Comparison of the postoperative anti-inflammatory efficacy of chlorhexidine, saline rinses and herbal mouthwashes after mechanical debridement in patients with peri-implant mucositis: A randomized controlled trial.

AIM: The null hypothesis is that there is no difference in the post-operative anti-inflammatory efficacy of chlorhexidine (CHX), 2% saline rinses (SR) and a herbal mouthwash (MW) after non-surgical mechanical debridement (MD) for treatment of peri-implant mucositis (PiM). The aim was to compare the post-operative anti-inflammatory efficacy of CHX, 2% SR and a herbal oral rinse after non-surgical MD of PiM. MATERIALS AND METHODS: The present randomized controlled trial had a single-blinded parallel arm design. Patients diagnosed with PiM were enrolled. Demographic information was recorded. All patients underwent MD and were randomly divided into 4 groups: CHX-group: 0.12% non-alcoholic CHX; Sodium chloride (NaCl) group: 2% NaCl rinses; Herbal MW group: Herbal-based MW and H2 O group: distilled water with peppermint flavour. After MD, all the participants were advised to rinse twice daily (every 12 hrs) for 2 weeks with their respective MWs. In all groups, peri-implant modified plaque index (mPI), modified gingival index (mGI) and probing depth (PD) were measured at baseline and at 12 weeks of follow-up. Sample size was estimated using data from a pilot investigation; and group-comparisons were performed. Statistical significance was confirmed when P-values were below 0.01. RESULTS: Sixty individuals (15 patients/group) were included. At baseline, mPI, mGI and PD were comparable in all groups. At baseline, there was no significant difference in peri-implant mPI, mGI and PD in all groups. At 12-weeks' follow-up, there was a statistically significant reduction in peri-implant mPI (p < 0.01), mGI (p < 0.01) and PD (p < 0.01) in CHX, NaCl and herbal MW groups compared with H2 O group. There was no significant relation between implant location, duration for which, implants were functional, gender and peri-implant clinical parameters in all groups. CONCLUSION: After non-surgical MD, post-operative use of CHX and herbal and NaCl MWs is useful for the management of PiM in the short-term.

Potential adjunct therapies for the management of temporomandibular disorders: An evidence-based review.

OBJECTIVE: The aim was to review the role of adjuvant therapies that may potentially contribute toward the management of temporomandibular disorders (TMD). METHODS: The addressed focused question was, "Are there any adjuvant therapies that may contribute toward the management of TMD?". Indexed databases were searched up to June 2021. The eligibility criteria were the following: (a) original clinical studies and (b) randomized controlled clinical trials (RCTs). RESULTS: Adjuvant therapies were comprised of acupuncture, manual therapy, jaw exercises, dietary modifications, botulinum toxin therapy, and photobiomodulation. Short-term follow-up results from each of these RCTs showed beneficial effects in terms of pain reduction and improvements in jaw movement among patients with TMD. There are no long-term follow-up results in this regard. CONCLUSION: The most effective adjunct treatment for managing TMD remains unknown, primarily due to a lack of sufficient scientific evidence.

Analgesic Efficacy of Curcuma longa (Curcumin) after Surgical Periodontal Therapy.

PURPOSE: To compare the analgesic efficacy of orally administered Curcuma longa (curcumin) and mefenamic acid (MA) after surgical periodontal therapy (SPT). MATERIALS AND METHODS: Seventy-six periodontitis patients were randomly divided into two groups. In the test group, patients received curcumin capsules (200 mg), and in the control group, patients received MA (500 mg). All patients underwent post-operative antibiotic therapy using 500 mg amoxicillin and 400 mg metronidazole for 7 days. Post-operative pain and discomfort were evaluated using the numerical rating scale (NRS) and verbal rating scale (VRS), respectively. Evaluation were performed after 24 (T1), 48 (T2), and 72 h (T3). Group comparisons were done using Student's t-test and the Mann-Whitney U-test. The level of statistical significance was established at p < 0.05. RESULTS: All patients had stage 3/grade C periodontitis. The mean age of individuals in the test and control groups were 58.4 ± 7.3 and 57.2 ± 5.2 years, respectively. A family history of periodontal diseases was reported by 37.5% and 47.4% individuals in the test and control groups, respectively. In the test and control groups, the total mean duration of periodontal surgery was 168.2 ± 12.2 and 173.4 ± 10.7 min, respectively. There was no statistically significant difference in the mean NRS and VRS scores among patients in the test and control groups. In both groups, there was no statistically significant difference in the change in NRS scores at any time point. CONCLUSIONS: Compared with MA, curcumin is ineffective for pain and discomfort management after SPT. The possibility of the results being biased due to lack of operator blinding cannot be overlooked.

Efficacy of herbal- versus chlorhexidine-based mouthwashes towards oral hygiene maintenance in patients undergoing fixed orthodontic therapy: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: The review aims to fill the gap in literature by comparing the efficacy of herbal and chlorhexidine-based mouthwashes towards oral hygiene maintenance (OHM) in patients undergoing fixed orthodontic treatment (OT). METHODS: Indexed databases were searched electronically to include randomized controlled trials (RCTs) for data gathering. The protocol was registered in PROSPERO (CRD42020182497). Risk of bias assessment, quality of evidence investigation and meta-analysis were performed to evaluate reported OHM-related parameters at time points before and after the use of chlorhexidine (control group) and herbal mouthwashes (intervention group). With 95% confidence intervals, mean difference (MD) or standardized mean difference (SMD) was used to estimate effect size. RESULTS: Out of eight RCTs, results from one RCT favoured chlorhexidine and the results from a second RCT favoured herbal mouthwashes. Results from three RCTs showed comparable effects for the respective investigated OHM-related parameters. Chlorhexidine demonstrated higher antimicrobial efficacy against Streptococcus mutans (S. mutans) in two studies, and one RCT found comparable antimicrobial efficacies. Risk of bias was low in two studies, and moderate and high in two studies each. Quality of evidence was very low to moderate for the respective investigated parameters. Sub-group analysis for parameters colony forming units (CFU) {SMD (0.40) [95% CI (-0.22, 1.03)], gingival index (GI) {MD (0.06) [95% CI (-0.08, 0.20)]}, plaque index (PI) {SMD 0.22 [95% CI (-0.23, 0.67)]} before the use of chlorhexidine and herbal mouthwashes remained inconclusive. CONCLUSION: The comparison between efficacy of herbal and chlorhexidine towards OHM in patients undergoing fixed OT remains debatable.

Influence of low-level-laser therapy on the stability of orthodontic mini-screw implants. A systematic review and meta-analysis.

BACKGROUND: The influence of low-level-laser therapy (LLLT) on the stability of orthodontic mini-screw implants (MSIs) has not been systematically reviewed. OBJECTIVES: The aim was to assess the influence of LLLT on the stability of orthodontic MSIs. METHODS: An unrestricted search of indexed databases was performed. SELECTION CRITERIA: Randomized controlled clinical trials (RCTs) investigating the influence of LLLT on orthodontic MSI stability. DATA COLLECTION AND ANALYSIS: Two authors independently performed study retrieval and selection, and data extraction. The risk of bias (RoB) of individual studies was assessed using the Cochrane RoB Tool for RCTs. Meta-analyses were performed separately for RCTs using periotest and resonance frequency analysis (RFA) to measure MSI stability; and a random effects model was applied. Subgroup analyses were performed based on the time-points of MSI stability evaluation. The quality of available evidence was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation approach. RESULTS: Initially, 1332 articles were screened. Six RCTs with a split-mouth design were included. The periotest was used in 4 RCTs and 2 RCTs used RFA to measure MSI stability. All RCTs had a low RoB. Subgroup analyses based on periotest indicated that MSIs treated with LLLT had significantly higher stability than untreated MSIs at 21 and 30 days [weighted mean difference (MD) = -2.76, confidence interval (CI): [-4.17, -1.36], P-value = 0.0001) and at 60 days (weighted MD = -3.47, CI: [-4.58, -2.36], P < 0.00001); and the level of certainty was high. Subgroup analyses based on RFA showed higher stability of MSIs treated with than without LLLT at 56 and 60 days (standardized MD = 0.82, CI: [0.32, 1.32], P = 0.001), and at 70 and 90 days (standardized MD = 0.86, CI: [0.36, 1.36], P = 0.0007); and the level of certainty was moderate. LIMITATIONS: Due to limited number of relevant studies, it was not possible to perform sensitivity analysis, subgroup analyses for patient and intervention-related characteristics, and reporting biases assessment. CONCLUSIONS: The role of LLLT on the secondary stability of MSIs placed in patients undergoing OT remains debatable. CLINICAL TRIAL REGISTRATION: PROSPERO (CRD42021230291).

Role of Essential Oil-Based Mouthwashes in Controlling Gingivitis in Patients Undergoing Fixed Orthodontic Treatment. A Review of Clinical Trials.

Essential oil (EO)-based mouthwashes have been used for oral health maintenance due to their antimicrobial and anti-inflammatory properties. The aim was to review clinical trials that assessed the role of EO-based mouthwashes in controlling gingivitis in patients undergoing fixed orthodontic treatment (OT). The Patients, Interventions, Control and Outcome (PICO) format was based on the following: (a) P: Patients undergoing fixed OT (b) Intervention: EO-based mouth-wash; Control: Mouthwashes that did not contain EOs or no mouthwash (d) Outcome: Control of gingivitis measured by clinical indices. Databases were searched manually and electronically up to and including May 2021 using different medical subject subheadings. Data screening and extraction were performed. The risk of bias within randomized controlled trials was assessed using the revised Cochrane Collaboration's risk of bias tool (RoB 2). The Risk of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool was used for non-randomized controlled trials. Disagreements related to literature search and RoB evaluations were resolved via discussion. Six clinical studies were included. Four studies showed that Listerine® is effective in controlling gingivitis in patients undergoing fixed OT. One study reported that the use of 5% Fructus mume mouthwash resulted in a significant reduction in gingival bleeding. Two mouthwashes that contained 1% Matricaria chamomilla L. and 0.5% Zingiber officinale were also found to be efficient in controlling gingival bleeding. Four, one and one studies had a low, moderate and high RoB, respectively. In conclusion, EO-based mouthwashes seem to be effective for the management of gingivitis among patients undergoing fixed OT. Further well-designed and power-adjusted clinical trials are needed.

Influence of thyroxine supplementation on orthodontically induced tooth movement and/or inflammatory root resorption: A systematic review.

The role of thyroxine administration on orthodontically induced tooth movement and/or inflammatory root resorption remains unclear. The aim was to assess the influence of thyroxine administration on orthodontically induced tooth movement and/or inflammatory root resorption. The study protocol was registered in PROSPERO (CRD42020164151). An electronic search of indexed databases was conducted without time or language restrictions up to and including May 2020. The following eligibility criteria were imposed: (a) original prospective controlled clinical studies and/or experimental studies on animal models; (b) subjects undergoing orthodontic therapy with fixed appliances; (c) presence of a control group [orthodontic tooth movement without thyroxine administration]; and (d) intervention: orthodontic tooth movement with thyroxine administration. Review articles, commentaries, letters to the editor, case reports/series, studies with no control group, cross-sectional studies, retrospective studies and studies where thyroxine was administered along with other interventions such as calcitonin and prostaglandins were excluded. Quality of available evidence and risk of bias within studies were assessed. Any disagreements were resolved via consensus discussions. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 8 animal studies were included. Four studies reported that thyroxine administration increases the rate of orthodontic tooth movement; 3 studies did not show a significant difference. Three studies showed that thyroxine administration decreases orthodontically induced inflammatory root resorption; 2 studies found no significant difference. The risk of bias among studies was high. In conclusion, the influence of thyroxine administration on orthodontic tooth movement and/or orthodontically induced inflammatory root resorption in animal models remains unclear.

Assessment of routine diet (garlic consumption) as a pre- and postoperative protocol in oral and maxillofacial surgical interventions: An evidence-based literature review.

BACKGROUND: It was hypothesized that pathological bleeding (PB) during and/or after oral surgical procedures is higher in systemically healthy patients who have a history of garlic intake compared to controls (patients without a history of garlic consumption). AIM: The aim of the present review article was to identify studies in which garlic consumption was included as a patient management protocol before and after oral and maxillofacial surgery (OMFS). METHODS: A review of pertinent indexed literature was performed. The focused question that was addressed was "Has diet (garlic consumption) been considered as a patient management protocol before and after OMFS?" The inclusion criteria were: (a) studies published in indexed databases, (b) original studies, (c) studies on OMFS, and (d) studies that considered diet (garlic consumption) as a patient management protocol before and after OMFS. Literature review, commentaries, letters to the editor, and studies published in non-indexed resources were excluded. The pattern of the present review was customized to summarize the pertinent information. RESULTS: The initial search using the terms "oral," maxillofacial," "protocol," and "surgery" yielded 1478 studies. The addition of the term "diet" to this search strategy reduced the number of studies to five. Further filtration of these studies using the terms "garlic" and/or "Allium sativum" showed no studies. CONCLUSIONS: Garlic intake predisposes patients to PB. However, there are no studies in the indexed literature that have considered the inclusion of garlic consumption in patient management protocols before and after OMFS.

Photothermal Effects of Defocused Initiated Versus Noninitiated Diode Implant Irradiation.

Background: Diode lasers have been used for implant decontamination. However, the use of initiated or noninitiated tips remains unevaluated to verify potential photothermal risks. Objective: To assess the photothermal effects of defocused-initiated versus noninitiated irradiation. Materials and methods: A dental implant (3.5 × 11 mm) was placed into an artificial bone, an infrabony defect was created to simulate a four-wall peri-implant defect. Irradiation was performed using pulsed diode lasers of 940, 975, and 980 nm. The laser tips were positioned parallel to the implant (maximum 2W pulsed mode). The implant was irradiated for 30 sec using noninitiated, cork-, and blue paper-initiated tips. Temperature differences were observed at the apical and coronal regions of the implant. The data were statistically evaluated and compared using one-way analysis of variance and Tukey tests. Results: The average temperature increase and the amount of time that it took to yield the critical temperature were comparable at the coronal level for the 940 and 975 nm diode lasers (p > 0.05). For the 980 nm laser, blue-initiated tip had the highest temperature increase (22.4°C), followed by cork (18.8°C) and noninitiated tip (17.3°C). The critical threshold at the coronal portion for the 980 nm laser was reached in 11.5, 8.79, and 6.46 sec for the blue paper-, cork-, and noninitiated tips, respectively. The 975 and 980 nm lasers had average temperature increases, comparable among the blue paper-, cork-, and noninitiated tips at the apical level (p > 0.05). Apically, for the 940 nm, the noninitiated tip had the highest temperature increase (5.57°C), followed by the cork- (4.96°C) and blue paper-initiated tip (4.54°C). Conclusions: The initiator does not affect the temperatures produced during implant decontamination although noninitiated diode lasers may overheat (within 30 sec) than initiated tips. There is minimal risk of overheating at the apical portion. It seems that the 940 nm diode is the safest of the evaluated laser systems.

Influence of low-level laser therapy on orthodontically-induced inflammatory root resorption. A systematic review.

OBJECTIVE: The aim was to assess the influence of low-level laser therapy (LLLT) on orthodontically-induced inflammatory root resorption (OIIRR). METHODS: A systematic search was conducted in indexed databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The eligibility criteria were as follows: (a) original clinical and animal/experimental studies; (b) prospective studies; (c) intervention: effect of LLLT on OIIRR; (d) control group (OIIRR without LLLT); (e) statistical analysis; and (f) tomographic or histologic assessment of OIIRR. Quality assessment of the experimental and clinical studies was performed following the Animal Research Reporting In-vivo Experiments (ARRIVE) and Consolidated Standards of Reporting Trials (CONSORT) guidelines, respectively. The risk of bias of the included studies was also determined. RESULTS: Nine (7 experimental and 2 clinical) of the initially identified 39 studies were included. One clinical and 2 experimental studies showed that LLLT during orthodontic tooth movement (OTM) significantly reduces OIIRR. One experimental study reported that LLLT during OTM in sockets treated with alloplastic materials significantly reduces OIIRR. One experimental study found that LLLT after OTM significantly repairs OIIRR, whereas one clinical study did not report a significant reparative affect. Three experimental studies showed that LLLT increases OIIRR during OTM, corticotomized-OTM, and OTM into grafted defects, respectively. The minimum, median and highest ARRIVE scores (out of 20) of the included experimental studies were 15, 17 and 19, respectively. The mean CONSORT score of the included clinical studies was 23 (out of 25). CONCLUSIONS: In conclusion, the influence of LLLT on OIIRR remains debatable.

Low-level laser therapy as an adjunct to connective tissue graft procedure in the treatment of gingival recession defects: A systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to systematically evaluate the effectiveness of low level laser therapy (LLLT) as an adjunct to connective tissue graft (CTG) procedure for the treatment of gingival recession (GR). MATERIALS AND METHODS: The addressed PICO question was; "In patients with Miller Class I or II recession defects (Population), what is the effect of LLLT as adjunct to CTG (Intervention) in comparison to CTG alone (Comparison) on gingival recession depth (Outcome)" Electronic databases were searched up to December 2017. Primary outcomes included gingival recession depth (GRD), whereas secondary outcomes were width of keratinized tissue (WKT) and relative clinical attachment level gain (RCAL). The weighted mean differences (WMD) of outcomes and 95% confidence intervals (CI) for each variable were calculated using random effect model. RESULTS: Four randomized clinical studies were included. Two studies showed significantly greater improvements with LLLT whereas, 2 studies showed comparable outcomes between LLLT and CTG group. Considering the effects of adjunctive LLLT as compared to CTG, a high degree of heterogeneity for GRD (Q value = 9.40, P = .02, I2 =68.11%) and WKT ((Q value = 16.04, P = .001, I2 =81.31%) was noticed among both the groups. Meta-analysis showed a statistically significant GRD (WMD= -0.61, 95% CI= -1.23 to 0.004, P = .05) for LLLT + CTG treatment versus CTG alone only. CONCLUSIONS: LLLT improves clinical and patient-centered outcomes of CTG procedures for the treatment of GR remains debatable. However, due to the small number of included studies and high heterogeneity in the laser parameters, precautions must be exercised when interpreting the results of the present systematic review. CLINICAL SIGNIFICANCE: Gingival recessions in dentistry are of major esthetic concern. Minimal gingival recessions can be treated by flap operations, but the predictability and stability of the outcomes is debatable. In the present review, low level laser therapy (LLLT) adjunct to connective tissue graft (CTG) depicted a significant improvement in the predictability and stability of root coverage outcomes compared with CTG alone.

Efficacy of low-level laser therapy compared to steroid therapy in the treatment of oral lichen planus: A systematic review.

BACKGROUND: Low-level laser therapy (LLLT) has been proposed as a potential treatment strategy for the treatment of oral lichen planus (OLP). The aim of this systematic review was to assess the efficacy of LLLT, in comparison with corticosteroid therapy, in the treatment of OLP. MATERIALS AND METHODS: This systematic review aimed to address the following focused question: "Does LLLT yield better clinical outcomes than corticosteroid therapy in the treatment of OLP?" Indexed databases were searched up to and including April 2017. Clinical trials in humans diagnosed clinically and/or histologically with OLP allocated to test (LLLT) versus control (steroid therapy) groups were included. RESULTS: Five clinical studies were included. The risk of bias was considered high in four studies and moderate in one study. Laser wavelengths, power, spot size, and duration of laser exposure ranged between 630 and 970 nm, 10-3000 mW, 0.2-1.0 cm2 , and 6-480 seconds, respectively. The follow-up period ranged from 4 to 48 weeks. All included studies reporting clinical scores showed that LLLT was effective in the treatment of OLP in adult patients at follow-up. Three studies showed significantly higher improvements with topical use of corticosteroids compared to LLLT, while one study showed significant improvement with LLLT. One study showed comparable outcomes between LLLT and corticosteroid application. CONCLUSION: It remains debatable whether LLLT is more effective as compared to corticosteroids in the treatment of OLP, given that the scientific evidence is weak. These findings are preliminary and further randomized clinical trials are recommended.

Laser-assisted removal of all ceramic fixed dental prostheses: A comprehensive review.

OBJECTIVE: The aim of this comprehensive review was to assess the effectiveness of erbium lasers in the removal of all ceramic fixed dental prostheses (FDPs). OVERVIEW: Indexed databases were searched without language or time restriction up to and including December 2017 using different combinations of the following keywords: "lasers"; "phototherapy"; "crowns"; "prostheses and implants"; "inlays"; "ceramics"; "dental porcelain"; "zirconium"; "removal"; "debonding"; "fixed dental prostheses"; "veneers"; "laminates"; and "fixed bridge." All levels of available evidence including experimental studies, case reports and case series were included. Six clinical studies reporting a total of 13 cases and 6 experimental studies were included. Results from all studies showed that erbium lasers are effective reducing the shear bond strengths of all ceramic FDPs, in terms of easy removal of the restorations with none or minimal damage to teeth or ceramic surfaces. CONCLUSION: Laser-assisted removal of all ceramic FDPs is a promising treatment protocol. Further well-designed controlled clinical trials and longitudinal prospective studies are needed to determine the precise laser parameters and duration of irradiation that could be used for removal of ceramic restorations with varying thicknesses. CLINICAL SIGNIFICANCE: Benefits of lasers over mechanical instrumentation for crown removal encompass efficient restoration retrievability without restoration or teeth surfaces damages; and relatively easier and time effective procedure with no prerequisite for anesthetic agents. It is however imperative for clinicians to be well-trained and exhibit adequate knowledge regarding recommended power settings and laser-safety parameters with reference to interactions between light and different tissues and ceramics.

Various Tip Applications and Temperature Changes of Er,Cr:YSGG-Laser Irradiated Implants In Vitro.

The impact of the laser tip on implant temperature when irradiating implants with lasers to treat peri-implantitis has received little attention. The present study was designed to assess the influence of two laser tips (sapphire chisel [MC3] and radial firing perio [RFP]) on temperature change of an implant irradiated with an Er,Cr:YSGG laser in vitro under various operational conditions. The results suggest that Er,Cr:YSGG irradiation using either tip with supplemental cooling can be a thermally safe approach to implant decontamination. However, use of the RFP tip consistently resulted in a greater temperature rise. The MC3 tip thus may be preferable to the RFP tip for open-flap implant debridement.

Efficacy of low level laser therapy in the treatment of burning mouth syndrome: A systematic review.

BACKGROUND: Burning mouth syndrome (BMS) is a chronic pain condition with indefinite cure, predominantly affecting post-menopausal women. The aim of this study was to systematically review the efficacy of low level laser therapy in the treatment of burning mouth syndrome (BMS). METHODS: PubMed, Embase and Scopus were searched from date of inception till and including October 2016 using various combinations of the following keywords: burning mouth syndrome, BMS, stomatodynia, laser therapy, laser treatment and phototherapy. The inclusion criteria were: Prospective, retrospective and case series studies. Letter to editors, reviews, experimental studies, studies that were not published in English, theses, monographs, and abstracts presented in scientific events were excluded. Due to heterogeneity of data no statistical analyses were performed. RESULTS: Ten clinical studies fulfilled the eligibility criteria, five of which were randomized clinical trials. In these studies, the laser wavelengths, power output and duration of irradiation ranged between 630-980nm, 20-300mW, 10s-15min, respectively. Most of studies reported laser to be an effective therapy strategy for management of BMS. CONCLUSION: Majority of the studies showed that laser therapy seemed to be effective in reducing pain in BMS patients. However, due to the varied methodologies and substantial variations in laser parameters among these studies, more clinical trials are required to ascertain the efficacy of laser for treating BMS.

Efficacy of Vitamin D3 Supplementation on Osseointegration of Implants.

PURPOSE: The aim was to systematically review the efficacy of vitamin D3 (VD3) supplementation on the osseointegration of implants. METHODS: The addressed focused question was "does VD3 supplementation affect osseointegration around implants?" Indexed databases were searched from 1969 up to and including March 2015 using various key words including: "Bone to implant contact"; "implant"; "vitamin D"; and "osseointegration." Letters to the editor, case reports/case series, reviews, and articles published in languages other than English were excluded. The pattern of the present systematic review was customized to primarily summarize the pertinent data. RESULTS: Six experimental studies (4 in rodents and 2 in rabbits) were included. Number of titanium implants placed ranged between 28 and 100 implants. Results from 5 studies showed that VD3 supplementation enhanced new bone formation and/or bone to implant contact (BIC) around implants. One study showed no significant difference in BIC and new bone formation around VD3 coated and noncoated implants. One study reported that insulin therapy with adjunct VD3 supplementation enhances new bone formation around implants in diabetic rats than when insulin replacement therapy is used alone. CONCLUSION: Efficacy of VD3 supplementation on osseointegration of implants remains controversial and requires further investigations.

Severity of periodontal disease in individuals chewing betel quid with and without tobacco.

BACKGROUND: The deleterious effects of chewing betel quid (BQ) with or without tobacco on periodontal health are poorly addressed. The aim of this study was to investigate the severity and extent of periodontal disease among individuals chewing BQ with and without tobacco. METHODS: One hundred twenty individuals (70 BQ chewers: 35 with tobacco and 35 without tobacco) and 50 control individuals (non-chewers) were included in this study. Sociodemographic data and information regarding BQ chewing habit were collected using a questionnaire. Plaque index, bleeding on probing and probing pocket depth were measured. Numbers of missing teeth were recorded and marginal bone loss was measured on panoramic radiographs. Statistical analyses were performed using 1-way analysis of variance and Bonferroni post hoc test. RESULTS: The socioeconomic status of subjects in the control group was significantly higher as compared with those chewing BQ either with or without tobacco. Plaque index, bleeding on probing and probing pocket depth were greater in subjects chewing BQ with tobacco than in those chewing BQ without tobacco and the controls. Subjects chewing BQ with tobacco had fewer teeth than those chewing BQ without tobacco and the controls. Marginal bone loss was higher in subjects chewing BQ with tobacco than in those chewing BQ without tobacco and the controls. CONCLUSIONS: The severity of periodontal disease is enhanced in subjects chewing BQ with tobacco as compared with those chewing BQ without tobacco. Subjects with a low socioeconomic status and poor education are significantly more likely than others to develop periodontal disease.

Role of dentifrices with essential oil formulations in periodontal healing.

INTRODUCTION: Essential oil (EO)-formulated dentifrices have significant effectiveness in reducing periodontal inflammation. This study aimed to review the role of dentifrices with EO formulations in periodontal healing. METHODS: Databases were explored from 1968 until March 2010. The focused question was what is the impact of dentifrices with EO formulations on periodontal wound healing? Databases were searched using the following terms in various combinations: "essential oil," "periodontal healing," "mouthrinse," "mouth-wash" and "periodontitis." RESULTS: Twenty studies were included. The numbers of participants ranged from 20 to 316 individuals (aged 18-70 years) and were rinsing with the EO-formulated dentifrices at least twice daily for 1 week to 48 weeks. Fourteen clinical studies showed reduced periodontal inflammatory conditions in the test group (individuals using EO dentifrices) compared with the placebo group. Three studies showed a reduction in periodontal pathogens in the test group compared with the placebo group. In 1 study, the microbiological findings remained inconclusive between the 2 groups. CONCLUSION: EO-formulated dentifrices have beneficial effects on the clinical and microbiological parameters of periodontal inflammation.

Long-term effects of a single application of a water-cooled pulsed Nd:YAG laser in supplement to scaling and root planing in patients with periodontal inflammation.

The aim of this work was to investigate the long-term effects of a single application of a water-cooled pulsed neodymium yttrium aluminium garnet (Nd:YAG) laser, in combination with scaling and root planing (SRP) for the treatment of periodontal inflammation. Twenty-two patients were included in this split-mouth single blind randomized controlled clinical trial. The parameters of the air and water-cooled Nd:YAG laser were: 4 W, 80 mJ/pulse, 50 Hz and a pulse width of 350 µs. The "test side" was treated with a single application of Nd:YAG laser and SRP; while the "control side " was treated with SRP alone. At baseline, and after a median follow-up time of 20 months (range 12-39), periodontal inflammatory parameters (plaque index [PI], gingival index [GI], probing pocket depth [PPD]), and marginal bone loss (on digital bite-wing radiographs) were measured. Gingival crevicular fluid (GCF) was collected from the teeth 35, 36, 45, and 46 at baseline and at follow-up. Pl (p < 0.01), GI (p < 0.01), and PPD (p < 0.001) were significantly lower on the test side compared to the control side at follow-up. Radiological results showed significantly less bone loss on the test side compared to the control side (p < 0.05). GCF volume was lower on the test side compared to the control side (p < 0.01). In conclusion, a single application of Nd:YAG laser in combination with SRP had a positive long-term effect on periodontal health compared to treatment by SRP alone.