Efficacy of a Novel Zn-Substituted Monetite-Based Scaffold in the Treatment of Periodontal Osseous Defects.

PURPOSE: The objective of this study was to evaluate the efficacy of a zinc-substituted nanostructured monetite-based scaffold (Sil-Oss®) in the treatment of periodontal intra-bony osseous defects. METHODS: Thirty subjects participated in this study. Two sites in each subject were randomly assigned into each of the following experimental groups: Test group - open flap debridement (OFD) with Sil-Oss®; and control group - OFD with hydroxyapatite (HA) bone graft. Recorded clinical parameters included site-specific measures of plaque, probing pocket depth (PPD) and clinical attachment loss (CAL) at baseline, 3, 6 and 9 months. The evaluation of bone fill was performed by using digital subtraction technique and morphometric area analysis using two image processing software. Histological evaluation was done after 7 months by taking bone biopsy samples during crown lengthening procedures. Ten regions of interest (ROIs) per slide were visualized for mineralized tissue volume using an Olympus BX53® microscope at 40X magnification. RESULTS: Sil-Oss® showed a significantly greater bone fill compared to HA at 3 and 6 months. Sil-Oss®-treated defects also showed a marked increase in the percentage of tissue mineralization (25.38% vs 23.73%) compared to HA-treated defects. No significant differences were observed between the two groups for CAL and PPD at 6 months. CONCLUSION: We conclude from this trial conducted over a period of 9 months that Sil-Oss® has the potential to function as a graft material for periodontal regeneration.

Possible Association Between the Mallampati Score of the Oropharynx and Measures of Tongue Coating, Oral Hygiene and Periodontal Status.

PURPOSE: To assess oral hygiene and the gingival and periodontal disease status in subjects scored under the modified Mallampati classification (MMC) of the oropharynx. PATIENTS AND METHODS: The clinical parameters included recording MMC scores, simplified oral hygiene index (OHI-S), modified gingival index (MGI), tongue coating index (TCI) and periodontal status of the subjects. Eight additional parameters, which included percentage of sites with bleeding on probing (BOP), sites with probing depth (PD) ≥ 5 mm, tooth loss, attachment loss (AL):age ratio, diabetic status, smoking, the interplay of dental status and systemic factors (DS-SFI), and background characteristics (socioeconomic status and stress) were also assessed. RESULTS: Class IV MMC group showed the highest mean scores for OHI-S, periodontal status, AL:age ratio, diabetic status, background characteristics, PD ≥ 5 mm and DS-SFI when compared to other groups. In measures of OHI-S, periodontal status, PD > 5 mm, AL:age ratio and background characteristics, Class IV MMC group showed significant intergroup differences over MMC class I. Regression analysis revealed a highly significant but low degree of correlation (R2 = 0.079; p ≤ 0.001) between the predictors and the dependent values. CONCLUSION: The results suggest that increasing MMC scores can be a possible determinant in identifying gingival and periodontal disease. Any dental professional dealing with a multifactorial disease such as periodontitis can use this classification as a basic screening tool in identifying the modifiable factors of periodontitis.

Identical mitochondrial somatic mutations unique to chronic periodontitis and coronary artery disease.

CONTEXT: The inflammatory processes involved in chronic periodontitis and coronary artery diseases (CADs) are similar and produce reactive oxygen species that may result in similar somatic mutations in mitochondrial deoxyribonucleic acid (mtDNA). AIMS: The aims of the present study were to identify somatic mtDNA mutations in periodontal and cardiac tissues from subjects undergoing coronary artery bypass surgery and determine what fraction was identical and unique to these tissues. SETTINGS AND DESIGN: The study population consisted of 30 chronic periodontitis subjects who underwent coronary artery surgery after an angiogram had indicated CAD. MATERIALS AND METHODS: Gingival tissue samples were taken from the site with deepest probing depth; coronary artery tissue samples were taken during the coronary artery bypass grafting procedures, and blood samples were drawn during this surgical procedure. These samples were stored under aseptic conditions and later transported for mtDNA analysis. STATISTICAL ANALYSIS USED: Complete mtDNA sequences were obtained and aligned with the revised Cambridge reference sequence (NC_012920) using sequence analysis and auto assembler tools. RESULTS: Among the complete mtDNA sequences, a total of 162 variations were spread across the whole mitochondrial genome and present only in the coronary artery and the gingival tissue samples but not in the blood samples. Among the 162 variations, 12 were novel and four of the 12 novel variations were found in mitochondrial NADH dehydrogenase subunit 5 complex I gene (33.3%). CONCLUSIONS: Analysis of mtDNA mutations indicated 162 variants unique to periodontitis and CAD. Of these, 12 were novel and may have resulted from destructive oxidative forces common to these two diseases.

Effect of a Locally Delivered Probiotic-Prebiotic Mixture as an Adjunct to Scaling and Root Planing in the Management of Chronic Periodontitis.

OBJECTIVES: This study aimed to determine the efficacy of a probiotic, Saccharomyces boulardii (S. boulardii), mixed with a prebiotic, fructooligosaccharide (FOS), in the treatment of periodontal disease when used as an adjunct to non-surgical periodontal therapy (NSPT). METHODS: The study was carried out on 30 subjects who were diagnosed as having chronic periodontitis and had at least two sites in two different quadrants with ≥ 5 mm probing pocket depth (PPD). Two sites in each subject were randomly selected: in control sites, scaling and root planing (SRP) was performed, while the study sites received SRP followed by placement of the probiotic mixture. The viability of the probiotic (S. boulardii) in the pocket (at baseline, 2 days, 4 days and 7 days after treatment) and in vitro (at baseline, 1 week and 2 weeks after treatment) was estimated at designated time periods. Site-specific measures of plaque, gingival inflammation and periodontitis were recorded at baseline and specific intervals. RESULTS: S. boulardii in vivo survived up to 4 days, while in vitro reduction in the mean counts of S. boulardii did not differ statistically from baseline to 14 days. Significant reduction in probing pocket depths and gain in clinical attachment level in the test sites was observed when compared to controls. CONCLUSION: The results suggest that S. boulardii is effective in improving the clinicalmeasures of periodontal disease. S. boulardii seems to thrive well in the subgingival environment and may function as an effective oral probiotic in subjects with periodontitis.

Evaluation of the Antibacterial Effect of Silver Nanoparticles on Guided Tissue Regeneration Membrane Colonization--An in Vitro Study.

OBJECTIVE: The aim of this in vitro study was to investigate the colonization and penetration of specific bacteria on nanosilver-impregnated GTR (guided tissue regeneration) membranes. METHODS: Three sets of GTR membranes were used in this study: 1) GTR-C: Plain GTR membrane as a negative control; 2) GTR-NS: GTR membrane impregnated with silver nanoparticles as the test group; 3) GTR-DOX: GTR membrane impregnated with 25% (w/w) doxycycline hydrochloride acting as a positive control. Stress-strain characteristics were calculated to determine the physical properties of the control and impregnated membranes. Qualitative observation of microbial adherence and bacterial penetration through GTR membranes were performed by using four organisms (Streptococcus mutans, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum and Porphyromonas gingivalis) reported to have strong adherent capabilities to collagen membranes. RESULTS: The mean bacterial adherence scores were significantly greater (p < 0.001) in the GTR-C group when compared to GTR-DOX and GTR-NS groups. GTR-NS showed lower adherence scores than GTR-DOX across all four microorganisms; this difference, however was not statistically significant. The difference in colony forming units (CFUs) was highly significant (p < 0.001), suggesting greater penetration in GTR-C membranes when compared to GTR-NS and GTR-DOX groups. Though the mean CFUs were lower in GTR-DOX than in GTR-NS across all four microorganisms, this difference was statistically significant only for S. mutans and F. nucleatum. CONCLUSION: The incorporation of silver nanoparticles may be of value when controlling membrane-associated infection. Studies with different nanosilver particle sizes should be conducted to further evaluate the beneficial properties of nanosilver against periodontal pathogens.

Evaluation of clinical, antiinflammatory and antiinfective properties of amniotic membrane used for guided tissue regeneration: A randomized controlled trial.

BACKGROUND: The objective of this study was to evaluate the antiinflammatory, antiinfective and clinical properties of amniotic membrane (AM) when used for guided tissue regeneration (GTR) in contained interdental defects. MATERIALS AND METHODS: A total of 30 subjects participated in this study. Two sites in each subject were randomly assigned into each of the following experimental groups; test group: AM with bone graft and control group: Bone graft only. Clinical parameters included recording site-specific measures of plaque, gingivitis, probing pocket depth (PPD), and clinical attachment loss (CAL). The levels of interleukin-1ß (IL-1ß) and human beta-defensin-2 (hBD-2) levels in gingival crevicular fluid (GCF) from the test and control sites were measured by using commercially available enzyme linked immunosorbent assay kits. The evaluation of bone fill was performed by using digital subtraction technique and morphometric area analysis. One-way analysis of variance followed by the post-hoc test was used for intragroup and intergroup comparison. A P < 0.05 was considered as statistically significant. RESULTS: Combination therapy using an AM increased bone fill and reduced PPD and CAL when compared to controls. AM also resulted in a significant reduction of GCF IL-1ß levels and insignificant increase in the hBD-2 levels. CONCLUSION: From this trial conducted over a period of 24 weeks, AM demonstrated a marked antiinflammatory effect and its use resulted in an improvement in periodontal parameters. AM has the potential to function as a barrier for GTR and the unique properties associated with this material can augment its potential as a matrix for periodontal regeneration.

Effect of a single session of antimicrobial photodynamic therapy using indocyanine green in the treatment of chronic periodontitis: a randomized controlled pilot trial.

OBJECTIVE: The aim of this randomized controlled pilot study was to evaluate the effects of indocyanine green (ICG) as an adjunct to nonsurgical periodontal therapy in terms of reduction in percentage of viable bacteria and host tissue injury. METHOD AND MATERIALS: The study included a small cohort of 30 subjects diagnosed with chronic periodontitis. Three sites from three different quadrants were selected and were randomly treated by (1) scaling and root planing (SRP), (2) SRP with application of 810 nm diode laser, or (3) SRP with application of 810 nm diode laser and ICG at a concentration of 5 mg/ mL. Primary parameters included estimation of viable bacteria percentage and lactate dehydrogenase (LDH) levels. Secondary parameters included site-specific measures of plaque, gingivitis, pocket depth (PD), and clinical attachment loss (CAL) at specific time intervals. RESULTS: Sites receiving laser and ICG resulted in a significant decrease in the percentage of viable bacteria at the end of 1 week when compared to the other groups. ICG application does not seem to cause tissue damage as evident by the LDH levels. Comparison of CAL and PD revealed nonsignificant differences in sites treated with laser and ICG at the end of the study period. CONCLUSION: Laseractivated ICG dye may enhance the potential benefits of SRP and can be used as an adjunct to nonsurgical periodontal therapy.

Locally delivered antioxidant gel as an adjunct to nonsurgical therapy improves measures of oxidative stress and periodontal disease.

PURPOSE: The present study has two aims; firstly, it attempts to verify the presence of oxidative stress by estimating the reactive oxygen species (ROS) levels in periodontal pockets ≥5 mm as compared to controls. The second aim is to evaluate the effect of lycopene as a locally delivered antioxidant gel on periodontal health and on the gingival crevicular fluid (GCF) levels of 8-hydroxydeoxyguanosine (8-OHdG), a marker of oxidative injury. METHODS: Thirty-one subjects participated in this study. In the pretreatment phase, the ROS levels in pockets ≥5 mm were measured by flow cytometry. Three sites in each subject were randomly assigned into each of the following experimental groups: sham group, only scaling and root planing (SRP) was done; placebo group, local delivery of placebo gel after SRP; and lycopene group, local delivery of lycopene gel after SRP. Clinical parameters included recording site-specific measures of GCF 8-OHdG, plaque, gingivitis, probing depth, and clinical attachment level. RESULTS: The gel, when delivered to the sites with oxidative stress, was effective in increasing clinical attachment and in reducing gingival inflammation, probing depth, and 8-OHdG levels as compared to the placebo and sham sites. CONCLUSIONS: From this trial conducted over a period of 6 months, it was found that locally delivered lycopene seems to be effective in reducing the measures of oxidative stress and periodontal disease.

Efficacy of lycopene as a locally delivered gel in the treatment of chronic periodontitis: smokers vs nonsmokers.

OBJECTIVE: The present study was carried out as a multicenter, randomized controlled, split-mouth clinical trial to evaluate the efficacy of locally delivered lycopene on periodontal health and gingival crevicular fluid (GCF) levels of 8-hydroxydeoxyguanosine (8-OHdG) in smokers and nonsmokers compared with periodontally healthy control subjects. METHOD AND MATERIALS: One hundred ten subjects including 50 smokers, 50 nonsmokers, and 10 controls participated in this study. Subjects in the smoker and nonsmoker groups had contralateral sites treated with lycopene gel and a placebo. Clinical parameters included recording site-specific measures of plaque, gingivitis, probing depth, and clinical attachment level. GCF 8-OHdG values were analyzed using a commercially available ELISA kit. RESULTS: Compared with the placebo, lycopene-treated sites in smokers and nonsmokers showed significant reductions in probing depths and gain in the clinical attachment levels. However, there was no statistically significant difference in the clinical parameters when lycopene-treated sites in smokers and nonsmokers were compared, except for the reduction in the 8-OHdG levels. The 8-OHdG levels at 1 week and 3 months in sites treated with lycopene in the smoker and nonsmoker group were comparable with those in the periodontally healthy control group. CONCLUSION: The gel formulation was effective in increasing clinical attachment and reducing gingival inflammation, probing depth, and oxidative injury compared with the placebo in smoking and nonsmoking subjects.

A randomized, double-blind clinical study to assess the antiplaque and antigingivitis efficacy of Aloe vera mouth rinse.

AIMS: To evaluate the efficacy of Aloe Vera mouth rinse on experimental plaque accumulation and gingivitis. MATERIALS AND METHODS: In this randomized, controlled, and double-blind study, a total of 148 systemically healthy subjects were screened in the age group of 18-25 years. Finally, 120 subjects were requested to abstain from oral hygiene (tooth brushing) for 14 days and used a specially fabricated plaque guard. Following cessation of tooth brushing in the specified area, the subjects were randomly divided into Group A (test group) who received 100% Aloe vera, Group B (negative control group) who received placebo (distilled water), and Group C (positive control group) who received 0.2% chlorhexidine. The rinse regimen began on the 15(th) day and continued for 7 days. Plaque accumulation was assessed by Plaque Index (PI) and gingivitis was assessed by Modified Gingival Index (MGI) and Bleeding Index (BI) at baseline (0), 7(th), 14(th), and 22(nd) days. RESULTS: There was statistically significant decrease in PI, MGI, and BI scores after the rinse regimen began in both Group A (test group) and Group C (chlorhexidine) compared with Group B. Mouth wash containing Aloe vera showed significant reduction of plaque and gingivitis but when compared with chlorhexidine the effect was less significant. CONCLUSION: Aloe vera mouthwash can be an effective antiplaque agent and with appropriate refinements in taste and shelf life can be an affordable herbal substitute for chlorhexidine.

Multi-centre, randomized clinical trial on the efficacy and safety of recombinant human platelet-derived growth factor with ß-tricalcium phosphate in human intra-osseous periodontal defects.

AIM: the objective of the study was to evaluate the safety and efficacy of a formulation containing recombinant human platelet-derived growth factor (rhPDGF-BB) and ß-tricalcium phosphate (ß-TCP) in patients with periodontal defects and to compare it with those of ß-TCP alone. MATERIALS AND METHODS: in this double-blind, prospective, parallel, active-controlled, randomized, multi-centre clinical trial, 54 patients with periodontal osseous defects were randomly assigned to rhPDGF-BB+ß-TCP or ß-TCP. Following periodontal surgery, respective implantation was performed. The primary and secondary end points of treatment were evaluated at the third and the sixth month. RESULTS: among the outcome measures, the extent of linear bone growth (p<0.01) and per cent bone fill (p<0.004) at the sixth month over baseline were significantly higher in the rhPDGF-BB+ß-TCP group when compared with the ß-TCP group. Similarly, it also resulted in significantly higher area under the curve clinical attachment level gain at 0-6 months (p<0.01), CAL gain and greater reduction in probing depth at the third and the sixth month than that with ß-TCP treatment alone. The incidence of adverse events was similar in both the groups and no serious adverse events were reported in any of the patients. CONCLUSIONS: rhPDGF-BB+ß-TCP is safe and effective in the treatment of periodontal defects. It increases bone formation and soft tissue healing (clinicaltrials.gov, number NCT00496847; CTRI No.: CTRI/2008/091/000152).