Does Non-surgical Periodontal Therapy With Adjunct Antimicrobial Photodynamic Therapy Help Reduce Periodontal Inflammation and Haemoglobin A1c Levels in Patients With Type-2 Diabetes Mellitus? A Systematic Review and Meta-analysis.

PURPOSE: The aim of the present systematic review and meta-analysis was to assess the efficacy of non-surgical periodontal therapy (NSPT) with adjunct photodynamic therapy (aPDT) in reducing periodontal inflammation and haemoglobin A1c (HbA1c) levels in patients with diabetes mellitus (DM). MATERIALS AND METHODS: The focused question was 'Does NSPT with adjunct aPDT help reduce periodontal inflammation and HbA1c levels in patients with DM?' The PICO (patient/population, intervention, comparison and outcomes) was formatted as follows: Patients (P): Participants diagnosed with DM; Intervention (I): NSPT with adjunct PDT for the treatment of periodontitis; Control (C): NSPT alone or NSPT with adjunct systemic antibiotic therapy; and Outcome (O): Changes in HbA1c levels. The inclusion criteria comprised RCTs specifically evaluating the impact of NSPT on HbA1c levels in diabetic patients, with a specific focus on interventions involving NSPT with and without adjunct aPDT. The literature search was performed in accordance with the Preferred reporting items for systematic reviews and meta-analysis. Indexed databases were searched without time and language restrictions using various keywords. Forest plots were created to illustrate the effects of the different studies and the global estimation. RESULTS: Five RCTs were included and processed for data extraction. The number of participants ranged from 12 to 45 patients with medically diagnosed type-2 DM. In all RCTs, aPDT was done using a diode laser with wavelengths ranging between 660 and 810 nm. Three and two RCTs had moderate and high RoB, respectively. In two RCTs, NSPT with adjunct aPDT reported no improvement in clinical periodontal parameters. Two studies reported that NSPT with adjunct aPDT significantly reduces periodontal probing depth compared to NSPT alone. Four of the five RCTs reported that NSPT+PDT does not influence HbA1c levels. CONCLUSIONS: NSPT with or without adjunct aPDT does not affect HbA1c levels in patients with type-2 DM.

Socket Preservation Using Platelet-Rich Fibrin and Free Gingival Grafts.

OBJECTIVE: The present randomised controlled trial is based on the null hypothesis that there is no difference in crestal bone levels (CBLs) following socket preservation (SP) using platelet-rich fibrin (PRF) and free gingival graft (FGG). The aim was to evaluate CBLs following SP using PRF and FGG. METHODS: This study is a parallel-arm randomised controlled trial. Patients in the test and control groups underwent SP using PRF and FGG, respectively. Intraoral visual examination was performed to clinically assess signs of swelling, pus/abscess, and stability of sutures and graft. Self-rated postoperative pain was assessed after 1 week and 6 months using the visual analogue scale (VAS). At the 6-month follow-up, cone-beam computed tomography was performed to evaluate CBL in mesiodistal and buccolingual dimensions. The preoperative cone-beam computed tomographic images were superimposed with those taken at the 6-month follow-up to compare CBLs. Statistical comparisons were performed and level of significance was set at P < .05. RESULTS: The test and control groups each comprised 13 individuals with comparable ages. All teeth included in the test and control groups were located in the maxillary aesthetic zone. At the 1-week follow-up, VAS scores were higher in the control than in the test group (P < .01). At the 6-month follow-up, none of the participants reported self-rated pain. The change in buccolingual dimension was greater in the control group than in the test group (P < .05). CONCLUSIONS: Both FGG and PRF are effective techniques for SP; however, the latter technique is more effcacious in maintaining buccolingual dimensions of the extraction socket.

The antimicrobial activity of tea tree oil (Melaleuca alternifolia) and its metal nanoparticles in oral bacteria.

Tea tree (Melaleuca alternifolia) oil (TTO) is an antimicrobial agent, and hence, its use in fabricating nanoparticles (NP) may be useful in providing more efficacious antimicrobial agents. The current research aimed to test the antimicrobial efficacy of TTO and its TTO-Metal-NPs against oral microbes: Porphyromonas gingivalis, Enterococcus faecalis, and Streptococcus mutans. The antimicrobial activity of TTO and zinc (Zn) and iron (Fe) nanoparticles (NPs) and the combined effects of antimicrobial agents were investigated using agar well diffusion assays. Fourier-transform infrared spectroscopy (FT-IR) was used to identify the phyto-constituents of TTO. Field emission scanning electron microscopy (FE-SEM), dynamic light scatter (DLS), and zeta potential were utilized to analyze the biogenic nanoparticles' morphology, size, and potential. The antimicrobial mode of action was determined by assessing the morphological changes under scanning electron microscopy (SEM). The TTO extracts converted Zn and Fe ions to NPs, having an average size of 97.50 (ZnNPs) and 102.4 nm (FeNPs). All tested agents had significant antibacterial efficacy against the tested oral microbes. However, the TTO extract was more efficacious than the NPs. Combination treatment of TTO with antibiotics resulted in partial additive effects against P. gingivalis and partial antagonistic effects against E. faecalis, S. mutans, and common mouthwashes (Oral B and chlorhexidine). TTO and NP-treated bacteria underwent morphological changes on treatment. M. alternifolia phytochemicals could be useful for further research and development of antimicrobial NPs. The current study highlights the variance in activity observed for different types of bacteria and antagonistic effects seen with common mouthwashes, which represent a threat to therapeutic efficacy and heighten the risk of clinical microbial resistance.

Periodontal and peri-implant status and whole salivary interleukin 1-beta levels among individuals using selective serotonin reuptake inhibitors: an observational study.

OBJECTIVE: Selective serotonin reuptake inhibitors (SSRI) are commonly used for managing psychological diseases such as depression. These disorders are also directly associated with periodontal and peri-implant diseases, namely periodontitis and peri-implantitis, respectively. It is hypothesized that there is no difference in periodontal and peri-implant clinicoradiographic status and unstimulated whole salivary interleukin (IL)-1ß levels in participants using selective serotonin reuptake inhibitors (SSRI) and controls (individuals not using SSRI). The aim of the present observational case-control study was to compare periodontal and peri-implant clinicoradiographic statuses and whole salivary IL-1ß in participants using SSRI and controls. METHODS: Users of SSRI and controls were included. In all participants, periodontal (plaque index [PI], gingival index [GI], probing depth [PD], clinical attachment loss [AL] and marginal bone loss [MBL]) and peri-implant (modified PI [mPI], modified GI [mGI], PD and crestal bone loss [CBL]) were assessed. Unstimulated whole saliva was collected and IL-1ß levels were determined. Information related to duration of implants in function, duration of depressive symptoms and treatment of depression was retrieved from healthcare records. Sample-size was estimated using 5% error and group comparisons were performed. P < 0.05 was considered statistically significant. RESULTS: Thirty-seven SSRI users and 35 controls were assessed. Individuals using SSRI had a history of depression of 4.2 ± 2.5 years. The mean age of SSRI-users and controls were 48.7 ± 5.7 and 45.3 ± 5.1 years, respectively. Tooth brushing twice daily was reported by 75.7% and 62.9% SSRI-users and controls, respectively. There was no statistically significant difference in PI, mPI, GI, mGI, PD, clinical AL, numbers of MT and mesial and distal MBL and CBL among individuals using SSRI compared with controls (Tables 3 and 4). The unstimulated whole salivary flow rate in individuals using SSRI and controls was 0.11 ± 0.003 and 0.12 ± 0.001 ml/min, respectively. Whole salivary IL-1ß levels in individuals using SSRI and controls were 57.6 ± 11.6 pg/ml and 34.6 ± 5.2 pg/ml, respectively. CONCLUSION: Users of SSRI and controls demonstrate healthy periodontal and peri-implant tissue statuses with no marked differences in whole salivary IL-1ß levels provided oral hygiene is stringently maintained.

Photobiomodulation for Managing "Dry Socket": A Randomised Controlled Trial.

OBJECTIVE: There are no studies that have evaluated the effect of Alveogyl with and without adjunct photobiomodulation therapy (PBMT) in reducing self-rated post-operative pain (SPP) in patients with alveolar osteitis (AO; dry socket). The aim of the present randomised controlled trial was to assess the effectiveness of Alveogyl with and without PBMT for the management of SPP in patients with AO. METHODS: Adult nonsmokers with diagnosed AO were included. Patients were randomly divided into 4 groups. In Group 1, patients underwent mechanical curettage (MC) with copious normal saline irrigation. In Group 2, patients underwent MC + Alveogyl dressings in extraction sites which were changed every 48 hours until cessation of pain. In Group 3, patients underwent MC + Alveogyl followed by PBMT using a 660-nm indium-gallium-aluminum-phosphide diode laser. In Group 4, patients were treated solely with PBMT. The visual analogue scale was used up to 3 postoperative days to assess SPP up to 3 days at 6- (T0) and 12-hour (T1) intervals. Statistical analyses were performed using the analysis of variance and Bonferroni post hoc adjustment tests. Correlation between SPP scores and age, sex, and eruption status of teeth was assessed using logistic regression models. P values <.01 were nominated as being statistically significant. RESULTS: In all, 14, 13, 14, and 14 individuals with AO were included in groups 1, 2, 3 and 4, respectively. All patients had undergone extraction of mandibular third molars. At baseline and on day 1, there was no difference in SPP in all groups. On days 2 and 3, mean visual analogue scale (VAS) scores at T1 (P < .01) and T2 (P < .01) intervals were significantly high in Group 2 compared with Group 3. On days 2 and 3, mean VAS scores at T1 (P < .01) and T2 (P < .01) intervals were significantly high in Group 4 compared with Group 3. There was no difference in SPP in groups 3 and 4 on day 3 at T0 and T1 intervals. CONCLUSIONS: PBMT following MC and Alveogyl dressing is more efficient in reducing SPP compared with MC with or without Alveogyl dressing in patients with AO.

Periodontal status and whole salivary adipokines after scaling and root planing with and without adjunct antimicrobial photodynamic therapy in obese patients with periodontitis.

OBJECTIVE: Whole-salivary (WS) adiponectin and leptin levels after scaling and root planing (SRP) with and without antimicrobial-photodynamic-therapy (aPDT) in obese and normal-weight individuals with periodontitis remain uninvestigated. This study compared the effect of SRP without and with adjuvant aPDT on periodontal status and WS leptin and adiponectin levels (LAL) in obese patients with periodontitis. METHODS: Groups 1 and 2 entailed obese patients without and with periodontitis. Groups 3 and 4 had normal weight individuals without and with periodontitis. Therapeutically, individuals with periodontitis were categorized into test- (SRP+aPDT) and control- (SRP alone) subgroups. All patients without periodontitis underwent routine dental prophylaxis. Clinical attachment loss (AL), gingival and plaque index (GI and PI), probing depth (PD), missing teeth (MT) and WS LAL were measured at baseline and at three months of follow-up. P<5% were graded statistically significant. RESULTS: At baseline, clinicoradiographic variables were significantly higher among patients in test- and control-groups in groups 1 (P<0.01) and 3 (P<0.01) versus 2 and 4. In group 2 and 3, LL were significantly high at baseline compared with follow-up (P<0.01). There was no difference in periodontal parameters and WS adiponectin and LL in the test and control-groups at of follow-up. No correlation existed between salivary LAL and clinical periodontal parameters (PI, GI, PD and clinical AL). No correlation existed between age, gender and BMI and WS LAL. CONCLUSION: In the short-term, SRP with or without aPDT is ineffective in the treatment of periodontitis in obese patients with periodontitis.

Development, In-Vitro Characterization and In-Vivo Osteoinductive Efficacy of a Novel Biomimetically-Precipitated Nanocrystalline Calcium Phosphate With Internally-Incorporated Bone Morphogenetic Protein-2.

The repair of large-volume bone defects (LVBDs) remains a great challenge in the fields of orthopedics and maxillofacial surgery. Most clinically available bone-defect-filling materials lack proper degradability and efficient osteoinductivity. In this study, we synthesized a novel biomimetically-precipitated nanocrystalline calcium phosphate (BpNcCaP) with internally incorporated bone morphogenetic protein-2 (BpNcCaP + BMP-2) with an aim to develop properly degradable and highly osteoinductive granules to repair LVBDs. We first characterized the physicochemical properties of the granules with different incorporation amounts of BMP-2 using scanning electron microscopy, X-ray diffraction, Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy. We evaluated the cytotoxicity and cytocompatibility of BpNcCaP by assessing the viability and adhesion of MC3T3-E1 pre-osteoblasts using PrestoBlue assay, Rhodamine-Phalloidin and DAPI staining, respectively. We further assessed the in-vivo osteoinductive efficacy in a subcutaneous bone induction model in rats. In-vitro characterization data showed that the BpNcCaP + BMP-2 granules were comprised of hexagonal hydroxyapatite with an average crystallite size ranging from 19.7 to 25.1 nm and a grain size at 84.13 ± 28.46 nm. The vickers hardness of BpNcCaP was 32.50 ± 3.58 HV 0.025. BpNcCaP showed no obvious cytotoxicity and was favorable for the adhesion of pre-osteoblasts. BMP-2 incorporation rate could be as high as 65.04 ± 6.01%. In-vivo histomorphometric analysis showed that the volume of new bone induced by BpNcCaP exhibited a BMP-2 amount-dependent increasing manner. The BpNcCaP+50 µg BMP-2 exhibited significantly more degradation and fewer foreign body giant cells in comparison with BpNcCaP. These data suggested a promising application potential of BpNcCaP + BMP-2 in repairing LVBDs.

Comparison of the Anti-bacterial Efficacy of Saussurea costus and Melaleuca alternifolia Against Porphyromonas gingivalis, Streptococcus mutans, and Enterococcus faecalis: An in-vitro Study.

The aim was to compare the in-vitro antibacterial effectiveness of two herbal extracts (a) Saussurea-costus (S. costus) and (b) Melaleuca-alternifolia (M. alternifolia) against Porphyromonas gingivalis (P. gingivalis), Streptococcus mutans (S. mutans) and Enterococcus faecalis (E. faecalis). Aqueous extracts from M. alternifolia were prepared by adding 2 grams of S. costus and M. alternifolia, respectively to 100 ml distilled water. Bacterial strains of P. gingivalis, E. faecalis and S. mutans were treated into 3 groups. In groups 1 and 2, bacterial strains were treated with aqueous extracts of S. costus and M. alternifolia, respectively. In the control-group, bacterial strains were exposed to distilled water. Antibacterial activity of the samples and nanoparticles was determined. The minimum-inhibitory-concentration (MIC) values were determined using the microdilution method. P < 0.01 was considered statistically significant. The MIC for all bacterial strains treated with S. costus was significantly higher than that of M. alternifolia (P < 0.001). There was no significant difference in MIC for strains of P. gingivalis, E. faecalis and S. mutans treated with S. costus. For bacterial strains treated with M. alternifolia, the MIC was significantly higher for P. gingivalis compared with E. faecalis and S. mutans strains (P < 0.01). There was no difference in MIC for E. faecalis and S. mutans strains treated with M. alternifolia. The in-vitro antibacterial efficacy of M. alternifolia is higher than S. costus against P. gingivalis, E. faecalis and S. mutans.

Effect of mechanical instrumentation with adjunct photodynamic therapy on salivary TNFα levels and clinical periodontal and peri­implant status in patients with depression: A randomized controlled trial.

INTRODUCTION: The aim of the present randomized controlled trial was to assess the effect of mechanical instrumentation (MI) with adjunct photodynamic therapy (PDT) on salivary tumor necrosis factor-alpha (TNFα) levels and clinical periodontal and peri­implant status in patients with depression. MATERIALS AND METHODS: In groups 1 and 2, individuals with periodontal and peri­implant diseases with and without depression, respectively were included. Group-3 comprised of systemically healthy individuals with a healthy periodontal and peri­implant status. In groups 1 and 2, patients in the test- and control groups received MI with and without PDT respectively. Periodontal and peri­implant probing depth and plaque and gingival indices were measured. Radiographic evaluation was done at baseline. Whole salivary tumor necrosis factor alpha (TNFα) in peri­implant sulcular fluid were measured at baseline. The clinical and immunological parameters were reassessed at 120 days' follow-up. Level of significance was set at P<0.05. RESULTS: Thirty-four, 36 and 37 implants were in function in groups 1, 2 and 3, respectively. At baseline, periodontal and peri­implant clinical parameters and TNFα levels were significantly higher in groups 1 (P<0.05) and 2 (P<0.05) than Group-3. At 4-months follow-up, there was no difference in periodontal and peri­implant clinical parameters in the test- and control groups among individuals in groups 1 and 3. In Group-2, there was a significant reduction in periodontal (P<0.05) and peri­implant (P<0.05) clinical parameters at 4-months follow-up than baseline. In Group-2, there was no significant difference in these parameters among patients in the test- and control-groups. CONCLUSION: In patients with depression clinical periodontal and peri­implant status is poorer and salivary TNFα levels are higher after MI with or without PDT. In healthy patients, PDT offers no additional benefits in the treatment of periodontal inflammation.

Assessment of Knowledge towards Radiation Protection Measures among Newly Graduated Dentists from Egypt and the Kingdom of Saudi Arabia: A Questionnaire-Based Cross-Sectional Study.

Background: It is hypothesized that knowledge towards ionizing radiation (IR) protection measures is lacking among newly graduated dentists from Egypt and Saudi Arabia. The purpose of the present questionnaire-based study was to compare the IR protection knowledge among newly graduated dentists from Egypt and the Kingdom of Saudi Arabia (KSA). Methods: The present investigation was a questionnaire-based study and had a cross-sectional observational analytical design. Newly graduated dentists were defined as individuals who had graduated from a credentialed dental institution within the past 36-months. The questionnaire was related to knowledge about radiation safety, awareness and practices. The questionnaire comprised of 17 multiple choice questions. Questionnaires in which all the 17 questions were not answered or had missing pages were excluded. Odds ratios were computed for the number of correct and incorrect responses and 95% confidence intervals were determined. Individuals that provided up to 40%, 41% to 70% and >70% correct answers were categorized as having "low competence"; "moderate competence" and "high competence" in IR knowledge. p-values less than 0.05 were considered statistically significant. Results: The mean percentage of correct answers provided by dentists from Egypt and KSA were 56.9% and 67.4%, respectively. There was no statistically significant difference in the percentages of correct responses for the 17 questions submitted by respondents from Egypt and KSA. The overall percentage of correct responses ranged between 40.2−71.2% and 45.4−81.4% for respondents from Egypt and KSA, respectively. The odds ratios and 95% confidence intervals showed no statistically significant correlation in the responses from respondents from Egypt and KSA for each of the 17 questions addressed. Conclusion: Newly graduated dentists from Egypt and KSA are moderately competent regarding IR doses and related safety measures. It is recommended that modifications in the undergraduate dental education curriculum with emphasis on IR safety and practice would help enhance the knowledge and competence of students and newly graduated dentists. Moreover, routine continuing dental education seminars/programs may help enhance the IR knowledge of dental students and dentists.

Is a single session of antimicrobial photodynamic therapy as an adjuvant to non-surgical scaling and root planing effective in reducing periodontal inflammation and subgingival presence of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in patients with periodontitis?

OBJECTIVE: The aim was to assess the influence of a single session of antimicrobial photodynamic therapy (aPDT) as an adjunct to non-surgical scaling and root planing (SRP) in reducing periodontal inflammation and subgingival presence of Porphyromonas gingivalis (P. gingivalis) and Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) in patients with periodontitis. METHODS: Patients diagnosed with periodontitis were included. Information regarding age and gender was recorded using a questionnaire. All patients underwent full mouth non-surgical SRP and the following parameters were assessed at baseline: (a) marginal bone loss (MBL); (b) probing depth (PD) (c) clinical attachment loss (CAL); and (d) presence of supra-and subgingival bleeding and plaque (GI and PI). Identification of A. actinomycetemcomitans and P. gingivalis was performed using polymerase chain reaction. For aPDT (test-group), methylene-blue (MB) (0.005%) was used as photosensitizer and it was applied over and inside the buccal pockets of teeth. Using a Diode laser at 660 nm and 150 mW, irradiation was performed All clinical parameters except for MBL and microbiological evaluations were re-assessed at 3-months of follow-up. Level of significance was set at P<0.05. RESULTS: At 3-months of follow-up A. actinomycetemcomitans and P. gingivalis were identified in significantly lower number of patients in groups 1 and 2 compared with their respective baseline values. Number of patients in whom A. actinomycetemcomitans and P. gingivalis were identified at 3-months of follow-up were similar in both groups. At baseline, there was no statistically significant difference in PI, GI, PD, CAL and MBL among patients in groups 1 and 2. In groups 1 and 2, scores of PI (P<0.001), GI (P<0.001) and PD (P<0.001) were significantly higher at baseline compared with their respective 3-months' follow-up scores. CONCLUSION: One application of aPDT with non-surgical SRP is ineffective in managing periodontal inflammation and presence of P. gingivalis and A. actinomycetemcomitans in periodontitis patients.

Effect of multiple sessions of photodynamic therapy on bone regeneration around dental implants among patients with peri­implantitis.

OBJECTIVE: The aim of the present study was to assess the effect of multiple sessions of antimicrobial photodynamic therapy (aPDT) on bone regeneration around dental implants among patients with peri­implantitis. METHODS: Patients with peri­implantitis were included. Therapeutically, patients were randomly divided into 4 groups: (a) Group-I: Mechanical debridement (MD) alone; (b) Group-II: MD at baseline followed by a single session of adjunct a PDT; (c) Group-III: MD at baseline followed by aPDT at baseline and at 3-months of follow-up; and Group-IV: MD at baseline followed by aPDT at baseline and at 3- and 6-months of follow-up. Demographic data was collected and peri­implant clinical (plaque index [PI], gingival index [GI], and probing depth [PD]) and radiographic (crestal bone loss [CBL]) parameters were assessed at baseline and after 9 months. Sample-size estimation was done on data from a pilot investigation and group comparisons were done using one-way analysis of variance and Bonferroni post-hoc adjustment tests. Level of significance was set at P<0.01. RESULTS: Twenty-two, 22, 22 and 22 patients with peri­implantitis were enrolled in groups -I, -II, -III and -IV. The mean age of individuals in groups -I, -II, -III and -IV were 59.2 ± 5.3, 60.5 ± 2.8, 59.6 ± 3.1 and 58.7 ± 0.8 years, respectively. Compared with Group-I, there was a statistically significant reduction in PI (P<0.01), GI (P<0.01) and PD (P<0.01) in all groups at 9-months follow-up. There was no significant difference in PI, GI and PD in groups -II, -III and -IV at 9-months follow-up. There was no statistically significant difference in CBL in all groups at baseline and at 9-months-follow-up. CONCLUSION: The use of aPDT as an adjunct to MD reduces the severity of peri­implant mucositis but does not contribute towards bone regeneration in peri­implant osseous defects.

Myrrh mixed with silver nanoparticles demonstrates superior antimicrobial activity against Porphyromonas gingivalis compared to myrrh and silver nanoparticles alone.

INTRODUCTION: Gingivitis is an oral condition characterized by inflammation and bleeding of the gingiva (gums), largely caused by Porphyromonas gingivalis. Oral hygiene options for controlling P. gingivalis include mouthwash containing Commiphora myrrha (myrrh), which has been shown to be effective against the microbe. Silver nanoparticles (SN) have been studied for their antibacterial effect in different oral health applications, including mouthwash. This was an in vitro laboratory study of the anti-microbial actions of myrrh and SN against P. gingivalis. METHODS: We compared the anti-microbial properties against P. gingivalis of four solutions: a) placebo solution, b) myrrh solution (MS), c) MS mixed with silver nanoparticles (MSN), and d) SN suspension alone. Sixteen agar plates were divided into four groups of four plates, and each group was treated with one of the solutions/suspensions. The solution/suspension was administered on the agar disc diffusion method, and inhibition zones (IZs) were measured after 24 (time 1), 48 (time 2), and 72 h (time 3). To characterize MSN and SN, Fourier-transform infrared spectroscopy (FT-IR) was used. UV-Vis spectroscopy and energy dispersive X-ray (EDX) were used to further characterize MSN. RESULTS: After 24 h, the median IZ for the MS plates was 16 mm, and the median IZ for MSN plates was 15 mm. At time 2, the MS median IZ was 15 mm, but the MSN median IZ increased to 18 mm, and the interquartile ranges (IQRs) did not overlap. At time 3, the median IZs was similar again, with MSN and MS having IZs of 16 mm and 15 mm, respectively. SN alone showed no anti-microbial activity. CONCLUSIONS: Our findings show that MSN displayed superior anti-microbial activity against P. gingivalis compared to MS and SN after 48 h of incubation, but not after 24 h. Also, the increased anti-microbial activity had ceased by 72 h.

Effect of Systemic Calcitonin Delivery with and Without Adjunct Local Platelet-rich Fibrin Therapy on Osseointegration in Ovariectomized Osteoporotic Rabbits: A Scanning Electron Microscopy-based Study.

PURPOSE: It is hypothesised that systemic calcitonin delivery with adjunct local platelet-rich fibrin (PRF) therapy is more effective in augmenting osseointegration than calcitonin delivery alone under experimental osteoporosis conditions. The primary objective of the present experiment was to assess the effect of systemic calcitonin delivery with and without adjunct local PRF therapy on osseointegration in ovariectomised osteoporotic rabbits. MATERIALS AND METHODS: Thirty female bilaterally ovariectomized rabbits were used. The animals were fed a low-calcium diet to establish a model for osteoporosis. In each animal, 2 implants were bilaterally placed in tibia. The animals were randomly divided equally into 3 groups. In group 1, no treatment was offered (control group). In groups 2 and 3, the animals received intramuscular injections of calcitonin without and with local PRF delivery prior to implant placement, respectively. All animals were euthanised at 12 weeks, and osseointegration was assessed as the gap widths between the bone and implant surface in the cervical, middle and apical third using scanning electron microscopy and energy-dispersive x-ray spectroscopy. The bone-to-implant contact (BIC) was also measured. p < 0.05 was defined as statistically significant. RESULTS: Gap widths in the cervical (p < 0.001), middle (p < 0.001) and apical third (p < 0.001) were statistically significantly higher in group 1 than groups 2 and 3. Gap widths in the cervical (p < 0.001), middle (p < 0.001) and apical third (p < 0.001) were significantly higher in group 3 than group 2. The mean BIC was statistically significantly higher in the cervical (p < 0.001), middle (p < 0.001) and apical third (p < 0.001) in group 3 compared with groups 2 and 3. CONCLUSIONS: When used as an adjunct to calcitonin, PRF enhanced osseointegration in an experimental osteoporosis model. However, further well-designed studies with inclusion of additional groups (treatment with PRF alone) are needed.

Association between Periodontitis and Genetic Polymorphisms in Interleukins among Patients with Diabetes Mellitus.

There is a perplexity in the association between interleukin (IL) polymorphisms and periodontitis among patients with and without diabetes mellitus (DM). The aim of the present study was to evaluate indexed data regarding the association between periodontitis and genetic polymorphisms in interleukins among patients with and without DM. The addressed question was "Is there an association between periodontitis and polymorphisms in interleukins among patients with and without DM?" Original studies were included. Indexed databases were searched, and the pattern of the present literature review was customized to summaries' the pertinent information. Eight studies were included and processed for data extraction. Two studies showed that polymorphisms in IL-1B genes aggravate periodontitis in patients with type-2 DM, and two studies showed that IL-1B genes either do not or are less likely to contribute towards the progression of periodontitis in patients with type-2 DM. Two studies reported that IL genes do not show cross-susceptibility with periodontitis and type-2 DM. One study reported that the primary factor that governs the occurrence and progression of periodontitis in patients with and without type-2 DM is poor routine oral hygiene maintenance. Seven studies had a high risk of bias. The role of IL gene polymorphisms in the development and progression of periodontitis in patients with and without DM remains controversial.

Antimicrobial efficacy of 0.8% Hyaluronic Acid and 0.2% Chlorhexidine against Porphyromonas gingivalis strains: An in-vitro study.

OBJECTIVE: The aim of the present in-vitro study was to assess antimicrobial efficacy of 0.8% hyaluronic acid (HA) and 0.2% Chlorhexidine gluconate (CHX) against Porphyromonas gingivalis (P. gingivalis). METHODS: The study was performed between December 2018 and March 2019 at the College of Dentistry at the Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. The P. gingivalis biofilms were formed and grown for 72 hours at 37°C under anaerobic conditions on glass slides coated with human saliva. The slides were individually positioned and exposed to 0.8% HA or 0.2% CHX. Therapeutically, the biofilms were divided into 3 groups as follows: (a) negative group; (b) 0.8% HA group and (c) 0.2% CHX group. P-values less than 0.05 were considered statistically significant. RESULTS: In the 0.8% HA group, P. gingivalis CFUs/ml were significantly higher at baseline than at 24- (P<0.05), 48 (P<0.05) and 72 hours (P<0.05) intervals. In the 0.2% CHX group, P. gingivalis CFUs/ml were significantly higher at baseline than at 72 hours interval (P<0.05). In the CHX group, there was no difference in P. gingivalis CFUs/ml between baseline, 24- and 48-hours intervals. At 48- and 72-hours intervals, the P. gingivalis CFUs/ml were significantly higher in the 0.2% CHX group compared with the 0.8% HA group. CONCLUSION: In-vitro, 0.8% HA is more effective in reducing the P. gingivalis CFUs/ml compared with 0.2% CHX.

Clinical periodontal status and gingival crevicular fluid cytokine profile among cigarette-smokers, electronic-cigarette users and never-smokers.

OBJECTIVE: There are no studies that have compared the clinical (plaque index [PI], bleeding on probing [BOP], probing depth [PD], clinical attachment loss [AL] and number of missing teeth [MT]) and radiographic (marginal bone loss [MBL]) periodontal parameters and gingival crevicular fluid (GCF) levels of proinflammatory cytokines among cigarette-smokers and individuals using electronic-cigarettes. The aim was to compare the clinical periodontal status and gingival crevicular fluid (GCF) cytokine profile among cigarette-smokers (Group-1), electronic-cigarette users (Group-2) and never-smokers (Group-3). METHODS: Demographic data including age, gender, duration and reason for smoking and vaping and daily frequency and duration of smoking and vaping was collected using a questionnaire. Clinical (PI, BOP, PD and clinical AL) and radiographic (MBL) periodontal parameters were recorded. The volume of collected GCF was determined and levels of interleukin (IL) 1ß, IL-6, tumour-necrosis-factor-alpha (TNF-α), matrix metalloproteinase (MMP)-8 and interferon-gamma (IFN-γ) were investigated. RESULTS: Forty-six cigarette-smokers, 44 electronic-cigarette users and 45 never-smokers were included in groups 1-3, respectively. Mean scores of PI (P < 0.05), PD (P < 0.05) and clinical AL (P < 0.05) were significantly higher among individuals in Group-1 than Group-3. Compared with groups 1 (P < 0.05) and 2 (P < 0.05), BOP was more often manifested among patients in Group-3. Compared with Group-3, MBL was significantly higher in groups 1 (P < 0.01) and 2 (P < 0.01). GCF volume was significantly higher in Group-1 compared with groups 2 and 3. The concentrations of IL-1ß, IL-6, IFN-γ, TNF-α and MMP-8 were significantly higher in the GCF samples of individuals in Group-1 (P < 0.05) than groups 2 and 3. CONCLUSION: Periodontal status is poorer and GCF levels of proinflammatory cytokines are higher in cigarette-smokers compared with electronic-cigarette smokers and never-smokers. However, the probability of increased periodontal inflammation and GCF proinflammatory cytokine levels in electronic-cigarette users than never-smokers cannot be annulled.

Role of problem-based learning in undergraduate dental education: a questionnaire-based study.

BACKGROUND: There is a debate regarding the significance of problem-based learning (PBL) model in educational systems. The aim of this study was to assess the awareness of dental students at the Princess Nourah Bint Abdulrahman University (PNU), Saudi Arabia, toward PBL. METHODS: The present cross-sectional study was performed at the College of Dentistry, PNU, Riyadh, Saudi Arabia. An anonymous, standardized and self-administered questionnaire (based on nine items) coded as 1, 2, 3 and 4 was distributed to the first-, second-, third- and fourth-year undergraduate students, respectively, after a seminar that focused on the perceptions of PBL among the students at the end of the academic year 2017. The questionnaire was developed following an exhaustive search of indexed databases. Based on the students' responses (yes/no) to the questions, group mean differences (95% CI) were computed and Pearson's chi-squared test was used for data analysis. Cronbach's alpha coefficient was also determined. The level of significance was set at P<0.05. RESULTS: In total, 238 female undergraduate dental students (61 first-year, 59 second-year, 60 third-year and 58 fourth-year students) were included. The Cronbach's alpha coefficient ranged between 0.82 and 0.93. Group comparisons (95% CI) showed no statistically significant difference in the responses (yes) of students in the first, second, third and fourth year of academic years related to the perceptions listed earlier (P>0.05). CONCLUSION: Perception of female undergraduate dental students at the PNU was inconclusive. Further studies are warranted in this regard.

Impact of cigarette smoking and vaping on the outcome of full-mouth ultrasonic scaling among patients with gingival inflammation: a prospective study.

OBJECTIVES: There are no studies that have assessed the oral soft tissue response to full-mouth ultrasonic scaling (FMUS) among cigarette-smokers (CS) (group 1), individuals vaping electronic-cigarettes (E-cigs) (group 2), and never-smokers (NS) (group 3). The aim was to assess the impact of cigarette smoking and vaping on periodontal tissues following FMUS. MATERIALS AND METHODS: In a clinical prospective study, 89 male individuals were divided into three groups: CS (group 1), E-cig users (group 2), and NS (group 3). A questionnaire was used to gather demographic data and information regarding duration and daily frequency of CS and vaping. Full-mouth plaque index (PI), bleeding on probing (BOP), clinical attachment loss (AL), and probing depth (PD) were measured at baseline and 3 and 6 months after FMUS (without root surface debridement). Numbers of missing teeth (MT) were also recorded. RESULTS: In groups 1, 2, and 3, 30, 28, and 31 individuals, respectively were included. In group 1, there was no statistically significant difference in mean PI and PD and numbers of sites with PD ≥ 4 mm at 6 months' follow-up compared with baseline and 3 months' follow-up. In groups 2 and 3, there was no significant difference in PI, BOP, and PD at 3 months' (P > 0.05) and 6-months' (P > 0.05) follow-up. There were no pockets with PD ≥ 4 mm at 3 and 6 months' follow-up in groups 2 and 3. There was no difference in the numbers of MT and none of the individuals exhibited clinical AL in all groups. CONCLUSION: Following FMUS, gingival inflammation is worse in CS compared with individuals vaping E-cigs and NS. CLINICAL RELEVANCE: Periodontal inflammatory parameters are worse in cigarette-smokers than individuals vaping electronic cigarettes and never-smokers following FMUS. However, these findings should be interpreted with extreme caution as a number of factors may have influenced the present results.