Effectiveness of 0.2% Hyaluronic Acid on Clinical, Biomolecular and Microbiological Parameters in Type 2 Diabetes Mellitus Patients with Periodontitis.

OBJECTIVE: This double-blind randomized clinical trial assessed the effectiveness of 0.2% hyaluronic acid (HA) gel as an adjunct to scaling and root planning (SRP) in patients with periodontitis and type 2 diabetes mellitus (DM), focusing on changes in clinical periodontal parameters, the expression of inflammatory mediators, and oral pathogens. MATERIALS AND METHODS: The randomized clinical trial involved 36 participants, 18 DM patients, and 18 healthy patients. The participants in each group were randomly assigned to receive placebo or HA gel after SRP. Gingival crevicular fluid and subgingival plaque samples were taken before treatment and at 4-week follow-up. Clinical parameters, interleukin-1ß (IL-1ß) and IL-10 levels, and proportions of Porphyromonas gingivalis (Pg) and Fusobacterium nucleatum (Fn) were evaluated at baseline and follow-up. STATISTICAL ANALYSIS: Paired t-test (parametric data) or Wilcoxon signed-rank test (nonparametric data) was used for intragroup comparison between baseline and follow-up, and comparisons between groups one-way analysis of variance test (parametric data) or Kruskal-Wallis test (nonparametric data). RESULTS: At 4 weeks, most of the groups showed statistically significant decreases (p ≤ 0.05) in various clinical and biomolecular parameters. However, there were exceptions: the pocket probing depth (PPD) and clinical attachment loss (CAL) parameter did not significantly decrease for the placebo (p > 0.05) non-DM group, and the IL-10 parameter in the DM HA gel group (p = 0.108). Regarding bacterial proportions, the non-DM and DM placebo group exhibited significant test results for Pg after 4 weeks (p ≤ 0.05). In the case of Fn bacteria proportions, they decreased in all groups, but these results were not statistically significant (p ≥ 0.05). An intergroup analysis revealed no significant differences (p ≤ 0.05) for bleeding on probing (BOP), PPD, and both proinflammatory and anti-inflammatory cytokines. Only clinical attachment loss (CAL) exhibited a statistically significant intergroup difference 0.042. CONCLUSION: The use of 0.2% HA gel into periodontal pockets alongside SRP, for both diabetic and healthy individuals, showed no statistically significant variances in clinical, biomolecular, and microbiological measures.

Bibliometric Network Analysis and Visualization of Research Trends in Gingivectomy.

Background: Gingivectomy has been the preferred method since the findings in 1884. It evolved from "blind" subgingival scaling to "the excision of the soft tissue". The use of these techniques is no longer mandatory in clinical situations; therefore, researchers have searched for numerous publications that have been registered regarding gingivectomy. This research aims to fill the niche area by assessing more about gingivectomy and it's trend among the periodontology topic of discussion. Methods: Descriptive and analytical observation by evaluating the result of the VOS viewer mapping and calculation throughout the bibliographic data from publications obtained from SCOPUS in July 2022. Results: There are 660 publications from six types of publication. Related keywords are compiled and visualized by network mapping. There is a significant gap among the contributing countries in the number of documents and number of citations per journal. However, a minimal gap is seen in other objectives, such as authors, journals, and institutions on their contribution towards the publication of gingivectomy topics. Conclusion: A total of 660 of 1914 articles were included in the analysis after the filtering process, and these articles were cited 5910 times, with an average of 9 citations per article.

Mobile Application-Based Support for Periodontal Treatment Improves Clinical, Cognitive, and Psychomotor Outcomes: A Randomized Controlled Trial Study.

This study aims to evaluate the clinical, cognitive, and psychomotor changes that emerged among patients with gingivitis and patients with periodontitis via mobile application assistance. Forty subjects were randomly and evenly distributed into test and control groups and were administered a professional mechanical plaque removal (PMPR) procedure. The clinical parameters examined were bleeding on probing (BoP), probing pocket depth (PPD), and the oral hygiene index (OHI-S). The test group was administered a mobile application intervention, namely PerioUICare, which provided users with continuous education and motivation and served as a daily dental hygiene reminder. The comparative results of the mean values of all parameters between the groups (inter-group) and within the groups (intra-group) after one- and three-month evaluations were analyzed. A one-month inter-group evaluation uncovered significant differences in the BoP, PPD, cognitive, and psychomotor scores of subjects with gingivitis and the BoP, OHI-S, cognitive, and psychomotor scores of subjects with periodontitis. A three-month inter-group evaluation revealed significant differences across all parameters except for PPD in subjects with periodontitis. The results of the intra-group comparison demonstrated statistically significant differences in all parameters in the test group but no significant differences in the cognitive and psychomotor scores of the control group. This study revealed that mobile application-based support for periodontal treatment can be considered effective.

Effectiveness of chlorhexidine gels and chips in Periodontitis Patients after Scaling and Root Planing: a systematic review and Meta-analysis.

Periodontal pockets are characteristic of periodontitis. Scaling and root planing is the gold standard for periodontitis treatment. Additional local antimicrobials are recommended in patients with a probing depth of ≥ 5 mm. This study aims to determine the effectiveness of chlorhexidine compared to other local antimicrobials in periodontitis. Searches were conducted using the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines. Meta-analysis was performed on studies that met inclusion criteria after risk of bias assessment. Meta-analysis between chlorhexidine chips and other antimicrobials showed a mean difference in probing depth after one month of 0.58 mm (p < 0.00001) whereas after three months the mean difference in probing depth was 0.50 mm (p = 0.001), index plaque 0.01 (p = 0.94) and gingival index - 0.11 mm (p = 0.02). Between chlorhexidine gel and other antimicrobials showed a mean difference in probing depth of 0.40 mm (p = 0.30), plaque index of 0.20 mm (p = 0.0008) and gingival index of -0.04 mm (p = 0.83) after one month. Chlorhexidine chips were more effective on the gingival index than other antimicrobials after three months. The other antimicrobials were more effective than chlorhexidine chips on probing depth after one and three months, and than chlorhexidine gels on plaque index after one month.

Fabrication and mechanical properties of newly developed triphasic blocks composed of gypsum-brushite-monetite for bone graft applications.

Objective: A triphasic bone graft block composed of gypsum, brushite, and monetite is expected to be better for regenerating bone than a gypsum-hydroxyapatite-tricalcium phosphate block. Therefore, the aim of this study was to fabricate and evaluate the mechanical properties of a newly developed triphasic block composed of gypsum, brushite, and monetite. Materials and method: Triphasic blocks were prepared by mixing calcium sulfate hemihydrate, brushite, and monetite powders with distilled water at a powder-to-liquid ratio of 0.5. The content of calcium sulfate hemihydrate was fixed at 50%, and the contents of brushite and monetite powders were varied. After molding and setting, the obtained blocks were characterized, and their mechanical properties were evaluated. Results: The triphasic blocks were prepared and could maintain their shape without collapsing. The XRD characterization of the obtained triphasic blocks showed that only three phases existed in the block. Calcium sulfate hemihydrate was transformed into its dihydrate form and provided mechanical strength to the block through a setting mechanism. The transformation of calcium sulfate hemihydrate into its dihydrate crystals formed an interlocked structure that was disrupted in triphasic blocks, as observed in SEM images. The disruption of the interlocked structure resulted in lower mechanical strength of the obtained triphasic blocks compared to the set gypsum control. The variation in brushite and monetite composition did not affect the mechanical properties of the triphasic blocks. Conclusion: The triphasic gypsum-brushite-monetite block was successfully prepared, and no other crystal phases were found. The triphasic blocks could maintain their shape after setting. The addition of brushite and monetite powders disrupted the interlocked structure of the set gypsum crystal, resulting in a decrease in mechanical strength. Furthermore, the variation in brushite and monetite powders did not affect the mechanical properties of the triphasic blocks.

Fate of the HA coating of loaded implants in the augmented sinus floor: a human case study of retrieved implants.

A histomorphometric study was performed on six retrieved loaded hydroxyapatite (HA)-coated titanium implants. The implants had been clinically functioning in a 50-year-old patient. She originally presented a severely atrophic maxilla that was reconstructed by sinus floor augmentation using autogenous bone from the iliac crest. In spite of good clinical function, because of psychiatric problems, all implants, including some bordering bone, were removed using a trephine bur. Thin ground sections were prepared for histology and used for histomorphometry. The aim of this study was to observe the condition of the calcium phosphate coating after 2.5 years of functional loading, the nature of the bone-to-implant interface, as well as the density of the bone graft around the implants. Intimate and abundant bone-to-implant contact was observed, ranging from 90.4% to 99.8% along the implant surface. Active bone remodeling occurred within all threads, as demonstrated by secondary osteons close to the implant surface. The thickness of the calcium phosphate coating varied from 51 to 88 pm for the loaded retrieved implants, versus 53 to 89 microm for the nonused control implant. All implants showed bone contact including the first thread and up to the smooth titanium neck. Both the nature and thickness of the coating had hardly changed after 2.5 years of loading. The HA-coated implants used achieved excellent osseointegration and must be considered clinically safe and effective in maxillary grafted bone.

High concentrations of bioactive glass material (BioGran) vs. autogenous bone for sinus floor elevation.

In this study, high concentrations of bioactive glass (BG) particles were compared with autogenous bone in their capacity to augment maxillary bone when grafted in the human sinus floor using a split mouth design. Three female patients with severe maxillary atrophy underwent bilateral sinus floor elevation and bone grafting using 80-100% BG particles (300-355 microm in size) mixed with 20% to 0% iliac crest bone particles at one (experimental) side, and 100% iliac crest derived bone particles at the other (control) side. A total of 22 bone biopsies was taken at the time of fixture installation; that is, at 4, 6 and 15 months after grafting, and processed for histology and histomorphometry. At the control (autogenous bone) sides, trabecular bone amounted to 39% of the biopsy volume in the graft (site) at 4 months, almost 41% at 6 months, and 42% at 15 months. This bone contained viable osteocytes and was mostly of mature, lamellar type. At the experimental (BG particles) sides, the graft consisted of 27% of mostly woven (and some lamellar) bone at 4 months, 36% (woven and lamellar) bone at 6 months, and 39% (mainly lamellar) bone at 15 months. The grafted BG particles started to excavate at 4 months and their centers gradually filled with bone tissue. As a consequence, the volume of BG particles in the biopsy decreased from 29% at 4 months to 15% at 6 months and 8% at 15 months. The BG particles appeared to resorb within 1-2 years by dissolution rather than by osteoclastic activity. Parameters for bone turnover (% osteoid surface, % resorption surface) indicated that bone remodeling was very active at both experimental and control sides, during more than 6 months. These results suggest that mixtures of mainly (80-90%) BG particles and some (10-20%) autogenous bone are effective for bone regeneration in the augmented sinus offer 6 months healing time, while about 12 months healing time is needed for 100% BG particles.