Statins and IL-1ß, IL-10, and MPO Levels in Gingival Crevicular Fluid: Preliminary Results.

Statins possess a wide variety of pleiotropic properties that are independent of their lipid-lowering abilities such as attenuating inflammation, oxidative stress, coagulation, platelet aggregation and stimulating bone formation. The aim of the study is to evaluate the effect of statins on clinical periodontal parameters and gingival crevicular fluid (GCF) levels of IL-1ß, IL-10, and myeloperoxidase (MPO) in inflammatory periodontal diseases. Seventy-nine subjects with hyperlipidemia and 48 systemically healthy controls (C) were included. Hyperlipidemic patients were either given a diet (HD) or prescribed statin (HS). Patients were classified into three subgroups as those who were periodontally healthy (h), who had gingivitis (g), or who had chronic periodontitis (p). Blood samples were collected for the measurement of lipid profiles. Plaque index (PI), gingival index (GI), probing pocket depth (PD), clinical attachment level (CAL), and percentage of bleeding on probing (BOP) were recorded. Gingival crevicular fluid levels of IL-1ß, IL-10, and MPO were measured in order to determine the anti-inflammatory and antioxidant effects of statins. Probing depth values of the HSp group were significantly lower than those of the Cp group. Percentage of BOP of the HSg group was significantly lower than those of the HDg and Cg groups. While the IL-1ß level of the HSp group was significantly lower than that of the HDp group, IL-10 levels of the HSg group were significantly higher than those of the HDg group. MPO levels were significantly lower in the HSg group when compared to those in the HDg and Cg groups. Statin use decreased the IL-1ß and MPO levels and enhanced IL-10 in GCF. It can be suggested that statins may attenuate periodontal inflammation and progression of periodontal inflammation.

Systemic administration of doxycycline versus metronidazole plus amoxicillin in the treatment of localized aggressive periodontitis: a clinical and microbiologic study.

OBJECTIVE: The use of antibiotics as an adjunctive therapy in the management of periodontal diseases has always been of interest for dental practitioners. Although studies have demonstrated the importance of different antibiotics as adjunct in the treatment of periodontitis, few studies have reported comparative results of antibiotics in localized aggressive periodontitis (LAP). The aim of the present study was to evaluate the comparative effects of systemic tetracycline derivative doxycycline versus a combination of metronidazole and amoxicillin in the elimination/suppression of Actinobacillus actinomycetemcomitans and their clinical effects during 90 days of follow-up in patients with LAP. METHOD AND MATERIALS: Thirty patients with untreated LAP participated in the study. Patients were randomly divided into 2 groups and given doxycycline or metronidazole plus amoxicillin, and periodontal clinical parameters were achieved at baseline and 10, 30, 60, and 90 days after microbiologic sampling. Patients were also given mechanical debridement after measurement at baseline. RESULTS: Both groups of patients demonstrated improvement in clinical parameters, and microbiologic samples did not show any A actinomycetemcomitans at days 30, 60, and 90. CONCLUSION: Systemic use of doxycycline or metronidazole plus amoxicillin as an adjunct to conventional therapy may be used for the treatment of patients with LAP.

Use of platelet gel with connective tissue grafts for root coverage: a randomized-controlled trial.

BACKGROUND: Platelet-rich plasma (PRP) was speculated to be a promoter of periodontal regeneration. There are only a few clinical comparative studies using PRP in the treatment of gingival recession. AIM: The aim of the present study was to compare connective tissue graft (CTG)+PRP with CTG alone in the treatment of gingival recession. MATERIAL AND METHODS: Forty patients with Miller I/II recessions were included. Each recession was randomly treated with either CTG+PRP or CTG. Clinical variables were recorded at baseline and at 6 weeks, 6 and 12 months. Root coverage (RC) and attachment gain (AG) were also calculated. RESULTS: Probing depth, recession depth, clinical attachment level, keratinized tissue width and recession width (RW) were improved in both study groups. However, no difference was observed between groups, except RW. RW in the control group was statistically lower than the test group at all follow-up periods. CONCLUSION: Treatment of recession with CTG or a CTG-PRP combination resulted in favourable clinical outcomes. However, no difference could be found between CTG and CTG+PRP. Whether much longer follow-up studies with higher statistical power may change these results remains questionable.

Clinical evaluation of platelet-rich plasma and bioactive glass in the treatment of intra-bony defects.

BACKGROUND: There are limited numbers of studies focused on the using of platelet-rich plasma (PRP) combined with different types of bone substitutes in intra-bony defects. AIM: The purpose of this study was to evaluate the effect of bioactive glass graft material (BG) with and without PRP on the clinical healing of intra-bony defects. MATERIALS AND METHODS: Twenty-nine intra-bony defects were randomly treated with either PRP/BG or BG alone. Clinical parameters were recorded at baseline and repeated 9 months after surgery and surgical reentries were also performed. RESULTS: The results showed that both treatment modalities were effective. Pocket depth reduction of 3.60 +/- 0.51 mm, clinical attachment gain of 3.3 +/- 1.77 mm and defect fill of 3.47 +/- 0.53 mm were noted in the PRP/BG group, with 3.29 +/- 1.68, 2.86 +/- 1.56 and 3.36 +/- 0.55 mm improvements, respectively, noted for the BG group. None of the differences between the two treatment modalities were statistically significant. CONCLUSIONS: It is suggested that both PRP/BG combination and BG alone are effective in the treatment of intra-bony defects. The results also showed that using PRP with BG has no additional benefit in the reduction of pocket depth, clinical attachment gain and defect fill.

Vertical and horizontal dimensional evaluation of free gingival grafts in the anterior mandible: a case report series.

The shrinkage of free gingival grafts (FGGs) is a well-known clinical phenomenon but there are limited studies demonstrating the dimensional changes during healing in FGGs. The aim of the study is to examine the shrinkage of FGG in both horizontal and vertical dimensions and calculate the changes in the surface area of the graft at early and delayed periods of healing. The FGG procedure was applied to 15 consecutive patients in their mandibular anterior area. The graft sizes and areas were measured and the shrinkage of the graft was calculated at baseline and days 10, 21 and 180. Hemorrhage, sense alteration and pain symptoms were also examined. Change in the horizontal direction was not statistically significant during the whole study period (p > 0.05). However, there was a statistically significant reduction in the vertical direction in all visits, except day 10 (p < 0.05). Calculated graft area was also significantly reduced during the study period at all time-points compared to the baseline (p < 0.001). At day 10, 4 (26.7%) recipient sites and 5 (33%) donor sites demonstrated paresthesia. Only one (0.07%) recipient site demonstrated paresthesia at day 21 where the donor site resulted with an uneventful healing. At day 10, 5 (33%) patients demonstrated bleeding at their donor regions and resulted with a complete cessation of bleeding at day 21. Pain symptom was found in 8 (53.3%) recipient sites where 3 (20%) donor regions presented pain symptom at day 10. Graft shrinkage in the vertical dimension seems to affect the clinical outcomes of the FGG procedure. However, the influence of horizontal graft shrinkage was minimal.

Long-term uncontrolled hereditary gingival fibromatosis: a case report.

Hereditary gingival fibromatosis (HGF) is a rare condition characterized by varying degrees of gingival hyperplasia. Gingival fibromatosis usually occurs as an isolated disorder or can be associated with a variety of other syndromes. A 33-year-old male patient who had a generalized severe gingival overgrowth covering two thirds of almost all maxillary and mandibular teeth is reported. A mucoperiosteal flap was performed using interdental and crevicular incisions to remove excess gingival tissues and an internal bevel incision to reflect flaps. The patient was treated 15 years ago in the same clinical facility using the same treatment strategy. There was no recurrence one year following the most recent surgery.

Treatment of gingival recession: comparison of two techniques of subepithelial connective tissue graft.

BACKGROUND: The increasing interest in esthetics and the subsequent need to solve related problems such as hypersensitivity and root caries have favored the development of many surgical procedures that permit the coverage of exposed roots. This clinical study was conducted to examine the coverage of gingival recession defects, where two different subepithelial connective tissue graft (SCTG) techniques (Langer and Langer and modified tunnel) were used. METHODS: Thirty one patients (21 females and 10 males), each contributing Miller Class I and II gingival recessions, were selected. Recession defects were randomly treated by using the Langer and Langer technique (17 patients) or the modified tunnel technique (14 patients). Vertical recession, probing depth (PD), and attachment level were assessed at baseline and 6 months postoperatively. RESULTS: Six months after the surgery, a significant reduction in recession depth was noticed in both groups. There was also a decrease of PD and attachment level for both groups, but not statistically significant. In comparison, at 6 months, statically significant differences were found between the tunnel and Langer and Langer techniques for root coverage and attachment gain. The percentage of root coverage was 96.4% and 75.5% in the tunnel and Langer and Langer groups, respectively. CONCLUSIONS: The present study suggests that the use of SCTG in combination with a tunnel procedure may result in an increased amount of root coverage and clinical attachment gain compared to the Langer and Langer technique. Further comparative studies are necessary to understand the periodontal healing generated by the tunnel procedure and Langer and Langer technique.

Necrosis of gingiva and alveolar bone caused by acid etching and its treatment with subepithelial connective tissue graft.

The misuse of various chemicals in dentistry may cause damage to gingiva and alveolar bone. In this case report, we describe necrosis of the gingiva and alveolar bone caused by acid etching. A patient whose caries on the cervical third of the root of his mandibular right first molar were treated 2 days earlier presented to our clinic with severe pain and discomfort in the treated area. Intraoral examination revealed a spreading gingival ulceration and exposed alveolar bone. The patient was followed and a week later, when the gingival inflammation had decreased, periodontal surgery was performed. A full-thickness flap was raised and necrotic gingiva and bone were removed. As a result, only a narrow band of keratinized gingiva remained. To treat the gingival recession and protect the underlying bone, a subepithelial connective tissue graft was placed during the same session. After the operation, the patient"s complaints resolved. Subepithelial connective tissue graft can be an important treatment approach in cases of necrosis and gingival recession caused by the misuse of various chemicals.

Biomaterials in periodontal regenerative surgery: effects of cryopreserved bone, commercially available coral, demineralized freeze-dried dentin, and cementum on periodontal ligament fibroblasts and osteoblasts.

The ultimate goal of periodontal therapy is to achieve successful periodontal regeneration. The effects of different biomaterials, allogenic and alloplastic, used in periodontal surgeries to achieve regeneration have been studied in vitro on periodontal ligament (PDL) cells and MC3T3-E1 cells. The materials tested included cryopreserved bone allograft (CBA), coralline hydroxyapatite (CH), demineralized freeze-dried dentin (DFDD), and cementum. CBA and CH revealed an increase in initial PDL cell attachment, whereas CH resulted in an increase in long-term PDL cell attachment. Mineral-like nodule formation was observed significantly higher in DFDD compared to other materials tested for osteoblasts. Based on the results of this in vitro study, we conclude that the materials used are all biocompatible with human PDL cells and osteoblasts, which have pivotal importance in periodontal regeneration.

A comparative evaluation of the clinical effects of systemic and local doxycycline in the treatment of chronic periodontitis.

In this study, the clinical efficacies of systemic doxycycline (SD) and local doxycycline (LD) in the treatment of chronic periodontitis were compared. Forty-five patients were studied in 3 main groups with 5 treatments: SD alone, SD+scaling-root planing (SD+SRP), LD alone, LD+SRP and SRP alone. Antibiotic-treated patients were given doxycycline treatment alone in 1 quadrant of their upper jaws, and doxycycline+SRP was given in the contralateral quadrant. The areas included at least 4 teeth with > or = 5 mm pockets. Probing depth (PD), clinical attachment level, gingival index, sulcular bleeding index and plaque index values were recorded at baseline and the 7th week. The results were statistically analyzed. All of the clinical parameters were significantly reduced by all treatments (P < or = 0.05). The SD and LD treatments alone provided significant clinical healings. The significant differences among the groups were only in PD at the 7th week. The LD treatment provided significantly higher PD reduction than the SD treatment (P < or = 0.05). No significant difference was found between the SD+SRP and the LD+SRP treatments. There was no significant difference between SD+SRP and SRP alone treatment (P > 0.05). The SD group showed lower PD reduction than SRP group (P < or = 0.05), while no significant difference was found between LD and SRP treatments. The LD alone treatment seemed more effective than SD alone treatment on PD reduction, but no significant difference was found between them when combined with the SRP. LD may be more preferable than SD as an adjunct to mechanical treatment since LD seems more effective than SD on PD reduction and does not have the side effects of SD.