A preliminary randomized clinical trial comparing diode laser and scalpel periosteal incision during implant surgery: impact on postoperative morbidity and implant survival.

The aim of this preliminary randomized clinical trial was to compare: (1) post-operative morbidity after application of laser or scalpel incision for flap advancement during implant surgery and bone grafting and (2) implant survival rate following flap advancement with laser or scalpel incision after 6 months of loading. Eighteen patients who were scheduled for dental implant placement and simultaneous bone grafting were randomly assigned to test or control groups. Diode laser (810 nm, 2 W, pulse interval 200 µs; pulse length 100 µs, 400-µm initiated fiber tip), or scalpel (control) was used to sever the periosteum to create a tension-free flap. Visual analogue scale (VAS) pain score, rate of nonsteroid anti-inflammatory drug (NSAID) consumption, intensity of swelling, and ecchymosis were measured for the six postsurgical days. Six months after loading, implant survival was assessed. VAS pain score (during the first four postoperative days), rate of NSAID consumption (during the first three postoperative days), and intensity of swelling (during the first five postoperative days) were significantly lower in the test group compared to the control group (All P values < 0.05). One patient in the control group experienced ecchymosis. All implants were successful in function. Application of laser for performing periosteal releasing incision reduced the incidence and severity of postoperative morbidity of the patients undergone implant surgery in conjunction with bone augmentation procedure. We did not find any detrimental effect of laser incision on the implant survival within 6 months of loading.

Photoactivated disinfection using light-emitting diode as an adjunct in the management of chronic periodontitis: a pilot double-blind split-mouth randomized clinical trial.

AIM: This split-mouth double-masked randomized controlled clinical study evaluated the effectiveness of photoactivated disinfection (PAD) using light-emitting diode (LED) as an adjunct in the management of patients affected by moderate to severe chronic periodontitis. MATERIALS AND METHODS: Sixteen patients affected by moderate to severe chronic periodontitis were enrolled. After scaling and root planing (SRP), each quadrant was assigned to one of the following groups: LED group (625-635 nm, maximum power density: 2000 mW/cm(2) ), photosensitizer group (tolouidine blue O, 0.1 mg/ml), PAD group (photosensitizer and LED) and control group (no adjunctive treatment). The adjunctive treatments were repeated after 7 and 14 days. The clinical parameters of bleeding on probing, probing pocket depth and clinical attachment level were measured at baseline and 1 and 3 months after SRP. RESULTS: At 1 and 3 months, all groups showed significant improvements with regard to all clinical parameters compared to baseline (all p: <0.001). There were no significant differences among groups in terms of changes of clinical parameters in any time interval (all p > 0.05). CONCLUSION: The application of PAD using LED with the current setting did not have additional effects on clinical parameters in patients diagnosed with moderate to severe chronic periodontitis compared with SRP alone.

Multiple maxillary periodontal abscesses as a manifestation of post-coronavirus disease 2019 mucormycosis: a case report.

BACKGROUND: Coronavirus disease 2019 makes patients more susceptible to superinfection of fungal disease as a consequence of immunological system impairment. Mucormycosis is a fungal infection that is rare but has a high mortality rate and mostly affects patients with poorly controlled diabetes mellitus or those receiving corticosteroids. CASE PRESENTATION: Here, we present a case of post-coronavirus disease 2019 mucormycosis in a 37-year-old Persian male presenting with multiple periodontal abscess with purulent discharge and necrosis of maxillary bone (without oroantral communication). Surgical debridement following antifungal therapy was the treatment of choice. CONCLUSION: Early diagnosis and immediate referral are the cornerstone of comprehensive treatment.

Acellular dermal matrix allograft versus subepithelial connective tissue graft in treatment of gingival recessions: a 5-year randomized clinical study.

AIM: The present randomized clinical trial compared the long-term results of subepithelial connective tissue graft (SCTG) versus acellular dermal matrix allograft (ADMA) in treatment of gingival recessions. MATERIALS AND METHODS: In 16 patients with bilateral Miller Class I/II gingival recessions, one side was treated with SCTG and the other side with ADMA. Clinical parameters were measured at baseline, 6 months, and at 5 years post-surgery. RESULTS: Fifteen patients completed the study. At 6 months, all parameters showed significant improvement in ADMA and SCTG groups [complete root coverage (CRC): 73.3% versus 26.7%, p = 0.027; reduction of recession depth (RD): 2.6 ± 1.1 mm versus 2.2 ± 1.1 mm, p = 0.376; reduction of recession width (RW): 3.0 ± 1.4 mm versus 2.4 ± 1.4 mm, p = 0.207 respectively]. At 5 years, significant relapses were detected in CRC and reduction of RD and RW in both groups with no statistically significant difference (CRC: 20.0% versus 13.3%, p = 1.00; RD: 1.6 ± 1.2 mm versus 1.5 ± 1.4mm, p = 0.838; RW: 1.8 ± 1.4 mm versus 1.3 ± 1.5mm, p = 0.367). Patients practicing horizontal toothbrushing habit showed more relapse (OR = 11.2; p = 0.01). Compared with baseline, the gingival width (GW) did not increase in ADMA-treated sites (p = 0.903). CONCLUSION: Five-year results of SCTG and ADMA were similar in terms of CRC and reduction of RD and RW. Both techniques showed a significant relapse associated with returning to horizontal toothbrushing habit. Increase of GW was stable in SCTG-treated sites, but reached to pre-surgical values in ADMA-treated cases.

Effect of laser photobiomodulation on wound healing and postoperative pain following free gingival graft: A split-mouth triple-blind randomized controlled clinical trial.

BACKGROUND AND AIM: Free gingival graft (FGG) is one of the most predictable techniques for gingival augmentation. However, patient's discomfort and pain during healing period are significant concerns. The aim of this study was to assess if laser photobiomodulation (PBM) was effective in terms of enhancing wound healing and reducing postoperative pain. METHODS AND MATERIALS: Twelve patients participated in this split-mouth randomized controlled clinical trial. Each patient had a 30-day interval between the two procedures. In the test group, donor and recipient sites received diode laser (660nm, 200mW, continuous mode, time of irradiation:32s, energy density: 4J/cm2, spot size:0.5cm) immediately after FGG surgery, and 1,2,4 and 7days later. The control side received the same sequence of irradiation with the laser-off. Complete wound epithelialization of donor site and clinical wound healing and visual analogue scale (VAS) pain score of donor and recipient sites were evaluated after surgery. RESULTS: At 14 and 21days after surgery, the number of donor sites with complete epithelialization was greater in laser group compared to the placebo. After 21days, all donor sites in the test group were epithelialized completely, while at the same time, only eight donor sites in the control group showed complete epithelialization (P value=0.05). In terms of clinical healing of the recipient and donor sites, the test and control groups did not show any significant difference during the 45-day period, except at days 1 (for recipient site) and 14 (for donor site), when the test group showed better results (P values: 0.01 and 0.03, respectively). The VAS pain score did not show statistically significant difference between two groups during the study period, except for the first 3h after procedure when laser group showed greater VAS pain score (P values<0.05). CONCLUSION: PBM following FGG procedure with the parameters used in this study could accelerate the rate of epithelialization at the donor site. However, it did not reduce postoperative pain.

Effect of hydrosoluble chlorine-mediated antimicrobial photodynamic therapy on clinical parameters and cytokine profile in ligature-induced periodontitis in dogs.

BACKGROUND: Recently, a hydrosoluble chlorine composed of sodium salts chlorine e6, chlorine p6, and purpurine-5 has been shown to be a promising photosensitizer in antimicrobial photodynamic therapy (aPDT). The aim of this study is to evaluate the effects of adjunctive application of hydrosoluble chlorine-mediated aPDT compared with scaling and root planing (SRP) alone on clinical parameters and cytokine levels in gingival crevicular fluid of dogs with experimental periodontitis. METHODS: Periodontal disease was induced by placing silk ligatures around both maxillary and mandibular teeth. After establishment of attachment loss, full-mouth SRP was performed in all dogs. One day after SRP, each quadrant randomly received one of the following treatment modalities: hydrosoluble chlorine plus diode laser (wavelength 662 nm, power 100 mW, continuous mode, time of irradiation 20 seconds), hydrosoluble chlorine alone, laser alone, or no adjunctive treatment. The same adjunctive procedure was repeated 1 week later. Clinical parameters including periodontal probing depth, clinical attachment level, and bleeding on probing, as well as crevicular levels of interleukin-1ß and tumor necrosis factor-α, were evaluated at baseline, at 3 weeks, and at 3 months after treatment. RESULTS: After both 3 weeks and 3 months, all treatment groups showed significant improvement in all clinical and immunologic parameters (P <0.001). No significant differences were found between the four groups with regard to the measured parameters (P >0.05). CONCLUSION: Based on the results of this study, adjunctive use of hydrosoluble chlorine-mediated aPDT with the current setting has no additional effect on the clinical parameters or proinflammatory cytokine levels in ligature-induced periodontitis.