Ultrasound analysis of the masseter and anterior temporalis muscles in edentulous patients rehabilitated with full-arch fixed implant-supported prostheses.

OBJECTIVES: Total tooth loss is common in the aging population resulting in insufficient chewing function with subsequent weakening of the masticatory muscles. The study aims to evaluate the changes in thicknesses of the masseter and anterior temporal muscle in edentulous patients following the reconstruction of implant-supported fixed prostheses and compare them with the dentate individuals. MATERIALS AND METHODS: The study was designed as a prospective, single-center, controlled clinical trial. A total of 60 participants were included in the present study. The patients were divided into two groups; Group I (Test Group): 30 edentulous patients who received implant-supported fixed prostheses, Group II (Control Group): 30 dentate individuals of an age and sex-matched group. Ultrasonography was used to measure the cross-sectional thickness of the left and right musculus masseter and anterior temporalis immediately after the cementation of the prosthetic rehabilitation (T1), on the 1st (T2) and 6th (T3) months after rehabilitation and at a single time point in the control group. RESULTS: The results showed that there were significant comparison differences in muscle thickness at the baseline measurements between groups while at the end of the 6th month, these differences were not significant. The muscle thicknesses of both the masseter and anterior temporalis muscles increased significantly at T2 and T3 compared to T1 in the test group. The asymmetry index between the left and right muscles in the test group and the asymmetry differences between groups also decreased significantly at the end of the 6th month. CONCLUSION: The implant-supported fixed prostheses significantly increase the thicknesses of the masseter and anterior temporal muscle together with a decrease in the asymmetry between the left and right muscles. At six months, implant-treated patients showed similar muscle thicknesses compared to dentate individuals. CLINICAL RELEVANCE: The findings suggest that implant-supported fixed prostheses can improve the masticatory function and facial symmetry of edentulous patients.

Evaluation of salivary stress markers and inflammatory cytokine levels in peri-implantitis patients.

BACKGROUND AND OBJECTIVE: Psychological stress has been identified in some observational studies as a potential factor that may modify and affect periodontal diseases, but there are no similar data for peri-implantitis. The aim of this study was to determine the relationship between interleukin (IL)-1ß, IL-6, IL-10, interferon (IFN)α inflammatory cytokines and the psychological stress-related markers, glucocorticoid receptor-α (GRα), and salivary α-amylase (sAA) gene expression levels in saliva samples obtained from healthy implants and peri-implantitis patients. MATERIALS AND METHODS: The study included a total of 50 systemically healthy subjects. Peri-implant clinical parameters were recorded and psychological stress level was evaluated with the hospital anxiety and depression scale (HAD) and state-trait anxiety inventory (STAI) questionnaire forms. Following the evaluations, the patients were divided into 4 groups according their stress and clinical status (Ia, Ib, IIa, IIb). IL-1ß, IL-6, IL-10, IFNα, GRα, sAA gene expression levels in the saliva samples were quantified by quantitative polymerase chain reaction (qPCR). RESULTS: In the group of peri-implantitis who had a high score in stress level assessment scales, significantly higher IL-1ß, IL-6, sAA expression levels were observed (p < 0.001). The IL-10 gene expression levels were lower in the groups with a high score in the stress level assessment scales (p < 0.001). GRα gene was expressed at lower levels in the group of peri-implantitis who had a high score in stress level assessment scales but the difference was not statistically significant (p = 0.065). CONCLUSION: The study findings suggest that psychological stress may increase the inflammation associated with peri-implantitis by affecting cytokine expression levels. CLINICAL RELEVANCE: To prevent peri-implantitis or reduce its prevalence, it could be beneficial to evaluate stress levels and identify individuals experiencing stress.

Assessing the osseointegration potential of a strontium releasing nanostructured titanium oxide surface: A biomechanical study in the rabbit tibia plateau model.

OBJECTIVES: To investigate the impact of a Ti-Sr-O technology, applied to either a turned surface or an SLA surface, on the mechanical robustness of osseointegration, benchmarked against the SLActive surface. MATERIAL AND METHODS: Ti discs (6.25-mm-diameter and 2-mm-thick) with three different surfaces were inserted on the proximal-anterior part of the tibial plateau of adult Swedish loop rabbits: (I) turned surface modified with Ti-Sr-O (turned + Ti-Sr-O), (II) SLA surface modified with Ti-Sr-O (SLA + Ti-Sr-O), and (III) SLActive surface (SLActive). Following a healing period of 2 weeks and 4 weeks, the pull-out (PO) force needed to detach the discs from the bone was assessed, as a surrogate of osseointegration. RESULTS: The SLActive surface exhibited statistically significant higher median PO forces, compared with the SLA + Ti-Sr-O surfaces at both 2- and 4 weeks post-op (p > .05). In this study, no single turned + Ti-Sr-O surface disk was integrated. CONCLUSIONS: The tested Ti-Sr-O technology failed to enhance osseointegration; however, this finding may be related to the inappropriateness of the rabbit tibia plateau model for assessing third-generation implant surface technologies, due to the limited diffusion and clearance at the disk-bone interface.

The impact of local and systemic penicillin on antimicrobial properties and growth factor release in platelet-rich fibrin: In vitro study.

OBJECTIVE: This study evaluates the impact of local and systemic administration of penicillin on the antimicrobial properties and growth factors of platelet-rich fibrin (PRF) under in vitro conditions. MATERIALS AND METHODS: The study involved 12 volunteers. Four tubes of venous blood were collected before systemic antibiotic administration. Two tubes were centrifuged at 2700 RPM for 12 min to obtain PRF, while 0.2 ml of penicillin was locally added into other two tubes. After systemic administration, blood samples were again collected and subjected to centrifugation. The release of growth factors (IGF-1, PDGF, FGF-2, and TGFß-1) was determined using the Enzyme-Linked Immunosorbent Assay (ELISA), and an antibiotic sensitivity test was performed for S. aureus and E. coli bacteria. RESULTS: Results showed that local antibiotic addition before PRF centrifugation had a significant antimicrobial effect without affecting growth factor releases. There was no statistically significant difference in antimicrobial properties between PRF prepared with systemic antibiotic administration and PRF prepared without antibiotics. MATERIALS AND METHODS: The study suggests that incorporating localized antibiotics into PRF results in strong antimicrobial effects without compromise of growth factor release. However, the combination of PRF with systemic antibiotics did not significantly enhance its antimicrobial properties compared to PRF prepared without antibiotics. CLINICAL RELEVANCE: Local addition of penicillin into PRF provides strong antimicrobial properties which may help reduce dependence on systemic antibiotic regimens, mitigating antibiotic resistance and minimizing associated side effects.

Evaluation of periodontal status and cytokine levels in saliva and gingival crevicular fluid of patients with inflammatory bowel diseases.

BACKGROUND: Periodontal diseases and inflammatory bowel diseases (IBD, ulcerative colitis [UC] and Crohn disease [CD]) have been reported to present with increased salivary and gingival crevicular fluid (GCF) concentrations of cytokines. The aim of this study was to evaluate the salivary and GCF levels of TNF-α, IL-1ß, IL-10, and IL-17A and their associations with the periodontal statuses of UC, CD, and non-IBD patients, and to analyze the interrelationships among these cytokines, IBD conditions, and periodontal diseases. METHODS: This cross-sectional study was performed with a total of 131 patients (62 women and 69 men, mean age 42.96±13.02 years). Patients were divided into three groups: UC, CD, and non-IBD. Periodontal status was defined according to the 2017 World Workshop Disease Classification. Salivary and GCF cytokine levels were analyzed using ELISA. RESULTS: UC and CD patients diagnosed as having periodontitis and gingivitis presented with significantly higher levels of TNF-α and lower levels of IL-10 as compared with non-IBD patients (p<0.05). UC patients diagnosed with periodontitis exhibited significantly higher scores of bleeding on probing (p = 0.011) and increased salivary and GCF IL-1ß levels as compared with CD patients (p = 0.005, and 0.012, respectively). Considering the active and remission status of IBD, salivary IL-1ß was found to be correlated with the parameters representing the severity of periodontal diseases in active UC and CD patients. CONCLUSION: In the presence of periodontal diseases, UC and CD patients showed different expression levels of TNF-α, IL-1ß, and IL-10 in oral secretions as compared with non-IBD patients.

Efficacy of concentrated growth factor versus collagen membrane in reconstructive surgical therapy of peri-implantitis: 3-year results of a randomized clinical trial.

OBJECTIVES: To compare the 3-year clinical and radiographic outcomes of two different reconstructive surgical management of peri-implantitis using a bone substitute in combination with either concentrated growth factor (CGF) or collagen membrane (CM). MATERIAL AND METHODS: Fifty-one patients who had at least one implant presenting peri-implantitis with an intrabony defect were filled with a xenogenic bone grafting material and covered either CGF or CM. Clinical and radiographic assessments were carried out at baseline and postoperative years 1 and 3. Three different composite outcomes were defined to evaluate treatment success at a 3-year follow-up. The effects of possible prognostic indicators on treatment success were identified by using multilevel regression analysis. RESULTS: The changes in probing depth (PD) and radiographic vertical defect depth (VDD) between baseline and year 1 and baseline and year 3 presented significantly greater decreases for the CM group in comparison with the CGF group (p < 0.05). No significant differences between the two treatment modalities were demonstrated regarding treatment success outcomes. History of periodontitis, VDD at baseline, and the number of intrabony defect walls revealed significant impacts on treatment success (p = 0.033; OR = 3.50, p = 0.039; OR = 0.975, and p = 0.024; OR = 7.0 and p = 0.019;OR = 6.0, respectively). CONCLUSIONS: CM in combination with a bone substitute seems to have slightly better outcomes compared to the CGF membranes in reconstructive surgical therapy of peri-implantitis. The history of periodontitis, baseline VDD, and peri-implant bone defect configuration could be possible predictors influencing treatment success. TRIAL REGISTRATION: ClinicalTrials.gov NCT04769609. CLINICAL RELEVANCE: For the reconstruction of peri-implant bone defects, using a bone substitute in combination with a collagen membrane may show more favorable outcomes.

Assessment of salivary stress and pain biomarkers and their relation to self-reported pain intensity during orthodontic tooth movement: a longitudinal and prospective study.

PURPOSE: The aim of this prospective study was to evaluate the relationship between pain intensity and concentrations of salivary pain and stress biomarkers during orthodontic tooth movement. METHODS: Eighteen patients (8 males, 10 females; mean age 14.57 ± 2.39 years) who needed orthodontic treatment with maxillary premolar extraction and segmental canine distalization participated in this study. Baseline samples were collected (T1), and orthodontic attachments were placed to maxillary first molars, second premolars, and canines. Then extractions were performed. After 1­month follow-up, canine distalization started with a segmental wire (T2). Concentrations of salivary α­amylase (sAA), cortisol, secretory immunoglobulin A (sIgA) and chromogranin A (CgA) were examined at T1, T2, and on days 4 (T3), 7 (T4), 14 (T5), and 30 (T6) after starting retraction. Participants also scored their pain on a visual analogue scale (VAS). Pain catastrophizing behavior and dental anxiety levels of the participants were evaluated by the Pain Catastrophizing Scale (PCS) and Corah's Dental Anxiety Scale (C-DAS), respectively. Repeated measure ANOVA, Mann-Whitney U test and Spearman's rank correlation coefficient analysis were used for statistical evaluations (p < 0.05). RESULTS: The maximum values for sAA were seen at T1. Males had higher sAA levels than females with statistical differences at T1, T3, and T4. No significant differences for cortisol, sIgA, and CgA concentrations were observed. The highest mean VAS score was recorded at T3. No correlations were detected between any salivary biomarkers, VAS, C­DAS, and PCS scores. CONCLUSIONS: The stress of starting orthodontic treatment increased sAA levels more than the pain that was experienced during orthodontic tooth movement. Being male was a predictor of higher sAA concentrations. Orthodontic tooth movement did not cause significant alterations in salivary pain and stress biomarkers.

Identification of a Predictive Decision Model Using Different Data Mining Algorithms for Diagnosing Peri-implant Health and Disease: A Cross-Sectional Study.

PURPOSE: The aim of this study was to determine a predictive decision model for peri-implant health and disease and to reveal the highest accuracy of prediction using three different data mining methods. MATERIALS AND METHODS: This cross-sectional study included a total of 216 patients with 542 dental implants from the Periodontology Department of Gazi University. The implants were classified into peri-implant health, peri-implant mucositis, and peri-implantitis groups based on established clinical and radiographic assessments. Prediction models were created using clinical variables in combination with possible risk factors for peri-implant diseases. Different data mining methods (decision-tree [DT]; J48), logistic regression, and artificial neural network (multilayer perceptron [MLP]) were compared to yield a better predictive decision model based on predictor variables with the highest potential of effect. RESULTS: The prevalence of peri-implant mucositis and peri-implantitis among the participants of the specialist referral periodontal practice of the university was 36.1% (95% CI: 29.7 to 42.5) and 34.7% (95% CI: 28.4 to 41.0) at the patient level, respectively. The J48 method revealed a higher prediction of peri-implant health and disease with an accuracy of 0.871 compared with the logistic regression and MLP methods (0.832 and 0.852, respectively) for the present data set. In this specific patient population, the J48 model revealed the top-level node as "bleeding on probing (BOP)." "Maintenance therapy" and "medication use" were noted as powerful predictors in the next split-levels. CONCLUSION: The J48 model presented an acceptable predictive accuracy of peri-implant health and disease. The model revealed BOP as a major predictive clinical parameter when evaluated with possible risk factors for this patient population.

Evaluation of heat shock protein 70 and toll-like receptor 4 expression in gingival crevicular fluid in response to orthodontic forces.

OBJECTIVES: The aim of this study was to assess the concentrations of heat shock protein 70 (HSP70) and toll-like receptor 4 (TLR4) during orthodontic tooth movement and to compare their levels with interleukin-1ß (IL-1ß), a well-known proinflammatory biomarker. MATERIALS AND METHODS: This study consisted of 20 patients (8 males, 12 females; mean age 14.75 ± 2.34 years) who needed maxillary premolar extraction and segmental canine distalization. Concentrations of HSP70, TLR4, and IL-1ß were examined before extraction (T1), at the 1st (T2), 4th (T3), 7th (T4), 14th (T5), and 30th (T6) days of canine retraction by enzyme-linked immunosorbent assay analysis of gingival crevicular fluid samples. Statistical analyses were performed with repeated measure ANOVA and Spearman's rank correlation coefficient analysis (p < 0.05). RESULTS: HSP70 increased gradually from T1 to T6 and showed significant differences between T1-T6 and T2-T6 (T1:3.28 ± 0.92 ng/ml; T2:3.72 ± 0.66 ng/ml; T6:9.35 ± 2.45 ng/ml). The lowest TLR4 concentration was at T1, peaked at T3 and remained constant afterwards with significant differences between T1-T3, T1-T4, and T1-T6 (T1:0.71 ± 0.02 pg/ml; T3:1.04 ± 0.11 pg/ml; T4:0.95 ± 0.06 pg/ml; T6:1.00 ± 0.07 pg/ml). IL-1ß increased from T1 to T6 with significant differences between T1-T4, T1-T5, and T1-T6 (T1:55.71 ± 5.48 pg/ml; T4:100.11 ± 16.92 pg/ml; T5:103.71 ± 23.19 pg/ml; T6:125.12 ± 22.04 pg/ml). The increase in HSP70 and TLR4 from T2-T3 showed a significant correlation (r = 0.598; p = 0.005). CONCLUSIONS: The increased levels of HSP70, TLR4, and IL-1ß show the contribution of these mediators to the inflammatory response from the early stages of orthodontic tooth movement. CLINICAL RELEVANCE: The regulation of HSP70, TLR4, and/or IL-1ß secretion during orthodontic force application could provide alterations for desired optimal tooth movement.

De-epithelialized gingival graft versus subepithelial connective tissue graft in the treatment of multiple adjacent gingival recessions using the tunnel technique: 1-year results of a randomized clinical trial.

AIM: To compare the clinical efficacy and postoperative morbidity of de-epithelialized gingival graft (DGG) with subepithelial connective tissue graft (SCTG) on treatment of multiple adjacent gingival recessions (MAGRs) with tunnel technique (TUN) and to evaluate histological characteristics of the palatal grafts. MATERIALS AND METHODS: Twenty-seven patients with MAGRs affecting at least 2 adjacent teeth were treated with either DGG + TUN or SCTG + TUN. Recession depth(RD) and width(RW), probing depth(PD), clinical attachment level(CAL), keratinized tissue height(KTH), gingival thickness(GT), and complete and mean root coverage(CRC, MRC) were evaluated at 6 and 12 months postoperatively. Multilevel analysis was performed to identify patient- and tooth/site-related predictors for the 12-month MRC outcomes. Postoperative patient morbidity and histological characteristics of palatal graft samples obtained during harvesting were investigated. RESULTS: At the 12-month follow-up, MRC was 91.72% ± 16.59% and 84.72% ± 19.72% in DGG + TUN and SCTG + TUN groups (p = .001). Multilevel regression analysis identified RD, KTH and GT as variables associated with MRC. No significant difference between the groups was observed regarding postoperative patient morbidity parameters. Cellularity was found significantly higher in the SCTG samples compared to the DGG samples (p < .05). CONCLUSIONS: Although DGG + TUN presented higher MRC and CRC compared to SCTG + TUN in the treatment of MAGRs, treatment method was not a significant predictive factor for the amount of MRC outcomes while RD, KTH and GT were significant predictive factors.

The effects of decontamination methods of dental implant surface on cytokine expression analysis in the reconstructive surgical treatment of peri-implantitis.

The aim of this trial was to analyze the effect of implant surface decontamination procedures combined with reconstructive surgical treatment (RST) of peri-implantitis on gene expression levels of selected biomarkers in peri-implant crevicular fluid (PICF). Forty patients diagnosed with peri-implantitis were treated with RST + decontamination of the implant surface using sterile saline and ozone therapy (ozone group) or sterile saline alone (control group). The gene expression levels of interleukin (IL)-6, IL-8, IL-17, vascular endothelial growth factor (VEGF), sclerostin (SOST) and osteoprotegerin (OPG) were evaluated by qPCR analysis at baseline and 6-month follow-up. Changes in cytokine mRNA expression levels were analyzed and compared with clinical/radiographic parameters. Both decontamination methods lead to the downregulations of the selected gene expressions. Ozone group showed significantly higher clinical attachment level (CAL) and radiographic defect fill (DF) values at 6 months compared to the control group (p = 0.026 and p = 0.011). The downregulation of SOST levels was significantly associated with probing depth reduction and radiographic DF (p < 0.05). Implant surface decontamination procedures applied with the RST contribute to a notable reduction in immuno-inflammatory response. The additional use of ozone therapy could have favorable effects in anti-infective regimens of peri-implantitis therapy. SOST, which was found to have significant relationship with both clinical and radiographic outcomes, could be a valuable indicator for the progression of peri-implantitis and may aid the development of new therapeutic strategies for bone gain in the RST of peri-implantitis.

Evaluation of adipokines and inflammatory mediator expression levels in patients with periodontitis and peri-implantitis: a cross-sectional study.

OBJECTIVES: The aim of this study was to analyze the mRNA and protein expression of adiponectin, leptin, visfatin, tumor necrosis factor (TNF)-α, and interleukin (IL)-6 levels in periodontitis and peri-implantitis sites in systemically healthy individuals and to investigate the influence of the presence of current periodontitis on their expression levels in peri-implantitis sites. MATERIALS AND METHODS: Soft tissue biopsy samples were collected from 60 systemically healthy patients [15 periodontally healthy patients (group I), 16 patients with periodontitis (group II), 15 patients with peri-implantitis (group III), and 14 patients with peri-implantitis and periodontitis (group IV)]; mRNA expression levels of adiponectin, leptin, visfatin, TNF-α, and IL-6 were measured by quantitative real-time PCR; and their protein levels were assessed by immunohistochemistry. RESULTS: The mRNA expression levels of all biomarkers were significantly higher for group II compared to group I, while significantly higher levels of leptin, TNF-α, and IL-6 were observed in group III in comparison with group I. Group II exhibited significantly higher mRNA expression of adiponectin and TNF-α than group III. Group IV showed significantly higher expression levels of adiponectin, leptin, TNF-α, and IL-6 compared to group III. Regarding the expression of protein levels, which was estimated through quantification of the histoscore, both groups II and III presented higher H-scores than group I for all biomarkers except leptin. CONCLUSIONS: The presence of current periodontitis may enhance expression levels of adiponectin, leptin, TNF-α, and IL-6 in peri-implant soft tissue. CLINICAL RELEVANCE: The presence of periodontitis is an important risk factor for the severity of peri-implant inflammation as well as the onset of peri-implantitis.

Ozone application as adjunctive therapy in chronic periodontitis: Clinical, microbiological and biochemical aspects.

BACKGROUND/PURPOSE: The application of ozone as an adjunctive treatment represents a new approach in the management of chronic periodontitis. The purpose of this study was to evaluate the clinical, biochemical and microbiological efficacy of ozone treatment as an adjunct to scaling and root planing (SRP) in generalized chronic periodontitis (GCP) patients. MATERIALS AND METHODS: Eighteen patients (9 males and 9 females; aged from 28 to 47 years, mean age of 40 ± 6.51 years) with GCP were recruited in the study. In a split mouth design, two quadrants in each patient were randomly allocated to SRP-alone or SRP-ozone therapy (SRP + OT) groups by coin toss method. Subgingival plaque and gingival crevicular fluid (GCF) samples were collected at baseline, following 1st and 3rd months. The clinical parameters were monitored at baseline and after 3 months. Microbiological parameters were analyzed by quantitative-PCR and GCF biomarkers were determined by ELISA. Results were analyzed statistically. RESULTS: Statistically significant improvements in all clinical parameters were accompanied by a reduction in microbiological and biochemical parameters in both treatment groups. SRP treatment resulted in a significant reduction of Porphyromonas gingivalis (Pg) at 1st month and Tannerella forsythia (Tf) and Prevotella intermedia (Pi) at 3 months. Following SRP treatment the interleukin (IL)-8 levels were significantly reduced at month 1. There were no significant differences between two treatments for any of the parameters. CONCLUSION: Within the limitations of this study, adjunctive ozone therapy did not provide additional benefits to clinical, microbiological and biochemical parameters over SRP in chronic periodontitis patients.

An Evaluation of the Relationship Between Peri-implant Soft Tissue Biotype and the Severity of Peri-implantitis: A Cross-Sectional Study.

PURPOSE: This cross-sectional study aimed to analyze the relation between peri-implant soft tissue biotype (STB) and different levels of peri-implantitis severity, and to identify the possible risk indicators that affect the severity of peri-implantitis with regard to STB around dental implants. MATERIALS AND METHODS: Eighty-seven patients with 229 implants were diagnosed with peri-implantitis and recruited to the study. Clinical and radiographic parameters including Plaque Index (PI), probing depth (PD), bleeding on probing (BOP), gingival/mucosal recession (GR/MR), clinical attachment level (CAL), and marginal bone loss (BL) were analyzed. The periodontal status was assessed, and the levels of peri-implantitis severity were defined. These parameters were compared among the peri-implant STB groups (thick and thin biotype). To evaluate the effect of possible risk indicators on the levels of severity of peri-implantitis, univariate and multivariate logistic regression analyses were conducted for thick and thin biotype groups. RESULTS: The mean values of BOP, MR, CAL, and marginal BL were significantly lower for the thick group compared with the thin group (P < .05). For PI and PD values, no significant differences were found between the groups (P > .05). Moreover, multivariate analysis revealed statistically significant associations between peri-implantitis severity and the risk indicators maintenance therapy compliance and current periodontitis for the thin group (P < .05). CONCLUSION: The thin biotype could be more prone to increase in the severity of peri-implantitis. Maintenance therapy compliance and current periodontitis could be important risk indicators that affect the progression of the severity of peri-implantitis for implants where keratinized mucosa is thin or absent.

Effects of Laser Photobiomodulation and Ozone Therapy on Palatal Epithelial Wound Healing and Patient Morbidity.

OBJECTIVE: The aim of this study was to compare the effects of laser photobiomodulation (PBM) and topical ozone therapy on the reepithelialization of palatal donor site wounds through clinical assessment and computer-aided image analysis and to assess the patient morbidity following free gingival graft (FGG) surgeries. MATERIAL AND METHODS: Thirty-six patients requiring FGG were randomly allocated into three groups: laser group (n = 12), ozone group (n = 12), and control group (n = 12). Epithelialization was evaluated by applying 3% hydrogen peroxide (H2O2) to the wound area and also measured by using digital image analysis (ImageJ). Bland-Altman plots were used for assessing agreement between H2O2 and ImageJ measurements. Parameters in relation to patient morbidity were assessed by using visual analog scale (VAS) on the first 3, 7, 14, and 30 days postoperatively. RESULTS: At day 14, statistically significant smaller wounds were observed with digital image analysis in the ozone group as compared with the control group (p = 0.034). However, intergroup comparison of the remaining wound area evaluated by the clinician using the H2O2 method did not reveal any significant differences (p > 0.05). Nonetheless, according to Bland-Altman analysis, the lower and upper limits showed a moderate agreement between the two measurement methods. The mean VAS sores exhibiting postoperative discomfort was observed to be significantly higher in the control group compared with the laser group (p = 0.002) and ozone group (p < 0.001) at day 7. CONCLUSIONS: Adjunctive ozone therapy could have a significantly beneficial effect on the acceleration of palatal wound healing following FGG procedures. Both PBM and ozone treatment modalities reduced postoperative discomfort as compared with spontaneous healing.

Regenerative surgical treatment of peri-implantitis using either a collagen membrane or concentrated growth factor: A 12-month randomized clinical trial.

BACKGROUND: Platelet concentration based membranes, as well as collagen membranes in combination with bone substitutes, have demonstrated successful outcomes in regeneration of peri-implant bone defects (PBD). PURPOSE: The aim of this study was to evaluate the clinical and radiographic outcomes of regenerative surgical treatment (RST) of peri-implantitis using a bone substitute combined with two different bioresorbable barrier membranes, either collagen membrane (CM) or concentrated growth factor (CGF), during 12-month follow-up. MATERIALS AND METHODS: Fifty two patients, who had at least one peri-implantitis lesion was treated by using a bone substitute in combination with CGF or CM. After surgical procedures, implants were allowed for submerged healing. Clinical assessments were conducted at baseline, 6 and 12 months postoperatively, while radiographic evaluation was performed at baseline and 12 months. RESULTS: Significant reductions were obtained in the mean gingival index (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL) and mucosal recession (MR) values at both 6 and 12 months postoperatively compared to baseline for both treatment procedures (P < 0.05). At 6 months, no statistically significant difference was observed for all clinical parameters between the groups, whereas the mean PD, CAL and vertical defect depth (VDD) values were statistically significant in favor of the CM group at 12 months (P < 0.05). The mean defect fill (DF) in the CM group (1.99 ±0.76) was not statistically significantly different from that observed in the CCF group (1.63 ±1.00) (P = 0.154). CONCLUSIONS: The outcomes of the present study suggest that both regenerative approaches yielded significant improvements in both clinical and radiographic assessments. The procedure using a collagen membrane in combination with a bone substitute showed better results at 12 months in RST of peri-implantitis.

The effects of ozone therapy as an adjunct to the surgical treatment of peri-implantitis.

PURPOSE: The decontamination procedure is a challenging aspect of surgical regenerative therapy (SRT) of peri-implantitis that affects its success. The purpose of the present study was to determine the impact of additional topical gaseous ozone therapy on the decontamination of implant surfaces in SRT of peri-implantitis. METHODS: A total of 41 patients (22 males, 19 females; mean age, 53.55±8.98 years) with moderate or advanced peri-implantitis were randomly allocated to the test group (ozone group) with the use of sterile saline with additional ozone therapy or the control group with sterile saline alone for decontamination of the implant surfaces in SRT of peri-implantitis. Clinical and radiographic outcomes were evaluated over a period of 12 months. RESULTS: At the 12-month follow-up, the plaque and gingival index values were significantly better in the ozone group (P<0.05). Probing depth decreased from 6.27±1.42 mm and 5.73±1.11 mm at baseline to 2.75±0.7 mm and 3.34±0.85 mm at the end of the 12-month observation period in the ozone and control groups, respectively. Similarly, the clinical attachment level values changed from 6.39±1.23 mm and 5.89±1.23 mm at baseline to 3.23±1.24 mm and 3.91±1.36 mm at the 12-month follow-up in the ozone and control groups, respectively. According to the radiographic evidence, the defect fill between baseline and 12 months postoperatively was 2.32±1.28 mm in the ozone group and 1.17±0.77 mm in the control group, which was a statistically significant between-group difference (P<0.05). CONCLUSIONS: Implant surface decontamination with the additional use of ozone therapy in SRT of peri-implantitis showed clinically and radiographically significant. Trial registry at ClinicalTrials.gov, NCT03018795.

Oral flurbiprofen spray for mucosal graft harvesting at the palatal area: A randomized placebo-controlled study.

BACKGROUND: Flurbiprofen which is a non-steroidal anti-inflammatory drug (NSAID), has been safely used for the control of postoperative patient's morbidity after periodontal plastic surgeries requiring palatal graft harvesting, but there is little information on the efficacy of topical use. The aim of the study was to evaluate whether patient pain perception was reduced and patient morbidity was improved by using oral spray of flurbiprofen after palatal graft harvesting. METHODS: Forty-eight patients (21 males and 27 females), scheduled for subepithelial connective tissue graft (SCTG) and free gingival graft (FGG) requiring periodontal plastic surgeries were selected. The patients were randomly assigned to each group and used oral spray of flurbiprofen or placebo three times a day for a week. The palatal donor area was evaluated at 1, 3, 7, 14, 21, 28, 42, and 56-day follow-up after the surgery for postoperative pain, patients' discomfort, complete epithelialization, changes in dietary habits, burning sensation, color match, the amount of systemic analgesic consumption and the presence of delayed bleeding. Wound healing scores were recorded at 14-day follow up. RESULTS: The prevalance of complete epithelialization was significantly higher in the placebo-FGG group than flurbiprofen-FGG group at 21 days postoperatively (P < 0.05), while there was no significant alteration for both flurbiprofen-SCTG and placebo-SCTG groups at any follow-up periods. In flurbiprofen-FGG group, significant improvements were observed for postoperative pain, patients' discomfort and burning sensation at 14 days postoperatively (P < 0.05). CONCLUSION: Oral flurbiprofen spray reduces patient's morbidity, however it might have negative effects on epithelialization of secondary wound healing after FGG operations.

The effects of different restorative materials on periodontopathogens in combined restorative-periodontal treatment.

Objective The aim of the study was to evaluate the association between subgingival restorations and the target periodontopathogenic bacteria (Pg, Td and Pi) in subgingival biofilm during one year after combined restorative-periodontal treatment. Material and Methods Seventeen systemically healthy subjects, who were positive for the presence of three cervical lesions associated with gingival recessions in three different adjacent teeth, were included in the study. A total of 51 combined defects were treated with connective tissue graft plus a nanofilled composite resin (NCR+CTG), a resin-modified glass ionemer cement (RMGI+CTG) and a fluoride-releasing resin material with pre-reacted glass (PRG), called giomer (Giomer+CTG). Periodontal clinical measurements and subgingival plaque samples were obtained from all combined defects at baseline and at 6 and 12 months after the surgery. The number of bacteria were evaluated by the real-time polymerase chain reaction (qPCR) method. Results No statistically significant difference in the amount of DNA copies of Pg, Td and Pi was observed in any of the groups at any time points (p>0.05). In addition, there was no statistically significant difference in the amount of DNA copies of the bacteria at baseline and at 6 and 12 months postoperatively, regardless of treatment group (p>0.05). Conclusion This study suggests that subgingivally placed NCR, RMGI and giomer restorations can show similar effects on periodontopathogenic bacteria in the treatment of gingival recessions that are associated with noncarious cervical lesions (NCCLs).

Clinical evaluation of combined surgical/ restorative treatment of gingival recession-type defects using different restorative materials: A randomized clinical trial.

BACKGROUND/PURPOSE: An ideal therapeutic procedure for the treatment of gingival recession associated with an NCCL has presented a challenge to clinicians. Various dental materials and surgical approaches have been used to manage gingival recessions associated with NCCLs for the most predictable combined surgical/restorative treatment. The objective of this study was to evaluate the treatment of gingival recessions associated with non-carious cervical lesions (NCCL) using a modified coronally advanced flap (MCAF) in combination with a connective tissue graft (CTG) on restored root surfaces. MATERIALS AND METHODS: Twenty-three systemically healthy subjects, who were positive for the presence of three cervical lesions associated with gingival recessions in three different adjacent teeth, were enrolled in the study. The NCCL were each restored prior to surgery by using one of three different materials: nanofilled composite resin (NCR), resin-modified glass ionomer cement (RMGI) or giomer. The gingival recession defects were treated by CTG. RESULTS: Inter-group differences were not statistically significant for probing depth (PD), relative recession height (rRH), relative clinical attachment level (rCAL), keratinized tissue width (KTW) or keratinized tissue thickness (KTT) (p > 0.05) among the groups at any time. The mean percentage of defect coverage was 71.18 ± 23.16% for NCR + CTG group; 71.33 ± 22.33% for RMGI + CTG group; and 64.23 ± 20.33% for giomer + CTG group at 1 year postoperatively (p > 0.05). CONCLUSION: The combined surgical/restorative treatments provided successful clinical results. Giomer + CTG may be less effective compared to other groups for treatment of gingival recession associated with NCCL.