The Assessment of Different Gingival Management Materials for Immediate Implant Treatment in the Esthetic Zone: A Clinical and Biochemical Study.

PURPOSE: To observe the effect of different prosthetic materials (polymethyl methacrylate [PMMA] and flowable composite [FC]) on marginal bone loss, pink esthetic score (PES), and cytokine levels (receptor activator of nuclear factor kappa-Β ligand [RANKL] and osteoprotegerin [OPG]). MATERIALS AND METHODS: A total of 46 patients (31 women, 15 men) were treated with immediate implant therapy after tooth extraction. For standardization, only the maxillary premolar tooth of each patient was restored, and also, both of the adjacent teeth were present in the dental arch. Provisional crowns were prepared before the surgery on patient models with two different materials (24 PMMA, 22 FC). Following the surgical procedure, provisional crowns were adjusted on polyetheretherketone (PEEK) abutments as nonfunctional in centric and eccentric movements. After the surgery, patients were evaluated monthly for 3 months. At each follow-up, periapical radiography was obtained by the parallel technique, and peri-implant crevicular fluid (PICF) was collected. Pink esthetic scoring was done. MBL was calculated for the mesial and distal sides separately. Cytokine levels were analyzed from PICF. Statistical analyses (Shapiro-Wilk, Mann-Whitney U, independent-samples t test, Wilcoxon t test, paired-samples t test, and Friedman two-way analysis of variance with Bonferroni correction) were completed (α = .05). RESULTS: PES was increased significantly within groups (P < .01). However, there was no statistically significant difference between groups. According to the Mann-Whitney U test, no significant difference was found for the MBL (P > .05). When the RANKL/OPG values were evaluated within the group by using the Friedmann two-way analysis of variance test, no significant difference was found (P > .05). CONCLUSION: Similar pink esthetics, cytokine levels, and bone loss can be achieved using a protocol including immediate implants, particle grafts, soft tissue graft, PEEK abutments, and provisional restorations fabricated using PMMA and FC.

Does abutment preparation affect abutment screw joint stability? An in vitro study.

STATEMENT OF PROBLEM: Whether preparation of an implant abutment decreases the stability of the abutment screw joint is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the effect of the abutment preparation in laboratory conditions on the reverse torque value (RTV) of the abutment screw. MATERIAL AND METHODS: Sixty implants, implant analogs, and abutments obtained from 2 different manufacturers were used in the present study and divided into 2 groups (groups B and N) according to the manufacturer. Each group was then divided into 3 subgroups (n=10) according to the remaining wall thickness (control, 0.4 mm, 0.6 mm). All abutments were tightened to analogs with 15 Ncm, and standardized preparation was made with a custom-designed copy-milling system. All abutments were tightened to the implants with 30 Ncm, and then, the abutment screws were removed and RTVs were recorded. Subgroups were analyzed by using 1-way ANOVA (α=.05), and the independent-sample t test was used to compare groups. Relationships between categorical variables were analyzed by chi-square tests. One abutment screw from each subgroup was randomly selected and analyzed by using a scanning electron microscope. RESULTS: A statistically significant difference was found between RTVs of different manufacturers (group B=28.2 ±1.2 Ncm, group N=25.9 ±1.4 Ncm; P<.005). In group N, there was a significant difference among subgroups, control (26.7 ±1.4 Ncm), and 0.6-mm wall thickness (24.8 ±0.8 Ncm) (P<.05). A statistically significant relationship was found between preparation and RTV for the NucleOSS only (P<.05) and between manufacturer and RTV (P<.001). Scanning electron microscopy evaluations identified different screw head and thread designs. CONCLUSIONS: The abutment screw joint stability of the BioHorizons implant was not affected by abutment preparation.

Masseter muscle thickness and elasticity in periodontitis.

This study aimed to compare the thickness and elasticity of the masseter muscle between patients with gingivitis and patients with periodontitis. A total of 124 patients (63 gingivitis, 61 chronic periodontitis) were recruited at the start of the study, but only 84 patients were declared as final participants. Patients were divided into two groups: (1) patients suffering from gingivitis and (2) those with generalized chronic periodontitis. Clinical (PI, plaque index; GI, gingival index; PD, probing depth; CAL, clinical attachment loss; and BOP, bleeding on probing scores) and ultrasonographic (thickness and elasticity of the masseter muscle) measurements of periodontitis were performed. There were no significant differences in gender, age, body mass index, education status, income level, or marital status between the two groups (P > 0.05). The mean age ± SD for the gingivitis and periodontitis groups was 39.5 ± 10.8 years and 44.8 ± 8.8 years, respectively. There were significant differences between the two groups in the number of PI, GI, PD, CAL, and BOP scores. There were significant differences between the two groups when thickness of masseter during contraction and at rest was taken into account. The gingivitis group had significantly thicker masseter during both contraction and rest. On the other hand, when the elasticity of the masseter was evaluated, there were no significant differences found between the two groups and two sides for each group. Masseter muscle thickness in the periodontitis group was found to be decreased compared with that in the gingivitis group. Furthermore, loss of periodontal tissues due to periodontitis reduces the masticatory ability.

Evaluation of Vestibular Bone Thickness in Class I Malocclusion Treatment With Corticotomy-Assisted Rapid Orthodontics.

BACKGROUND: Corticotomy-assisted rapid orthodontics is a widely used method for speeding up conventional orthodontics. This study (i) evaluates the effects of corticotomy alone, corticotomy combined with bone graft, and corticotomy with platelet-rich fibrin (PRF) on vestibular alveolar bone thickness in patients with class I malocclusion; (ii) compares the treatment time with a conventional orthodontic therapy group, and (iii) investigates the periodontal health of patients who have undergone corticotomy-assisted rapid orthodontics. METHODS: The patients were divided into 3 groups: Group 1 (n = 10) underwent corticotomy alone; Group 2 (n = 10) underwent corticotomy combined with bone graft, and Group 3 (n = 10) underwent corticotomy combined with PRF. In the following stage, vestibular alveolar bone thicknesses were evaluated using 3-dimensional cone-beam computed tomography images. RESULTS: The findings showed that Group 2 achieved a more significant augmentation of the vestibular alveolar bone than Groups 1 and 3 (P = 0.001, P = 0.003), while corticotomy-assisted rapid orthodontics decreased treatment times. Sufficient alveolar bone thickness and preservation of the periodontal health were achieved when the corticotomy procedure was either combined with a bone graft or with PRF in the Class-I malocclusion patients. CONCLUSION: Bone grafts provided better bone thickness at the buccal surface of the anterior teeth of the mandible and maxilla, whereas the thickness of the keratinized gingiva was better with PRF.

The effects of ozone therapy on periodontal therapy: A randomized placebo-controlled clinical trial.

OBJECTIVES: The aim of this randomized split-mouth clinical trial was to evaluate the effects of ozone therapy on clinical and biochemical parameters of moderate to severe generalized periodontitis patients after non-surgical periodontal therapy. METHODS: A total of 36 moderate to severe generalized periodontitis patients were included in the study. The patients were systemically healthy and 18 to 64 years of age. Periodontal parameters, including plaque index (PI), gingival index (GI), probing depth (PD), percentage of bleeding on probing, percentage of pockets deeper than 5 mm and clinical attachment level (CAL), and percentage of ≥3 mm CAL, were evaluated at baseline and 3 months following periodontal therapy. All participants were treated non-surgically. Topical gaseous ozone was applied into periodontal pockets twice a week for 2 weeks during active periodontal therapy. Gingival crevicular fluid pentraxin-3 (PTX-3), interleukin-1ß (IL-1ß), and high sensitivity C-reactive protein (Hs-CRP) were evaluated. All statistical data were analyzed using SPSS software. RESULTS: Total of 36 participants completed the study (18 males, 18 females). PI, GI, PD, percentage of bleeding on probing, percentage of pockets deeper than 5 mm and CAL, and percentage of ≥3 mm CAL were improved, and there were no significant differences between the two sides. All inflammatory parameters, PTX-3, Hs-CRP, and IL-1, were reduced at 3-month follow-up. Only the decrease in PTX-3 levels between baseline and 3-month follow-up was statistically significant. CONCLUSIONS: Ozone therapy did not have any additional effect on periodontal parameters. All cytokines were reduced after periodontal therapy. Only PTX-3 levels were significantly lower at ozone sites compared to those at the control sites.

The effect of nonsurgical periodontal treatment on gingival crevicular fluid stress hormone levels: A prospective study.

OBJECTIVES: The purpose of this prospective study was to investigate the effect of nonsurgical periodontal treatment (PT) on anxiety/depression scale scores and on gingival crevicular fluid (GCF) cortisol (COR) and dehydroepiandrosterone (DHEA) levels. METHODS: Fifty-five participants with generalized chronic periodontitis (GCP group, n: 21), with localized chronic periodontitis (LCP group, n: 19) and with gingivitis or healthy (control group, n: 15) subjects were treated and followed up for 6 months. Clinical periodontal parameters include plaque index, gingival index, bleeding on probing, probing depth and attachment level; psychosocial measurements include Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI 1-2) psychometric instruments; hormone levels in GCF including COR and DHEA were evaluated. RESULTS: All clinical parameters were significantly decreased (except attachment loss) after PT (p < 0.05). No significant differences were observed between the two groups for STAI-1-2 and BDI scores, either at baseline or at 6 months (p > 0.05). COR levels were statistically lower following PT in GCP and LCP groups when compared to the baseline levels (p < 0.05). DHEA values at baseline and 6 months did not show significant differences. CONCLUSION: Within the limits of the study, decreased GCF COR and unchanged GCF DHEA levels were determined in nonsurgically treated patients regardless of the extent and severity of periodontitis.

Production of a Piece of Custom-Made Abutment Screwdriver: Technique and Case Report.

Crown fractures, framework fractures, and abutment screw loosening or screw fracture are examples of mechanical implant failures. Abutment screw loosening is a serious problem that can result in abutment screw fractures. This clinical report describes the production method of a custom-made abutment screwdriver piece for a patient with abutment screw loosening.

The effect of periodontal disease treatment in patients with continuous ambulatory peritoneal dialysis.

PURPOSE: Chronic inflammation is an obvious risk factor of atherosclerotic diseases, and the presence of periodontal disease is one of the important sources of chronic inflammation in patients with chronic kidney disease (CKD) and diabetes mellitus (DM). Thus, we aimed to investigate the effects of non-surgical periodontal therapy of the patients undergoing CAPD due to diabetic nephropathy, diabetic patients without CKD, and healthy controls on inflammation exponents. METHODS: Thirty-two CAPD patients due to diabetic nephropathy (group III), 31 diabetic patients without nephropathy (group II), and 38 healthy subjects (group I) were enrolled to the study. All patients enrolled to the study (to all groups) suffered from chronic periodontitis. Plaque index, Gingival index, pocket depth (PD) measurements were recorded before and after periodontal therapy. All blood samples for biochemical parameters were measured by using standard laboratory techniques with an automatic analyser. Blood samples for TNF-α, IL-6, and PTX-3 were centrifuged, and separated serum and plasma samples were stored at - 80 °C until analysis. RESULTS: All inflammatory markers were significantly higher in group III than the other two at baseline. TNF-α levels were significantly decreased after periodontal treatment at 3-month visit in all groups. PTX-3, IL-6, and Hs-CRP levels were significantly reduced after periodontal treatment at 3 months in group III. CONCLUSION: Periodontal disease is an important source of inflammation in diabetic CAPD patients and treatment of periodontal disease can be monitored by inflammatory markers including TNF-alpha, PTX-3, IL-6, and Hs-CRP. TNF-alpha may be useful and more sensitive monitoring inflammation in healthy patients and diabetic patients after periodontal treatment.

The clinical and systemic effects of periodontal treatment in diabetic and non-diabetic obese patients.

The purpose of the present study was to evaluate the response to periodontal management in obese individuals with poorly controlled diabetes mellitus (DM) and obese individuals without DM. Changes in clinical and biochemical parameters were also investigated. Seventeen obese patients with poorly controlled DM and 14 obese non-DM patients with generalized chronic periodontitis were enrolled. The anthropometric measurements, periodontal parameters, and serum levels of lipid (triglyceride, high-density lipoprotein cholesterol, total cholesterol, low-density lipoprotein cholesterol) and glucose (fasting plasma glucose [FPG], insulin, insulin resistance [IR], hemoglobin [Hb]A1c) metabolism, pro-inflammatory mediators (high-sensitivity C-reactive protein, tumor necrosis factor-α [TNF-α] and Pentraxim-3), and interleukin-6 were measured before and at 3 months, and 6 months after full-mouth scaling and root planing (FM-SRP) together with full-mouth disinfection (FMD). A significant reduction in TNF-α (P < 0.001) values was observed in both groups following periodontal healing. However, significant changes in FPG (P < 0.05), HbA1C (P < 0.05), and the homeostasis model assessment of IR (HOMA-IR; P < 0.05) were only observed after 3 months in the DM group. Our findings suggest that obesity with or without DM does not seem to be a modifying factor for the clinical outcome of FM-SRP and FMD.(J Oral Sci 58, 523-531, 2016).

Gingival crevicular fluid and saliva stress hormone levels in patients with chronic and aggressive periodontitis.

AIM: This cross-sectional study aims to analyse cortisol and dehydroepiandrosterone (DHEA) levels in gingival crevicular fluid (GCF) and saliva in generalized aggressive periodontitis (GAP) and generalized chronic periodontitis (GCP) patients, as well as in periodontally healthy individuals (C). MATERIAL AND METHODS: A total of 92 patients (31 C, 34 GCP and 27 GAP) were included in the study. Clinical parameters including plaque index, gingival index, bleeding on probing, probing depth and clinical attachment level; psychosocial measurements including Beck depression inventory and state-trait anxiety inventory; and hormone levels in GCF and saliva including cortisol and DHEA were evaluated. RESULTS: Gingival crevicular fluid cortisol and GCF/saliva DHEA values were significantly higher in the GAP group when compared to the other two groups (p < 0.05). The lowest values were in the C group and the difference between the GCP and GAP groups was statistically significant (p < 0.05). Salivary cortisol levels were comparable for the GAP and GCP groups (p > 0.05), and the C group had the lowest values in comparison with the other two groups (p < 0.05). CONCLUSIONS: Within the limits of this study, salivary/GCF cortisol and DHEA levels were suggested to be related with more severe and aggressive forms of periodontal disease.

Free gingival grafting procedure after excisional biopsy, 12-year follow-up.

The total removal of a lesion via excisional biopsy causes gingival recession, resulting in dentin hypersensitivity and esthetical problems. In this case report, a gingival recession defect resulting from an excisional biopsy was treated with a free gingival grafting procedure performed during the same appointment, and its 12-year follow-up was presented. A 44-year-old female patient was presented to our clinic with a firm, pedunculated, red gingival enlargement located on the labial surface of lower incisors. The exposed root surface, after the excisional biopsy, was covered with a free gingival graft. The lesion was pathologically diagnosed as pyogenic granuloma, and in the early postoperative phase, no recurrence was observed, but partial root coverage was determined. At 6-month follow-up, root coverage resulting from "creeping attachment" was observed, and this situation was maintained throughout the 12-year follow-up period. Repetitious postoperative discomfort and emotional stress for the patient may be avoided with a timesaving single appointment performing excisional biopsy and free gingival graft. Free gingival grafting procedure was used for this purpose not only to cover exposed root surfaces but also to eliminate dentin hypersensitivity and make oral hygiene procedures more effective.

Light emitting diode mediated photobiomodulation therapy improves orthodontic tooth movement and miniscrew stability: A randomized controlled clinical trial.

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the effects of light-emitting diode-mediated-photobiomodulation therapy (LPT) on the stability of miniscrews, rate of orthodontic tooth movement, and interleukin-1ß levels in gingival and peri-implant crevicular fluid. MATERIALS AND METHODS: This study was a double blind, randomized placebo/control matched pairs clinical trial to test the efficacy of LPT. This split-mouth design study consisted of 20 patients (13 girls, 7 boys). The eligibility criteria included patients who had extraction of maxillary first premolars. Mini-screws were placed between maxillary first molars and second premolars on both sides as anchorage units. LPT was applied with an energy density of 20 mW/cm2 over a period of 21 successive days (20 minutes per day) over the movement of canine teeth on the test side and using a pseudo application on the placebo side. The main outcome of this study was to assess effect of LPT on the rate of orthodontic tooth movement. The secondary outcomes were measuring stability of miniscrews and interleukin-1ß levels in gingival and peri-implant crevicular fluid after LPT. Randomization was accomplished with random LPT application side selection by coin toss. Measurements were made by blinding clinicians. Blinding of the patients was achieved using the same LPT device on both sides but irradiating only one side. For statistical comparison, paired samples t-test and one-way analysis of variance (ANOVA) were used at P < 0.05 level. RESULTS: Miniscrew stability was similar between control and LPT groups at baseline (T0) and the 1st month (T1). However, miniscrew stability was significantly increased in the LPT group in 2nd (T2) and 3rd (T3) months. Comparison of tooth movement during three different time intervals (T1-T0, T2-T1, and T3-T2) revealed that statistically significantly increased in every time intervals after LPT. No statistically significant change was detected in the IL-1ß levels between groups. CONCLUSION: LPT had the potential of accelerating orthodontic tooth movement and had a positive effect on miniscrew stability. Lasers Surg. Med. 48:936-943, 2016. © 2016 Wiley Periodicals, Inc.

Effects of Ozone Therapy on the Early Healing Period of Deepithelialized Gingival Grafts: A Randomized Placebo-Controlled Clinical Trial.

BACKGROUND: This study evaluates the effects of ozone therapy (OT) on the early healing period of deepithelialized gingival grafts (DGG) placed for non-root coverage gingival augmentation by laser Doppler flowmetry (LDF). METHODS: Thirty-three patients were assigned to study groups: 1) test: DGG + OT; or 2) control group: DGG alone. Thirty patients completed the study. Ozone was applied on DGGs placed in the recipient bed and donor site immediately after surgery and at days 1 and 3 post-surgery. Blood perfusion in the recipient site was measured by LDF on the day of surgery and at 1, 2, 3, 6, 8, 10, and 13 days after surgery. Quality of life (assessed by the Oral Health Impact Profile-14) and pain at donor/recipient sites (assessed by visual analog scale) were also investigated. RESULTS: Increase in blood perfusion units in the test group was significantly higher than control group at 1, 2, 3, 6, and 8 days post-surgery (P <0.001). Significant differences occurred between test and control groups in terms of visual analog scale values during the first week post-surgery for both donor and recipient sites (P <0.05). The ozone-treated group showed significantly higher quality of life than control group on postoperative day 6 (P = 0.002). CONCLUSIONS: OT enhanced blood perfusion units in the first postoperative week. This outcome is also consistent with improvement in wound healing, accompanied by an increase in quality of life and decrease in postoperative pain in the test group.

Knowledge of medical doctors in Turkey about the relationship between periodontal disease and systemic health.

Understanding the relationship between periodontal disease (PD) and systemic health (SH) is necessary for the accurate diagnosis and treatment of both. The aim of this study was to evaluate the knowledge of medical doctors in Turkey with regard to the association between PD and SH. This study was carried out using self-reported questionnaires that were sent to medical doctors who work at various universities and public and private hospitals in different cities in Turkey. The questionnaires consisted of questions about the demographic information of the medical doctors, as well as the knowledge of those doctors about the relationship between PD and SH. In total, 1,766 responses were received and 90.8% of the participants agreed that there was a relationship between PD and SH. Diabetes mellitus was the most frequent systemic disease (66.8%) known to be related to PD. Of the participants, 56.5% of the medical doctors referred their patients to periodontists for different reasons. Gingival bleeding was the most frequent reason for patient referrals, with 44% of doctors giving such referrals. Doctors who worked in basic medical sciences were significantly less aware of the relationship between PD and SH than the doctors in other specialties. Although the vast majority of the medical doctors reported that they knew the relationship between PD and SH, the findings of this study showed that this awareness was not supported by precise knowledge, and often failed to translate into appropriate clinical practice.