Efficacy of adjunctive photodynamic therapy in the treatment of generalized aggressive periodontitis: A randomized controlled clinical trial.

OBJECTIVES: Generalized aggressive periodontitis (GAgP) is a distinct type of periodontal disease characterized by rapid loss of attachment and alveolar bone occurring in young individuals. Photodynamic therapy (PDT) was introduced in periodontology as an adjunctive approach to non-surgical periodontal treatment (NPT) in periodontitis patients. In this trial, the aim was to evaluate the clinical and microbiological effects of adjunctive PDT to NPT in patients with GAgP. METHODS: In this prospective controlled clinical study, 24 systemically healthy, non-smoking subjects with GAgP were enrolled. Subjects were randomly assigned into a control group (n = 12) treated with NPT only or to a test group (n = 12) treated with NPT and PDT. Plaque index, sulcus bleeding index (SBI), probing depth (PD), relative attachment level, gingival recession, and tooth mobility were recorded at baseline and on day 63. Microbiological samples were obtained from the sites with PD ≥ 5 mm at both time periods and evaluated for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola via micro-IDent® test. RESULTS: Clinical and microbial parameters declined significantly in both groups after the treatments (P < 0.01). The comparisons between the groups showed that only the full mouth SBI score of the test group was significantly lower than the control group on day 63 (P < 0.05). Although the reduction in periodontopathogens of the test group was greater than the control group, there was no significant difference between the groups (P > 0.05). CONCLUSIONS: Within the limits of this study, it can be concluded that in the treatment of GAgP, usage of PDT as an adjunct to NPT does not lead to any beneficial effects on the investigated clinical and microbiological parameters except for SBI. Nevertheless, the statistically significant difference for the SBI score demonstrates that PDT may have additional effect on the reduction in gingival bleeding. Lasers Surg. Med. 51:167-175, 2019. © 2018 Wiley Periodicals, Inc.

Determination of storage time of saliva samples obtained from patients with and without chronic periodontitis for the comparison of some biochemical and cytological parameters.

BACKGROUND: Salivary glutathione (GSH), malondialdehyde (MDA), protein, sialic acid (SA) levels, cytological parameters, and tissue factor activities (TFa) were investigated when fresh and after 3, 7, 11, 15, 21, and 30 days (d) of storage at -20°C both in the control and the periodontitis group. Moreover, the control and the periodontits groups were compared and continuity of the significances detected between the two groups were evaluated. METHODS: GSH, MDA, SA, protein, and TFa were determined using the methods of Beutler, Yagi, Warren, Lowry, and Quick, respectively. Saliva imprint samples were stained with Giemsa and microscopically examined. RESULTS: When the continuity of the significances of differences between the two groups was investigated, differences continued to be significant for GSH and TFa on days 3, 7, 11, 15, 21, and 30. Cytologically, only the significance detected between leucocyte numbers continued to be significant for 30 d. However significance of differences in total protein, MDA, and SA levels on day 0, were interrupted on days 3, 7, and 11, respectively. CONCLUSION: Saliva samples may be stored for 30 d for GSH and TFa analyses in patients with and without periodontitis. However, to compare salivary MDA, SA, and total protein levels in these groups we suggest fresh samples to be studied.

Evaluation of the clinical and antimicrobial effects of the Er:YAG laser or topical gaseous ozone as adjuncts to initial periodontal therapy.

OBJECTIVE: The aim of this study was to evaluate the clinical and microbiological results of treatment with the Er:YAG laser and topical gaseous ozone application as adjuncts to initial periodontal therapy in chronic periodontitis (CP) patients. BACKGROUND DATA: Although many studies have evaluated the effectiveness of the Er:YAG laser as an adjunct to initial periodontal therapy, few studies have focused on the use of gaseous ozone as an adjunct. MATERIALS AND METHODS: Thirty patients with CP were randomly divided into three parallel groups, each composed of 10 individuals with at least four teeth having at least one approximal site with a probing depth (PD) of ≥5 mm and a sulcus bleeding index (SBI) ≥2 in each quadrant. Groups of patients received: (1) Scaling and root planing (SRP)+Er:YAG laser; (2) SRP+topical gaseous ozone; or (3) SRP alone. The microbiological and clinical parameters were monitored at day 0 and day 90. RESULTS: At the end of the observation period, statistically significant improvements in clinical parameters were observed within each group. Parallel to the clinical changes, all treatments reduced the number of total bacteria and the proportion of obligately anaerobic microorganisms. Although intergroup comparisons of microbiological parameters showed no significant differences, clinical findings, including attachment gain and PD reduction, were found to be statistically significant in favor of the SRP+Er:YAG laser group. CONCLUSIONS: Although statistically nonsignificant, the fact that the obligate anaerobic change was mostly observed in the SRP+Er:YAG laser group, and a similar decrease was noted in the SRP+topical gaseous ozone group, shows that ozone has an antimicrobial effect equivalent to that of the Er:YAG laser.

Er:YAG lasers versus ultrasonic and hand instruments in periodontal therapy: clinical parameters, intracrevicular micro-organism and leukocyte counts.

OBJECTIVE: The aim of this study was to compare the clinical parameters and crevicular cell population, particularly leukocyte counts, changes after initial periodontal therapy with different instruments by a chairside laboratory technique, in severe periodontitis patients. BACKGROUND DATA: Although scaling and root planing (SRP) with hand curettes or ultrasonic scalers may alter the subgingival microbial composition and improve clinical parameters, it is known that this effect decreases as the pocket depth (PD) increases. MATERIAL AND METHODS: Thirty systemically healthy subjects with severe chronic periodontitis were randomly assigned to three groups (n=10), and were treated either with hand curettes, ultrasonic scalers, or Er:YAG laser alone. Clinical measurements were made before and 90 days after treatment. A total of four subgingival plaque samples were collected from pockets with a PD 4-6 and ≥7 mm and were analyzed with a phase-contrast microscopy for microorganism proportions and leukocyte counts at baseline and 7 and 90 days after treatment. RESULTS: From day 0 to day 90, clinical parameters were significantly improved in all groups (p<0.01), but there were no significant differences among groups. Laboratory assessments revealed significant differences in all groups between baseline, day 7, and day 90. However, considering changes from day 7 to day 90, hand curettes were the most successful for maintaining the levels of micro-organisms and leukocytes. CONCLUSIONS: Although Er:YAG lasers are promising in treating periodontitis, the results of this study favor finishing SRP with hand curettes. Moreover, as there is a similar tendency between micro-organism and leukocyte count changes, leukocyte counts may be used as chairside marker to evaluate the efficacy of SRP.

Er:YAG laser versus systemic metronidazole as an adjunct to nonsurgical periodontal therapy: a clinical and microbiological study.

OBJECTIVE: The objective of this randomized clinical trial was to describe the clinical and microbiological results obtained by treatment with Er:YAG laser and systemic metronidazole used as adjuncts to mechanical subgingival debridement in chronic periodontitis. METHODS: Twenty-seven chronic periodontitis (CP) patients were randomly divided into three parallel groups each comprising nine individuals with at least four teeth having at least one approximal site with a probing depth (PD) of ≥5 mm and gingival index (GI) of ≥2 in each quadrant. Groups of patients received: (1) Scaling and root planing (SRP)+ Er:YAG laser (10 hz, 30 mJ/pulse, 1 min per pocket, apico-coronal direction in parallel paths with 30 degree angle tips, under water irrigation), (2) SRP+ systemic metronidazole, or (3) SRP alone. In all treatment groups, SRP was performed at 1 week intervals in two sessions. The microbiological and clinical effects of the treatments were evaluated after 90 days. RESULTS: At the end of the experimental period, statistically significant improvements in plaque index, GI, PD and attachment level, as well as reductions in the number of total bacteria and proportions of obligately anaerobic microorganisms were observed within each group. Although intergroup comparisons revealed no significant microbiological differences, clinical parameters as attachment gain and PD reduction were found significantly higher in Group 1 compared with the other groups. CONCLUSIONS: Within its limits, this study demonstrated the possibility of better resolution of infection with combined SRP+Er:YAG laser treatment. However, microbiological results failed to demonstrate significant advantages of this combination in comparison with SRP alone or SRP+systemic metronidazole.

Levels of C-reactive protein and protein C in periodontitis patients with and without cardiovascular disease.

Since periodontitis is a chronic and inflammatory disease, a number of hypotheses have proposed that it has an etiological or modulating role in cardiovascular disease (CVD). This study aimed to ascertain the changes in the plasma levels of C-reactive protein (CRP) and protein C (PC), a natural anticoagulant also having an anti-inflammatory effect, in patients who have mild-to-severe periodontitis with or without CVD. The test group consisted of 26 patients with CVD and chronic periodontitis and the control group consisted of 26 patients with chronic periodontitis and no systemic disease. In both groups Community Periodontal Index of Treatment Needs scores were recorded and blood samples were collected. CRP levels were significantly high and PC activity was significantly low in the test group compared to the control group (p < 0.001). There was a negative correlation between tooth loss and PC and between CRP and PC. How PC is affected by the inflammatory events and its association with CRP is an active area of investigation.

Serum and saliva sialic acid in periodontitis patients with and without cardiovascular disease.

Serum total sialic acid (sTSA) has recently been shown to be a cardiovascular risk factor. However, there is little information about the role of sTSA and TSA in saliva in periodontitis, a chronic and inflammatory disease known to be a risk factor for cardiovascular disease (CVD). We aimed to investigate the changes in sTSA and TSA levels in saliva in patients having both periodontitis and CVD versus periodontitis patients without diagnosed CVD. The study group consisted of 26 patients with proven periodontitis and 26 controls with no diagnosed systemic disease but periodontitis. sTSA and saliva TSA levels were determined by the thiobarbituric acid method, and C-reactive protein (CRP) was evaluated by the nephelometric method. The severity of periodontitis has been determined by the community periodontal index of treatment needs (CPITN). TSA in blood and saliva and CRP levels in blood were significantly increased in CVD patients compared with the control group. CPITN ranged from 2 to 4 in both groups. Significant and positive correlations were found between sTSA and saliva SA levels in patients and controls and between tooth loss and TSA both in blood and saliva. Therefore, TSA in saliva may be a useful marker similar to sTSA in CVD patients.

Treatment of gingival recession using enamel matrix proteins: a case report with 4-year follow-up.

Obtaining predictable and optimal coverage of exposed root surfaces and correction of corresponding gingival recessions have become important goals of periodontal plastic surgery. Various surgical techniques have been proposed for coverage of root surfaces. A therapeutic advantage may be gained if periodontal regeneration is obtained in addition to coverage of root with gingiva. In this case report, surgical recession coverage was performed as the bilaterally pedicled lateral sliding flap technique with the adjunctive use of enamel matrix derivative bioactive material (Emdogain). A female patient with gingival recession on maxillary central incisors is presented with 4-year follow-up observation. The surgical procedure used in this clinical pilot case study produced a marked reduction in gingival recession that was maintained for 4 years. Initial gingival recession averaged 4.25 mm with a probing depth of 1.25 mm. The 4-year follow-up demonstrated no significant changes in the degree of postoperative results obtained after 1 year. At the 4-year follow-up, a mean of 3.75 mm of root coverage was observed (93.8% root coverage). Probing depth averaged 0.75 mm, indicating a total of 4.25 mm gain of clinical attachment. Within the limits of this case, the results demonstrated the possibility of treating human buccal recessions by means of enamel matrix protein derivative together with the laterally repositioned flap technique, with a predictable reduction in recession and clinical gain in attachment.

Enamel matrix derivative alone or in combination with a bioactive glass in wide intrabony defects.

This controlled clinical study investigated the clinical and radiographic outcome of wide intrabony periodontal defects treated by enamel matrix derivatives alone or in combination with a bioactive glass over a period of 8 months. Twenty-three chronic periodontitis patients, who received initial therapy and had radiographical interproximal defects with an associated probing depth of 6 mm or more and an intrabony component of at least 4 mm, were included. Each of the patients, contributing at least one intrabony defect, was treated with either enamel matrix derivative alone (group 1, n=10) or the combination (group 2, n=13). In both groups, all clinical and radiographical parameters were improved. Groups 1 and 2 presented a mean pocket reduction of 5.03+/-0.89 and 5.73+/-0.80 mm, recession of 0.97+/-0.24 and 0.56+/-0.18 mm, relative attachment gain of 4.06+/-1.06 and 5.17+/-0.85 mm, and radiographic bone gain of 2.15+/-0.42 and 2.76+/-0.69 mm, respectively. An intergroup comparison revealed significant differences for all of the parameters, yielding a more favorable outcome towards the combined approach. Within the limits of the study, both treatments resulted in marked clinical and radiographical improvements, but combined treatment seemed to enhance the results in the treatment of wide intrabony defects.

Effect of gallium arsenide diode laser on human periodontal disease: a microbiological and clinical study.

BACKGROUND AND OBJECTIVE: The present study is aimed to describe short-term results on selected microbiological and clinical parameters obtained by treatment with soft laser in conjunction with methylene blue and/or mechanical subgingival debridement in human periodontal disease. STUDY DESIGN/MATERIALS AND METHODS: Ten patients, in whom each dental quadrant was randomly designated to receive one of four types of treatment procedures, were included in the study. Groups of quadrants received: scaling/root planing (SRP); laser application (L); SRP combined with L (SRP/L); oral hygiene instructions (OHI). Four single rooted teeth (one in each quadrant), having an interproximal site with a probing depth of 4 mm mesio-buccally, were selected in each patient. The selected teeth were first assessed for microbiological (one site/tooth) and then for clinical variables (six sites/tooth). Supragingival irrigation with methylene blue was performed prior to laser application. The microbiological (proportions of obligate anaerobes) and clinical measurements (plaque and gingival indices, bleeding on probing, probing pocket depth) were evaluated over a period of 32 days. RESULTS: Only the SRP/L and SRP groups provided significant reductions in the proportions of obligate anaerobes before and after treatments with no significant differences in between. Parallel to the microbiological changes, both SRP/L and SRP resulted in similar clinical improvements, whereas L alone revealed a limited effect similar to OHI. CONCLUSION: Within the limits of this study, methylene blue/soft laser therapy provided no additional microbiological and clinical benefits over conventional mechanical debridement.