Treatment of Gingival Recession in Multiple Teeth Using Coronally Advanced Flap with Connective Tissue Graft: A Case Report.

This report describes a case of gingival recession in multiple teeth with severe dentin hypersensitivity (DH) in which treatment included periodontal plastic surgery. The patient was a 34-year-old woman presenting with the chief complaint of DH at gingivalrecession sites. The patient had undergone orthodontic treatment when she was 30 years old. An initial examination revealed that none of the sites showed a probing depth of ≥4 mm and 21% of sites bleeding on probing. The clinical diagnosis was plaque-induced gingivitis. Teeth #14, 16, 23, 25, 26, 34, 35, 45, and 46 showed gingival recession ranging from 1 to 4 mm. Gingival recession at #45 extended to the muco-gingival junction. No association with alveolar bone loss was observed in any of the interdental areas. Therefore, the sites presenting with gingival recession were classified as Miller Class I, except #45, which was classified as Class II. The periodontal phenotype was 'thin'. Based on the results of clinical examination and diagnosis, initial periodontal therapy (IP) consisting of oral hygiene instruction, supra-gingival scaling, application of a desensitizing agent, and composite resin restoration was performed. The Visual Analog Scale (VAS) score, which was used to assess degree of DH, showed only a minimal decrease, however, at post-IP. Subsequently, a modified coronally advanced tunnel (a modified technique for achieving a coronally advanced flap) using a connective tissue graft was performed in #14, 16, 23, 25, 26, 45, and 46. After re-evaluation, the patient was placed on maintenance care. The series of interventions resulted in a considerable improvement in the VAS and oral health-related quality of life scores. Furthermore, a change in the periodontal phenotype, from 'thin' to 'thick', was observed, which may contribute to the prevention of further gingival recession and DH. The present case suggests that periodontal plastic surgery is an effective treatment modality for the resolution of DH.

Treatment of Chronic Periodontitis with Smoking Cessation Care and Periodontal Surgery in an Elderly Patient: A Case Report Including a 4-year Follow-up.

This report describes a case of chronic periodontitis requiring treatment including smoking cessation care and periodontal surgery in an elderly patient with a long-term smoking habit. The patient, a 79-year-old man, presented with the chief complaint of halitosis. He had a 56-year history of smoking cigarettes. An initial examination revealed that 34.5% of sites had a probing depth (PD) of ≥4 mm, with 24.1% of sites showing bleeding on probing (BOP). Open bite and loss of appropriate anterior and lateral guidance were also found. Radiographic examination revealed extensive horizontal bone resorption in the maxillary and mandibular molars. Based on a clinical diagnosis of severe generalized chronic periodontitis, initial periodontal therapy consisting of plaque control, smoking cessation care, scaling and root planing, and caries treatment of #47 was performed. Prosthetic treatment with a removable partial denture was planned for #26, which was missing. The patient quit smoking at the end of initial periodontal therapy. Subsequently, surgical periodontal therapy including open flap debridement was performed on #16, #17, #18, and #27. Following reevaluation, a full metal crown (#47) and removal partial denture (#26) were placed. The patient was then placed on supportive periodontal therapy (SPT). Periodontal treatment including surgical therapy resulted in an improvement in PD and a reduction in the number of sites with BOP. The patient has not started smoking again since initial treatment. Improvement has been adequately maintained over a 4-year period. The present results suggest that even when a patient has been exposed to a risk factor for a long time, periodontal treatment and control of that risk factor can contribute to stabilization of periodontal conditions. Some problems with occlusion have persisted, however. Additional care is necessary to retain stable periodontal conditions during SPT.

Effect of Periodontal Treatment on Reducing Chronic Inflammation in Systemically Healthy Patients With Periodontal Disease.

BACKGROUND: We determined the effects and an accurate marker of periodontal treatment on serum interleukin (IL)-6 and high-sensitivity C-reactive protein (HsCRP) levels in systemically healthy individuals with periodontal disease. METHODS: This multicenter study included systemically healthy individuals with periodontal disease who received initial periodontal treatment and had no periodontal treatment history. Periodontal parameters, including periodontal inflamed surface area, masticatory efficiency, and periodontal disease classification; serum IL-6 and HsCRP levels; and serum immunoglobulin (Ig)G titers against periodontal pathogens were evaluated at baseline and after treatment. Subjects were classified as low or high responders (group) based on periodontal inflamed surface area changes. RESULTS: There were 153 participants. Only periodontal inflamed surface area changes were markedly different between low and high responders. Periodontal treatment (time point) decreased both serum IL-6 and HsCRP levels. The interaction between group and time point was remarkable only for serum IL-6 levels. Changes in serum immunoglobulin (Ig)G titers against periodontal pathogens were not associated with IL-6 changes in high responders. We analyzed the indirect effect of serum anti-Porphyromonas gingivalis type 2 IgG titer changes using mediation analysis and found no significance. However, the direct effect of group (low or high responder) on IL-6 changes was considerable. CONCLUSIONS: Periodontal treatment effectively decreased serum IL-6 levels, independent of periodontal pathogen infection, in systemically healthy individuals with periodontal disease.

Comparative studies of polyethylene glycol-modified liposomes prepared using different PEG-modification methods.

To address the issue of excess polyethylene glycol (PEG)-lipid degradation observed when PEG-modified liposomes are prepared using the pH-gradient method, a concept using a novel PEG-modification method, called the post-modification method, was proposed and evaluated. To assess the proof concept, a preservation-stability study and a pharmacokinetic study were performed that compared the conventional PEG-modification method, called the pre-modification method, with the post-modification method. The results show that PEG-lipid degradation could be markedly inhibited in the post-modification method. Furthermore, the post-modification method could be used without any manufacturing process difficulties, especially with high PEG-lipid content. In addition, a higher blood circulation capability was observed in the post-modification method. Through comparative studies, it was found that the post-modification method was advantageous compared to the pre-modification method. In conclusion, the post-modification method has the potential to be a novel PEG-modification method that can achieve a higher preservation stability of PEG-lipid, a greater ease of manufacturing, and a higher blood circulation capability, especially in the manufacturing of pH-gradient liposomal products.

Comparative studies of irinotecan-loaded polyethylene glycol-modified liposomes prepared using different PEG-modification methods.

Recently, a polyethylene glycol (PEG)-modification method for liposomes prepared using pH-gradient method has been proposed. The differences in the pharmacokinetics and the impact on the antitumor effect were examined; however the impact of PEG-lipid molar weight has not been investigated yet. The main purpose of this study is to evaluate the impact of PEG-lipid molar weight against the differences in the pharmacokinetics, the drug-release profile, and the antitumor effect between the proposed PEG-modification method, called the post-modification method, and the conventional PEG-modification method, called the pre-modification method. Various comparative studies were performed using irinotecan as a general model drug. The results showed that PEG-lipid degradation could be markedly inhibited in the post-modification method. Furthermore, prolonged circulation time was observed in the post-modification method. The sustained drug-release was observed in the post-modification method by the results of the drug-releasing test in plasma. Moreover, a higher antitumor effect was observed in the post-modification method. It was also confirmed that the same behaviors were observed in all comparative studies even though the PEG molecular weight was lower. In conclusion, the post-modification method has the potential to be a valuable PEG-modification method that can achieve higher preservation stability of PEG-lipid, prolonged circulation time, and higher antitumor effect with only half the amount of PEG-lipid as compared to the pre-modification method. Furthermore, it was demonstrated that PEG(5000)-lipid would be more desirable than PEG(2000)-lipid since it requires much smaller amount of PEG-lipid to demonstrate the same performances.

Periodontal Regenerative Therapy Using rhFGF-2 and Deproteinized Bovine Bone Mineral versus rhFGF-2 Alone: 4-Year Extended Follow-Up of a Randomized Controlled Trial.

The aim of this study was to evaluate longitudinal outcomes of recombinant human fibroblast growth factor (rhFGF)-2 plus deproteinized bovine bone mineral (DBBM) therapy in comparison with rhFGF-2 alone for treating periodontal intrabony defects. This study describes 4-year follow-up outcomes of the original randomized controlled trial. Intrabony defects in periodontitis patients were treated with rhFGF-2 (control) or rhFGF-2 plus DBBM (test). Clinical, radiographic, and patient-reported outcome (PRO) measures were used to evaluate the outcomes. Thirty-two sites were able to be followed up. At 4 years postoperatively, clinical attachment level (CAL) gains in the test and control groups were 3.5 ± 1.4 mm and 2.7 ± 1.4 mm, respectively, showing significant improvement from preoperative values but no difference between groups. Both groups showed an increase in radiographic bone fill (RBF) over time. At 4 years, the mean value for RBF in the test group (62%) was significantly greater than that in the control group (42%). In 1-2-wall defects, the test treatment yielded significantly greater RBF than the control treatment. No significant difference in PRO scores was noted between the groups. Although no significant difference in CAL gain was found between the groups at the 4-year follow-up, the combination treatment significantly enhanced RBF. Favorable clinical, radiographic outcomes, and PRO in both groups can be maintained for at least 4 years.

Designing a novel in vitro drug-release-testing method for liposomes prepared by pH-gradient method.

In order to evaluate the drug-release behavior from pH-gradient liposomal formulation, a simple release-testing method without using biological components was newly designed on the basis of inversed ammonia gradient principle. Various factors influencing drug-release (releasing factor) were examined. As a result, releasing factor's concentration, pH, osmolarity in test fluid, and releasing factor's structure were found to be the critical factors to be optimized. Various vincristine-loaded liposomes with different lipid compositions or with different lipid/cholesterol ratio were tested for drug-release behavior and successfully obtained drug-release profiles reflecting differences in the physicochemical properties of individual liposomes. Furthermore, since the comparative release study of vincristine-loaded liposomes and doxorubicin-loaded liposomes could reproduce the phenomena as other researchers recently reported, a possibility was suggested for the proposed method to estimate the physicochemical status of drug inside of liposomes. Proof of concept study concluded, as a whole, that the novel release-testing method would be useful for a formulation study and also useful as a tool for the quality assurance or quality control in the manufacturing of pH-gradient liposomal products.

Cell-adhesive and blood-coagulant properties of ultrathin poly(methyl methacrylate) stereocomplex films.

Isotactic (it) and syndiotactic (st) poly(methyl methacrylate)s (PMMAs) were assembled on a poly(ethylene terephthalate) cell disk (as a solid substrate), which is normally used for cell culture, to produce ultrathin stereocomplex films. Static contact angles of the films using air bubbles in aqueous phase revealed the stepwise assembly of both polymers. More L929 fibroblast cells adhered and were flattened on the ultrathin stereocomplex films, compared to homogeneous PMMA films and to spin-coated films comprised of a mixed solution of it- and st-PMMAs with a molar ratio of 1 : 2, which is the stoichiometry of a stereocomplex. The difference in the number of adherent cells was greatest after the first 3 h of incubation. Pre-adsorption of proteins, which are related to cell adhesion, onto the stereocomplex film potentially modulated the cell-adhesive properties. Fresh whole human blood did not coagulate on the complex film for 20 min, although blood coagulated after 15 min on the homogeneous films and on the 1 : 2 mixed film. Platelets did not adhere onto the complex films after 15 min of incubation, which was consistent with the results of blood coagulation. These observations indicate that the stereocomplex formation of PMMAs on the surface of films strongly affects the bioactivity of these films.