Estimation of tissue and crevicular fluid oxidative stress marker in premenopausal, perimenopausal and postmenopausal women with chronic periodontitis.

OBJECTIVES: The aim of this study was to estimate tissue and gingival crevicular fluid (GCF) levels of the oxidative stress marker 8-hydroxy-2'-deoxyguanosine (8-OHdG) in premenopausal, perimenopausal and postmenopausal women with chronic periodontitis. BACKGROUND: Oxidative stress has been implicated in the etiopathogenesis of periodontitis and menopause induces oxidative stress. MATERIALS AND METHODS: According to Stages of Reproductive Aging Workshop (STRAW) criteria, women diagnosed with periodontitis were subdivided into three groups of 31 participants each 1. Premenopausal 2. Perimenopausal and 3. Postmenopausal. GCF and gingival tissue samples were collected from sites with maximum probing depth. Tissue DNA was extracted from the gingival sample and 8-OHdG in the extracted DNA, and GCF samples were measured using ELISA. RESULTS: There was a highly significant difference in the overall GCF 8-OHdG levels among the three groups with the pairwise difference being highly significant between the premenopausal-postmenopausal groups and perimenopausal-postmenopausal groups. However, no overall significant differences in tissue 8-OHdG levels were found among the three groups. Pairwise, highly significant differences were found between the premenopausal-postmenopausal groups and perimenopausal-postmenopausal groups for tissue 8-OHdG levels. No significant correlations were found between various measure of periodontal disease and GCF/tissue 8-OHdG levels among all the groups. CONCLUSION: Premenopausal-postmenopausal and perimenopausal-postmenopausal transition resulted in significant increase in tissue and GCF 8-OHdG levels. However, no association was found between stages of reproductive ageing and tissue levels of 8-OHdG.

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.

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.

Non-Cross-Linked Versus Cross-Linked Collagen Membrane In Maxillary Sinus Perforation Repair: A Comparative Histologic Study In A Rat Model.

PURPOSE: To compare and evaluate maxillary sinus perforation repair, bone regeneration, and membrane degradation with cross-linked and non-cross-linked collagen membranes in rat sinuses at 2, 4, and 10 weeks, respectively. MATERIALS AND METHODS: Fifty-one Sprague-Dawley rat models were included in the study. Bilateral maxillary sinus perforations were made with a straight bur. In the control site, cross-linked collagen membrane (Ossix Plus) was placed, and in the test site, non-cross-linked collagen membrane was used (Pro-Tiss). Euthanasia was carried out under carbon dioxide asphyxia where 17 rats were sacrificed at weeks 2, 4, and 10. Histologic evaluation of the specimens was subsequently done. RESULTS: At 2 (P = .001), 4 (P = .031), and 10 (P = .024) weeks, there was a significant regeneration of maxillary sinus lining in sites treated with non-cross-linked collagen membrane over the cross-linked collagen membrane. No significant differences were observed in measures of bone regeneration (P = .92; 10 weeks) and membrane degradation (P = .06; 4 weeks) at the end of the study period between the two groups. CONCLUSION: The non-cross-linked collagen membrane appears to be more beneficial in maxillary sinus repair. However, they do not seem to confer additional benefits in bone regeneration or membrane degradation over cross-linked collagen membranes.

Lateral osteoperiosteal flap versus lateral pedicle flap in the treatment of class III gingival recession: A single-center, open-label trial.

AIMS: The aim of this study was to compare outcomes of lateral osteoperiosteal flap (OPF) and lateral pedicle flap (LPF) in the treatment of Miller's Class III gingival recession. MATERIALS AND METHODS: Twenty-two anterior maxillary and mandibular sites from 16 participants requiring mucogingival surgery for Miller's Class III gingival recession were included in the study. Eleven sites each were assigned to two groups. OPF: sites treated with lateral OPF and LPF: sites treated with LPF. Recession depth (RD) and bone level (BL) were the primary outcome variables, and probing pocket depth, clinical attachment level (CAL), and keratinized tissue width (KTW) were the secondary variables. All the variables were recorded at baseline (on the day of surgery), 3 months, and 6 months postsurgery. RESULTS: OPF and LPF resulted in similar reduction in RD at the end of the study period (P ≤ 0.001). There was no statistically significant difference in RD between OPF and LPF at 6 months (P = 0.862). OPF-treated sites showed greater gain in BL at 3 months (P = 0.0004) and 6 months (P = 0.0002). No significant differences were seen between OPF and LPF in measures of PD, CAL, and KTW. CONCLUSION: Data from this 6-month trial seem to suggest that OPF can be used as an alternative procedure for treating Miller's class III recessions with adjacent edentulous sites or wide interproximal spaces. Long-term effects of OPF on the stability of root coverage outcomes are an exciting direction for future research.

Autogenous Bone Ring Transplant vs Autologous Growth Factor-Enriched Bone Graft Matrix In Extraction Sockets With Deficient Buccal Bone: A Comparative Clinical Study.

PURPOSE: The purpose of this study was to compare the efficacies of autogenous bone ring and autologous growth factor-enriched bone graft matrix as graft materials in extraction sockets. MATERIALS AND METHODS: Subjects (n = 34) requiring extraction of a single incisor or premolar in a type II socket were segregated into two groups: BR and AFG. Autogenous bone ring transplant and autologous fibrin glue with particulate bone graft (sticky bone) was used in subjects under the BR and AFG groups, respectively, for socket augmentation. After 6 months, osteotomy preparation was carried out, and implants were placed in all subjects. The efficacies of both of the procedures were compared by assessing measures of bone density, buccal/lingual plate height, implant stability quotient (ISQ) readings, and mineralized tissue volumes. RESULTS: At 6 months, there was a highly significant gain (P ≤ .001) in the buccal (3.09 ± 1.6 mm vs 1.90 ± 0.94 mm) and lingual/palatal bone heights (3.31 ± 2.66 mm vs 1.99 ± 1.22 mm) and a significant difference in the bone density (659.6 ± 133.8 vs 552.1 ± 65.6; P = .016) in the BR group compared with the AFG group. Significant differences were observed between the two groups for ISQ values at the end of 6 months (61.60 ± 8.9 vs 45.02 ± 6.33; P = .034). Biopsy specimens from the BR group showed a highly significant increase (50.39% ± 11.96% vs 38.91% ± 12.22%; P ≤ .001) in the percentage of tissue mineralization over the AFG group. CONCLUSION: Autogenous bone ring procedure seemed to confer additional benefits over autologous growth factor-enriched bone graft when various parameters were compared. The sites augmented with autogenous bone ring at the end of the study period showed a sufficient gain in bone height and quality for implant placement.

Periodontally accelerated osteogenic orthodontics combined with recombinant human bone morphogenetic protein-2: An outcome assessment.

CONTEXT: Periodontally accelerated osteogenic orthodontics (PAOO) combines alveolar corticotomy, bone graft materials, and the application of orthodontic forces for rapid correction of malocclusions. AIMS: The present study aims to primarily assess differences in orthodontic treatment duration, bone quality around corticotomy sites, postoperative healing, and subjective pain when corticotomy was done conventionally and with the placement of recombinant human bone morphogenetic protein-2 (rhBMP-2). SETTINGS AND DESIGN: Thirty individuals participated in this study. Individuals were randomly assigned into each of the following experimental groups; C + BMP: Corticotomy with 0.5 µg/mL rhBMP-2 and C: Corticotomy only. MATERIALS AND METHODS: Clinical parameters included recording the duration of the treatment period, visual analog scale scores and early wound healing index scores. The evaluation of bone density was performed at baseline, 3 months, and 6 months by using RVG. STATISTICAL ANALYSIS USED: Two-way analysis of variance and post hoc multiple comparison tests were used to compare data between test and control groups at different time points. RESULTS: rhBMP-2 application was effective in reducing the overall treatment time and resulted in an increase in bone density around corticotomy sites at the end of the treatment period when compared to conventional corticotomy procedure. Placement of rhBMP-2 neither delayed wound healing nor affected participant pain scores. CONCLUSIONS: From this trial conducted over a period of 6 months, rhBMP-2 has the potential to function as a regenerative material in PAOO.

Trephine Core Procedure Versus Bone-Added Osteotome Sinus Floor Elevation in the Augmentation of the Sinus Floor: A Comparative Clinical and Radiographic Study.

PURPOSE: The aim of this study was to clinically and radiographically compare the trephine core procedure and the bone-added osteotome sinus floor elevation technique in the augmentation of the sinus floor. MATERIALS AND METHODS: A single site in each subject requiring sinus augmentation where the residual bone height was ~4 mm was randomly allocated to either the trephine core procedure or the bone-added osteotome sinus floor elevation technique. Measures of bone fill and bone height were also acquired through scans from cone beam computed tomography obtained before the sinus augmentation procedure (baseline) and before implant placement at approximately 6 months postoperatively. Clinical parameters for healing (early wound healing index), swelling (measurement of preset facial landmarks), and pain (through visual analog scale) were assessed at 1 week and 2 weeks after surgery. The evaluation of bone fill was performed using the digital subtraction technique and morphometric area analysis on the baseline and postoperative scans using two kinds of image processing software. Implants were placed after a healing period of 4 to 6 months, and implant stability quotient values (using SmartPeg Type 49) were recorded immediately after implant placement. RESULTS: While both of the procedures resulted in an increase in bone fill and bone height, there were no significant differences between the techniques. No significant differences were observed between the two groups for implant stability quotient values after implant placement. No significant differences were observed between the two groups for measures of healing, swelling, and pain. CONCLUSION: Based upon this study that compared the trephine core procedure with the bone-added osteotome sinus elevation technique, comparing bone height, bone fill, and primary implant stability, the two procedures appeared to perform in an equivalent fashion.

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.

Comparing the outcomes of incisions made by colorado microdissection needle, electrosurgery tip, and surgical blade during periodontal surgery: A randomized controlled trial.

CONTEXT: Electrosurgery offers many unique advantages such as hemostasis and precise tissue cutting; however, there are a number of disadvantages including thermal injury and delayed wound healing. AIMS: The aim of the present study was to compare the outcomes of incisions made by Colorado® microdissection needle, electrosurgery tip, and surgical blade during periodontal surgery. SETTINGS AND DESIGN: Twenty-two individuals participated in this study. Three quadrants in each individual were randomly assigned into each of the following experimental groups: Colorado® microdissection needle (CMD), electrosurgery tip (EC) and surgical blade (BP), in which, incisions were given with Colorado® microdissection needle, straight electrocautery tip, and a scalpel blade, respectively. MATERIALS AND METHODS: Blood loss (BL) was measured immediately after surgery, and changes in interdental papilla dimensions were recorded at baseline, 7, 30, 120, and 180 days after surgery. Measures of periodontal disease were recorded at baseline, 120, and 180 days after surgery. Postoperative pain and wound healing were recorded at 1, 7, and 15 days after surgery. RESULTS: The use of CMD for periodontal surgery showed better results over EC in all parameters. CMD resulted in lesser bleeding and less postoperative pain and attained similar results to that of BP in clinical parameters of periodontal disease. CONCLUSIONS: Colorado® microdissection needle may be a better choice for incisions as it seems to show less tissue damage than cautery and offers tissue healing comparable to scalpel blade.

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.

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.

Concomitant Correction of a Soft-Tissue Fenestration with Keratinised Tissue Augmentation By Using A Rotated Double-Pedicle Flap During Second-Stage Implant Surgery- A Case Report.

Soft tissue deficiencies and defects around dental implants have been observed frequently. Soft-tissue defects after implant procedures originate from the process of modelling of periimplant mucosa and often cause aesthetic disharmony, food debris accumulation and soft tissue shrinkage. Periimplant mucogingival surgery focuses on creating an optimum band of keratinized tissue resulting in soft tissue architecture similar to the gingiva around natural teeth. A 23-year-old male reported to the Department of Periodontology with a complaint of gum soreness, foul smell and food accumulation at a site where a 3.75 x 11.5mm implant was placed previously. On clinical examination, fenestration of tissue above the cover screw was observed and there appeared to be a keratinized tissue of 1mm surrounding the implant. The case was managed by use of a rotated double-pedicle flap during second-stage implant surgery to correct the soft-tissue fenestration defect and to obtain a keratinized periimplant soft tissue. A periosteal bed was prepared by giving a horizontal incision at the mucogingival junction to a depth of 4 mm. Two split-thickness keratinized pedicles were dissected from the mesial and distal interproximal tissues near the implant. After rotation, both the pedicles were sutured to each other mid-buccally and the pedicles were rigidly immobilized with sutures. At 1 month, there was a 3mm band of stable and firm keratinized tissue over the underlying tissues. The procedure resulted in an aesthetic improvement due to enhanced soft tissue architecture and optimum integration between the peri-implant soft tissue and the final prosthesis.

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.

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.