Management of recurrent aphthous ulcers with therapeutic Nd:YAG laser, using two different methods.

BACKGROUND: Low-level laser therapy (LLLT) has been applied for the management of craniomaxillofacial disorders, including intraoral wounds, as well as recurrent aphthous stomatitis (RAS) lesions. However, the proper combination of laser features and tissue characteristics remains the major challenge in the realm of photobiomodulation (PBM). OBJECTIVES: The aim of the present study was to assess the feasibility of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser therapy in treating RAS lesions, and to compare 2 techniques, different with regard to the distance between the fiber tip and the ulcer. MATERIAL AND METHODS: A total of 138 patients (94 males and 44 females) with untreated RAS were divided into 3 groups: focused laser (energy density: 48 J/cm2; power density: 0.797 W/cm2; spot size: 0.1256 cm2); defocused laser (energy density: 21 J/cm2; power density: 0.354 W/cm2; spot size: 0.2826 cm2); and placebo. In the focused group, laser irradiation was performed with the laser tip kept 1 mm away from the lesion. Acrylic cylinders were prepared to precisely fit the handpiece tip and hold it in the proper position. In the defocused group, acrylic cylinders were prepared to set the laser tip 6 mm away from the lesion to obtain defocused irradiation. Finally, in the placebo group, a routine laser therapy procedure was carried out with a helium-neon (He-Ne) red light laser. The lesion size, and pain intensity and duration were recorded. RESULTS: Photobiomodulation showed a significantly more efficient pain relief as compared to the placebo group (p < 0.001) and also significantly better results in decreasing pain duration (p < 0.001). Besides, the diameter of the lesions in the exposed cases decreased during the 3 consecutive days of the study, while an increase in the diameter of the lesions was noticed in the placebo group. CONCLUSIONS: The Nd:YAG laser therapy, with the conditions and adjustments of the present study, may be successfully applied to manage RAS lesions, using either focused and defocused scanning techniques.

Average and Maximum Papilla Heights around Dental Implants in the Anterior Maxillary Region: A Retrospective Clinical Study.

OBJECTIVE: The aim of this study was to determine the average and maximum height of the papilla around maxillary anterior implants in respect of neighboring structures and location of implants. MATERIALS AND METHODS: 92 dental implants from 63 patients were investigated in this study. Those implants were placed in the anterior maxillary region and had been loaded for a minimum of one year. After receiving written consent, clinical data including the height of interproximal papillae adjacent to the tooth/implant/pontic were obtained through clinical observation. The independent t-test or ANOVA, the regression modeling, and generalized estimating equation (GEE) models were used for statistical analysis (p < 0.05). RESULTS: Papilla height was calculated as 2.8 mm (1-5.5 mm) for implant-tooth sites, 2.6 mm (1-4 mm) in implants beside pontics, and 2.5 mm (1-3.5 mm) for implants adjacent to implants. Despite the lack of a significant difference in the mean papilla height in the studied groups, the maximum values of papilla heights were significantly different. CONCLUSIONS: In this study, no significant differences were found in papilla height mean values in relation to neighboring structures or location of implants in the anterior maxilla. However, the maximum values of papilla heights were observed around implants next to natural teeth.

Comparison of the Effects of Er, Cr: YSGG Laser and Super-Saturated Citric Acid on the Debridement of Contaminated Implant Surfaces.

Introduction: Several techniques such as using citric acid, plastic curettes, ultrasonic devices, and lasers have been suggested for debridement of contaminated implant surfaces. This comparative investigation aimed to assess and compare the effects of Er, Cr: YSGG laser and super-saturated citric acid on the debridement of contaminated dental implant surfaces. Methods: In this in-vitro study, 12 contaminated failed implants were collected and randomly divided into 2 groups (6 in group A, and 6 in group B). Also, one implant was considered as the control. The implants were horizontally sectioned into coronal and apical portions and subsequently irradiated by Er, Cr: YSGG laser in coronal and citric acid in apical in group A and the opposite in group B. In order to evaluate the effect of water spray on the laser section, half the laser portion of the implants was irradiated using water, while the other half was irradiated without water with an irradiation time of 1 minute. Results: Results revealed that calculus and plaque removal was greater in the laser part of both groups (with and without water) compared to citric acid parts and the correlation between calculus removal and surface roughness were statistically significant. Furthermore, the surface roughness in the citric acid parts was significantly higher than in laser parts. Water spray during irradiation had a very small influence on understudy factors. Conclusion: Based on the results of this study, the Er, Cr: YSGG laser was more effective in calculus removal and caused less surface roughness compared with citric acid application.

Effects of Root Debridement With Hand Curettes and Er:YAG Laser on Chemical Properties and Ultrastructure of Periodontally-Diseased Root Surfaces Using Spectroscopy and Scanning Electron Microscopy.

Introduction: The efficacy of erbium-doped yttrium aluminum garnet (Er:YAG) laser for root debridement in comparison with curettes has been the subject of many recent investigations. Considering the possibility of chemical and ultra-structural changes in root surfaces following laser irradiation, this study sought to assess the effects of scaling and root planing (SRP) with curettes and Er:YAG laser on chemical properties and ultrastructure of root surfaces using spectroscopy and scanning electron microscopy (SEM). Methods: In this in vitro experimental study, extracted sound human single-rooted teeth (n = 50) were randomly scaled using manual curettes alone or in conjunction with Er:YAG laser at 100 and 150 mJ/pulse output energies. The weight percentages of carbon, oxygen, phosphorous and calcium remaining on the root surfaces were calculated using spectroscopy and the surface morphology of specimens was assessed under SEM. Data were analyzed using one-way analysis of variance (ANOVA). Results: No significant differences (P > 0.05) were noted in the mean carbon, oxygen, phosphorous and calcium weight percentages on root surfaces following SRP using manual curettes with and without laser irradiation at both output energies. Laser irradiation after SRP with curettes yielded rougher surfaces compared to the use of curettes alone. Conclusion: Although laser irradiation yielded rougher surfaces, root surfaces were not significantly different in terms of chemical composition following SRP using manual curettes with and without Er:YAG laser irradiation. Er:YAG laser can be safely used as an adjunct to curettes for SRP.

Comparing fibroblast attachment in root surface scaling with Er, Cr:YSGG laser versus ultrasonic scaler: A SEM study.

BACKGROUND AND OBJECTIVES: The regeneration of periodontal support is the main concern in periodontal therapy. The aim of this in vitro study was to investigate the fibroblasts attachment on root surfaces after scaling with Er, Cr:YSGG laser and ultrasonic instruments using scanning electron microscopy (SEM). METHODS: 72 root plates of ∼6 × 4 × 1 mm3 in dimension were prepared from 27 single-rooted human mature teeth and were then divided into four groups. One group irradiated with a G6 tip of Er, Cr:YSGG laser (2.78 µm, 0.75 W, pulse duration of 140 µs, repetition rate of 20 Hz) for 5 to 7 s, and the other groups were scaled with ultrasonic alone or laser-ultrasonic. The control group was subjected to neither laser nor ultrasonic scaling. Subsequently, Viability and proliferation rates were done using MTT assay on days 3 and 5. Finally the cell attachment was observed using SEM. RESULTS: The data derived from MTT and cell-attachment analysis indicated that laser-ultrasonic scaling tended to increase cell-viability by the lapse of time (within 3-5 days), with significantly better cell-attachment compared with other groups on days 3 and 5 (p < .05). The comparison of the difference in fibroblast cell attachment rate on both the third and the fifth day with independent T-Test indicated a significant rise on the fifth day compared to the third day of study (p < .05). CONCLUSION: Indeed, both Er, Cr:YSGG laser and ultrasonic scaling may promote fibroblast attachment on dentinal root surfaces more than laser or ultrasonic scaling alone.

Clinical Comparison of Full and Partial Double Pedicle Flaps with Connective Tissue Grafts for Treatment of Gingival Recession.

STATEMENT OF THE PROBLEM: Gingival recession has been considered as the most challenging issue in the field of periodontal plastic surgery. PURPOSE: The purpose of this study was to evaluate the clinical efficacy of root coverage procedures by using partial thickness double pedicle graft and compare it with full thickness double pedicle graft. MATERIALS AND METHOD: Eight patients, aged 15 to 58 years including 6 females and 2 males with 20 paired (mirror image) defects with class I and II gingival recession were randomly assigned into two groups. Clinical parameters such as recession depth, recession width, clinical attachment level, probing depth, and width of keratinized tissue were measured at the baseline and 6 months post-surgery. A mucosal double papillary flap was elevated and the respective root was thoroughly planed. The connective tissue graft was harvested from the palate, and then adapted over the root. The pedicle flap was secured over the connective tissue graft and sutured. The surgical technique was similar in the control group except for the prepared double pedicle graft which was full thickness. RESULTS: The mean root coverage was 88.14% (2.83 mm) in the test group and 85.7% (2.75 mm) in the control group. No statistical differences were found in the mean reduction of vertical recession, width of recession, or probing depth between the test and control groups. In both procedures, the width of keratinized tissue increased after three months and the difference between the two groups was not statistically significant in this respect. CONCLUSION: Connective tissue with partial and full thickness double pedicle grafts can be successfully used for treatment of marginal gingival recession.

Bone-added periodontal plastic surgery: a new approach in esthetic dentistry.

This article proposes a combined technique including bone grafting, connective tissue graft, and coronally advanced flap to create some space for simultaneous bone regrowth and root coverage. A 23 year-old female was referred to our private clinic with a severe class II Miller recession and lack of attached gingiva. The suggested treatment plan comprised of root coverage combined with xenograft bone particles. The grafted area healed well and full coverage was achieved at 12-month follow-up visit. Bone-added periodontal plastic surgery can be considered as a practical procedure for management of deep gingival recession without buccal bone plate.

Comparison of the clinical outcomes of connective tissue and acellular dermal matrix in combination with double papillary flap for root coverage: A 6-month trial.

BACKGROUND: Different techniques have been proposed for the treatment of gingival recession. The majority of current procedures use autogenous soft-tissue grafts, which are associated with morbidity at the donor sites. Acellular dermal matrix (ADM) Alloderm is an alternative donor material presented to reduce related morbidity and provide more volume of the donor tissue. This study aimed to evaluate the effectiveness of an ADM allograft for root coverage and to compare it with a connective tissue graft (CTG), when used with a double papillary flap. MATERIALS AND METHODS: Sixteen patients with bilateral class I or II gingival recessions were selected. A total of 32 recessions were treated and randomly assigned into the test and contralateral recessions into the control group. In the control group, the exposed root surfaces were treated by the placement of a CTG in combination with a double papillary flap; and in the test group, an ADM allograft was used as a substitute for palatal donor tissue. Probing depth, clinical attachment level, width of keratinized tissue (KT), recession height and width were measured before, and after 2 weeks and 6 months of surgery. RESULTS: There were no statistically significant differences between the test and control groups in terms of recession reduction, clinical attachment gain, and reduction in probing depth. The control group had a statistically significant increased area of KT after 6 months compared to the test group. CONCLUSION: ADM allograft can be considered as a substitute for palatal donor tissue in root coverage procedure.

Analysis of RANKL gene polymorphism (rs9533156 and rs2277438) in Iranian patients with chronic periodontitis and periimplantitis.

OBJECTIVE: RANK/OPG/RANKL pathway plays a significant role in osteoclastogenesis, osteoclast activation, and regulation of bone resorption. The aim of this study was to investigate the association of RANKL gene polymorphisms (rs9533156 and rs2277438) with chronic periodontitis and peri-implantitis in an Iranian population. DESIGN: 77 patients with chronic periodontitis, 40 patients with peri-implantitis and 89 periodontally healthy patients were enrolled in this study. 5cc of blood was obtained from the cephalic vein of subjects arms and transferred into tubes containing EDTA. Genomic DNA was extracted using Miller's Salting Out technique. The DNA was transferred into 96 division plates, transported to Kbioscience Institute in United Kingdom and analyzed using the Kbioscience Competitive Allele Specific PCR (KASP) technique. Differences in the frequencies of genotypes and alleles in the disease and control groups were analyzed using Chi-square and Fisher's exact statistical tests. RESULTS: Comparison of frequency of alleles in SNP rs9533156 of RANKL gene between the chronic periodontitis group with the control and peri-implantitis groups revealed statistically significant differences (P=0.024 and P=0.027, respectively). Comparison of genotype expression of SNP rs9533156 on RANKL gene between the peri-implantitis group with chronic periodontitis and control groups revealed statistically significant differences (P=0.001); the prevalence of CT genotype was significantly higher amongst the chronic periodontitis group. Regarding SNP rs2277438 of RANKL gene, comparison of prevalence of genotypes and frequency of alleles did not reveal any significant differences (P=0.641/P=0.537, respectively). CONCLUSIONS: The results of this study indicate that CT genotype of rs9533156 RANKL gene polymorphism was significantly associated with peri-implantitis, and may be considered as a genetic determinant for peri-implantitis.

Three dimensional socket preservation: a technique for soft tissue augmentation along with socket grafting.

BACKGROUND: A cursory review of the current socket preservation literatures well depicts the necessity of further esthetic considerations through the corrective procedures of the alveolar ridge upon and post extraction. A new technique has been described here is a rotational pedicle combined epithelialized and connective tissue graft (RPC graft) adjunct with immediate guided tissue regeneration (GBR) procedure. RESULTS: We reviewed this technique through a case report and discuss it's benefit in compare to other socket preservation procedures. CONCLUSION: The main advantages of RPC graft would be summarized as follows: stable primary closure during bone remodeling, saving or crating sufficient vestibular depth, making adequate keratinized gingiva on the buccal surface, and being esthetically pleasant.

Clinical, histologic and histomorphometric evaluation of socket preservation using a synthetic nanocrystalline hydroxyapatite in comparison with a bovine xenograft: a randomized clinical trial.

OBJECTIVES: The aim of this study was to compare a nanocrystalline hydroxyapatite (NCHA), NanoBone(®) and a deproteinized bovine bone mineral (DBBM), Bio-Oss(®) with a collagen membrane on the horizontal ridge width alterations following tooth extraction, in addition to histologic aspects of the grafted extraction sockets. MATERIAL AND METHODS: In this randomized clinical trial, 28 symmetrical, non-molar, extraction sockets using a split-mouth design in 12 patients (eight women and four men; aged 21-60; mean 44.6 ± 11.4 years), were randomly selected in the first group to be grafted with DBBM granules covered with a collagen membrane and in the other group grafted with NCHA covered with a collagen membrane. Following extraction horizontal ridge width was measured using caliper and was blindly compared to the dimensions measured prior to implant placement, at the 6- to 8-month follow-up. Subsequently, a 2 × 6 mm trephine core was obtained with aid of acrylic stent and routine histologic preparation was performed on the specimens. RESULTS: The width of the DBBM group decreased from 7.75 ± 1.55 to 6.68 ± 1.85 mm (P < 0.05), whereas the width of the NCHA group decreased from 7.36 ± 1.94 to 6.43 ± 2.08 mm (P < 0.05). The mean between-group difference did not reach statistical significance (P = 0.62). Furthermore, histologic and histomorphometric analyses revealed 28.63 ± 12.53% vital bone in NCHA group vs. 27.35 ± 12.39% in DBBM group, and no statistically significant difference between the groups (P = 0.68). CONCLUSION: Socket preservation using either NCHA or DBBM in combination with collagen membrane, results in similar, limited horizontal ridge width alterations following tooth extraction.

Effect of bioactive ceramic and recombinant human transforming growth factor-beta (rhTGF-beta) on regeneration of parietal bone defects in rat.

AIMS: The purpose of this study was to evaluate the regenerative response of parietal bone defects in rats to bioactive ceramic and TGF-beta 1. MATERIALS AND METHODS: Sixty mature adult rats with initial weights of 300 g to 324 g were used. The diameter of each defect was 3 mm. The animals were divided into four study groups consisting of 15 rats per group. Groups 1 and 3 (control groups) received 30 µg bioceramic per surgical defect site. Groups 2 and 4 (experimental groups) received 30 µg bioceramic combined with 10 µL of reconstituted TGF-beta 1 (200 ng). Animals of Groups 1 and 3 were euthanized at 18 days; Group 2 and 4 animals were terminated at 49 days after surgery. Each of the outcomes was analyzed via two-way analysis of variance model (ANOVA). RESULTS: Histologic reactions to the implants were similar with no significant difference between bioceramic and bioceramic + TGF-beta 1 specimens. In the 18-day specimens, the percentage of ceramic was marginally higher than the 49-day specimens. No significant difference was noted in the percentage of bone in 18-day and 49-day specimens. CONCLUSIONS: Based on the findings of this study, it was concluded that TGF-beta 1 promoted no significant increase in new bone when compared to bioactive ceramic alone.

An evaluation of the occluding effects of Er;Cr:YSGG, Nd:YAG, CO2 and diode lasers on dentinal tubules: a scanning electron microscope in vitro study.

OBJECTIVE AND BACKGROUND: Dentin hypersensitivity (DH) is one of the most frequent problems causing patients' complaints following stimulation of cervically exposed dentin. Studies have shown that different lasers have various occluding effects on dentinal tubules. This study is aimed at evaluating the occluding effects of Er;Cr:YSGG (P:0.25W,F:20Hz,Pd:140µS), Nd:YAG (P:1W,F:20Hz), CO(2) (P:1W, Pd:50µs), and 810-nm diode (P:2 W, Pd:30ms) lasers on dentinal tubules. METHODS: Fifteen human third molars were collected and ground-sectioned vertically on the buccal and lingual surfaces to yield two dentin disks of 2-mm thickness. Then, four sites for laser irradiation and one control site were marked in the cervical areas of the dentin disks. Before laser application, specimens were exposed to a 14% EDTA solution to expose dentinal tubules and were then evaluated by scanning electron microscopy (SEM). The tubules' entrance diameters were determined by "scale-bar" software (Phillips Scale-Bar, Phillips, Amsterdam, The Netherlands), which is specifically designed for SEM. The mean diameters for the tubules were then estimated for each site and analyzed statistically. RESULTS: The mean dentinal tubule entrance diameters for Er;Cr:YSGG, 810-nm diode, CO(2), and Nd:YAG, were 1.73, 3.27, 2.10, and 1.64 microns, respectively, compared with 3.52 microns before laser irradiation. Overall, the furthest reduction in mean tubule diameter resulted from the Nd: YAG laser (53%). However, tubular diameter reduction in all laser groups (p<0.05) was found to be statistically significant. In all laser groups, melting of the peritubular dentin was the dominant observed phenomenon. CONCLUSION: Our results indicate that Nd: YAG, Er; Cr: YSGG, and CO(2) lasers, through their ability to melt peritubular dentin, can occlude dentinal tubules partially or totally, and therefore reduce patients' hypersensitivity symptoms. The 810-nm diode laser sealed tubules to a far lesser degree, with negligible effects on desensitization.