A Comparative Evaluation of Root Surface Biomodification with Erbium-Doped Yttrium Aluminum Garnet Laser, Ethylenediaminetetraacetic Acid Gel, and Titanium Nitride Curette: In Vitro Scanning Electron Microscope and Profilometry Analyses.

Objective: This study aims to evaluate the in vitro effects of different biomodification treatment methods on extracted tooth/root surfaces in terms of biologically acceptable changes favoring better periodontal healing. Background data: The use of various agents for root surface biomodification (RSB), during periodontal procedures is of critical importance to increase the success of the treatments through healing. Ethylenediaminetetraacetic acid (EDTA) is the most frequently used chemical RSB agent in periodontal clinical practice. Erbium-doped yttrium aluminum garnet (Er:YAG) lasers have well-known advantages on blood cell adhesion and fibrin network formation on root surfaces. Recently, novel titanium nitride (TIN) curettes are of great interest due to smoother surface changes obtained after their application. Materials and methods: Forty-four dentine specimens from extracted single-rooted teeth were randomly divided into four groups: Group 1: No treatment; Group 2: Er:YAG laser irradiation; Group 3: EDTA gel application; Group 4: TIN curette instrumentation. All specimen surfaces were wet polished before treatments. Before and after root surface roughness parameters of all specimens were assessed with a profilometer. Further, all scanning electron microscopy micrographs were analyzed and scored for root surface and smear layer morphology characteristics by two different blinded researchers. Results: There were no statistical differences between the initial roughness of all groups (p = 0.687). After treatments, EDTA gel group revealed an intact intertubular area, some smear debris on dentine surfaces, and partially occluded dentine tubules. Er:YAG laser created the highest roughness (p < 0.05) among all treatment groups with no smear layer and exhibited fully exposed dentine tubules and collagen fibrils. Surfaces instrumented with TIN curette were the smoothest (p < 0.05) and covered with a compact and thick smear layer. Conclusions: Within the limits of this study, Er:YAG laser-irradiated surfaces exhibited exposed collagen fibrils, and Er:YAG laser irradiation was found as the only method yielding the desired surface characteristics for better periodontal healing, where the fibrils are exposed in the absence of smear layer.

Plaque Inhibitory Effect of Hyaluronan-Containing Mouthwash in a 4-Day Non-Brushing Model.

PURPOSE: Despite being the gold standard antiplaque agent, chlorhexidine (CHX) has many adverse effects that make scientists search for new agents to combat biofilms as effective as CHX. Hyaluronan, also known as hyaluronic acid (HA), is a natural polysaccharide with anti-inflammatory, antioxidant and bacteriostatic properties. The objectives were to evaluate the plaque inhibitory, and anti-inflammatory effects of HA mouthwash compared to CHX and distilled water (DW) in a 4-day non-brushing model together with the participants' preference to the used products. MATERIALS AND METHODS: Thirty-three systemically and periodontally healthy subjects were included in this randomised, double-blinded, crossover clinical study. Subjects were randomly assigned into three treatment-sequence groups to use three mouthwashes one after another, in three different time periods. After professional prophylaxis at day 1, subjects refrained from all oral hygiene measures and used mouthwashes that were individually allocated to them. On day 5, scoring of plaque index (PI) according to Turetsky modification of Quigley Hein Index system, modified gingival index (MGI) and measurement of gingival crevice fluid (GCF) volume were performed. Treatment satisfaction questionnaire form was given at the end of each experimental period. RESULTS: CHX showed statistically significant reduction in PI followed by HA (p = 0.048). No statistically significant differences were detected between HA and CHX in terms of MGI and GCF volume. For HA, subjects reported significantly better taste, less sensitivity, burning sensation, mouth dryness and numbness perception compared to CHX and DW. CONCLUSIONS: CHX revealed the best plaque inhibition closely followed by HA. Early gingival inflammatory changes were found similar for CHX and HA. Furthermore, HA was well accepted with better perceptions than CHX and DW.

Profilometric Analysis of Periodontally Diseased Root Surfaces After Application of Different Instrumentation Tools: An In Vitro Study.

Objective: The topography of the root surface plays an important role in plaque accumulation, cell adhesion, and periodontal healing. The aim of this study is to profilometrically evaluate the root surface changes following the instrumentation using different tools. Methods: Forty dentin blocks of buccal and lingual root surfaces were obtained from 20 single-rooted periodontally diseased hopeless teeth and randomly divided into 4 groups. Each group was subjected to different root instrumentation tools such as stainless steel (SS) Gracey curette (Group 1); titanium nitride (TIN) Gracey curette (Group 2); ultrasonic piezoelectric device with a special tip designed for root surfaces (H3) (Group 3); and Er:YAG laser (Er:YAG tip) chisel (Group 4). A calibrated clinician instrumented all surfaces in each group. The root surfaces were profilometrically evaluated before and after instrumentations. Results: There were no statistical differences between the initial roughness levels of the groups. TIN curettes revealed the most prominent effect on smoothing the surface, whereas the Er:YAG tip showed the highest roughness in comparison with the other root surface instrumentation tools. Conclusions: Considering the importance of root surface roughness after treatment for the success of periodontal therapy, the TIN curette was the most periodontally appealing tool followed by H3, SS curette, and Er:YAG tip.

Evaluation of the Effects of Er:YAG Laser for the De-Epithelialization of the Palatal Graft in the Treatment of Multiple Gingival Recessions: A Randomized Clinical Trial.

Objective: The purposes of this split-mouth pilot study were to investigate the efficacy of the Er:YAG laser use for the de-epithelialization of the palatal graft in the treatment of the multiple gingival recessions using the bilaminar procedure and also to evaluate the patient-reported esthetic outcomes after 6 months. Materials and methods: Five systemically healthy participants with total 28 bilateral-multiple adjacent maxillary Miller I recessions were included. The treatment was performed with the bilaminar technique [coronally advanced flap (CAF)+de-epithelialized free gingival graft]. De-epithelialization procedure was done with scalpel (control site) or Er:YAG laser (Versawave, Hoya ConBio, San Francisco, CA; 40 hz, 50 mJ/pulse), under water irrigation, noncontact mode (∼1 mm away from the target tissue) in sweeping motion with chisel-type laser (test site). Root coverage and patient-reported outcomes were evaluated at 6 months after the operations. Results: Clinical outcomes of the both treatment sites did not show any statistically significant differences except for the gingival thickness parameter. However, patient-reported outcomes regarding the esthetic appearance of the gingiva was detected in favor of the Er:YAG laser applied sites. Conclusions: Within the limits of the study, it can be concluded that both de-epithelialization techniques were highly effective at 6 months. However, Er:YAG laser-applied grafted sites revealed more uniform and esthetic gingival appearance compared with scalpel-used grafted sites.

Comparison of two different xenografts in bilateral sinus augmentation: radiographic and histologic findings.

OBJECTIVE: The aim of this study was to evaluate the radiographic and histomorphometric results of two different xenografts in bilateral sinus augmentation in patients with posterior maxillary atrophy. METHOD AND MATERIALS: Eight patients with less than 5 mm residual alveolar bone height were included in this study. One side was augmented with bovine bone graft-1 and the other side with bovine bone graft-2. Radiographic analyses were performed before and after augmentation, and before the implant placement. After 8 months of healing period, bone biopsies were obtained during implant placement. RESULTS: No statistically significant difference was found between the groups, based on post-augmentation and pre-implantation graft heights (P > .05). Histomorphometric evaluation demonstrated 24.63% and 29.13% newly formed bone in the graft-1 and graft-2 groups, respectively. Intergroup differences were not significant for the mean percentage of new bone formation (P > .05). CONCLUSION: Within the limitations of this study, it can be concluded that xenograft materials resulted in satisfactory bone height and trabecular new bone formation, and they could be used for the rehabilitation of atrophic maxillae.