Clinical, microbiological and cytomorphometric evaluation of low-level laser therapy as an adjunct to periodontal therapy in patients with chronic periodontitis.

OBJECTIVE: A clinical prospective study was designed to evaluate microbiological, cytomorphometric and clinical efficacy of low-level laser therapy (LLLT) as an adjunct to periodontal therapy in the treatment of chronic periodontitis. METHODS: Sixty subjects were included and randomly assigned into 2 groups: SRP (scaling root planning) group (n = 30) and LLLT + SRP group (n = 30). Clinical parameters were measured before intervention, after the fifth treatment, and after a month. All subjects received oral hygiene instructions and full-mouth conservative periodontal treatment (removal of dental plaque followed by SRP). Afterwards, in group II, Kavo LLLT (980 nm, 0.2 W, 6 J/cm2 ) was applied. Subgingival samples were collected at baseline and after the fifth treatment to quantify Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Tannerella forsythensis and Treponema denticola by polymerase chain reaction (PCR). Gingival swabs were taken, and direct smears were prepared on slides for cytomorphometric analysis. RESULTS: Evaluation using clinical parameters showed better results in LLLT group. A statistically significant decrease in the prevalence of bacteria after treatment in LLLT group was observed for the following: T. forsythensis and T. denticola (P < .001), P. gingivalis (P < .01), A. actinomycetemcomitans and P. intermedia (P < .05). The values of nuclear area, perimeter and Ferret's diameter were significantly lower in both studied groups after treatment, but statistical significance was higher in LLLT group (P < .001) than in the SRP therapy group (P < .05). CONCLUSION: Low-level laser therapy as an adjunct to periodontal therapy demonstrates short-term additional bacteriological, cytological and clinical benefits.

The influence of the tooth preparation finish line position on the expression of matrix metalloproteinase-9 and the presence of periodontopathogens in the gingival crevicular fluid.

OBJECTIVE: The objective of the study was to determine the concentration of matrix metalloproteinase 9 (MMP-9) and changes in the presence of periodontopathogens in the gingival crevicular fluid before and after tooth preparation with the subgingival and equigingival finish line position. PATIENTS AND METHODS: The clinical prospective study included 20 subjects with an indication for upper canine preparation, with the subgingival (group 1) and equigingival finish line (group 2). Samples were taken in four observation intervals: 5 minutes before (control samples), as well as 15 minutes, 24 and 72 hours after tooth preparation (experimental samples). Measurement of MMP-9 was done using Enzyme-linked Immunosorbent Assay (ELISA). The presence of bacteria in the gingival fluid was proven by the Polymerase chain reaction (PCR) analysis. RESULTS: The MMP-9 values did not differ statistically significantly between the groups (p=0.524). The MMP-9 values showed a statistically significant difference in the given observation period (p<0.001) with a significant linear increase in values (p<0.001). A significant quadratic trend recorded a decrease in the MMP-9 values 15 minutes after preparation, and an increase 24 hours after preparation, without a significant difference in the interaction between groups (p=0.392). After preparation, a significant difference in the presence of periodontopathogens was confirmed, i.e., a decrease in the presence of Prevotella intermedia (p=0.025) and Tannerella forsythia (p=0.016) in group 1, and an increase in the presence of Aggregatibacter actinomycetemcomitans in both groups (p=0.029, p=0.026). CONCLUSIONS: The study is a good basis for determining the influence of tooth preparation on gingival inflammation, with therapeutic (choice of preparation technique) and preventive significance regarding the protection of the periodontal tissue from possible iatrogenic damage.

Chronic gingivitis: the prevalence of periodontopathogens and therapy efficiency.

The purpose of this study was to determine the level of gingival inflammation and the prevalence of periodontopathogenic microorganisms in adolescents with chronic gingivitis, as well as to compare the effectiveness of two approaches in gingivitis treatment-basic therapy alone and basic therapy + adjunctive low-level laser therapy (LLLT). After periodontal evaluation, the content of gingival pockets of 140 adolescents with gingivitis was analyzed by multiplex PCR for the presence of P. gingivalis, A. actinomycetemcomitans, T. forsythensis and P. intermedia. Subsequent to bacteria detection, the examinees were divided into two groups with homogenous clinical and microbiological characteristics. Group A was subjected to basic gingivitis therapy, and group B underwent basic therapy along with adjunctive LLLT. A statistically significant difference between the values of plaque-index (PI) and sulcus bleeding index (SBI) before and after therapy was confirmed in both groups (p<0.001), though more pronounced in group B. Following therapy, the incidence of periodontopathogenic microorganisms decreased considerably. The best result was obtained in P. gingivalis eradication by combined therapy (p=0.003). The presence of periodontopathogens in adolescents with gingivitis should be regarded as a sign for dentists to foster more effective oral health programs. LLLT appears to be beneficial as adjuvant to basic therapy.

Role of smoking in periodontal disease among diabetic patients.

OBJECTIVE: The objective of the study was to analyse the effect of smoking on periodontal disease in diabetic patients. METHODS: One hundred and fifty patients participated in the study Fifty patients with Type 1 diabetes mellitus (DM) and periodontal disease were the first group; 50 patients with Type 2 DM and periodontal disease were the second group, and 50 non-diabetic patients with periodontal disease were the third group. After anamnesis was taken, the variable in the analysis was smoker/non-smoker The status of the oral hygiene and periodontal condition was recorded using Plaque index, Supragingival calculus index, Subgingival calculus index, Gingival index, Periodontal Disease Index and Community Periodontal Index of Treatment Needs, by the periodontologist. RESULTS: Except Gingival index, mean values of all investigated indices were higher in smokers in all investigated groups. CONCLUSION: Periodontal disease is more advanced in diabetic smokers compared to diabetic non-smokers. It can be concluded that smoking negatively affects the course of diabetic periodontal disease and increases the risk of attachment loss. Diabetic smokers are at high risk for poor periodontal prognosis, and they should be included in careful periodontal treatment.

C-reactive protein as a systemic marker of inflammation in periodontitis.

Periodontitis has been identified as a potential risk factor for systemic pathologies such as cardiovascular disease (CVD). The aims of this investigation were to assess the relationship between periodontitis and systemic inflammatory factor, as well as to discover whether there is a relation to the severity of periodontitis and to the periodontopathogens. Periodontal examinations and serum C-reactive protein (CRP) level measurements were performed in 50 patients with periodontitis. Periodontal health indicators included the gingival bleeding on probing index and periodontal disease status. The patients with moderate periodontitis had low attachment loss and pocket depth <4 mm. The patients with severe periodontitis had high attachment loss and pocket depth >5 mm. The control group comprised 25 volunteers with healthy gingiva, gingival sulcus <2 mm and no attachment loss. The presence of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in subgingival plaque samples was analysed by the polymerase chain reaction (PCR) method. The periodontal parameters and CRP levels were significantly higher in the patients with periodontitis. Patients who had severe periodontitis, with high levels of mean clinical attachment loss, and subjects with moderate periodontitis had higher mean CRP levels. The percentage of subjects with elevated levels of CRP >5 mg/l was greater in the higher clinical attachment loss group compared to the group with lower attachment loss. The presence of P. gingivalis and A. actinomycetemcomitans were also associated with elevated CRP levels and poor periodontal status. Periodontitis and the presence of P. gingivalis are associated with an enhanced inflammatory response expressed by higher CRP levels. The association of periodontitis with CRP levels appears to be a contributing factor for CVD and might be a possible intermediate pathway in this association.

Malignant transformation of oral lichen planus. A case report.

Lichen planus is a chronic, immunological mucocutaneous disease with a wide range of clinical manifestations. Since oral lichen planus is considered a pre-malignant condition, a recall system has been recommended one to four times annually to facilitate the early diagnosis of malignant transformation. This paper reports the case of a patient with malignant transformation of oral lichen planus and points out the significance of both the recall system and adequate education by dental care providers regarding early detection of transformation into oral cancer.

False gingival enlargement as a diagnostic problem: a case report.

The aim of the case report was to describe gingival enlargement in a patient who came to the Department of Oral Medicine and Periodontology at Nis Dental Clinic. After anamnesis had been taken, and following clinical examination, laboratory blood analysis, radiological examination and pathological examination, it was established that gingival enlargement was a consequence of medicament injection. We are of the opinion that gingival enlargement was a consequence of sclerotic agent injection.