Effect of Acellular Dermal Matrix Placement Simultaneous with Implant Placement on Vertical Soft Tissue Thickness: A Randomized Controlled Clinical Trial.

Acellular dermal matrix (ADM) is commonly used for soft tissue augmentation in root coverage, increasing the width of keratinized gingiva or vestibular depth, or filling the localized alveolar bone defects. This parallel-design randomized controlled clinical trial assessed the effect of ADM membrane placement simultaneous with implant placement on vertical soft tissue thickness. A total of 25 submerged implants were placed in 25 patients (8 men, 17 women) with vertical soft tissue thickness < 3 mm at the surgical site. Patients were randomized into two groups: The intervention group (n = 13) received ADM over the implant for soft tissue augmentation, while no augmentation was performed for the control group (n = 12). After 3 months, healing abutments were placed, and the soft tissue thickness at the surgical site was measured again with a periodontal probe in both groups. Data were analyzed using Mann-Whitney and Wilcoxon tests. All 25 patients were successfully treated. The presurgical vertical soft tissue thickness was 2 mm and 1.92 mm in the control and test groups, respectively (P > .05). These values changed to 1.83 mm and 2.69 mm, respectively, after the intervention. The mean gain in soft tissue thickness was 0.76 mm in the test group, and the difference between groups was statistically significant (P < .05). ADM membrane can be successfully used to augment vertical soft tissue thickness simultaneous with implant placement.

Evaluating the Efficacy of a Modified Piezo-Puncture Method on the Rate of Tooth Movement in Orthodontic Patients: A Clinical Study.

OBJECTIVE: Owing to the increasing demand from orthodontic patients for a more rapid treatment, many studies have focused on accelerated tooth movement. Currently, one of the prevalent methods to achieve accelerated tooth movement is piezo-puncture. The aim of the present study was to evaluate the effect of a modified piezo-puncture method on tooth movement rate and type during canine retraction. METHODS: A total of 17 patients who required fixed orthodontic treatment with extraction of the maxillary first premolars were included in the study. Following a split-mouth design, upper canines were retracted with Ni-Ti coil spring that applied 150 g of force on each side (piezo-puncture on one side and contralateral side served as the control). Then, the rates of tooth movement, canine angulation and rotation, and anchorage loss were evaluated at T0 (before the intervention), T1 (1 month after the intervention), and T2 (2 months after the intervention). For calculating the canine movement rate, either the distance between the canine and the lateral incisor or the space between the second premolar and the canine was measured. In addition, pain perception was documented by Visual Analog Scale. Data were analyzed using the Kolmogorov-Smirnov normality test, Spearman correlation test, paired sample t-test, and Wilcoxon signed-rank test. RESULTS: No significant acceleration was observed in canine movement, canine tipping, rotation, or anchorage loss of molar in different times. CONCLUSION: Considering the limitations of the study, the application of piezo-puncture employing the protocol used in the present study failed to accelerate tooth movement and to decrease the unfavorable tipping, rotation, and molar anchorage loss.

Immediate Nonfunctional Loading of a Single Implant in the Posterior Maxillary Area: A Randomized Clinical Trial.

This study compared the clinical and radiographic outcomes of immediate nonfunctional loading of implants to conventional loading in the posterior maxilla. In this single-blind randomized clinical trial, a total of 39 implants were inserted and evaluated in 32 patients. Nineteen implants were in the control group, and 20 implants were placed in the test group. The test group received implants and immediate restoration within 72 hours after surgery; the control group was followed by a conventional loading protocol 4 months after surgery. Follow-up appointments were performed at 4, 6, and 12 months. Clinical assessment included measurement of implant stability through resonance frequency analysis (RFA), probing depth around the implant in four aspects, and survival rate. Radiographic assessment, including evaluation of crestal bone loss in the mesial and distal of the implants by parallel periapical radiography, was conducted. Twenty-nine implants were followed throughout the study period, completing the entire intended follow-up. No significant difference was seen between the test and control groups in terms of crestal bone loss at any interval either in mesial or distal aspects. Also, no significant difference was found between the two groups regarding implant stability. Probing depth did not show significant differences between groups at 6 and 12 months. Only one implant in the control group failed before prosthesis loading, and no failure was observed in the test group. Average of insertion torque in the control group and the test groups were 49 and 51 N/cm, respectively. This variable also showed no significant difference between the two groups. If appropriate primary stability is achieved, nonfunctional immediate loading of implants in the posterior maxilla may have similar results to conventional loading in this area. Using this protocol, the time of edentulousness could be minimized.

Piezopuncture-Assisted Canine Distalization in Orthodontic Patients: Two Case Reports.

With the increasing number of young adults seeking orthodontic treatment to improve their smile esthetics or oral function, the time spent wearing brackets is one of the biggest challenges for these patients. Various surgical techniques have been developed over the years to accelerate tooth movement and reduce the total treatment time. A newly introduced, minimally invasive procedure namely piezopuncture, which uses a piezosurgical tool to create multiple cortical punctures through the gingiva, is presented in this report of two extraction cases.

The effect of smoking on inflammatory cell infiltrate subtypes in gingival tissue of patients with chronic periodontitis.

BACKGROUND: Examinations on blood samples and gingival crevicular fluid of subjects with chronic periodontitis showed that smoking increased production of cytokines. OBJECTIVE: To evaluate the expression of immune markers on mononuclear inflammatory cell infiltrate at periodontitis and healthy tissue among smoking and non-smoking subjects. METHODS: This case-control study was performed on 41 patients who referred to a clinic of periodontology at a Mashhad dental school in Iran in 2016. The participants were all of Iranian Khorasanian ethnicity with age range of 35-65 years. Gingival biopsies were obtained during routine periodontal flap procedure. Immunohistochemistry using markers of CD20, CD3, CD68, and CD45RO was carried out. Data was analyzed by SPSS version 15, using one-way ANOVA and Tukey HSD test. RESULTS: Nonsmoker subjects showed significantly greater numbers of CD20+, CD68+, CD3+ cells compared to smoker subjects, both at healthy and periodontitis tissue biopsies (p<0.00), whereas there was no significant difference in terms of CD45RO (p=0.120). CONCLUSION: Cigarette smoking, results in infiltrative mononuclear chronic inflammatory cells reduction in connective periodontium.

Clinical and histological evaluation of increase in the residual ridge width using mineralized corticocancellous block allografts: A pilot study.

Background. Lateral ridge augmentation is conventionally accomplished by means of autogenous bone grafts. However, due to its complications, the application of autogenous bone graft substitutes, e.g. mineralized corticocancellous allograft, is ecommended. Methods. In the present study, twelve patients were included, with insufficient alveolar ridge widths in the designated sites for dental implant placement. During the primary surgery, mineralized corticocancellous block allografts were fixed in deficient sites with titanium screws and resorbable collagen membranes were used to cover the blocks. After a period of six months, a flap was raised and variations in ridge width values was measured. Finally, a micro-biopsy was obtained from the sites for histologic investigation prior to preparing them for subsequent implant placement. Results. All the applied blocks were incorporated into the underlying bone except for one. A statistically significant difference was seen between the average ridge widths before placing the allografts compared with that of implant placement stage (2.62±1.02 mm vs. 7.75±1.63 mm, respectively). Vital bone tissue was detected in all the histological specimens obtained from the interface of blocks and the underlying bone. Conclusion. The results suggest that mineralized corticocancellous block allografts might be used as scaffolds for bone growth and ridge width augmentation.

Evaluation of Alveolar Crest Changes following Buccal Bone Overbuilding in Immediate Implantation.

The aim of the present study was to evaluate alveolar crest changes when using demineralized freeze-dried bone allograft (DFDBA) and resorbable membrane between flap and buccal bone in addition to filling the gap, as compared to merely filling the gap, when performing immediate implantation. In 18 patients with 24 single-root teeth, implants were placed immediately after extraction. In the test group (nine patients with 12 teeth), DFDBA and barrier membrane were placed between buccal crest and flap after implant placement. In the control group (nine patients with 12 teeth), implants were placed without buccal grafting. In addition, in both groups, if the gap width between implant and buccal crest was ≥2 mm, the gap was filled with DFDBA at the time of extraction. The height of buccal crest soft tissue and the buccolingual width of bone at 3 and 5 mm, apical to the line connecting the two cementoenamel junctions (CEJs) of adjacent teeth (CEJ line), were measured at baseline and after 4 mo. In the test group, the mean height of the buccal crest increased by 1.04 ± 0.68 mm, but in the control group, height decreased by 0.83 mm (p < 0.001). In the test group, the mean height of soft tissue increased by 0.29 mm, but in the control group, height decreased by 0.79 ± 0.72 mm (p = 0.006). The mean reduction of buccolingual width of bone in 3 and 5 mm apical to the crest in the test group was lower than that of the control group, but not significantly (p = 0.231 and 0.212, respectively). The findings of this study show that using DFDBA and membrane between buccal crest and flap in immediate implantation could increase buccal crest and soft tissue height in the midfacial region but may not significantly prevent buccolingual width reduction of bone at 3 and 5 mm from the CEJ line.

Periodontal changes following molar intrusion with miniscrews.

BACKGROUND: With the introduction of skeletal anchorage system, recently it is possible to successfully intrude molar teeth. On the other hand, there have been concerns about periodontal changes associated with intrusion and there are few studies on this topic, especially for posterior teeth. MATERIALS AND METHODS: Ten female patients were enrolled in this study. Maxillary molar intrusion was achieved by inserting two miniscrews and a 17 × 25 titanium molybdenum alloy spring. Crestal height changes were evaluated at three intervals including: Baseline (T0), end of active treatment (T1) and 6 months after retention (T2). Other variables including probing depth, gingival recession, attachment level and bleeding on probing were evaluated by clinical measurements in the three above mentioned intervals. One-sample Kolmogrov-Smirnov test ascertained the normality of the data. For all patients, the changes in tooth position and crestal height were evaluated using one-sample t-test. (P < 0.05). RESULTS: Supra-erupted molars were successfully intruded a mean of 2.1 ± 0.9 mm during active treatment (T0-T1). A mean bone resorption of 0.9 ± 0.9 mm in mesial crest and 1 ± 0.8 mm in distal crest had occurred in total treatment (T0-T2). A mean of 0.6 ± 1.4 mm bone was deposited on mesial crest during the retention period (T1-T2) following tooth relapse. On average, 0.8 ± 0.4 mm attachment gain was obtained. Gingival margin coronalized a mean of 0.8 ± 0.6 mm throughout the entire treatment. Probing depth showed no significant change during treatment. CONCLUSION: Within the limitations of this study, these results suggest that not only periodontal status was not negatively affected by intrusion, but also there were signs of periodontal improvement including attachment gain and shortening of clinical crown height.

Resonance frequency analysis as a predictor of early implant failure in the partially edentulous posterior maxilla following immediate nonfunctional loading or delayed loading with single unit restorations.

OBJECTIVES: To assess the ability of baseline resonance frequency analysis (RFA) measurements to predict early implant failure in the posterior maxilla and to evaluate potential correlations between this measurement with Hounsfield units, bone quality variables, and implant dimension. MATERIALS AND METHODS: This prospective randomized study involved 46 SLActive Straumann implants placed in the posterior maxillae of 21 subjects. Each patient received at least one control (delayed loading) and one experimental (immediate nonfunctional loading) implant. Each site was evaluated with presurgical computer-assisted tomography (CT) scans, histomorphometric analysis of bone cores, and subjective determination of bone quality. Baseline implant stability quotients (ISQ) were determined by RFA measurements made at the time of fixture placement. Pearson's correlation analysis and Spearman's test were used to identify statistically significant correlations within the resultant data. Receiver operating characteristic (ROC) analysis was used to determine whether baseline ISQ values can accurately predict early implant failure. RESULTS: The mean baseline ISQ values for the two groups were 66.8 (experimental) and 66.2 (control). The 12-month survival rates were 86.4% (experimental) and 100% (control). There were no statistically significant correlations between baseline ISQ values and early implant failure, bone quality variables, or implant dimension. ROC analysis showed that baseline ISQ values cannot predict early implant failure. CONCLUSION: Baseline RFA measurements were not able to predict early failure of immediately loaded implants placed in the posterior maxilla and therefore should not be used to determine whether an implant is a candidate for immediate nonfunctional loading in this region of the mouth.

Gene polymorphisms of TNF-α and IL-1ß are not associated with generalized aggressive periodontitis in an Iranian subpopulation.

Cytokines play a part in pathogenesis of periodontitis via inflammation phenomenon. Aggressive periodontitis (AgP) is a multifactorial disease resulting in rapid tooth loss due to severe destruction of tooth supporting apparatus. Recently, researchers have focused on genetic susceptibility of periodontitis through investigating the gene variations of cytokines and other components of immune response. In this study we analyzed single nucleotide polymorphism (SNP) of two cytokines in association with AgP in an Iranian-khorasanian population; Interleukin-1 beta (IL-1ß) +3954 C/T and Tumor Necrosis Factor alpha (TNF-α) -308 G/A. From arm vein of patients (n=58) and periodontally healthy individuals (n=60) blood sample was obtained and the DNA was extracted. Polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) procedure was performed to recognize the SNPs. X2 test was used to determine the statistically significant differences between the two groups. The frequency of genotypes and alleles had no significant differences between patients and control groups. The distributions were as follows. IL-1ß +3954: CT, CC and TT genotypes in patients were 39.6%, 60.4% and 0.0% and in controls were 41.7%, 50% and 8.3%, respectively. TNF-α -308: GA, GG and AA genotypes in patients were 44.8%, 41.4% and 13.8% and in controls were 46.7%, 50% and 3.3%, respectively.This investigation do not substantiates the role of IL-1ß +3954 and TNF-α -308 polymorphisms, separately, as risk determinants for AgP in Iranian population. Further research based on all components of immune response, is needed to corroborate the genetic susceptibility of AgP.

The efficacy of gabapentin versus stabilization splint in management of sleep bruxism.

PURPOSE: This study aimed to determine if the use of gabapentin is more efficacious than a stabilization splint with regard to the intensity of masseter muscle contractions and/or sleep quality for patients experiencing sleep bruxism (SB). MATERIALS AND METHODS: Twenty patients with SB participated in this clinical study. They were randomly divided into two treatment groups: stabilization splint group (n = 10) and gabapentin group (n = 10). The first polysomnographic examination was performed before the beginning of the experiment for all the participants. At the end of a 2-month period of stabilization splint therapy or gabapentin usage, a second polysomnographic recording was made. RESULTS: Statistically significant reductions in the number of SB episodes per hour and per night, bruxism time index, total duration of SB episodes per night and number of SB episodes in stages NR I and NR II (p < 0.05) were observed in both groups after treatment. Both treatments significantly reduced the mean intensity of masseter muscle contractions during SB episodes. Moreover, the participants treated with gabapentin showed a significant improvement in total sleep time, slow wave sleep (stage III), and sleep efficiency (p < 0.05). CONCLUSIONS: Gabapentin could be an effective treatment modality in SBs, especially in those with poor sleep quality.

Evaluation of 3- to 8-year treatment outcomes and success rates with 6 implant brands in partially edentulous patients.

The use of osseointegrated implants as a foundation for the prosthetic replacement of missing teeth has become widespread, with new dental implant systems being introduced every year. There is growing interest in identifying the factors associated with implant failure, such as implant type. This study was designed to establish the relationship between implant type and success. Eighty-eight patients (mean age, 52 years) with 268 implants (110 BioHorizons, 60 ITI, 60 Paragon, 18 Xive, six 3i, and 19 Allfit) participated in this 5-year retrospective study. Statistical significance was defined for P < .05. Peri-implant probing depth was associated with bone loss and bleeding on probing. Implant failure was not associated with implant brand. Maximal (or minimal) peri-implant probing depth and bone loss values were seen at anterior regions (or premolars). Maximal (or minimal) bleeding on probing was seen at the posterior (or anterior) region. No significant differences were observed between the different systems in terms of implant failure.

Intrusion of supra-erupted molars using miniscrews: clinical success and root resorption.

INTRODUCTION: Conventional orthodontic techniques do not intrude posterior teeth effectively, and almost all methods result in anterior extrusion rather than posterior intrusion. New absolute anchorages (miniscrews and miniplates) are said to make posterior tooth intrusion possible. The aim of this study was to evaluate the clinical success of a new method for molar intrusion with miniscrews and its probable accompanying side effects. MATERIAL AND METHODS: Ten women with overerupted upper first molars participated in this study. Upper molar bands with brackets were cemented. Two miniscrews were placed, 1 in the mesiopalatal and another in the mesiobuccal aspect of the upper first molars; a spring made of 0.017 × 0.25-in titanium-molybdenum alloy (TMA) wire was used to apply 100 g of force through the attachments (50 g each side). Molar intrusion and external apical root resorption were evaluated by comparing parallel periapical radiographs with bite blocks at 3 intervals: beginning of treatment (T0), at the end of active treatment (T1), and 6 months after treatment completion (T2). RESULTS: The mean value of intrusion was 2.1 mm after completion of active treatment. On average, 0.4 ± 0.2 mm relapse had occurred during 6 months of retention, and the mean residual intrusion was 1.7 mm, which was statistically significant. Mean root resorption of 0.3 ± 0.2 mm for palatal root and 0.4 mm for mesiobuccal and distobuccal root was measured. CONCLUSIONS: Statistically significant intrusion (2.1 ± 0.9 mm) was obtained during active treatment. The mean value of relapse was 0.4 ± 0.2 mm, and the mean value for residual intrusion was 1.7 ± 0.6 mm. Minor apical root resorption occurred during treatment.

Association of interleukin-1 receptor antagonist gene polymorphisms with generalized aggressive periodontitis in an Iranian population.

BACKGROUND: Periodontitis is a multifactorial disease that occurs in the presence of bacteria, environmental factors, and genetic predispositions. It is suggested that polymorphisms in the interleukin-1 (IL1) receptor antagonist gene have an important role in the susceptibility of the host to periodontitis. This study investigates the association of a variable number of tandem repeat polymorphism in the IL1RN gene with generalized aggressive periodontitis (GAgP). METHODS: Sixty-six subjects with GAgP and 56 periodontally healthy subjects took part in the study. All subjects were of Iranian Khorasanian (north-east province of Iran) descent. Subjects were identified through clinical examinations and radiographs at the Mashad Dental School and Dental Research Center. DNA was extracted from peripheral blood cells, and different genotypes were detected using polymerase chain reaction amplification and fragment-size analysis. Data were analyzed using the chi(2) test. RESULTS: The frequencies of the IL1RN genotype A1A2 (chi(2) test; P = 0.001) and allele A2 (chi(2) test; P = 0.006) were found to be significantly increased in patients with GAgP compared to normal subjects. CONCLUSION: These findings suggest that the polymorphic IL1RN gene is a risk determinant for generalized aggressive periodontitis in the Iranian Khorasanian population.

Oral health status of dialysis patients based on their renal dialysis history in Kerman, Iran.

PURPOSE: Maintaining a high level of periodontal and oral health in patients undergoing renal dialysis is of paramount importance because of the inherent compromised host defence mechanisms. The aim of the present study was to determine the periodontal status and the level of dental caries in renal dialysis patients in Kerman, Iran. MATERIALS AND METHODS: A cross-sectional study was conducted on two groups of patients: one including 68 renal dialysis patients (test) and the other including 30 healthy subjects (control). Half-mouth measurements of Gingival Index (GI), Plaque Index (PI), probing pocket depth (PPD), gingival recession (GR), clinical attachment level (CAL) and bleeding on probing (BOP) as well as decayed, missing or filled teeth (DMFT) index were recorded. RESULTS: The GI, BOP, PPD, CAL and GR were significantly greater among the test group as compared with the control group; however, the DMFT did not differ significantly among the groups. There was no relationship between the duration of the dialysis and the periodontal indices. CONCLUSIONS: It seems that patients with chronic renal failure have less favourable periodontal health than normal patients. The present study showed that oral home care practices were inadequate. Thus, preventive programmes to promote the oral health status of haemodialysis patients are needed.

Polymorphism of IL-1alpha(-889) Gene and Its Association with Aggressive Periodontitis.

Adult periodontitis is a complex multifactorial disease whose etiology is not well defined. The pro-inflammatory and bone resorption properties of Interleukine-1alpha (IL-1alpha) strongly suggest a role for this cytokine in the pathogenesis of periodontal disease. Eighty Iranian adult patients with periodontitis and 80 Iranian controls were investigated in this study.In this study we report that the frequency of IL-1alpha genotypes including allele 2 of the IL-1alpha(-889) restriction fragment length bi-allele polymorphism were significantly increased in patients with advanced aggressive adult periodontitis compared to those with early and moderate disease. Furthermore, allele 2 was associated with increased production of IL-1alpha by activated peripheral blood polymorphonuclear cells of patients with advanced disease, although this increase failed to reach statistical significance. Finally, the data obtained revealed significant linkage disequilibrium between allele 2 of the IL-1alpha (-889) polymorphism and allele 2 of the bi-allelic IL-1beta (+3953) polymorphism in both patients and orally normal controls. These findings provide new insight into the possible rate of IL-1alpha and beta genes polymorphism in the susceptibility to adult periodontitis.

Improvement of periodontal parameters in untreated quadrants after surgical periodontal therapy at adjacent quadrants.

BACKGROUND: Once full-mouth surgery is planned following the non-surgical phase for a patient with chronic periodontitis, it often does not undergo revision during the surgical period. The aim of this study was to find out whether surgical treatments performed on each quadrant would have any influence on the periodontal status of the untreated quadrants. METHODS: Twenty patients with chronic periodontitis were selected and received full-mouth scaling and root planing. After 8 weeks, quadrant-wise surgery was performed during four consecutive sessions at 2-week intervals for sites with probing depth (PD) > or = 5 mm and bleeding on probing (BOP). Clinical parameters, including PD, BOP, and clinical attachment level, were recorded at baseline, at each session prior to surgery, and 8 weeks after the last surgical visit. RESULTS: Only the data recorded for the last-treated quadrant are presented in this article. Marked differences were found in the clinical measurements of the last-treated quadrant among all visits. A significant improvement in the clinical parameters of the last-treated quadrant between sessions two and five were mostly related to the treatment of the other three quadrants. CONCLUSION: The treatment plan made at the time of reassessment of the initial phase of therapy should be considered provisional, and it should be open to revision prior to each surgical visit to reconfirm or modify the treatment plan previously devised for the remaining quadrant(s).

Treatment of gingival recessions by guided tissue regeneration and coronally advanced flap.

Gingival recession refers to the denudation of root surface caused by apical migration of the gingival margin as a result of destruction of the covering gingival tissue of the affected area. It is among the most frequent problems presented by periodontal patients and may have different etiologies and sequels. So far, several techniques have been devised and tested to treat gingival recession. The aim of this study was to assess the effectiveness of using a GTR resorbable collagen membrane in conjunction with coronally advanced flap (CAF) as compared to CAF alone in the treatment of Miller's Class I & II gingival recessions. Seven patients took part in the study, each providing either two or four facial recessions of 3 mm. to 6 mm., totaling 11 pairs of gingival recessions. The two paired sites within each patient were randomly assigned to one of the two treatments mentioned above. Prior to and six months after treatments, the following clinical parameters were measured and recorded: recession depth; probing pocket depth; clinical attachment level; width of keratinized gingiva; and width of recession. After six months, recession depth showed a mean reduction of 67.88% and 57.42% in the "GTR + CAF" and "CAF alone" groups, respectively. The mean difference between the groups was 1+/-0.33 mm (P=0.03). The results of this study indicate that Miller's Class I & II gingival recessions are amenable to treatment using the GTR technique with satisfactory outcome.

The effect of periodontal treatment on IL-6 production of peripheral blood monocytes in aggressive periodontitis and chronic periodontitis patients.

BACKGROUND: Several cytokines, including IL-6 have been implicated in the pathogenesis of periodontal disease. It is established that monocytes from periodontitis subjects show an increased production of IL-6 as compared to healthy subjects. However, little is known about the effect of periodontal treatment on IL-6 production by monocytes in subsets of periodontitis patients. OBJECTIVE: The aim of the present study was to evaluate the effect of surgical periodontal treatment on IL-6 production of peripheral blood monocytes (PBM) in aggressive periodontitis patients (AP) and chronic periodontitis patients (CP) before and after stimulation by E.coli LPS. METHODS: Fifteen AP patients, 15 CP patients and 15 periodontally healthy subjects (PH) took part in the study. PBM IL-6 pro-duction was measured, using ELISA, before and after stimulation of cultured PBM cells by 0.1 microg/ml LPS of E.coli. Following full-mouth non-surgical and surgical periodontal treatment of the AP and CP groups, the same measurements were repeated for these two groups. RESULTS: LPS-stimulated IL-6 production was significantly greater than non-stimulated IL-6 for all 3 groups. Before periodontal treatment, LPS-stimulated IL-6 pro-duction of the AP group was significantly greater than the other 2 groups. Periodontal treatment did not result in a significant decrease in unstimulated or LPS-stimulated IL-6 production by PBM cells in AP and CP patients. No correlation was detected between IL-6 levels and baseline clinical parameters or changes in clinical parameters. CONCLUSION: PBM cells in AP patients might be hyper-responsive in terms of IL-6 production. This hyper-responsiveness does not seem to return to that of healthy subjects even after a successful periodontal treatment. Moreover, the regulation of host inflammatory mechanisms upon LPS challenge might be different between AP and CP patients.