatment of premalignant lesions of the soft oral tissues. Effective delivery of photosensitizer is challenging due to poor drug adherence to the oromucosal epithelium. In the present work, emulgels composed of natural polysaccharide gums (tragacanth, xanthan and gellan) were evaluated as novel oromucosal platforms of delta-aminolevulinic acid (ALA) for PDT. Apart from mucoadhesive and textural analysis, the specific steps involved studies on drug penetration behavior and safety profile using a three-dimensional human oral epithelium model (HOE). All designed emulgels presented greater mucoadhesiveness when compared to commercial oromucosal gel. Incorporation of ALA affected textural properties of emulgels, and tragacanth/xanthan formulation with greater hardness and cohesiveness exhibited a protective function against the mechanical tongue stress. Permeability studies revealed that ALA is capable of penetrating across oromucosal epithelium by passive transport and all formulations promoted its absorption rate when compared to a commercial topical product with ALA. Importantly, the combination of tragacanth and xanthan profoundly enhanced photosensitizer retention in the buccal epithelium. Tested samples performed negligible reduction in cell viability and moderately low IL-1ß release, confirming their non-irritancy and compatibility with HOE. Overall, the presented findings indicate that tragacanth/xanthan emulgel holds promise as an oromucosal ALA-carrier for PDT strategy.

Matrix Metalloproteinase 9 (MMP-9) and Interleukin-8 (IL-8) in Gingival Crevicular Fluid after Regenerative Therapy in Periodontal Intrabony Defects with and without Systemic Antibiotics-Randomized Clinical Trial.

The aim of our study was to assess changes in the levels of IL-8 and MMP-9 in gingival crevicular fluid (GCF) collected from the periodontal pocket before and after regenerative surgery with deproteinized bovine bone mineral (DBBM) and collagen membrane (GTR) either independently (DBBM/GTR) or with the postoperative administration of antibiotic (DBBM/GTR+AB). The study involved 41 patients, each with one intrabony defect. IL-8 and MMP-9 were determined before therapy and after 2 weeks, 4 weeks and 6 months following the surgical procedure by means of dedicated ELISA kits. No statistical differences were observed in the levels of IL-8 and MMP-9 after 2 weeks, 4 weeks and 6 months between the groups. The changes in the level of MMP-9 over time were not statistically significant in any group. The changes in the level of IL-8 were significant for the group given antibiotic but not in the nonantibiotic group in the follow-up period. IL-8 and MMP-9 were found to correlate positively but not after 4 weeks in the test group. Current assessment of IL-8 and MMP-9 obtained from GCF samples provides evidence that collagen matrix turnover occurs actively during the early healing phase in the periodontium after regenerative procedures. We observed positive correlations of MMP-9 and IL-8 throughout the study. However, we failed to reveal any differences regard parameters studied between the two groups.

Periodontitis-Related Knowledge and Its Relationship with Oral Health Behavior among Adult Patients Seeking Professional Periodontal Care.

BACKGROUND: Periodontitis is a chronic inflammatory disease that not only damages the stomatognathic system, but may also adversely influence other systems and organs. Patients with low oral health literacy levels are more prone to gingivitis/periodontitis and have a more severe disease course. METHODS: A written questionnaire was carried out to assess the knowledge of patients of the Outpatient Clinic of Department of Periodontal and Oral Mucosa Diseases, Medical University of Bialystok, Poland. The questions concerned knowledge regarding the causes of periodontal disease, its risk factors, and the connection between periodontal disease and general health status. To analyze the population, patients were divided according to gender, age and if they were first-time or regular outpatients. RESULTS: Written questionnaires were completed by a total of 302 patients. In the studied population, we noted knowledge deficits, particularly related to weaker periodontal disease risk factors (stress, diabetes, osteoporosis, obesity) and the genetic factor, which is the determinant of periodontitis. The patients' awareness of the role of plaque bacteria and the effect of smoking on the periodontium was at a relatively high level. The respondents were also aware of the impact of periodontal disease on general health as well as the role of oral hygiene in preventing the disease. At the same time, few of them (26%) used interdental brushes or an irrigator (8%). CONCLUSIONS: We demonstrated that patients have an insufficient level of knowledge related to risk factors as well as the prevention of periodontal disease. Awareness of the extent of oral health literacy among patients will help to identify key issues connected with health education interventions.

The Cone Beam Computed Tomography Evaluation of Cortical Bone Plate after Piezocision-Assisted Orthodontic Upper Arch Expansion: A Case Series.

BACKGROUND: The purpose of the study was to evaluate cone beam computed tomography (CBCT) after piezocision-assisted orthodontic maxillary arch expansion. METHODS: Forty CBCT images of 20 patients taken before and after treatment were included in the study. The following radiographic parameters were measured: buccal/palatal bone plate thickness measured in three locations, 0.5 mm, 3.5 mm, and 5 mm from the margin of alveolar process; cemento-enamel junction-crest distance (CEJ-C) measured at buccal (CEJ-B) and palatal/lingual (CEJ-P) aspects. RESULTS: After treatment there were insignificant changes in CEJ-C and thickness of buccal/palatal plates for all the dental groups except for incisors and premolars. CEJ-B increased by 1.43 mm on premolars and CEJ-P by 1.65 mm on incisors and by 0.31 mm on premolars. On the incisors, the buccal plate width increased significantly, by 0.2 mm and 0.44 mm at 3.5-mm and 5-mm measurement points. On premolars, the buccal plate width decreased in three measuring points by 0.27 mm, 0.37 mm, and 0.25 mm. CONCLUSIONS: Piezocision-assisted orthodontic maxillary arch expansion does not cause evident negative changes of cortical plates except for the premolar region. Therefore, premolars may be at greater risk of buccal plate loss than other teeth.

Dynamics of Matrix Metalloproteinase-1 and -8 Secretion in Gingival Crevicular Fluid after Gingival Recession Therapy via MCAT with Either Subepithelial Connective Tissue Graft or Collagen Matrix.

OBJECTIVES: The objective of this study was to determine and estimate the changing levels of matrix metalloproteinases 1 and 8 (MMP-1 and MMP-8) in GCF at consecutive stages of healing after root coverage procedure via modified coronally advanced tunnel (MCAT) combined with either sub-epithelial connective tissue graft (SCTG) or collagen matrix (CM) and also to relate those changes to clinical outcomes of both therapeutic approaches. MATERIALS AND METHODS: The study involved 20 patients with a total of 91 recessions. Those on one side of the mandible received MCAT plus CM while the contralateral ones MCAT plus SCTG. The evaluation of MMP-1 and MMP-8 concentrations in Gingival Crevicular Fluid (GCF) took place at baseline, then at 1, 2, and 4 weeks, and finally at 3 months after surgery. Elisa protocol was applied to determine the levels of MMP-1 and MMP-8 in GCF. RESULTS: Three-month observation revealed statistically significant changes in MMP-1, MMP-8 and Sulcus Fluid Flow Rate (SFFR) values after implementation of both techniques. A correlation was found between a difference in MMP-1 concentrations and gain in Keratinized Tissue (KT) after SCTG and CM. MMP-8 levels and a Gingival Thickness (GT) gain observed after CM was also correlated. CONCLUSIONS: A type of augmentative material does appear to determine the dynamics of MMP-1 secretion.

Effect of systemic antibiotics on the outcomes of regenerative periodontal surgery in intrabony defects: a randomized, controlled, clinical study.

OBJECTIVES: To assess the potential influence of systemic antibiotic administration on the healing of periodontal intrabony defects treated with deproteinized bovine bone mineral (DBBM) and collagen membrane. MATERIALS AND METHODS: Forty-one intrabony defects were treated by means of DBBM and collagen membrane (GTR). Postoperatively, the patients received either systemic antibiotics (i.e., 1 g of amoxicillin, twice daily for 7 days) (test) or no antibiotics (control). Clinical attachment level (CAL), probing depth (PD), and gingival recession (GR) were measured at baseline and at 1 year following regenerative surgery. The depth of the intrabony component (INTRA DD) and its width (INTRA DW) were measured during surgery and after 1 year at reentry. The depth (RxD) and width (RxW) of the intrabony defects were evaluated radiographically at baseline and at 1 year. RESULTS: No adverse events were observed in any of the two groups throughout the entire study period. In the test group, mean CAL changed from 8.7 ± 1.4 mm at baseline to 5.0 ± 1.7 mm at 1 year (p < 0.0001), while PD decreased from 7.8 ± 1.5 mm at baseline to 4.0 ± 0.9 mm at 1 year (p < 0.0001). In the control group, mean CAL changed from 8.6 ± 1.9 mm to 5.9 ± 1.6 mm (p < 0.001) and mean PD improved from 7.4 ± 1.3 mm to 4.1 ± 1.3 mm (p < 0.001). Mean CAL gain measured 3.6 ± 1.6 mm in the test and 2.7 ± 1.6 mm in the control group, respectively. Defect fill (i.e., INTRA DD gain) at re-entry measured 3.7 ± 1.8 mm in the test and 2.7 ± 2.1 mm in the control group. A CAL gain of ≥ 3 mm was measured in 76% of the defects in the test group and in 40% of the defects in the control group, respectively. In both groups, all evaluated clinical and radiographic parameters improved statistically significantly compared with baseline, but no statistically significant differences were found between the two groups. CONCLUSIONS: Within their limits, the present study has failed to show any substantial added clinical benefits following the postoperative administration of amoxicillin in conjunction with regenerative periodontal surgery using DBBM and GTR. CLINICAL RELEVANCE: The post-surgically administration of systemic antibiotics does not seem to be necessary following regenerative periodontal surgery.

The Protective Impact of Black Chokeberry Fruit Extract (Aronia melanocarpa L.) on the Oxidoreductive System of the Parotid Gland of Rats Exposed to Cadmium.

Cadmium (Cd) is a strongly toxic heavy metal with prooxidative properties. Since the exposure of the general population to this metal is predicted to increase, effective methods are being sought to prevent its negative actions. One of them involves the use of the antioxidant potential of polyphenol compounds contained in black chokeberry fruit extract and their capability of complex formation with Cd2+. The study objective was to investigate whether the administration of A. melanocarpa fruit extract rich in polyphenol compounds during low and moderate exposures to cadmium can protect the parotid gland against oxidative damage. The study was conducted using the experimental model on female Wistar rats which were given 0.1% aqueous extract of Aronia melanocarpa fruit (AE) and/or cadmium at a concentration of 1 (Cd1) or 5 (Cd5) mg Cd/kg feed for 3 and 10 months, and on control animals. The exposure to Cd attenuated the enzymatic antioxidant barrier (catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx)) and increased the concentration of hydrogen peroxide (H2O2), protein carbonyl (PC) groups, and oxidized lipids (LPO) in parotid gland. These disorders led to a reduction in the total antioxidative status (TAS), an increase in the total oxidative state (TOS), and development of stress. The administration of AE at both levels of exposure to cadmium substantially improved the enzymatic antioxidant barrier (CAT, SOD, GPx) and prevented oxidative damage to cellular macromolecules (PC, LPO) and the increase in the level of H2O2, MPO, TOS, and stress indicator (OSI = TOS/TAS) in the parotid gland. Concluding, it should be stated that the consumption of aronia products may prevent oxidative/antioxidative imbalance induced by Cd and oxidative stress development in the parotid gland, thus protecting the gland from damage.

Effect of Metronidazole on the Oxidoreductive Processes in the Submandibular and Parotid Glands in Experimental Research.

Oxidative stress takes part in the pathomechanisms of many diseases, including oral disorders. The imbalance between oxidative and antioxidative processes may lead to periodontitis, osteitis, or oral cancers. Furthermore, many chemotherapeutics, e.g., metronidazole (MTZ), may also cause toxic reactions and affect oxidative reactions. The research focused on MTZ influence on oxidative destruction in the parotid and submandibular gland tissue in animal experimental model. Therefore, the concentrations of enzymatic and nonenzymatic markers of oxidative stress were measured in these two rat glands in the control and experimental MTZ-treated groups. The material for analysis included parotid and submandibular glands of male Wistar rats, which were treated with metronidazole for 7 days by gastric tube in a dose of 100 mg/kg b.w. On day 8, the material was obtained and frozen in temp. -80°C. Then, the following seven enzymatic and nonenzymatic parameters were measured: GPx, TOS, TAS, SOD, LPO, CAT, and GSH. The data were analysed using Statistica 10.0. Metronidazole treatment in the experimental model showed an increase in LPO, TOS, and TOS/TAS and a decrease in CAT, SOD, GPx, and TAS. The conclusions of this research were made. Metronidazole treatment in a dose of 100 mg/kg b.w. caused imbalance between oxidative and antioxidative reactions in the rat parotid and submandibular glands. An increase was observed in LPO, TOS, and TOS/TAS in both glands exposed to metronidazole. Decreased activity of CAT, SOD, GPx, and TAS was noted, which indicates attenuation of the gland antioxidative protective barrier.

Assessment of the effect of the corticotomy-assisted orthodontic treatment on the maxillary periodontal tissue in patients with malocclusions with transverse maxillary deficiency: a case series.

BACKGROUND: The aim of the study was to assess the effect of corticotomy-assisted orthodontic treatment on soft tissue clinical parameters in patients with malocclusions with transverse maxillary deficiency. METHODS: The study included 20 generally healthy adult individuals with malocclusion, who underwent a corticotomy-assisted orthodontic treatment in maxilla. During the corticotomy performed after full-thickness flap elevation, only the buccal cortical plate was cut with the use of OTS-7, OTS7-4, OTS7-3 ultrasound tips of the piezosurgery device (Mectron s. p. a., Italy). A clinical examination was performed prior to the corticotomy procedure, then repeated - 3, 6, 9 and 12 months after the procedure. The following parameters were assessed: FMPI (full mouth plaque index), FMBOP (full mouth bleading on probing), PD (probing depth), CAL (clinical attachment level), GR (gingival recession height), RW (recession width), PH (papilla height), PW (papilla width), BS (bone sounding), biotype and KT. RESULTS: There was a statistically significant reduction in PD (mean difference: 0.06; 95% Cl: - 0.33, - 0.18), CAL (mean difference: 0.07; 95% Cl: - 0.33, - 0.19), PH (mean difference: 0.26; 95% Cl: - 0.47, 0.05) and BS (mean difference: 0.13; 95% Cl: - 0.41, - 0.14) after the treatment. Statistically significant changes were also noted in relation to KT (mean difference: 0.17; 95% Cl: - 0.07, 0.27) and biotype (mean difference: 0.07; 95% Cl: 0.26, 0.39), which thickness increased significantly after the treatment. No statistically significant differences were observed in GR, RW and PW. CONCLUSIONS: The corticotomy-assisted orthodontic treatment did not jeopardize the periodontal clinical status in maxilla. There is a need for further studies on a larger number of patient to compare the clinical findings with a control group as well as in patients with conventional orthodontic treatment in a longer follow-up time to find out more about the post-treatment periodontal tissue changes and stability.

Evaluation of concordance between CAD/CAM and clinical positions of abutment shoulder against mucosal margin: an observational study.

BACKGROUND: While working on CAD/CAM-customized abutments, the use of standard impression copings with a circular diameter produces inconsistency within the emergence profile. It may begin with a collapse of the supra-implant mucosa during impression taking, then lead to a computer-generated mismatch of the position and outline of the abutment shoulder, and consequently result in a compromised outcome of anticipated treatment. The aim of the study was to compare the virtual and clinical positions of the abutment shoulder in relation to the mucosal margin after the abutment delivery. METHODS: Conventional open-tray impression takings followed uncovering surgery. Master casts were scanned with a desktop scanner. Clinical examinations took place after abutment's insertion and temporization (T1) and prior to cementation of the definitive crown (T2). The distances between the abutment shoulder and marginal soft tissue were measured intraorally in four aspects and juxtaposed with those on the virtual model. RESULTS: The study evaluated 257 dental implants and CAD/CAM-customized abutments. As T1 and T2 showed, there was a positive correlation between the virtually designed abutment shoulder position and matching clinical location relative to the mucosal margin. In 42.1% of cases, the distance between the mucosal margin and the abutment shoulder did not change. It increased in 36.3% of cases while a decrease occurred in 21.6% of them. CONCLUSIONS: Computer-set position of the abutment shoulder in relation to the mucosal margin can be predictably implemented in clinical practice.

Correlation between the state of periodontal tissues and selected risk factors for periodontitis and myocardial infarction.

BACKGROUND: The current level of knowledge indicates a relationship between periodontitis and diabetes and/or cardiovascular diseases (CVD). Periodontitis can be not only a risk factor for these diseases, but also a condition modifying other primary risk factors associated with the occurrence of cardiovascular complications (lipid disorders, arterial hypertension, etc.) or diabetes. OBJECTIVES: The aim of the study was an analysis of the correlation between the state of periodontal tissues and selected risk factors for myocardial infarction (MI) in patients after recent myocardial infarction. MATERIAL AND METHODS: The study included 417 patients (92 women, 325 men) hospitalized due to recent MI. The inclusion criteria were MI history and age below 70 years. The state of periodontal tissues (plaque index, bleeding on probing, pocket depth and clinical attachment loss, CPI index) and selected risk factors for periodontitis and CVD were recorded. RESULTS: An analysis of the results showed no statistically significant correlation between the depth, the number, percentage of periodontal pockets and the average clinical attachment level on one hand and BMI on the other hand. Whereas a statistically significant correlation was observed between tobacco smoking and the degree of severity of periodontal diseases measured by the average pocket depth, the number and percentage of pockets above 4 mm and the average clinical attachment loss, as well as between hypertension and the state of oral hygiene and between diabetes and the number of preserved teeth and the number of pockets above 4 mm. CONCLUSIONS: The degree of severity of periodontal disease can impact hypertension and diabetes, which could potentially influence the occurrence and course of CVD.

A clinical evaluation of the efficacy of photodynamic therapy in the treatment of erosive oral lichen planus: A case series.

BACKGROUND: Erosive oral lichen planus (EOLP) poses a substantial risk of malignant transformation into squamous cell cancer. The absence of established treatment gives way to alternative therapeutic strategies, including photodynamic therapy. The aim of the study was to evaluate the efficacy of PDT in the treatment of EOLP. METHODS: Twelve female patients aged 63-80 with 22 OLP lesions (16 on the buccal mucosa, 6 on gingiva and tongue), underwent authors' own PDT scheme with the use of 5% solution of 5-aminolevulinic acid (ALA) as photosensitizer. An ALA-saturated occlusive dressing was applied directly onto a lesion and surrounding mucosa 2h prior to illumination with a custom-made diode lamp (light of 630nm, dose of 300mW). After a series of 10 weekly illumination sessions the patients were monitored for 12 months. RESULTS: The mean size of lesions before treatment was 1.46cm2±1.44. The lesions on the buccal mucosa were smaller (1.06cm2±0.98) than those on the gingiva and tongue (2.63cm2±1.93). Post-treatment improvement encompassed 16 lesions, 5 of which were in remission. The mean reduction in size after 10-session therapy was 8,05%. The healing continued and further reduction in size (by 69.13%) took place during the 12-month observation: 39.62% of lesions within the buccal mucosa and full remission of all lesions on the gingiva and tongue. CONCLUSIONS: The results suggest that PDT offers non-invasive treatment of lesions in oral mucosa and may become an alternative and complementary method to those currently in use. Further studies involving larger groups of patients should be undertaken before it becomes routine practice.

Periodontal status and selected parameters of oral condition of Poles aged 65 to 74 years.

INTRODUCTION: The goal of this study was the evaluation of the periodontal health by means of CPI score in inhabitants of big and small cities in the age range from 65 to 74 and making comparison with previous Polish and European studies from XXI century. Also an average number of natural teeth, the edentulous persons percentage, the percentage of people with oral function maintenance and prevalence of oral mucosal diseases were evaluated. There were also attempts to evaluate essential behaviours related to the oral health and the percentage of people that are treated with use of non-reimbursed or reimbursed services. MATERIAL AND METHODS: Studies were conducted in 5 big cities: Warszawa, Szczecin, Wroclaw, Bialystok and Torun, as well as in 4 towns, such as Olawa, Police, Lobez and Elk. From sampling 7400 people aged from 65 to 74 years for the study reported only 807 people. In the mouth evaluated CPI score, number of natural teeth and prevalence of pathological lesions on cavity mucosa. Answers for questions on selected attitudes and health-seeking behaviours related to the oral health and the range of dental treatment were also analysed. RESULTS: Distribution of values of CPI codes in the whole group was as follows: CPI0-1.2%, CPI1-9.4%, CPI2-16.6%, CPI3-21.8%, CPI4-19.7% and the number of people excluded from examinations (1 tooth in the sextant or edentulous 31.3%). The state of the periodontium was worse in big cities and in men. An average number of teeth was 13.7 and was higher in big cities and in men. The percentage of edentulous persons was 28.9% and was higher in towns and in woman. The percentage of people with oral function maintenance was 25.15% and was higher in big cities and in men. The most three common pathologies of the oral cavity were leukoplakia and leukokeratosis that were found in 10.5% of examined people, candidiasis 5.82% and lichen planus 2.2%. CONCLUSION: The state of the periodontium of Poles at the age from 65 to 74 has not been improved in XXI century, but also does not significantly differ from an average European level. An average number of remaining teeth of Poles at this age has increased, but remains under a European average; also the prevalence of edentulism has decreased, but still remains one of the highest in Europe. The percentage of people with oral function maintenance is very low, thus needs for prosthetic treatment and rehabilitation of masticatory ability remain high. Precancerous lesions in the oral cavity are quite common in this age group. Health-seeking behaviours related to the oral health of older Poles are inadequate and result from a low level of knowledge on dental prophylaxis.

Clinical evaluation of photodynamic therapy efficacy in the treatment of oral leukoplakia.

BACKGROUND: The aim of the study was clinical evaluation of photodynamic therapy efficacy in the treatment of oral leukoplakia lesions. METHODS: Twenty-three consecutive patients aged 21-79 were included to the study. In all patients 44 homogeneous, flat leukoplakia lesions were clinically diagnosed and confirmed histopathologically. Photodynamic therapy was performed with the use of Photolon(®) photosensitizer, containing 20% Chlorine-e6 and 10% dimethyl sulfoxide and a semiconductor laser, with power up to 300mW and a wavelength of 660nm. Ten illumination sessions were conducted with the use of superficial light energy density of 90J/cm(2). RESULTS: At baseline the mean size of leukoplakia lesion was 6.5±5.10cm(2) while after photodynamic therapy 3±2.99cm(2). Significant reduction (on average by 53.8%) of leukoplakia lesions sizes was observed after therapy. Twelve (27.27%) lesions had been completely cured, 22 (50%) partially cured, although 10 (22.73%) lasted unchanged. The efficacy of PTD was comparable in women and men irrespective of age. There have been no adverse site effects during therapy noted. CONCLUSIONS: Within the limits of the study it can be concluded that photodynamic therapy with the use of Chlorine-e6 can lead to considerable reduction of oral leukoplakia lesions size thus may be useful in clinical practice. However there is a need of further studies on larger number of cases and longer follow-up time.

Cytological picture of the oral mucosa in patients with gastric and colon cancer.

The incidence of malignant gastrointestinal cancers in Poland has been constantly growing, which has led to an intensification of the search for new markers of the early clinical stage of this disease. The oral cavity,as the first part of the gastrointestinal tract, has a very important role. The oral cavity presents symptoms of both typically stomatological and systemic diseases. Oral cancers, benign or malignant, may originate and grow in any of the tissues of the mouth, and within this small area they may be of varied clinical, histological and biological features. These can be lesions typically observed in the oral cavity, but also characteristic of cases where the symptoms occur both in the mouth and in other body parts. The aim of this study was to present a cytological picture of the oral mucosa in patients with gastric and colon cancer and to compare the cytological picture with that obtained from a group of patients with no cancer, using the Papanicolaou classification and the Bethesda system. The study was conducted in 126 patients treated surgically in the II General and Gastroenterological Surgery Clinic between 2006 and 2008. All patients were divided into two groups based on the type of lesions. In both of the studied groups, more than half of the patients did not present any abnormalities in the mucosa of the mouth, lips and cheeks in the physical examination. None of the patients had erosion, ulceration or lesions typical of leukoplakia or lichen planus. No malignant cells were detected in either of the studied groups, and there were no well-defined lesions found in the oral cavity that would distinguish the patients with gastrointestinal cancer.

Four-year results following treatment of intrabony periodontal defects with an enamel matrix derivative alone or combined with a biphasic calcium phosphate.

The aim of this study was to evaluate the 4-year clinical outcomes following regenerative surgery in intrabony defects with either EMD + BCP or EMD. Twenty-four patients with advanced chronic periodontitis, displaying one-, two-, or three-walled intrabony defect with a probing depth of at least 6 mm, were randomly treated with either EMD + BCP (test) or EMD alone (control). The following clinical parameters were evaluated at baseline, at 1 year and at 4 years after regenerative surgery: plaque index, gingival index, bleeding on probing, probing depth, gingival recession, and clinical attachment level (CAL). The primary outcome variable was CAL. No differences in any of the investigated parameters were observed at baseline between the two groups. The test group demonstrated a mean CAL change from from 10.8 ± 1.6 mm to 7.4 ± 1.6 mm (p < 0.001) and to 7.6 ± 1.7 mm (p < 0.001) at 1 and 4 years, respectively. In the control group, mean CAL changed from 10.4 ± 1.3 at baseline to 6.9 ± 1.0 mm (p < 0.001) at 1 year and 7.2 ± 1.2 mm (p < 0.001) at 4 years. At 4 years, two defects in the test group and three defects in the control group have lost 1 mm of the CAL gained at 1 year. Compared to baseline, at 4 years, a CAL gain of ≥3 mm was measured in 67% of the defects (i.e., in 8 out of 12) in the test group and in 75% of the defects (i.e., in 9 out of 12) in the control group. There were no statistically significant differences in any of the investigated parameters at 1 and at 4 years between the two groups. Within their limits, the present results indicate that: (a) the clinical improvements obtained with both treatments can be maintained over a period of 4 years, and (b) in two- and three-walled intrabony defects, the addition of BCP did not additionally improve the outcomes obtained with EMD alone. In two- and three-walled intrabony defects, the combination of EMD + BCP did not show any advantage over the use of EMD alone.

Four-year results of a prospective-controlled clinical study evaluating healing of intra-bony defects following treatment with an enamel matrix protein derivative alone or combined with a bioactive glass.

AIM: To evaluate the 4-year results following regenerative periodontal surgery at intra-bony defects with either a combination of an enamel matrix protein derivative (EMD) and a bioactive glass (BG) or with EMD alone. METHODS: Twenty-five patients with one deep intra-bony defect each were randomly treated with either an EMD+BG (test) or with EMD alone (control). Measurements were recorded at baseline, at 1 and at 4 years following therapy. The primary outcome variable was the clinical attachment level (CAL). RESULTS: The test group demonstrated a mean CAL change from 10.3+/-1.6 to 6.7+/-1.2 mm (p<0.001) and to 6.9+/-1.0 mm (p<0.001) at 1 and 4 years, respectively. No statistically significant differences were found between the 1- and 4-year results. The control group showed a mean CAL change from 10.4+/-1.6 to 6.7+/-1.1 mm (p<0.001) at 1 year and 7.0+/-0.9 mm (p<0.001) at 4 years. The CAL change between 1 and 4 years did not present statistically significant differences. In each of the two groups, four defects have lost 1 mm of the CAL gained at 1 year. A CAL gain of 1 mm compared with the 1-year results was measured in only one defect of the test group. Compared with baseline, a CAL gain of >/=3 mm was found at 4 years in 10 defects in both groups. Between the treatment groups, no statistically significant differences in any of the investigated parameters were observed at 1 and at 4 years. CONCLUSIONS: Within their limits, the present results indicate that the clinical improvements obtained with both regenerative modalities can be maintained over a period of 4 years.

Healing of human intrabony defects following regenerative periodontal therapy with an enamel matrix protein derivative alone or combined with a bioactive glass. A controlled clinical study.

AIM: The purpose of the present study was to compare clinically the treatment of deep intrabony defects with a combination of an enamel matrix protein derivative (EMD) and a bioactive glass (BG) to EMD alone. METHODS: Thirty patients (16 females and 14 males) suffering from advanced marginal periodontitis were included in this prospective, controlled parallel design multicenter study. In each of the patients, one intrabony defect was randomly treated with either EMD+BG (test) or with EMD alone (control). Clinical measurements were recorded at baseline and at 1 year following therapy. RESULTS: No differences in any of the investigated parameters were observed at baseline between the two groups. Healing was uneventful in all patients. At 1 year after therapy, the test group showed a reduction in mean probing depth (PD) from 8.5+/-1.1 to 4.4+/-1.2 mm (p<0.001) and a change in mean clinical attachment level (CAL) from 10.4+/-1.5 to 7.1+/-1.5 mm (p<0.0001). In the control group, the mean PD was reduced from 8.5+/-1.5 to 4.0+/-1.6 mm (p<0.001) and the mean CAL changed from 10.2+/-2.1 to 6.3+/-2.2 mm (p<0.01). In the test group, 12 sites (80%) gained at least 3 mm or more of CAL, whereas in the control group a CAL gain of 3 mm or more was measured at 13 sites (87%). No statistically significant differences in terms of PD reduction and CAL gain were found between the test and the control treatment. CONCLUSIONS: Within the limits of the present study it can be concluded that: (i) at 1 year after surgery, both therapies resulted in significant PD reductions and CAL gains, and (ii) the combination of EMD+BG does not seem to additionally improve the clinical results.

Evaluation of selected peripheral blood leukocyte functions in patients with various forms of periodontal disease.

INTRODUCTION: Periodontitis (P) is an infectious disease that develops in the supporting tissues of the tooth. One of the risk factors leading to it may be dysfunction of some immune system cells. Therefore, the object of the study was to assess selected functions of peripheral blood leukocytes in patients with various forms of P. As leukocytes are able to secrete interleukin (IL)-4 and IL-6, concentrations of their soluble receptors and the expression of their membrane receptors were investigated. MATERIAL AND METHODS: Twenty generally healthy subjects with aggressive (AP)and chronic periodontitis (CP)were enrolled in the study. The control group consisted of 8 healthy subjects,with no changes in periodontium. Peripheral blood mononuclear cells (PBMCs) were isolated and cultured. Levels of IL-4,IL-6,and their soluble receptors sIL-4R and sIL-6R were determined in the supernatant by ELISA. The expressions of cell surface IL-4R and IL-6R were assayed on PBMC using flow cytometry. RESULTS: No statistically significant differences were found in the selected parameters between people with periodontal disease and healthy controls. However, in subjects with AP, there was an increasing tendency in IL-6 concentration and IL-4R expression on PBMCs. CONCLUSIONS: Our results show that leukocytes play a significant part in P and their activity is probably lesion-dependent. Estimation of the cytokines secreted by leukocytes may facilitate differentiation and prognosis of the disease progression.

Evaluation of lymphocyte populations and subpopulations extracted from inflamed periodontal tissues.

The aim of the present study was evaluation the distribution of B- and T-cells and T-cell subsets in periodontal tissues from patients with different periodontitis forms. Periodontal tissue samples were collected from group P patients during routine surgical procedures, while from group C during tooth extraction for orthodontic or prosthetic purposes. Directly after collection, tissue samples were placed in a criostat or fixed in 10% buffered formalin for 24 h at room temperature. Following fixation the material was embedded in paraffin and subjected to routine histological techniques. Examinations of B- and T-lymphocytes populations and T-lymphocytes subsets were made with the use of immunohistochemical method. In C group single T and B lymphocytes were found in histological examination in pocket epithelium zones. In early onset periodontitis (EOP) patients in inflammatory infiltration lymphocytes T were dominating while in adult periodontitis (AP) patients dominating were B lymphocytes. Mean CD4/CD8 ratio in control group was 1.7 and in EOP and AP patients 1.1 and 2.6 respectively.