Impact of low-level laser therapy as an adjunct to non-surgical periodontal treatment on the levels of tissue plasminogen activator and plasminogen activator inhibitor 1 in Stage 3-4, Grade C periodontitis patients: a split-mouth, randomized control study.

AIM: To investigate the effects of low-level laser therapy (LLLT) as an adjunct to non-surgical periodontal treatment (NSPT) on the plasminogen-activating system. MATERIALS AND METHODS: Stage 3-4 Grade C periodontitis and age-gender-matched healthy individuals participated in the split-mouth study (ClinicalTrials.gov identifier, NCT05233501). The study groups were Periodontitis/NSPT (Sham); Periodontitis/NSPT + LLLT (LLLT); Healthy (Control). Following NSPT, LLLT was applied on Days 0, 2 and 7. Clinical parameters were recorded at baseline and on Day 30. Gingival crevicular fluid (GCF) was collected at baseline, on days 7, 14, and 30; tissue-type plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) levels were measured with ELISA. RESULTS: Clinical parameters, total GCF tPA (tPAt) and PAI-1 (PAI-1t) levels significantly reduced in LLLT and Sham groups (< 0.001). GCF tPAt levels in LLLT were significantly lower (< 0.05) than Sham on Day 7. GCF tPAt levels in periodontitis groups were significantly higher than the Control at baseline, on Days 7 and 14 (< 0.01). By Day 30, both groups decreased to control levels (> 0.05). GCF PAI-1t levels were significantly lower in LLLT than the Sham on day 30 (< 0.01), comparable to healthy controls (> 0.05). CONCLUSION: Adjunctive LLLT modulates the plasminogen activating system in severe periodontitis by altering GCF tPA and PAI-1 levels. CLINICAL RELEVANCE: LLLT as an adjunct to non-surgical periodontal treatment in patients with Stage 3-4 Grade C leads to reduced plasminogen activation.

Photobiomodulation impacts the levels of inflammatory mediators during orthodontic tooth movement? A systematic review with meta-analysis.

During orthodontic tooth movement (OTM), there is the release of cytokines in the gingival crevicular fluid (GCF) that are supposed to participate in the bone remodeling. This systematic review aimed at assessing the effects of photobiomodulation (PBM) on the levels of these cytokines during OTM. This systematic review according to Cochrane Collaboration guidelines aimed to answer the clinical question following the PICOS strategy. The broad search in the literature was performed before 05 April, 2021 in six electronic databases (Pubmed, Web of Science, Scopus, Embase, Cochrane, Biblioteca Virtual de Saúde) and supplemented by the grey literature. The risk of bias of randomized and non-randomized clinical trials was evaluated by two tools: RoB 2 and ROBINS-I. Mean and standard deviation of cytokine levels was extracted to meta-analysis, and the GRADE system was applied to assess the quality of the evidence. Nine studies were included in this review. Low-level laser therapy (LLLT) was the photobiomodulation type used in most of the studies (n = 8). The wavelengths used varied from 618 to 980 nm and also differed concerning the light emission pattern. LLLT increased the levels of IL-1ß, IL-8, OPN, and PGE2, but not TNF-α1, TGF-ß1. The levels of IL6, RANKL, and OPG presented conflicting results. LLLT was statistically associated with an increase of IL-1ß levels (standard mean difference [SMD] = 1.99; 95% confidence interval = 0.66 to 3.33; p < 0.001) with low certainty of evidence. LLLT may increase the levels of IL-1ß and other cytokines; however, the results should be interpreted with caution due to protocol variations between studies, and the few studies added in the meta-analysis.

Salivary, Plasma, and Gingival Levels of Melatonin and TNF-α in Nonsmokers and Current Smokers with and without Periodontal Disease.

AIM: The aim of this study was to quantify the levels of gingival, salivary, and plasma melatonin and tumor necrosis factor-α (TNF-α) in healthy individuals and chronic generalized periodontitis patients with and without cigarette smoking habit and to investigate whether a relationship exists between melatonin and TNF-α levels in the samples. MATERIALS AND METHODS: Blood of 5 mL, 5 mL of saliva, and gingival tissue samples were obtained from 30 periodontally healthy individuals without smoking habit (HP), 30 nonsmoking patients with chronic generalized periodontitis (CP), 30 periodontally healthy individuals with current smoking habit (SHP), and 30 current smoker patients with chronic generalized periodontitis (SCP). The levels of melatonin and TNF-α in the samples were measured using commercially available enzyme-linked immunosorbent assay (ELISA) kit. The results obtained were statistically analyzed using SPSS statistical software (23.0 version). RESULTS: This study demonstrated the presence of melatonin and TNF-α in all the saliva, plasma, and gingival tissue samples. Gingival tissue melatonin levels were highest in the HP group and least in the SCP groups, while TNF-α levels were least in the HP group and highest in the SCP groups. No significant difference was observed between the groups with regard to salivary and plasma melatonin. An overall significant difference was also observed between the groups with regard to salivary TNF-α but not with regard to plasma TNF-α. Binary logistic regression analysis was carried out after dividing the study groups into current smokers and nonsmokers. Results revealed that a reduction in gingival melatonin and an increase in gingival TNF-α were associated with a transition from periodontal health to chronic generalized periodontitis in current smokers but not in nonsmokers. CONCLUSION: This study sheds light on the anti-inflammatory actions of melatonin in the gingival tissues in states of periodontal health and disease in current smokers. CLINICAL SIGNIFICANCE: Melatonin could be used as a supplement to boost anti-inflammatory mechanisms in periodontal therapy especially in cigarette smokers.

Randomized controlled clinical effectiveness of adjunct 660-nm light-emitting diode irradiation during non-surgical periodontal therapy.

BACKGROUND/PURPOSE: The irradiation of 660-nm light-emitting diodes (LEDs) has exhibited potential to accelerate oral wound healing and prevent periodontal breakdown in rodents. This study was to evaluate the clinical effectiveness of 660-nm LEDs during non-surgical periodontal therapy (NSPT). METHODS: Nineteen patients with at least one periodontitis-involved tooth in three quadrants received NSPT, and three protocols of LED light irradiation, including LED light irradiation from initial clinical assessment (T0) until the completion of scaling and root planning (T1) (LED01), LED light irradiation from T1 until re-evaluation (T2) (LED02), and no LED light irradiation (control treatment), were randomly assigned to respective quadrant. Clinical parameters were assessed at T0 and T2, and such biomarkers as IL-1ß and MMP-8 from gingival crevicular fluid were assessed at T0, T1, and T2. RESULTS: At T2, all examined sites exhibited significantly reduced probing pocket depth (PD), clinical attachment level (CAL), gingival bleeding index, plaque score, and visual analog scale. In the sites with greatest initial PD and CAL, LED01 and LED02 significantly reduced PD and CAL compared with the control treatment. IL-1ß and MMP-8 were reduced in all groups at T1 and T2, and the reduction of MMP-8 was the most notable in LED01. CONCLUSION: LED light irradiation during or after scaling and root planing assisted in the recovery of periodontium and can be used as an adjunct treatment during NSPT, specifically for sites with severe periodontal breakdown.

Etiological periodontal treatment with and without low-level laser therapy on IL-1ß level in gingival crevicular fluid: an in vivo multicentric pilot study.

Cytokine proteins may have important roles during different human physiological and pathological processes. In the oral cavity, the bone loss and periodontal tissue pathology was related to inflammatory process activation. The aim of the present study was to assess the effects of etiological periodontal therapy with and without the use of Low Level Laser Therapy (LLLT) on clinical periodontal parameters and interleukin (IL)-1ß level in gingival crevicular fluid (GCF) from chronic periodontitis (CP) patients. Thirty non-smoker CP patients were selected from the Foggia University Dental Clinic and other 2 private dental clinics. All patients were divided into two homogeneous randomized groups: 15 patients were treated with only scaling and root planing (group 1) and 15 patients with scaling and root planing etiological treatment and LLLT (group 2). In all sites, at baseline before treatment, the periodontal pocket depth (PPD) and bleeding on probing (BOP) were measured. In the PPD sites, the GCF samples were collected from 30 deep (≥5 mm) and shallow (≤3 mm) sites and IL-1ß were evaluated at baseline, after 10 days and 1 month. In all the samples at baseline, the IL-1ß concentration in GCF and BOP rate were significantly higher at deep PPD sites than at the shallow ones. After 10 days in all samples no PPD improvement was observed in the BOP rate but the IL-1 ß level was statistically significantly improved (p<0.005) in group 2 compared to group 1. At 10 days and 1 month, in all deep PPD sites, PPD and BOP improvements were observed. At same time, IL-1ß levels were lower and statistically significantly (p<0.005) improved in group 2 compared to group 1. The results confirmed that the periodontal etiology treatment of deep PPD sites with or with-out associated LLLT promotes periodontal health. Etiological treatment associated with LLLT, improves BOP and inflammation in periodontal disease. Moreover, the IL-1ß concentration changes in GCF suggest these cytokines as a predictable marker of gingival inflammation in chronic periodontitis patients.

The effect of low-level laser therapy as an adjunct to non-surgical periodontal treatment on gingival crevicular fluid levels of transforming growth factor-beta 1, tissue plasminogen activator and plasminogen activator inhibitor 1 in smoking and non-smoking chronic periodontitis patients: A split-mouth, randomized control study.

BACKGROUND AND OBJECTIVE: This study aimed to investigate the effects of low-level laser therapy (LLLT) as an adjunct to scaling and root planing (SRP) on smoking and non-smoking patients with chronic periodontitis. MATERIAL AND METHODS: The study was conducted using a split-mouth design with 30 patients with chronic periodontitis (15 smokers, 15 non-smokers) and 30 healthy individuals matched for age, sex and smoking status as controls. Groups were constituted as follows: Cp+SRP+Sham: non-smokers with chronic periodontitis treated with SRP; Cp+SRP+LLLT: non-smokers with chronic periodontitis treated with SRP+LLLT; SCp+SRP+Sham: smokers with chronic periodontitis treated with SRP; SCp+SRP+LLLT: smokers with chronic periodontitis treated with SRP+LLLT; C: control group comprised of periodontally healthy non-smokers; SC: control group comprised of periodontally healthy smokers. LLLT was first applied on the same day as SRP and again on days 2 and 7 after SRP treatment. Clinical parameters were recorded before non-surgical periodontal treatment (baseline) and on day 30. Gingival crevicular fluid samples were collected before periodontal treatment (baseline) and during follow-up visits on days 7, 14 and 30. Gingival crevicular fluid transforming growth factor (TGF)-ß1, tissue plasminogen activator (tPA) and plasminogen activator inhibitor 1 (PAI-1) levels were measured using enzyme-linked immunosorbent assay. RESULTS: All clinical parameters showed significant reductions between baseline and day 30 following SRP treatment in both the LLLT and sham groups (P<.001). No significant differences were observed between the LLLT and sham groups of either the smokers or non-smokers (P>.05). Gingival crevicular fluid PAI-1 levels decreased significantly in the SCp+SRP+sham and SCp+SRP+LLLT groups (P<.05), and gingival crevicular fluid tPA levels decreased significantly in the Cp+SRP+sham, Cp+SRP+LLLT and SCp+SRP+LLLT groups (P<.05). Gingival crevicular fluid TGF-ß1 levels decreased significantly in all treatment groups (P<.05). Although no significant differences were found between the gingival crevicular fluid PAI-1, tPA and TGF-ß1 levels of the LLLT versus sham groups (P>.05) at any of the time points measured, both LLLT groups showed significant reductions in tPA/PAI-1 ratios over time. CONCLUSION: Within the limits of this study, LLLT may be understood to play a role in the modulation of periodontal tissue tPA and PAI-1 gingival crevicular fluid levels, particularly in smoking patients with chronic periodontitis, and may thus be recommended as an adjunct to non-surgical periodontal treatment.

Short- and Medium-Term Effects of Low-Level Laser Therapy on Periodontal Status in Lingual Orthodontic Patients.

OBJECTIVE: The purpose of this study was to evaluate the short- and medium-term effects of low-level laser therapy (LLLT) applied in repeated doses in adults with a healthy periodontium treated by lingual orthodontic appliances. BACKGROUND DATA: Plaque accumulation, in combination with difficulty in removing it in lingual orthodontic patients, can cause gingival inflammation. METHODS: Twelve orthodontic patients scheduled for fixed lingual orthodontic treatment were selected. Clinical measurements [visible plaque index (VPI), bleeding on probing (BOP), and probing depth (PD), and collection of gingival crevicular fluid (GCF)], which was used to measure the levels of interleukin-1beta (IL-1ß) and tumor necrosis factor alpha (TNF-α), was performed before bonding the lingual device, and at the short-term (1, 2, 3 months) and medium-term (12 months) follow-up appointments. For each patient, quadrant 1 or 2 was randomly chosen for irradiation by a diode laser (λ = 670 nm, 190 mW, 6.05 W/cm(2), 60 sec/ tooth) (Laser Group) and the contralateral quadrant was used as the Control Group. RESULTS: In both studied groups, a slight worsening of the periodontal condition was observed, which was evident at the 3rd month follow-up and which was mainly at the lingual side in the Control Group. The levels of IL-1ß in the GCF were significantly increased in the Control Group compared with the Laser Group at the 2nd and 3rd months after bonding. At the 12th month follow-up, an improvement of the inflammation was observed in both groups in the study. CONCLUSIONS: LLLT showed short-term effects by preventing a substantial increase in IL-1ß levels. At medium-term follow-up, LLLT diminished VPI, BOP, and PD scores.

Clinical and biochemical comparison of guided tissue regeneration versus guided tissue regeneration plus low-level laser therapy in the treatment of class II furcation defects: A clinical study.

OBJECTIVE: The present study was aimed to compare the clinical and biochemical effectiveness of guided tissue regeneration (GTR) alone and combined with low-level laser therapy (LLLT) application in the treatment of furcation II periodontal defects, over a period of 6 months. MATERIAL AND METHODS: Thirty-three furcation defects were included in the study. Seventeen of these defects were treated with GTR plus LLLT, and sixteen of them were treated with GTR alone. Probing pocket depth (PPD), clinical attachment level (CAL), horizontal probing depth (HPD), and alkaline phosphatase (ALP) and osteocalcin (OC) levels in the gingival crevicular fluid (GCF) were recorded at baseline and at postoperative 3rd and 6th months. RESULTS: Healing was uneventful in all cases. At the 3rd and 6th months, both treatment modalities-GTR and GTR plus LLLT--showed improved PPD, CAL, and HPD values compared to their baseline values. ALP and OC levels in GCF increased after the treatment in both groups (p < 0.05). When compared the two groups, at the 6th month, PPD, CAL, HPD, and ALP values showed significantly more improvement in laser group than non-laser group (p < 0.05). CONCLUSIONS: The results of this study showed that both treatments led to significantly favorable clinical improvements in furcation periodontal defects. LLLT plus GTR may be a more effective treatment modality compared to GTR alone.

Nonsurgical therapy of chronic periodontitis with adjunctive systemic azithromycin or amoxicillin/metronidazole.

OBJECTIVES: The objective of the present study is to compare the effect of systemic adjunctive use of azithromycin with amoxicillin/metronidazole to scaling and root planing (SRP) in a clinical study. MATERIALS AND METHODS: Data from 60 individuals with chronic periodontitis were evaluated after full-mouth SRP. Antibiotics were given from the first day of SRP, in the test group (n = 29), azithromycin for 3 days and, in the control group (n = 31), amoxicillin/metronidazole for7 days. Probing depth (PD), attachment level (AL), and bleeding on probing (BOP) were recorded at baseline and after 3 and 12 months. Gingival crevicular fluid was analyzed for matrix metalloprotease (MMP)-8 and interleukin (IL)-1beta levels. Subgingival plaque was taken for assessment of the major bacteria associated with periodontitis. RESULTS: In both groups, PD, AL, and BOP were significantly reduced (p < 0.001). A few significant differences between the groups were found; AL and BOP were significantly better in the test than in the control group at the end of the study (p = 0.020 and 0.009). Periodontopathogens were reduced most in the test group. CONCLUSIONS: A noninferiority of the treatment with azithromycin in comparison with amoxicillin/metronidazole can be stated. The administration of azithromycin could be an alternative to the use of amoxicillin/metronidazole adjunctive to SRP in patients with moderate or severe chronic periodontitis; however, a randomized placebo-controlled multicenter study is needed. CLINICAL RELEVANCE: Application of azithromycin as a single antibiotic for 3 days might be considered as an additional adjunctive antibiotic to SRP in selected patients.

Adjunctive Non-Surgical Therapy of Inflamed Periodontal Pockets During Maintenance Therapy Using Diode Laser: A Randomized Clinical Trial.

BACKGROUND: Numerous studies have documented the clinical outcomes of laser therapy for untreated periodontitis, but very few have reported on lasers treating inflamed pockets during maintenance therapy. The aim of this study is to compare the effectiveness of scaling and root planing (SRP) plus the adjunctive use of diode laser therapy to SRP alone on changes in the clinical parameters of disease and on the gingival crevicular fluid (GCF) inflammatory mediator interleukin-1ß (IL-1ß) in patients receiving regular periodontal maintenance therapy. METHODS: This single-masked and randomized, controlled, prospective study includes 22 patients receiving regular periodontal maintenance therapy who had one or more periodontal sites with a probing depth (PD) ≥ 5 mm with bleeding on probing (BOP). Fifty-six sites were treated with SRP and adjunctive laser therapy (SRP + L). Fifty-eight sites were treated with SRP alone. Clinical parameters, including PD, clinical attachment level (CAL), and BOP, and GCF IL-1ß levels were measured immediately before treatment (baseline) and 3 months after treatment. RESULTS: Sites treated with SRP + L and SRP alone resulted in statistically significant reductions in PD and BOP and gains in CAL. These changes were not significantly different between the two therapies. Similarly, differences in GCF IL-1ß levels between SRP + L and SRP alone were not statistically significant. CONCLUSION: In periodontal maintenance patients, SRP + L did not enhance clinical outcomes compared to SRP alone in the treatment of inflamed sites with ≥ 5 mm PD.

Effects of curcumin on crevicular levels of IL-1ß and CCL28 in experimental gingivitis.

BACKGROUND: Curcumin has anti-inflammatory properties. The aim of this study was to compare interleukin-1ß (IL-1ß) and chemokine (C-C motif) ligand 28 (CCL28) levels following a topical application of curcumin (CRM), chlorhexidine (CHX) and chlorhexidine-metronidazole (CHX-MTZ) in an experimental gingivitis human model. METHODS: Sixty systemically healthy selected subjects were randomly assigned to one of three topical antigingivitis gels. Each gel was applied twice daily for 10 minutes as the sole method of oral hygiene for 29 days on the test quadrant only. Modified gingival index (MGI), plaque index (PI), bleeding on probing (BOP) and probing depth (PD) were assessed at baseline, 29 days and 60 days. Estimation of IL-1ß and CCL28 levels in gingival crevicular fluid was done at baseline and at 29 days. RESULTS: The increase of IL-1ß in the CRM (14.52 ± 16.6 pg/ml) and CHX-MTZ (31.63 ± 15.96) groups was significantly less than that of the CHX group (70.55 ± 38.81). Similar results were also observed for CCL28 (CRM: 8.12 ± 8.78 pg/ml; CHX-MTZ: 12.81 ± 18.68; CHX: 41.15 ± 22.82). All groups had a significant increase in MGI, PI and BOP at 29 days. CONCLUSIONS: The anti-inflammatory potential of topical curcumin was similar to CHX-MTZ but superior to CHX in affecting IL-1ß and CCL28 levels.

Effect of omega 3 fatty acids plus low-dose aspirin on both clinical and biochemical profiles of patients with chronic periodontitis and type 2 diabetes: a randomized double blind placebo-controlled study.

BACKGROUND AND OBJECTIVES: The aim of this study was, first, to investigate the effect of omega 3 (ω3) fatty acids plus low-dose aspirin with closed debridement in the treatment of patients with periodontitis and type 2 diabetes mellitus (DM), and second, to estimate the expression of monocyte chemoattractant protein-3 (MCP-3) in response to the supposed modulatory therapy. MATERIAL AND METHODS: Forty patients with chronic periodontitis and type 2 DM were equally divided into groups 1 (patients received ω3 plus low-dose aspirin for 6 mo) and 2 (patients received placebo during the same period). Evaluation was done clinically (pocket depth, clinical attachment loss, gingival index and plaque index) and biochemically by estimating levels of interleukin 1ß and MCP-3 in gingival crevicular fluid, plus investigating the effect of treatment on glycemic control by levels of glycated hemoglobin A1c in serum. All data were collected at baseline, 3 and 6 mo after treatment. RESULTS: Subjects of group 1 showed a highly significant reduction in pocket depth, clinical attachment loss, gingival index (p ≤ 0.01) after 3 and 6 mo compared to group 2. Glycated hemoglobin A1c levels showed a reduction in both groups at the end of the study period, with a non-significant difference (p > 0.05). Furthermore, the treatment protocol showed a significant reduction in levels of MCP-3 and interleukin 1ß at 3 and 6 mo compared to the placebo group. CONCLUSIONS: Within the limits of the present study, ω3 plus low-dose aspirin proved effective as an adjunct to closed periodontal therapy in the management of patients with periodontitis and type 2 DM. Moreover, MCP-3 was proven to be effective both in the pathogenesis of the disease and as a biomarker in evaluating the response to periodontal treatment.

Clinical, microbial, and immune responses observed in patients with diabetes after treatment for gingivitis: a three-month randomized clinical trial.

BACKGROUND: Although patients with diabetes are frequently affected by periodontitis, only a few investigations have focused on gingivitis in this at-risk population. This randomized placebo-controlled clinical trial compared the response to a gingivitis treatment protocol that combined mechanical procedures and daily use of an essential oil (EO) mouthrinse between patients with and without diabetes. METHODS: The whole-mouth periodontal probing depth (PD), gingival index (GI), and plaque index (PI) were monitored in gingivitis cases among systemically healthy patients (n = 60) or those with diabetes (n = 60) at baseline and 3 months after treatment. Levels of Porphyromonas gingivalis, Tannerella forsythia, Aggregatibacter actinomycetemcomitans, and total bacterial load were determined by a real-time polymerase chain reaction in intrasulci plaque samples. The volume of gingival crevicular fluid (GCF) was quantified, and interleukin-1ß (IL-1ß) levels were determined in GCF samples. After a full-mouth ultrasonic debridement, patients were randomly assigned to an EO or a placebo rinse for 90 days (40 mL/day). The data were analyzed through repeated-measures analysis of variance and multiple comparisons Tukey tests (P <0.05). RESULTS: GI was more severe in the diabetes group. Diabetes impaired GI and reduced GCF volume. PD, bacterial levels, and IL-1ß improved similarly in both systemic conditions. The adjunctive use of EO provided greater reductions of PI, GI, total bacterial load, T. forsythia, A. actinomycetemcomitans, and GCF volume. CONCLUSIONS: Response to gingivitis treatment in patients with diabetes can slightly differ from that in patients without diabetes. Daily use of an EO mouthrinse after ultrasonic debridement benefited patients with and without diabetes.

Docosahexaenoic Acid and Periodontitis in Adults: A Randomized Controlled Trial.

Periodontitis is a common chronic inflammatory disease initiated by bacteria, resulting in bone resorption, tooth loss, and systemic inflammation. Long-chain omega-3 fatty acids such as docosahexaenoic acid (DHA) reduce periodontitis in animals. We aimed to determine whether DHA supplementation with low-dose aspirin would reduce periodontitis in humans. We conducted a double-blind placebo-controlled parallel trial lasting 3 mo. Fifty-five adults with moderate periodontitis were randomized to 2,000 mg of DHA or identical soy/corn oil capsules. All participants received 81 mg of aspirin but received no other treatments. We analyzed the primary outcome of per-pocket change in pocket depth using mixed models among teeth with pocket depth ≥5 mm. Secondary outcomes assessed with generalized estimating equations included gingival index, plaque index, and bleeding on probing. Gingival crevicular fluid samples were analyzed for changes in high-sensitivity C-reactive protein (hsCRP) and interleukins 6 and 1ß (IL-6 and IL-1ß). Plasma was analyzed for changes in systemic inflammatory markers, including hsCRP. We confirmed adherence with erythrocyte fatty acid measurement. Forty-six participants completed the trial. While similar at baseline, the proportion of DHA in red blood cell plasma membranes increased from 3.6% ± 0.9% to 6.2% ± 1.6% in the intervention group but did not change among controls. DHA supplementation decreased mean pocket depth (-0.29 ± 0.13; p = .03) and gingival index (-0.26 ± 0.13; p = .04). Plaque index and bleeding on probing did not change. Significant adjusted differences were found between DHA and control for both gingival crevicular fluid hsCRP (-5.3 ng/mL, standard error [SE] = 2.4, p = .03) and IL-1ß (-20.1 pg/mL, SE = 8.2, p = .02) but not IL-6 (0.02 pg/mL, SE = 0.71, p = .98) or systemic hsCRP (-1.19 mg/L, SE = 0.90, p = .20). In this randomized controlled trial, aspirin-triggered DHA supplementation significantly improved periodontal outcomes in people with periodontitis, indicating its potential therapeutic efficacy (clinicaltrials.gov NCT01976806).

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

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

The effects of stress on periodontal treatment: a longitudinal investigation using clinical and biological markers.

AIM: To investigate the effects of psychosocial stress on the outcome of non-surgical periodontal treatment (NPT). METHODS: Patients were categorized as stressed or unstressed, and the degree of stress was measured. One deep bleeding and one deep non-bleeding site ≥6 mm were selected in each patient for detailed investigation, and the clinical parameters were recorded before and at 6 months after NPT. Elastase and C-terminal teleopeptide of type I collagen (ICTP) were measured in gingival crevicular fluid (GCF) samples at both intervals. RESULTS: The baseline, clinical parameters and biological markers were similar in both stressed and unstressed groups, other than for GCF elastase levels, which were significantly higher in the stressed group of patients (p < 0.05). The effect of stress on the changes for clinical measurements and elastase levels in GCF was statistically significant for deep bleeding sites, with the response to treatment being poorer in the stressed group. The effects of smoking and the degree of stress were not statistically significant for any of the clinical or biological parameters (p > 0.05). CONCLUSIONS: Patients under psychosocial stress had a poorer outcome following NPT. The assessment of psychosocial stress may be valuable in the holistic management of periodontal disease.

Doxycycline-loaded ß-tricalcium phosphate release following EDTA root surface etching improved the clinical outcomes in chronic periodontitis: an in vivo study.

BACKGROUND: The main objective of the present study is to quantify doxycycline (DOX) release from ß-tricalcium phosphate (ß-TCP) after EDTA root surface treatment. METHODS: Thirty systemically healthy patients with ≥1 paired contralateral interproximal intrabony defect ≥4 mm deep along with an interproximal probing depth ≥6 mm and clinical attachment level ≥4 mm were randomized into two groups. Group 1 (G1) consisted of sites treated with open flap debridement followed by placement of DOX blended with ß-TCP (DOX-ß-TCP), whereas group 2 (G2) sites were treated with flap surgery followed by the placement of DOX blended with ß-TCP after EDTA etching of the exposed root surfaces (DOX-ß-TCP + EDTA). Samples of gingival crevicular fluid (GCF) were obtained 1, 3, 7, 14, and 21 days after surgery. Quantitative measurements of DOX were taken with high-performance liquid chromatography. Clinical evaluation and follow-up for 6 months were performed. RESULTS: At 21 days, the DOX-ß-TCP + EDTA-treated group showed a 194.7 µg/mL value. The DOX-ß-TCP + EDTA-treated group retained more DOX during the periods of 3, 7, 10, 14, and 21 days than the DOX-ß-TCP-treated group. Six months after therapy, DOX-ß-TCP + EDTA-treated sites showed more significant clinical improvements compared to DOX-ß-TCP-treated sites (P ≤ 0.05). CONCLUSIONS: EDTA root surface etching enhances DOX availability in the GCF following its release from ß-TCP as a drug carrier.

Efficiency of low-level laser therapy in reducing pain induced by orthodontic forces.

OBJECTIVE: The aim of this study was to investigate the effect of low-level laser therapy (LLLT) on reducing post-adjustment orthodontic pain via evaluation of gingival crevicular fluid (GCF) composition changes at the level of prostaglandin-E(2) (PGE(2)) and visual analogue scale (VAS). BACKGROUND DATA: LLLT has been found to be effective in pain relief. PGE(2) has the greatest impact on the process of pain signals and can be detected in GCF in order to investigate the response of dental and periodontal tissues in a biochemical manner. MATERIALS AND METHODS: Nineteen patients (11 females and 8 males; mean age 13.9 years) were included in this study. Maxillary first molars were banded and then a randomly selected first molar at one side was irradiated (λ820 nm; continuous wave; output power: 50 mW; focal spot: 0.0314 cm(2); exposure duration: 5 sec; power density: 1.59 W/cm(2); energy dose: 0.25 J; energy density: 7.96 J/cm(2) for each shot), while the molar at the other side was served as placebo control. The GCF was collected from the gingival crevice of each molar to evaluate PGE(2) levels, before band placement, 1 and 24 h after laser irradiation. Pain intensity was analyzed at 5 min, 1 h, and 24 h after band placement by using VAS. RESULTS: Although no difference was found in pain perception at 5 min and 1 h, significant reduction was observed with laser treatment 24 h after application (p<0.05). The mean PGE(2) levels were significantly elevated in control group, whereas a gradual decrease occurred in laser group. The difference in PGE(2) levels at both 1 and 24 h were statistically significant between two groups (p<0.05). CONCLUSIONS: The significant reductions in both pain intensity and PGE(2) levels revealed that LLLT was efficient in reducing orthodontic post-adjustment pain.

Gene expression of inflammation and bone healing in peri-implant crevicular fluid after placement and loading of dental implants. A kinetic clinical pilot study using quantitative real-time PCR.

PURPOSE: Early detection of healing complications after placement of dental implants is a pressing but elusive goal. This paper proposes a non-invasive diagnostic tool for monitoring healing- and peri-implant disease specific genes, complementary to clinical evaluations. MATERIAL AND METHODS: Eighteen partially edentulous patients were recruited to this pilot study. Three Brånemark TiUnite® implants/patient (Nobel Biocare) were placed in a one-stage procedure. Abutments with smooth or rough (TiUnite®) surface were placed. The test group (n = 9) received fixed bridges (immediate loading), whereas the control group (n = 9) implants were loaded 3 months after surgery. In addition to clinical measurements, crevicular fluid was collected using paper strips at the implant abutments 2, 14, 28, and 90 days postoperative. mRNA was extracted, purified, and converted to cDNA. Quantitative PCR assays for IL-1ß, TNF-α, Osteocalcin (OC), Alkaline Phosphatase (ALP), Cathepsin K, Tartrate Resistant Acid Phosphatase, and 18S ribosomal RNA were designed and validated. Relative gene expression levels were calculated. RESULTS: One implant was lost in the control group and three in the test group. In one test patient, one implant showed lowered stability after 2 to 4 weeks and was unloaded. Later implant stability improved which allowed for loading after 3 to 4 months. TNF-α and ALP most commonly showed correlation with clinical parameters followed by IL-1ß and OC. The strongest correlation was found for TNF-α with clinical complications at 2 and 14 days (p = .01/r = -048, and p = .0004/r = -0.56, respectively; test and control groups together). In some cases, gene expression predicted clinical complications (TNF-α, ALP, CK). CONCLUSION: This study is based on samples from few individuals; still, some genes showed correlation with clinical findings. Further studies are needed to refine and optimize the sampling process, to find the appropriate panel, and to validate gene expression for monitoring implant healing.

A novel approach to the use of doxycycline-loaded biodegradable membrane and EDTA root surface etching in chronic periodontitis: a randomized clinical trial.

BACKGROUND: The release profile of 25% doxycycline (DOX) gel loaded on a biodegradable collagen membrane (COL) after 24% EDTA root surface etching was evaluated. METHODS: Thirty systemically healthy patients, each with at least one pair of contralateral interproximal intrabony defects ≥4 mm deep, along with an interproximal probing depth ≥6 mm and clinical attachment loss ≥4 mm, were randomized into two groups. Group 1 consisted of sites treated with open-flap debridement followed by placement of DOX gel-loaded COL (DOX-COL), whereas group 2 sites were treated with flap surgery followed by the placement of DOX-COL after EDTA etching of the exposed root surfaces (DOX-COL + EDTA). Samples of gingival crevicular fluid were obtained 1, 3, 7, 14, and 21 days after surgery. Separation was performed, and quantitative measurements of DOX were taken with a high-performance liquid chromatography. Clinical evaluation and follow-up for 6 months were performed. RESULTS: At 21 days, DOX-COL + EDTA group showed 5.3 µg/mL value. However, no DOX was detected in samples of the DOX-COL group. DOX-COL + EDTA-treated group retained more DOX during the periods of 3, 7, 10, and 14 days than did the DOX-COL group. CONCLUSION: EDTA root surface etching could enhance DOX availability in the gingival crevicular fluid after its release from the collagen membrane.