Adjunctive use of laser biostimulation with nonsurgical periodontal therapy: a split-mouth, randomized, case-control study in diabetic and nondiabetic periodontitis patients.

Background/aim: Laser biostimulation therapy (LBT) is suggested to have positive effects on periodontal healing. This study evaluated LBT with nonsurgical periodontal therapy (NSPT) in diabetes mellitus (DM) and systemic health (SH) conditions. Materials and methods: Thirty periodontitis patients (15 with DM and 15 with SH) were included in the study, which had a split-mouth design, by applying LBT in the mouth of the same systemic condition. Thus, 4 study groups were formed, as 1) NSPT - DM: NSPT alone in DM, 2) NSPT + LBT - DM: NSPT + LBT application in DM, 3) NSPT - SH: NSPT alone in SH, and 4) NSPT + LBT - SH: NSPT + LBT application in SH. NSPT was performed on days 15, 30, 37, 44, 51, 58, and 65. LBT was performed 6 times on days 30, 37, 44, 51, 58, and 65 with an Nd:YAG laser. The plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were assessed as the clinical parameters and recorded at baseline and days 30, 37, and 72. Gingival crevicular fluid levels of interleukin 1 beta (IL-1ß) and IL-10 were evaluated by ELISA as the biochemical parameters at baseline and on days 30, 37, and 72. Results: Clinical parameters had improved in all of the groups on day 72 (p < 0.01). PPD and CAL improved more in the DM group with NSPT and LBT group than in the DM group with NSPT without LBT on day 37 (p < 0.05). IL-1ß decreased and IL-10 increased in all of the groups on day 72 (p < 0.01). This change was more evident in the DM group with NSPT and LBT than in the DM group with NSPT without LBT on day 7 (p < 0.05). Conclusion: These results revealed the short-term impacts of LBT on periodontal healing, which return to ineffectiveness with repeated irradiation. Therefore, it may be speculated that LBT via the protocol herein may have a short-term antiinflammatory contribution to NSPT, only in impaired healing conditions such as DM.

Effects of smoking on the gingival crevicular fluid levels of interleukin-17A, interleukin-17E, and oxidative stress following periodontal treatment process.

OBJECTIVE AND BACKGROUND: How smoking affects periodontal inflammation and healing still needs to be revealed with all its mechanisms. In this study, the gingival crevicular fluid (GCF) levels of: (a) interleukin-17A (IL-17A) and interleukin-17E(IL-17E) with their ratios and (b) oxidative stress by means of total oxidative stress (TOS), total anti-oxidant capacity (TAOC), and their ratios as the oxidative stress index (OSI) were evaluated and compared for smoking and non-smoking periodontitis patients after a periodontitis management process including both the non-surgical and surgical treatments. MATERIALS AND METHODS: Fifteen smoker and 15 non-smoker generalized periodontitis patients as 2 distinct groups participated in the study. Conventional clinical and radiographical examinations were utilized for the periodontitis diagnosis. The clinical data and GCF samples were collected at baseline, 4 week after non-surgical periodontal treatment (NSPT), and 4 weeks after surgical periodontal treatment (SPT). IL-17A, IL-17E, TOS, and TAOC were determined by ELISA and Rel Assay. RESULTS: Clinical parameters in both smokers and non-smokers improved following periodontal treatment (P < .001) and their clinical data were similar for all the examination times (baseline, NSPT, and SPT) (P > .05). Following the treatment phases, the IL-17A concentration decreased and the IL-17E concentration increased in both the smokers and non-smokers (P < .01). The total amount of IL-17A decreased while the total amount of IL-17E increased in smokers throughout NSPT and SPT (P < .01). Such an alteration was seen only at SPT compared to NSPT and baseline in non-smokers (P < .01). The concentration and total amount of IL-17A were higher at baseline, and the concentration and total amount of IL-17E were lower at all examination time points in non-smokers as compared to smokers (P < .01). The 17A/E ratio decreased in both groups following the treatment phases and was higher in smokers at all the examination times (P < .01). TOS were higher and TAOC were lower in smokers versus non-smokers at all the time points, but the differences were significant only for TOS levels (P < .01). Throughout the treatment phases, the concentration and total amount of TOS decreased in smokers(P < .01) and only the total amount of TOS decreased in non-smokers (P < .01). The concentration and total amounts of TAOC increased throughout the treatments in both smokers and non-smokers without significant changes (P > .05). The baseline OSI was higher in smokers, and it decreased only in smokers following the treatment phases (P < .01). CONCLUSIONS: Smoking and periodontal inflammation were found to alter IL-17A, IL-17E, and oxidant/anti-oxidant statuses in periodontitis patients. The intra-group assessments in smokers demonstrated more apparent alterations in the oxidant/anti-oxidant statuses and IL-17A and IL-17E levels after periodontitis management.

Assessment of the half-life of cationic periodontal pocket irrigation.

BACKGROUND: The concentration and persisting time of antimicrobial agents in the periodontal pockets are important factors for their antimicrobial efficacy. Increased clearance time in the periodontal pocket is a significant criterion for the selection of intrapocket irrigants. The aim of this study was to estimate the clearance time of a cationic agent from the periodontal pocket. METHODS: Thallium-201(Tl-201) was chosen as a tracer to simulate the clearance of cationic substance because of its electrical activity. Twenty patients with periodontitis and probing depths 6 to 9 mm were included in this study. In each patient, 3 Mega Becquerel (MBq) of Tl-201 were inserted into the periodontal pocket. Dynamic imaging was performed and clearance of radioactivity was measured. RESULTS: Clearance of radioactivity was 67.1 ± 16.9, 83.1 ± 13.9, 90.4 ± 10.4, 93.39 ± 8.0% at 30, 60, 90 and 120 min, respectively. Half-life of wash-out was determined as 20.3 ± 10.2 min. CONCLUSION: The results of this study demonstrate that the half-life of the cationic solution applied subgingivally was approximately 20 min and labelling of oral irrigants with radiotracers may be used to determine their clearance in further research.

Neurogenic inflammation in periimplant and periodontal disease: A case-control split-mouth study.

OBJECTIVE: Although the regulatory effects of substance-P (SP), neurokinin-A (NKA), calcitonin gene-linked peptide (CGRP) and neuropeptide-Y (NPY) on periodontal inflammatory responses have been described, the effects of these neuropeptides on healthy and diseased periimplant tissues are not clearly defined. MATERIALS AND METHODS: Thirty-nine implants loaded at least for 12 months with their symmetrically matching teeth were evaluated and compared by a split-mouth study design. Six study groups were created in this regard as follows: group 1 (healthy periodontal tissues), group 2 (healthy periimplant tissues), group 3 (gingivitis), group 4 (periimplant mucositis), group 5 (periodontitis) and group 6 (periimplantitis). Clinical examinations included Silness-Löe plaque index, Löe-Silness gingival index, bleeding on probing, probing pocket depth and clinical attachment level measurements. Gingival crevicular fluid and periimplant sulcular fluid samples were collected, and the concentrations of neuropeptides were determined by enzyme-linked immunosorbent assay. Their levels and correlations were investigated together with the clinical parameters. RESULTS: Neuropeptide levels were different in the teeth and implant groups according to the periodontal status (p < 0.001). SP and NKA levels were increased, whereas CGRP and NPY levels were decreased in the diseased states. There were no differences between the neuropeptide levels of matching teeth and implants (groups 1-2, groups 3-4 and groups 5-6; p > 0.05). CONCLUSION: Our study demonstrated the presence of local neuropeptides in healthy and diseased periimplant tissues. The neurogenic inflammatory responses were also found to be similar in both periimplant and periodontal tissues.

Effects of grape seed extract on periodontal disease: an experimental study in rats.

OBJECTIVE: This study aimed to demonstrate the effect of grape seed extract (GSE) on periodontitis. MATERIAL AND METHODS: Ligature induced periodontitis was created in 40 rats and they were assigned to four equal groups. One group was fed laboratory diet (group A) while three groups received GSE additionally. Silk ligatures were placed around the cervical area of the mandibular first molars for four weeks to induce periodontitis. The GSE groups were reallocated regarding GSE consumption as: for two weeks before ligation (group B; totally eight weeks), from ligation to two weeks after removal of the ligature (group C; totally six weeks), and for two weeks from ligature removal (group D; totally two weeks). Sections were assessed histologically and immunohistochemically. Inflammatory cell number (ICN), connective tissue attachment level (CAL), osteoclast density (OD), IL-10 and TGF-ß stainings in gingival epithelium (GE), connective tissue (GC), and periodontal ligament (PL) were used as the study parameters. RESULTS: Lower ICN, higher CAL, and lower OD were observed in the GSE groups (p<0.05). IL-10 was more intensive in the GSE groups and in the GEs (p<0.05). Group B showed the highest IL-10 for PL (p<0.05). TGF-ß was higher in the GEs of all groups (p<0.017). CONCLUSIONS: The results suggest anti-inflammatory activities of GSE, but further investigations are needed for clarification of these activities.

The Effects of Smoking on the Osmotic Pressure of Human Dental Pulp Tissue.

OBJECTIVE: We aimed to investigate the effect of smoking on the osmotic pressure (OP) of human dental pulp tissue. MATERIALS AND METHODS: Sixty male dental patients (smokers and nonsmokers) scheduled for root canal treatment for prosthodontics were included in the study. Fifteen patients (1 premolar tooth/patient) were allocated to each of the following groups according to their smoking habits, i.e. group 1: ≤10 cigarettes/day, group 2: 11-20 cigarettes/day, group 3: >20 cigarettes/day and group 4: nonsmoking controls. Apical pulp tissues were removed via coronal access. Pulp tissue supernatants were obtained to measure the pulpal OP by means of a semimicro digital osmometer. One-way analysis of variance and the post hoc Duncan test were used to analyze the differences in OP between groups. Regression analysis was used to determine the relationship between the number of cigarettes smoked daily and the pulpal OP. RESULTS: The mean (± SD) OP value decreased as cigarette consumption increased: group 4 (268.00 ± 10.09 mosm/kg) > group 1 (259.20 ± 7.16 mosm/kg) > group 2 (248.90 ± 2.23 mosm/kg) > group 3 (239.90 ± 7.40 mosm/kg). The OP differed significantly between groups (p < 0.01), and a significant negative correlation was found between cigarette consumption and pulpal OP (r = -0.809, p < 0.01). CONCLUSION: In this study, the OP decreased as the number of cigarettes smoked increased. In clinical examination, there may be misdiagnosis of pulpal conditions in smokers (even in healthy pulp tissue) due to the effect of altered OP on pulpal tissue reactions.

Gingival crevicular fluid levels of neuropeptides following dental restorations.

PURPOSE: Local neuropeptide release has a critical role in the initiation and progression of an inflammatory response. This study investigated the effects of different restorative materials on periodontium in this regard, by evaluating their neuropeptide-producing effects on gingival crevicular fluid (GCF). METHODS: The study included 14 patients suitable for metal-ceramic, composite and amalgam restorations. Four weeks after periodontal therapy, the restorations were performed. Study groups were constituted regarding the tooth/restoration surfaces contacting gingiva in each patient: 1 ceramic surface of a metal-ceramic crown (ceramic group), its opposite metal surface (metal group), 1 composite surface (composite group), its opposite enamel surface (opposite-composite group), 1 amalgam surface (amalgam group), its opposite enamel surface (opposite-amalgam group) and 1 nonrestored enamel surface (enamel group). Four weeks after dental restorations, clinical data and GCF were obtained from the group sites. Clinical data, GCF volume and its proinflammatory cytokine profile were utilized to evaluate the periodontal health. GCF levels of substance P (SP), neurokinin A (NKA) and calcitonin-gene related peptide (CGRP) were determined by ELISA for revealing the neuropeptide levels. RESULTS: GCF volume was found to increase in all groups compared with the enamel group (p<0.05). SP and NKA levels were higher in the ceramic, composite and amalgam groups than those in the enamel group (p<0.05). SP and NKA levels were also higher in the composite and amalgam groups than those in the opposite-composite/amalgam groups (p<0.05). CONCLUSIONS: These results suggest that ceramic, composite and amalgam materials may uniquely trigger local neuropeptide release in periodontium.

Excessive fluoride intake alters the MMP-2, TIMP-1 and TGF-ß levels of periodontal soft tissues: an experimental study in rabbits.

OBJECTIVES: This study evaluated the influence of fluoride on periodontal soft tissues by investigating any alterations in their MMP-2, TIMP-1 and TGF-ß profiles secondary to excessive fluoride intake. MATERIAL AND METHODS: Fluorosis was induced in 18 rabbits (test group) through consumption of fluoride added to drinking water, whereas 10 rabbits consumed regular tap water as daily supply (control group). Following fluorosis verification, animals were sacrificed and their 1st mandibular molar teeth were utilized in the assessments. MMP-2, TIMP-1 and TGF-ß were separately investigated for gingival epithelium (GE), gingival connective tissue (GC) and periodontal ligament (PL) to evaluate periodontal soft tissues. Histological sections were prepared from the groups, the parameters were determined by immunohistochemistry, and their levels were calculated by quantification of the immunostainings. RESULTS: Staining intensity of MMP-2 in GC and PL (p < 0.01); TIMP-1 and TGF-ß of GE, GC and PL (p < 0.01) were higher in the test group compared to those of the control group. Intra-group staining of TIMP-1 was higher than MMP-2 in all test group compartments (p < 0.01) and in the control group GE (p < 0.01). TIMP-1 was also higher than TGF-ß in the GE and PL of the test group (p < 0.05) and in the GE of the control group (p < 0.01). CONCLUSION: These results suggest that excessive fluoride intake may affect periodontal soft tissues by increasing MMP-2, TIMP-1 and TGF-ß, and thereby altering the MMP-2/TIMP-1 and TIMP-1/TGF-ß ratios. CLINICAL RELEVANCE: Excessive fluoride consumption may alter the periodontal tissue homeostasis which may be detrimental in the maintenance of periodontal health.

The impact of dietary induced hyperparathyroidism on healthy and diseased periodontia: an experimental study in rats.

BACKGROUND AND OBJECTIVE: Nutrition may be a potential modifying factor in periodontal conditions. The present study investigated this phenomenon for dietary induced hyperparathyroidism (dHPT) by revealing the histopathological and histomorphometrical profiles of healthy and diseased periodontia in dHPT. METHODS: Dietary induced hyperparathyroidism was induced in 12 rats by dietary calcium/phosphorous imbalance and 12 rats were fed standard diet (SD). Periodontitis was induced on the right mandibular molar teeth (mmt) of these rats by injecting an endotoxin + saline solution whereas injecting pure saline to the left mmt. Thus, four study groups were created: dHPT + saline (group 1), dHPT + endotoxin (group 2), SD + endotoxin (group 3) and SD + saline (group 4). Histological sections were obtained from the second mmt and examined using light microscope. RESULTS: Group 1 demonstrated inflammatory and degenerative alterations in periodontium without pocket formation. Periodontitis was evident in groups 2 and 3. Group 2 revealed the highest amounts of gingival inflammatory cell and vessel counts (group 2 > group 3 > group 1 > group 4), attachment and bone losses (group 2 > group 3 > groups 1 > group 4) and osteoclast count (group 2 > group 3 > group 1 > group 4) (p < 0.05). CONCLUSION: These results propose that dHPT may impair the health status of periodontium and may worsen the pathobiology of periodontal diseases.

Dietary-induced hyperparathyroidism affects serum and gingival proinflammatory cytokine levels in rats.

BACKGROUND: Poor diet and inadequate nutrition are suggested to affect the periodontium as well as impair the systemic health. This study investigated the systemic and periodontal effects of dietary-induced hyperparathyroidism (dHPT) by evaluating serum and gingival proinflammatory cytokine levels. METHODS: Twenty-four Sprague-Dawley rats were used in the study. dHPT was induced in 12 rats by calcium/phosphorus imbalance, and 12 rats were fed a standard diet (SD). Afterward, endotoxin-induced periodontitis was induced on the right mandibular molar teeth (mmt). Four study groups were created: dHPT + mmt without periodontitis (group 1), dHPT + mmt with periodontitis (group 2), SD + mmt with periodontitis (group 3), and SD + mmt without periodontitis (group 4). Interleukin (IL)-1beta and tumor necrosis factor-alpha (TNF-alpha) levels were measured by enzyme-linked immunosorbent assay to evaluate the proinflammatory cytokine profiles. Serum cytokines were analyzed in the blood samples collected prior to periodontitis induction, whereas gingival cytokines were analyzed in the gingival supernatants of the four groups. RESULTS: Serum cytokines were higher in dHPT rats than in SD rats (P <0.001), with a positive correlation between parathormone and the cytokines (P <0.001). Gingival cytokines were highest in group 2 and lowest in group 4 (group 2 > group 3 > group 1) (P <0.001). There was a positive correlation between parathormone and the gingival cytokines in group 1 (P <0.001 for IL-1beta; P <0.01 for TNF-alpha). CONCLUSION: The results suggested that increased serum proinflammatory cytokine production may be a complication of dHPT, and this may affect healthy and diseased periodontia by increasing gingival proinflammatory cytokine levels.

Local peptidergic innervation of gingiva in smoking and non-smoking periodontitis patients.

BACKGROUND: The present study aimed to investigate the local peptidergic innervation of diseased and healthy periodontia in smokers and non-smokers. METHODS: Fifteen smokers and 12 non-smokers, all with localized chronic periodontitis, participated in the study. Periodontally diseased and healthy tooth sites were selected in smokers (groups 1 and 2, respectively) and non-smokers (groups 3 and 4, respectively). Local peptidergic innervation was assessed by the concentrations of two neuropeptides, substance P (SP) and calcitonin gene-related peptide (CGRP), in the gingival biopsies obtained from the groups. Clinical data and biopsies were collected from the same two tooth sites in each group. SP and CGRP levels were measured by enzyme immunosorbent assay in the supernatants of gingival samples. RESULTS: Increased probing depth and attachment loss were found in group 1 compared to group 3 (P<0.05). SP was higher in group 1 compared to groups 2, 3, and 4, and it was higher in group 3 compared to groups 2 and 4 (P<0.05). CGRP was higher in group 1 than in groups 2, 3, and 4, but it was lower in group 3 than in groups 2 and 4 (P<0.05). CONCLUSION: The study results suggested that 1) although smoking may affect the neurogenic inflammation in the presence of periodontitis by increasing local peptidergic innervation, this effect may not be seen in periodontal health, and 2) SP may be regarded as an indicator of periodontitis, whereas CGRP may be important in the acute and/or initial periodontal inflammation.

Fluid dynamics of gingiva in diabetic and systemically healthy periodontitis patients.

OBJECTIVES: The influence of diabetes mellitus (DM) on the fluid dynamics of periodontium has not been reported in periodontal disease. The objectives of this study were (i) to investigate the alterations in the fluid dynamics of periodontium in diabetic periodontitis patients, and present the association of this phenomenon with the metabolic control of DM; (ii) to reveal any correlation between the fluid dynamics of periodontium and clinical signs of periodontal disease in DM and periodontitis. DESIGN: Fifteen well-controlled diabetic chronic periodontitis patients (Group 1), 14 systemically healthy chronic periodontitis patients (Group 2), and 14 systemically and periodontally healthy individuals were included in the study. Gingival crevicular fluid volume (GCF-V) and gingival tissue osmotic pressure (GOP) were used as the parameters of periodontal fluid dynamics. GCF-V was measured by a Periotron device, while GOP was measured by a digital osmometer. Silness-Löe plaque index (PI), Löe-Silness gingival index (GI) and clinical attachment loss (AL) levels were recorded to determine the periodontal health status. RESULTS: PI, GI and AL were higher in Groups 1 and 2 than in Group 3 (P<0.05), but similar between Groups 1 and 2 (P>0.05). Increased GCF-V and GOP were observed in Groups 1 and 2 compared with Group 3 (P<0.01), and the increase in Group 1 was greater than that in Group 2 (P<0.01). There were strong positive correlations between GCF-V and GOP in all three groups: between GI and GCF-V and GI and GOP in Groups 1 and 2; and between AL and GCF-V and AL and GOP in Groups 2 and 3. CONCLUSION: The results suggest that (i) DM may have an additive influence on the fluid dynamics of periodontium in the presence of periodontal disease; (ii) this phenomenon may not be prevented by the metabolic control of DM; (iii) the clinical signs of periodontal disease may be affected by the fluid dynamics of periodontium in both DM and periodontitis.

Osmotic pressure and vasculature of gingiva in experimental diabetes mellitus.

BACKGROUND: Alterations in tissue osmotic pressure (OP) and vasculature are considered to be the inevitable aspects of an inflammatory process that subsequently alter the fluid dynamics of the tissues involved. The aim of this study was to reveal a profile of OP and vascular changes in periodontally healthy gingival tissues and analyze the relationship between them in diabetes mellitus (DM) to evaluate the possible effects of DM on the fluid dynamics of the periodontium. METHODS: Experimental DM was created by intraperitoneal streptozotocin injection in 10 periodontally healthy rats. These rats were used as the test group, and 10 systemically and periodontally healthy rats served as the control group. Gingival tissue samples obtained from the groups were used for the test procedures. OP was measured in the supernatants of these samples by a semimicrodigital osmometer. Vasculature was assessed as the alterations in vascularization (vessel number [VN]) and vasodilatation (vessel diameter [VD]) by histomorphometric means. RESULTS: There was a gross increase in the OP level of the test group (172.7 +/- 59.7 mOsm/kg) compared to the control group (11.4 +/- 4.2 mOsm/kg; P <0.001). VN was found to be significantly larger in the test group (12.7 +/- 2.8) than in the control group (6.8 +/- 1.1; P <0.001). VD was found to be smaller in the test group (10.1 +/- 2.8 microm) than in the control group (15.5 +/- 2.4 microm), and this difference was statistically significant (P <0.001). A positive correlation between OP and VN (r = 0.77; P <0.001) and a negative correlation between OP and VD (r = 0.1; P >0.05) were observed in the test group. CONCLUSION: Our results reveal that the fluid dynamics of periodontal soft tissues may be affected by the diabetic conditions in this diabetic model because of the increased OP and VN during the pathogenesis of the disease.

Clinical outcomes of guided tissue regeneration with Atrisorb membrane in the treatment of intrabony defects: a 3-year follow-up study.

In this controlled clinical trial, initial and long-term treatment outcomes of guided tissue regeneration (GTR) were investigated for a synthetic absorbable membrane (Atrisorb) in intrabony defects. Eighteen defects in 16 patients received GTR with Atrisorb (test), with the membrane applied by an indirect method, and 15 defects in 15 patients were treated with open flap debridement (control). Probing pocket depth (PPD), gingival recession (GR), clinical attachment level (CAL), and linear alveolar bone level (ABL) were recorded at baseline and at 1 and 3 years following the treatment procedures and were assessed as the therapeutic outcome parameters. Both groups demonstrated significant PPD reduction and CAL and ABL gain after 1 year. Among these parameters, alterations in PPD and CAL were statistically significantly greater in the test group than the control group 1 year postsurgery. No significant changes were noted in the parameters of the first year between and within the study groups after 3 years. The results suggest that GTR performed with Atrisorb membrane via an indirect application method may provide favorable clinical outcomes for intrabony defects, and these outcomes may be maintained at least as well as open flap debridement over an extended period.

Osmotic pressure and vasculature of gingiva in periodontal disease: an experimental study in rats.

Alterations in vascularisation, vasodilatation and tissue osmotic pressure (OP) are inevitable aspects of the inflammatory process that have an adverse effect on the fluid dynamics of the tissue involved. The aim of this study was to investigate tissue OP and its relationship with the vasculature in inflammed gingival tissues, in order to reveal the possible effects of vascular changes on OP in the fluid dynamics of periodontal soft tissues during periodontal disease. The parameters of fluid dynamics assessed in this study were OP, vascularisation and vasodilatation. Ligature-induced periodontitis was performed in 10 rats (test group), and gingival biopsies taken from the diseased teeth were utilised for the test procedures. These biopsies were compared with biopsies of the same teeth from 10 periodontally healthy rats (control group). OP was measured in mosmol/kg using a semi-micro digital osmometer. Vascularisation and vasodilatation were examined histopathologically; the number of vessels (VN) was quantified and the micrometric changes in vessel diameters (VD) were calculated as the alterations in the vasculature. OP, VN and VD were found to be higher in the test group (84.3+/-37.1 mosmol/kg, 13.2+/-3.2 and 19.5+/-1.3 microm, respectively) than the control group (11.6+/-3.8 mosmol/kg, 6.8+/-1.1 and 15.5+/-2.4 microm, respectively) (P<0.000). There was a strong, positive correlation between OP and VN (r=0.55, P<0.000) and a weak, negative correlation between OP and VD (r=0.1, P>0.05) in the test group. These results confirm that the OP of periodontal soft tissues does change during inflammatory conditions. The increase in OP during this process may be affected by increased vascularisation in the inflammed tissue.

Reactive oxygen species scavenging activity during periodontal mucoperiosteal healing: an experimental study in dogs.

Excessive release of reactive oxygen species (ROS) in wounded tissue due to inflammation and ischaemia is a deleterious and destructive phenomenon for the healing process. Hence, scavenging of ROS is one of the essential steps in normal wound repair. In this study, we presented a profile of free radical scavenging enzyme (FRSE) activity of periodontal mucoperiosteal wounds in order to investigate ROS activity during periodontal wound healing. Mucoperiosteal periodontal flaps were elevated in the mandibular buccal region of seven dogs between the first premolar and first molar teeth, creating acute incisional wounds in the inner side of the flaps and they were replaced 30 min after elevation. Gingival samples taken from certain biopsy regions at baseline (before flap elevation), day 3, 12, 21 and 30 were processed for detection of active amounts of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPX). All enzyme activities had increased by more than 100% of their baseline levels by day 3. SOD activity decreased gradually from days 3 to 30 and reached a level lower than the baseline value. The increase in CAT activity continued until day 21, and decreased to a level higher than the baseline value by day 30. GPX also decreased from day 3, and reached a level less than its baseline value by day 30. Our results suggest that FRSEs may contribute to the detoxification of ROS during periodontal mucoperiosteal healing. This relationship may be utilized to facilitate soft tissue and/or flap management in periodontal or intra-oral treatments.

Recurrent aphthous ulcers in Fanconi's anaemia: a case report.

Fanconi's anaemia (FA) is an autosomal recessive disorder that is clinically characterized by aplastic anaemia, congenital malformations of the renal, cardiac, skeletal and skin structures, and an increased predisposition to malignancies. Patients with FA often present with bleeding and infection, which are symptoms related to thrombocytopenia and neutropenia. There are few reports of the oral manifestations of FA. We describe oral aphthous ulcerations in two siblings with FA. There was a rapid improvement and healing of ulcers after blood transfusions and increased haemoglobin levels. This may support the role of severe anaemia in oral ulcerations.

The effect of polylactide membranes on the levels of reactive oxygen species in periodontal flaps during wound healing.

It is consented that reactive oxygen species (ROS) are deleterious to wound healing process due to the harmful effects on cells and tissues. Absorbable synthetic biomaterials are considered to be degraded via ROS. Free-radical-scavenging enzymes (FRSE) are a cytoprotective enzymal group that has an essential role in the reduction, de-activation and removal of ROS as well as regulating wound healing process. In the present study, synthetic and absorbable polylactide (PLA) barrier membranes were evaluated by means of ROS activity levels during degradation in the healing periodontal flaps measuring the activity of FRSE superoxide dismutase (SOD) and catalase (CAT). Gingival biopsies taken from 10 patients allowing both guided tissue regeneration (test) and conventional flap surgery (control) before and 1 month after the operations were processed and the supernatants were studied by Mc Cord and Fridovich, Flohe and Otting, and Luck methods to measure total SOD and CAT levels respectively. A significantly increased enzyme activity of SOD and CAT was observed in both groups (p<0.05). SOD activity change was 62.92% in the test and 3.97% in the control group, and, CAT activity change was 48.04% in the test and 11.58% in the control group. Our results suggest that ROS, particularly superoxide anions, may contribute to the degradation phase of PLA membranes and this may affect the wound healing of periodontium at least for one-month period.

Healing of periodontal defects treated with enamel matrix proteins and root surface conditioning--an experimental study in dogs.

Application of enamel matrix proteins has been introduced as an alternative method for periodontal regenerative therapy. It is claimed that this approach provides periodontal regeneration by a biological approach, i.e. creating a matrix on the root surfaces that promotes cementum, periodontal ligament (PDL) and alveolar bone regeneration, thus mimicking the events occurring during tooth development. Although there have been numerous in vitro and in vivo studies demonstrating periodontal regeneration, acellular cementum formation and clinical outcomes via enamel matrix proteins usage, their effects on the healing pattern of soft and hard periodontal tissues are not well-established and compared with root conditioning alone. In the present study, the effects of Emdogain (Biora, Malmö, Sweden), an enamel matrix derivative mainly composed of enamel matrix proteins (test), on periodontal wound healing were evaluated and compared with root surface conditioning (performed with 36% orthophosphoric acid) alone (control) histopathologically and histomorphometrically by means of the soft and hard tissue profile of periodontium. An experimental periodontitis model performed at premolar teeth of four dogs were used in the study and the healing pattern of periodontal tissues was evaluated at days 7, 14, 21, 28 (one dog at each day), respectively. At day 7, soft tissue attachment evaluated by means of connective tissue and/or epithelial attachment to the root surfaces revealed higher connective tissue attachment rate in the test group and the amount of new connective tissue proliferation in the test group was significantly greater than the control group (p<0.01). New bone formation by osteoconduction initiated at day 14 in the test and control group. At day 21, the orientation of supra-alveolar and PDL fibers established, and new cementum formation observed in both groups. At day 28, although regenerated cementum was cellular in all of the roots in the control samples, an acellular type of cementum (1.32+/-0.83 mm in length and 3.16+/-0.23 microm in width) was also noted in six roots of test samples with an inconsistent distribution on the root surfaces. The amount of new cementum was significantly higher in the test group than the control group samples (p<0.01). The width of the cellular cementum in the control group was more than the cellular cementum in the test group, but the difference was not statistically significant (p>0.05). A firm attachment of acellular cementum to the root dentin with functional organization of its collagen fibers was noted, and, the accumulation and organization of cellular cementum in the control group was more irregular than the cellular cementum formed in the test group. The amount of new bone was 2.41+/-0.75 mm in the test and 1.09+/-0.46 mm in the control group at day 28. The rate of bone maturation (the number of osteons) was found higher in the test group (10.75+/-0.85) than the control group (5.50+/-0.86). Under the limitations of the study, our results reveal that when compared with root surface conditioning, enamel matrix proteins have more capacity for stimulating periodontal regeneration via their positive effects on root surfaces, i.e. inhibition of gingival epithelium down growth and stimulation of connective tissue proliferation and attachment to the root surfaces during wound healing. An acellular type of cementum regeneration and new alveolar bone formation by an accelerated osteoconductive mechanism are also achieved with application of enamel matrix proteins.

Rare lesions of the oral cavity: case report of an actinomycotic lesion limited to the gingiva.

Actinomycosis is an infectious disease that frequently has chronic granulomatous and suppurative lesions caused by saprophytic Actinomyces species. Although cervicofacial actinomycosis is known to be the most common type, intraorally and periodontally types occur rarely in a localized fashion. The present case reports on an adult periodontitis patient with a diffuse and atypic actinomycotic lesion which was limited to the gingiva and had an abscess formation, a large desquamation and subsequent exposure of the alveolar bone in the involved region. Diagnosis was based on histopathological examination, the history of the case and clinical nature of the lesion. The patient responded to daily administration of 100 g doxcycycline (first day-bid) for 3 weeks and 0.2% chlorhexidine gluconate irrigation (following tooth brushing) performed with oral hygiene reinforcement and periodontal debridement procedures. Complete improvement of the lesion was observed after 5 weeks. Due to the opportunistic characteristics of the actinomycotic infection, early and adequate differential diagnosis of actinomycosis prior to therapeutic attempts, as well as management steps, are of great importance in the oral cavity to prevent the spread of the disease.