Periodontal Comparison on Systemic Lupus Erythematosus Patients and Healthy Subjects: A Cross-Sectional Study

ABSTRACT Objective: To analyze periodontal comparison between Systemic Lupus Erythematosus (SLE) subject and healthy control. Material and Methods: This descriptive cross-sectional study included 122 subjects, 61 SLE patients and 61 healthy subjects who visited the Rheumatology Department, Dr. Saiful Anwar General Hospital, Malang, during 2017-2018. Clinical examination of SLE was using Mexican SLE Disease Activity Index and oral cavity conditions were assessed using the periodontal index, gingival index, calculus index, bleeding on probing, clinical attachment loss and mobility teeth. Results: The age of SLE patients ranged from 18-55 years old with the mean age of 29.50 ± 9.57 years old. Periodontitis was higher in SLE patients (88.5%) than healthy subjects (22.95%). In addition, periodontitis occurrence in SLE (2.66 ± 1.02) was significantly different (p<0.001) compared to healthy subjects (0.51 ± 0.81). Conclusion: This study found higher rates of periodontitis, gingivitis, bleeding on probing, clinical attachment loss, and mobility tooth among SLE patients compared to healthy subjects. Periodontitis was also found to be higher along with more severe SLE group.

Effect of Low Intensity Laser Therapy (LILT) on MMP-9 expression in gingival crevicular fluid and rate of orthodontic tooth movement in patients undergoing canine retraction: A randomized controlled trial.

INTRODUCTION: Low Intensity Laser Therapy (LILT) has been shown to increase the rate of tooth movement. Since its use in orthodontics as a method of acceleration there has been a variety of views regarding its mode of action. MMP-9 is a known bone resorption factor studied in Bone remodelling. The aim of this study was to know the effect of LILT on rate of tooth movement and expression of MMP-9 in GCF. MATERIALS AND METHODS: Ten patients (3 males and 7 females) who required maxillary first premolar extraction for routine orthodontic treatment were recruited. The individual canine retraction was studied, and the side of the experimental canine was randomly selected. The laser regimen was followed on the 1st, 3rd, 5th, 7th, 14th and then 15th days consecutively. GCF was collected at baseline, 14th day, 3 months and at the end of canine retraction on experimental side and MMP-9 was estimated quantitatively using a standard ELISA kit. RESULTS: The average increase in rate of tooth movement on experimental side at 3 months was 44% and MMP-9 concentration was also high. At the end of canine retraction (4.5 months) in the experimental group the average rate increase was 38% with MMP-9 concentrations similar in both the experimental and control group. CONCLUSIONS: LILT increases the rate of tooth movement. LILT also has an effect of bio-stimulation as depicted by rise in MMP-9 concentrations in GCF. However, this bio-stimulatory effect is restricted to the initial part of the tooth movement.

Methods of accelerating orthodontic tooth movement: A review of contemporary literature.

Technological progress and the introduction of modern therapeutic methods are constantly changing contemporary orthodontics. More and more orthodontic patients are working adults, who expect satisfactory therapeutic effects as soon as possible, increasing the importance of methods accelerating tooth movement. The aim of this study was to review the current literature regarding methods of accelerating tooth movement and reducing the duration of the active phase of therapy. The literature was collected from the PubMed and EBSCO databases using "accelerated orthodontic tooth movement" as the search key words. The methods described were categorized as conservative and surgical. The pharmacological agents used in conservative treatment, such as growth hormone, parathyroid hormone, thyroxine, and vitamin D, are especially worth mentioning. They stimulate osteoclasts to increase resorption through a variety of mechanisms. Effective methods also include physical stimuli, e.g., vibrations or photobiomodulation. Most studies describing the effects of pharmacological agents were based on animal subjects and they may therefore lack clinical relevancy. Corticotomy and its modifications based on the regional acceleratory phenomenon (RAP) might prove to be a useful augmentation of orthodontic treatment, especially in adults, including patients with periodontal disease.

Effects of corticopuncture (CP) and low-level laser therapy (LLLT) on the rate of tooth movement and root resorption in rats using micro-CT evaluation.

The aim of this study was to compare the rate of tooth displacement, quantity of root resorption, and alveolar bone changes in five groups: corticopuncture (CP), low-level laser therapy (LLLT), CP combined with LLLT (CP + LLLT), control (C), and negative control (NC). A total of 60 half-maxilla from 30 male Wistar rats (10 weeks old) were divided randomly into five groups: three (CP, LLLT, and CP + LLLT) test groups with different stimulation for accelerated-tooth-movement (ATM), one control (C) group, and one negative control (NC) group with no tooth movement. Nickel-titanium coil springs with 50 g of force were tied from the upper left and right first molars to micro-implants placed behind the maxillary incisors. For the CP and CP + LLLT groups, two perforations in the palate and one mesially to the molars were performed. For the LLLT and CP + LLLT groups, GaAlAs diode laser was applied every other day for 14 days (810 nm, 100 mW, 15 s). The tooth displacements were measured directly from the rat's mouth and indirectly from microcomputer (micro-CT) tomographic images. Bone responses at the tension and compression sites and root resorption were analyzed from micro-CT images. The resulting alveolar bone responses were evaluated by measuring bone mineral density (BMD), bone volume fraction (BV/TV), and trabecular thickness (TbTh). Root resorption crater volumes were measured on both compression and tension sides of mesial and distal buccal roots. The tooth displacement in the CP + LLLT group was the greatest when measured clinically, followed by the CP, LLLT, and control groups (C and NC), respectively (p <0.05). The tooth movements measured from micro-CT images showed statistically higher displacement in the CP and CP + LLLT groups compared to the LLLT and control groups. The BMD, BV/TV, and TbTh values were lower at the compression side and higher at the tension side for all three test groups compared to the control group. The root resorption crater volume of the distal buccal root was higher in the control group, followed by CP, LLLT, and CP + LLLT, mostly at the compression site. Combining corticopuncture and low-level laser therapy (CP + LLLT) produced more tooth displacement and less root resorption at the compression side. The combined technique also promoted higher alveolar bone formation at the tension side.

Recombinant osteoprotegerin effects during orthodontic movement in a rat model.

BACKGROUND AND OBJECTIVES: Anchorage is one of the most challenging sides in orthodontics. The use of biological modulators that inhibit osteoclasts could be a solution to address these problems and provide new adjunctive approaches. The aim of this study was to assess the effectiveness of recombinant osteoprotegerin fusion protein (OPG-Fc) in orthodontic anchorage. MATERIALS AND METHODS: Two groups of male Sprague-Dawley rats were utilized. The animals in the experimental group received twice-weekly injections with high dose of OPG-Fc (5.0mg/kg) in mesial and distal mucosa of the first molars, and those in the control group received no drugs. Right first maxillary molars were mesialized using a calibrated nickel-titanium spring connected to an anterior mini-screw. Tooth movement was measured by two blinded observers using scanned and magnified stone casts. Receptor activator of nuclear factor κB (RANK), run-related transcription factor 2 (Runx2), type I collagen, vimentin, matrix metalloproteinases 2 and 9, S100 protein and the putative mechanoproteins acid-sensing ion channel (ASIC2) and transient receptor potential vainilloid 4 (TRPV4) were evaluated using immunohistochemistry. RESULTS: OPG-Fc group showed an important decreased in mesial molar movement with only 52%, 31%, and 22% of the total mesial molar movement compared with control group at Days 7, 14, and 21, respectively (P < 0.001). RANK ligand and Runx2 positive cells were severely reduced after OPG-Fc treatment. Periodontal ligament architecture, cell arrangement, and immunohistochemical patter for vimentin, type I collagen and the mechanoproteins TRPV4 and ASIC2 were altered by tooth movement and all these parameters altered by the applied treatment. CONCLUSIONS: OPG-Fc effectively inhibits osteoclastogenesis resulting in improved bone quantity and orthodontic anchorage. Based on present results, OPG-Fc could have clinical utility in preventing undesired tooth movements.

Improvement in periodontal healing after periodontal surgery supported by nutritional supplement drinks

PURPOSE: The aim of this study was to determine the effects of nutritional supplements on periodontal health and tooth mobility after surgery. METHODS: Patients were randomly assigned to an intervention group who consumed nutritional supplement drinks for 8 weeks, while the placebo group did not receive any such supplements. The gingival index (GI) and tooth mobility were measured at baseline and at 1, 4, and 8 weeks. In addition, the oral health impact profile-14 and anthropometric measurements along with loss of appetite and dietary intake were assessed at baseline and 8 weeks. RESULTS: At 1 week, GI values were reduced in the intervention group (P<0.05), and tooth mobility had increased, but to a lesser extent in the intervention group (P<0.05). At 8 weeks, the intakes of protein, vitamins A and B1, and niacin were increased in the intervention group. CONCLUSIONS: These results demonstrate that nutritional supplementation improves early periodontal healing after surgery.

Incidence of dental lesions in musk shrews (Suncus murinus) and their association with sex, age, body weight and diet.

Both wild and laboratory strains of the musk shrew (Suncus murinus) have a high incidence of periodontitis. The authors completed necropsy examinations in 51 shrews to identify dental lesions including tooth loss, mobility and fractures. Dental lesions were identified in significantly more females than males, and older animals were more likely to have lesions present. Shrews with one or more dental lesions weighed significantly less than those without lesions present. Dietary supplementation with mealworms did not significantly affect the incidence of dental lesions or the body weight of male or female shrews. The authors recommend routine body weight measurement as a simple, noninvasive method of detecting shrews with an increased likelihood of having dental lesions.

Local delivery of recombinant osteoprotegerin enhances postorthodontic tooth stability.

Relapse after orthodontic tooth movement is a significant problem in orthodontics. The purpose of this study was to examine the efficacy of the osteoclast inhibitor osteoprotegerin-Fc (OPG-Fc) for inhibiting postorthodontic relapse. Rat maxillary molars were moved mesially and allowed to relapse for 24 days. Low-dose (1 mg/kg) or high-dose (5 mg/kg) OPG-Fc or saline was injected adjacent to the molars during relapse. Tooth movement, micro-CT, histologic bone quality, and serum OPG and TRAP-5b were measured. OPG-Fc injections significantly diminished postorthodontic relapse from 63% (0.78/1.20 mm) of total movement in vehicle control rats to 31% (0.31/1.00 mm) in low-dose and 24% (0.28/1.16 mm) in high-dose OPG-Fc groups 24 days after appliance removal. Normalization of bone and periodontal tissues occurred as early as 8 and 16 days in the high- and low-dose OPG-Fc-treated groups, respectively, while the vehicle-treated group showed only partial tissue recovery 24 days following tooth movement. After 24 days of relapse, there was complete recovery to pre-tooth-movement values for bone volume fraction (BVF) and tissue mineral density (TMD) in both the low- and high-dose OPG-Fc groups, while BVF recovered only partially and TMD did not recover in the vehicle control group. Greatly elevated serum OPG levels and reduced serum TRAP-5b levels in OPG-Fc-treated animals indicated systemic exposure to locally injected drug. The profound decrease in postorthodontic relapse by local OPG-Fc administration indicates that osteoclasts are critical to bone maturation following tooth movement and points to the potential pharmacologic use of OPG-Fc or other RANKL inhibitors for orthodontic retention.

Effectiveness of two flavored topical anesthetic agents in reducing injection pain in children: a comparative study.

UNLABELLED: Topical anesthesia is widely advocated in pediatric dentistry practice to reduce pain and anxiety produced by administration of local anesthesia. There are different combinations of topical anesthetic agents that are marketed worldwide. However, sparse literature reports exist regarding clinical efficacy of these agents. AIM: To compare the clinical effectiveness of two strawberry flavored topical anesthetics viz. Precaine (8% Lidocaine + 0.8% Dibucaine) and Precaine B (20% Benzocaine) in children before intra oral local anesthetic injections and for extraction of mobile primary teeth. STUDY DESIGN: This triple blind clinical study included sixty children divided equally under three techniques--palatal injections, inferior alveolar nerve block and extraction of mobile primary teeth. Both the products were used alternately using split mouth design in two visits and the child's pain response was assessed using VAS and SEM pain scale. The scores obtained were subjected to statistical analysis. RESULTS: Precaine has shown lower mean scores in all the techniques under both the pain scales, but were statistically insignificant. Gender wise comparison has also shown lower mean scores for Precaine for both males and females, however these were statistically insignificant. On visit wise comparison, Precaine B reported significant lower scores (p < 0.05) in visit 2 compared to visit 1 for inferior alveolar nerve block and extraction of mobile primary teeth under SEM pain scale. CONCLUSION: Precaine (8% Lidocaine + 0.8% Dibucaine) can be used as effectively as Precaine B (20% Benzocaine).

In vivo evaluation of lesion sterilization and tissue repair in primary teeth pulp therapy using two antibiotic drug combinations.

AIM: The purpose of this study is to evaluate and compare the clinical and radiographic effectiveness of Ciprofloxacin, Minocycline, Metronidazole combination with Ciprofloxacin, Minocycline and Tinidazole combination when used for Lesion Sterilization and Tissue Repair in primary teeth. METHOD: 25 healthy children, visiting Dept. of Pediatric & Preventive Dentistry, D.A.P.M.R.V. Dental College, Bangalore, India, aged between 6-9 years who were having 30 infected primary teeth are selected and divided into 2 groups. In Group A, a mixture of 3mix-MP Ciprofloxacin, Metronidazole and Minocycline was placed on the floor of the pulp chamber covering the root canal orifices. In Group B a mixture of Ciprofloxacin, Tinidazole and Minocycline was placed as a layer on the floor of the pulp chamber. The procedure was completed in a single visit. Post operative clinical evaluation was done after 1,6,12 and 24 months. Postoperative radiographic evaluation was done at 6, 12 and 24 months. RESULTS: No statistically significant difference is observed between both the groups and a combination of Ciprofloxacin, Minocycline and Tinidazole antibacterial drugs can be used on teeth pulpally involved with physiologic root resorption. CONCLUSION: After a 24 Month follow up, we can conclude that primary teeth with the periradicular lesions, can be conserved by using combination of Ciprofloxacin, Minocycline and Tinidazole antibacterial drugs.

Influence of resilient support of abutment teeth on fracture resistance of all-ceramic fixed partial dentures: an in vitro study.

PURPOSE: The influence of resilient support of abutment teeth on the fracture resistance of all-ceramic three-unit fixed partial dentures (FPDs) was tested in this study. MATERIALS AND METHODS: Three groups (n = 8) of glass-infiltrated, alumina-based, all-ceramic FPDs that were adhesively bonded to human molar teeth were investigated. In control group A, teeth that were rigidly inserted in polymethyl methacrylate (PMMA) resin were used for thermocycling and mechanical loading (TCML), as well as for fracture testing. In group B, TCML was conducted on teeth that had their roots covered with a polyether layer. After TCML, the polyether layer was removed entirely, and the teeth were rigidly fixed in PMMA for fracture testing. In group C, teeth roots remained covered with a polyether layer during TCML as well as during fracture testing. Using a resilient attachment, tooth mobility was determined in axial, buccal, and oral directions. RESULTS: Mean tooth mobility was 76 ± 4 Μm in the axial direction, 278 ± 41 Μm in the buccal direction, and 128 ± 17 Μm in the oral direction. Group C showed the lowest mean fracture strength (polyether during both TCML and fracture testing) of 523 N. For group B (polyether during TCML but not during fracture testing), a fracture strength of 676 N was found, and for control group A (rigidly embedded teeth), it was 919 N. CONCLUSION: These results confirmed the influence of resilient attachments on the aging process and fracture strength testing of FPDs. Fracture resistance was significantly reduced when this particular interface was used in both TCML and fracture testing.

Determinantes del diagnóstico periodontal / Determinants of periodontal diagnosis

Un correcto diagnóstico periodontal es necesario para la realización de una terapia periodontal exitosa en nuestro paciente. Entendiendo que la enfermedad periodontal es un proceso infeccioso-inflamatorio, diferentes variables se deben analizar clínicamente para determinar el diagnóstico. El diagnóstico entonces es un análisis concienzudo de la expresión clínica de la enfermedad, desde gingivitis hasta periodontitis. Este artículo analiza los determinantes más importantes del diagnóstico periodontal utilizados en la práctica clínica diaria.

The correct diagnosis of periodontal disease is a pre-requisite for an appropriate periodontal treatment. Periodontal disease is an infectious-inflammatory process that affects different clinical variables that must be analyzed before reaching the diagnosis. The diagnosis should be a carefully performed analysis of the clinical expression of the disease, from gingivitis to periodontitis. This article reviews the most important determinants of periodontal diagnosis.

General anesthesia increases the risk of bacteremia following dental extractions.

OBJECTIVE: The influence of oral health status, the number of teeth extracted, and the anesthetic modality used is currently a matter of debate in the prevalence of bacteremia following dental extractions (BDE). The aim of the present study was to analyze the factors affecting the prevalence, duration, and etiology of BDE. STUDY DESIGN: Blood samples were collected from 210 patients at baseline, 30 seconds, 15 minutes, and 1 hour after performing dental extractions. Samples were processed in the Bactec 9240 and the subculture and further identification of the isolates were performed using conventional microbiological techniques. RESULTS: The prevalence of BDE at 30 seconds, 15 minutes, and 1 hour were 71%, 45%, and 12%, respectively. In the multivariate analysis, the "anesthetic modality" (local anesthesia versus general anesthesia) was the only variable related to BDE. CONCLUSION: General anesthesia represents a risk factor for BDE, increasing its prevalence and duration.

Low-level laser therapy effects in traumatized permanent teeth with extrusive luxation in an orthodontic patient.

The aim of this case report was to present and evaluate the effect of low-level laser therapy on traumatized permanent teeth with extrusive luxation in an orthodontic patient. The treatment and follow-up evaluation of two orally luxated maxillary permanent central incisors in a 19-year-old man is described. Detailed anamnesis was taken, and extraoral, intraoral, radiographic examinations and electrical and thermal pulpal tests were performed to determine the type of the luxation and the further treatment protocol. Teeth were splinted with composite resin, and antibiotic therapy was prescribed. Low-level laser therapy was applied for 25 sessions. No root canal treatment was applied to the teeth. Continuation of the orthodontic treatment was restarted after 6 months. No sign of clinical or radiographic pathology was detected after 2 years from the end of the treatment. Teeth were identified healthy and sound without any root canal intervention. Treatments with low-level laser applications may be evaluated as noninvasive alternative treatment options in comparison with endodontic treatment for teeth with extrusive luxation more than 2 mm, especially for those who have orthodontic treatment needs.

Step-wise treatment of two periodontal-endodontic lesions in a heavy smoker.

AIM: To report a clinical case of two advanced periodontal-endodontic lesions with a focus on treatment issues related to tobacco use. SUMMARY: A 53-year-old Caucasian male was referred to the School of Dentistry, Basel, Switzerland, for periodontal treatment. The major diagnoses were chronic (smoker) periodontitis and advanced combined periodontal-endodontic lesions on the mandibular left lateral incisor and right incisor. Conventional root canal treatment was performed, and subsequently led to reduced radiolucencies around the affected roots after 14 months. The remaining osseous defect was augmented by guided tissue regeneration using bovine bone substitute and resorbable membrane. The follow-up revealed a stable situation from clinical (probing depth 2-4 mm) and radiological points of view 32 months after initiation of treatment. Treatment considerations related to tobacco use are discussed. KEY LEARNING POINTS: * After conventional root canal treatment, osseous healing should occur before further complementary therapy is taken into account. * Issues related to tobacco use have to be considered before treatment is initiated.

Actualización del diagnóstico de la enfermedad de histiocitosis de células de Langerhans en niños / An update on the diagnosis of Langerhans cell histiocytosis in children

Los pacientes que participaron de este estudio fueron derivados a la Cátedra de Odontología Integral Niños de la Facultad de Odontología de la Universidad de Buenos Aires (Argentina) con diagnóstico de histiocitosis de células de Langerhans. Los síntomas que presentaron fueron: dolor, movilidad dentaria, sangrado, inflamación gingival. Los pacientes se agruparon de acuerdo a la clasificación de la Histiocyte Society en tres subtipos: a) Unisistémico unifocal, b) Unisistémico multifocal y c) Multisistémico. Predominó el sexo masculino, con una edad media en los grupos de 3 años. La mayoría de los pacientes se hallaban en fase de remisión de la enfermedad, en todos los grupos se observaron manifestaciones bucales.

Actualización del diagnóstico de la enfermedad de histiocitosis de células de Langerhans en niños / An update on the diagnosis of Langerhans cell histiocytosis in children

Los pacientes que participaron de este estudio fueron derivados a la Cátedra de Odontología Integral Niños de la Facultad de Odontología de la Universidad de Buenos Aires (Argentina) con diagnóstico de histiocitosis de células de Langerhans. Los síntomas que presentaron fueron: dolor, movilidad dentaria, sangrado, inflamación gingival. Los pacientes se agruparon de acuerdo a la clasificación de la Histiocyte Society en tres subtipos: a) Unisistémico unifocal, b) Unisistémico multifocal y c) Multisistémico. Predominó el sexo masculino, con una edad media en los grupos de 3 años. La mayoría de los pacientes se hallaban en fase de remisión de la enfermedad, en todos los grupos se observaron manifestaciones bucales.(AU)

Bisphosphonate-related osteonecrosis of the jaws: a report of three cases demonstrating variability in outcomes and morbidity.

BACKGROUND: Bisphosphonates are used widely to manage skeletal disorders resulting from malignancies that destroy bone and from some metabolic bone diseases. A strong association between bisphosphonate treatment and the appearance of painful exposed nonvital bone in the mandible and maxilla after oral surgery has been reported in the last decade. Extensive reviews have appeared in the dental literature regarding bisphosphonate-related osteonecrosis of the jaws (BRONJ), including protocols for diagnosis, management and diagnostic imaging for early detection; feature definition; and determination of extent of the disease. CASE DESCRIPTION: The authors provide three case reports to show the contrast in treatment outcomes and morbidity in patients with BRONJ. The cases involved diagnostic imaging modalities commonly used in the practice of dentistry: panoramic radiography and cone-beam volumetric computed tomography. CLINICAL IMPLICATIONS: These case reports demonstrate the usefulness of dental diagnostic imaging in the detection and management of BRONJ, corroborate the increasing number of reports regarding high levels of morbidity associated with various BRONJ treatments, and underscore the danger of performing invasive dental procedures for patients receiving bisphosphonate therapy.

Clinical evidence and literature to compare two different therapeutic protocols in tooth avulsion.

AIM: This is to assess the priority in tooth avulsion: replantation as quickly as possible and deferred endodontic treatment, or replantation and elimination of every irritating stimulus for the periodontal ligament. The objective is to establish a univocal protocol by analysing and comparing the various components of these therapeutic procedures. STUDY DESIGN: 20 patients were selected and divided into 2 groups: in group A we focused our attention on the rapidity of replantation, in group B we focused on the elimination of the necrotic pulp and every possible irritating stimulus that might lead to root resorption of inflammatory nature. RESULTS: Clinically, dental mobility seems to be greater in the first group. However after 15 days teeth have a comparable mobility and after one month they all show a mobility degree 1. Radiographically a greater incidence of resorption can be observed in group A compared to group B as in the first one a higher number of replanted teeth undergo resorption. Such lesions have the tendency to remain constant or even increase. CONCLUSIONS: The results of this study seem to take only one direction: extraoral endodontic therapy.