Patient-Specific Gingival Recession System Based on Periodontal Disease Prediction.

AIM: To develop a periodontal disease prediction software and a patient-based gingival recession simulator for clinical practice aiming at improving oral hygiene motivation of patients with periodontal problems. MATERIALS AND METHODS: Periodontal Disease Prediction (PDP) software has three components: a) Data Loading Window (DLW) b) Three-Dimensional Mouth Model (3DM) and c) Periodontal Attachment Loss Indicator (PLI). Demographic and clinical examinations of 1057 volunteers were recorded to DLW. An unsupervised machine learning K means clustering analysis was used to categorize the data obtained from the study population and identified the periodontal risk groups. An intraoral scanner was utilized to capture direct optical intraoral data of a patient and transferred to the 3DM. The intraoral model went under two algorithm steps for obtaining a recessed model. First, gingival curves separating gingiva and tooth were extracted using a Dijkstra's algorithm. Limit curves determining boundaries of recessed regions in the intraoral model were then obtained using gingival curves. RESULTS: Study participants were divided into three different periodontal risk categories defined as low risk (n=462), medium risk (n=336) and high risk (n=259). Gingival curves separating gingiva and tooth were extracted, and recessed models were obtained given inputs for the expected amount of recession via the proposed method. Furthermore, the user can also demonstrate the gingival recession gradually via the slider method attached to the developed programme. CONCLUSIONS: User-friendly computer-based periodontal risk estimation tool and patient-specific gingival recession simulator was developed and presented for clinical usage of dentists.

Investigating the potential clinical impact of periodontitis on the progression of Alzheimer's disease: a prospective cohort study.

OBJECTIVES: This study aimed to investigate the effect of periodontitis and current occlusal relationship on the progression rate of Alzheimer's disease (AD). METHODS: Ninety Alzheimer's patients, who were divided into three groups as Stage I (n=42), Stage II (n=29), and Stage III (n=19), based on the Clinical Dementia Rating Scale, were included in the study. Cognitive status of the patients was evaluated with Standardized Mini-Mental Test (SMMT) at baseline and repeated 6 months later. Clinical periodontal examinations were recorded and occlusal relationship status was classified according to the Eichner Index. RESULTS: Of 90 Alzheimer's patients, 65 were toothed individuals with periodontitis and 25 were edentulous individuals without active periodontal disease. Stage II and Stage III toothed Alzheimer's patients had higher percentage of bleeding on probing (BOP%) and clinical attachment level (CAL) values than Stage I patients (p<0.05). Stage III Alzheimer's patients had significantly higher probing pocket depth (PPD) values than Stage I individuals (p<0.05). ΔSMMT values showed positive correlation with BOP% (r=0.308, p=0.013) and PPD (r=0.275, p=0.027). Among the evaluated parameters, being in the AD Stage II-Stage III, having periodontitis and age variable had significant effects on ΔSMMT levels (p<0.05). CONCLUSIONS: Within the limits of our study, it can be concluded that periodontitis may increase the severity and also accelerate the progression rate of AD. CLINICAL RELEVANCE: These results are precious to show the necessity of proper oral hygiene activities and regular dental visits in patients with toothed AD. CLINICAL TRIAL REGISTRATION: This study was registered and approved by clinical trials (NCT05807100).

The use of low level laser therapy in conjunction with diode laser-assisted and conventional vestibuloplasty: Comparison of wound healing and vestibular depth gain.

BACKGROUND: The aim of this study is to compare wound healing and vestibular depth gain in individuals undergoing vestibule deepening surgery using diode laser and conventional technique and to further investigate the possible wound healing effect of low-level laser therapy (LLLT). MATERIAL AND METHODS: 52 systemically healthy individuals with insufficient vestibular depth in the region of teeth 33-43 in the lower jaw were included. Following nonsurgical periodontal treatment, patients were divided into four groups as follows: a) diode laser (L); b) diode laser + LLLT; c) conventional surgery and d) conventional surgery + LLLT. Vestibular depth and horizontal wound size measurements of the individuals were recorded using digital calipers. Reepithelization was evaluated via an image analysis program. RESULTS: Vestibular depth measurements were found to be higher in the conventional surgery groups compared to that of diode laser groups after the operation, while the results were not statistically different between groups (p >0.05). Reepithelization area did not differ between groups in the evaluated time periods (p >0,05). On the other hand, horizontal wound shrinkage was significantly higher in the conventional surgery group than that of diode laser. CONCLUSIONS: Within the limits of this study, both methods yielded in vestibule depth gain. On the other hand, LLLT did not have an additional positive effect on mucosal wound healing. As a clinical relevance, the results are valuable for clinicians in terms of showing that suturing of the mucosal flap formed following vestibule deepening should not be necessary in laser assisted surgery for attaining more vestibule depth.

Periodontal health education session can improve oral hygiene in patients with gingivitis: A masked randomized controlled clinical study.

BACKGROUND: The aim of this clinical trial was to evaluate the effect of a periodontal health education session (PHES), which included education on the pathogenesis and consequences of periodontal diseases on oral hygiene motivation in patients with gingivitis. METHODS: A randomized controlled clinical trial was conducted on 50 (26 females and 24 males) patients with gingivitis who underwent periodontal treatment. Subjects were randomly allocated into the PHES group (experimental group) and standard oral hygiene education group (control group). The Rustogi Modified Navy Plaque Index (RMNPI) and Papillary Bleeding Index (PBI) were used to evaluate oral hygiene at baseline and were repeated after 1, 3, and 6 months. Knowledge about periodontal disease was measured and the participants' motivation was determined using the Oral Hygiene Motivation Scale. RESULTS: Although baseline knowledge levels and motivation scores were not different between the groups, following the educational motivational interviewing (MI) session, levels were higher in the experimental compared with the control group. The subjects' RMNPI and PBI scores at the 1-, 3-, and 6- month re-examinations were statistically higher in the control group than the experimental group. Furthermore, the level of knowledge and intrinsic and total motivation scores were moderately positively correlated with a reduction in clinical indices at 6 months compared with baseline. CONCLUSIONS: The results of this study indicated that increased knowledge and awareness about periodontal diseases and its consequences, including systemic effects, via educational MI session increased intrinsic motivation and improved oral hygiene of patients with gingivitis, especially regarding interproximal surfaces.

Analysis of risk indicators for prevalence of peri-implant diseases in Turkish population.

BACKGROUND: The aim of this cross-sectional study was (1) to determine the prevalence of peri-implant mucositis and peri-implantitis and (2) to reveal the risk indicators associated with peri-implant diseases. The second point was to investigate the role of keratinized mucosa on peri-implant health. MATERIALS AND METHODS: Three hundred and eighty-two subjects who were treated with 1415 dental implants between 2011-2017 were clinically evaluated. Patients' medical and dental history, as well as implant details, were recorded. Peri-implant examination included probing pocket depth (PPD), bleeding on probing (BoP), plaque index (PI), gingival index (GI), and keratinized tissue width. Furthermore, the patient (sex, age, and smoking) and implant/prosthesis-related factors (surface characteristic, time in function, design of prosthesis etc.) were evaluated. Implants were classified into three groups: healthy, peri-implant mucositis, and peri-implantitis. Uni- and multi-variate regression analyses were utilized for statistics. RESULTS: 41.1% (n = 157) and 36.9% (n = 84) of patients had mucositis and peri-implantitis, respectively. 53.6% (n = 758) of implants (95%CI 80.2-90.4) had mucositis, and 21.7% (n = 307) had peri-implantitis. Patients with a maintenance < 2/year (OR = 2.576), having periodontitis (OR = 3.342) and higher PI (OR = 3.046) had significant associations with the development of peri-implant mucositis. Significant ORs were determined for peri-implantitis with patients having maintenance < 2/year (OR = 2.048), having number of implants ≥ 4 (OR = 2.103), diagnosed with periodontitis (OR = 3.295), and higher PI (OR = 7.055). Keratinized tissue width < 2 mm (ORs = 5389/8.013), PPD (ORs = 1.570/8.338), PI (ORs = 6.726/5.205), and BoP (ORs = 3.645/4.353) independent variables were significantly associated with both peri-implant mucositis and peri-implantitis at implant level, respectively. CONCLUSIONS: Within the limits of this study, the prevalence of mucositis and peri-implantitis was shown to be high in Turkish population. Furthermore, increased risk for peri-implantitis was identified in patients having maintenance < 2/year, presence of periodontitis, poor plaque control, and having number of implants ≥ 4. Less keratinized tissue (< 2 mm), PPD, and BoP were also risk indicators for peri-implantitis development.

Clinical importance of neuregulin-4 and its receptor ErbB4 in periodontal disease pathogenesis.

OBJECTIVE: The aim of this clinical trial was to evaluate the levels of Neuregulin-4 (Nrg4), Erb-b2 receptor tyrosine kinase 4 (ErbB4), interleukin (IL)-6, IL-10, nitric oxide synthase (NOS)-2, and arginase (Arg)-1 in periodontal health and disease. MATERIALS AND METHODS: This study includes systemically healthy 20 periodontally healthy (H), 20 gingivitis (G), 20 stage II periodontitis (P1), and 20 stage III periodontitis (P2) subjects. Periodontal clinical measurements and samples of gingival crevicular fluid (GCF) and serum were obtained at baseline and 4 weeks after non-surgical periodontal treatment (NSPT). Enzyme-linked immunosorbent assay (ELISA) was used to determine ErbB4, Nrg4, IL-6, IL-10, NOS2, and Arg1 levels in all samples. RESULTS: GCF ErbB4 and Nrg4 total amounts and IL-6/IL-10 ratio were significantly higher in G, P1, and P2 groups than H group. Serum NOS2 levels were significantly lower, whereas serum Arg1 levels were higher in H group than the others. The GCF levels of ErbB4 and Nrg4 were significantly decreased after NSPT in G, P1, and P2 groups. Additionally, the GCF levels of ErbB4 and Nrg4 were positively correlated with all clinical parameters and IL-6/IL-10 ratio. CONCLUSIONS: Nrg4 and its receptor ErbB4 might have crucial roles in the pathogenesis of periodontal disease. These results should be verified with future prospective studies to further clarify the exact role of those biomarkers.

Evaluation of the Effect of Topical Hypericum perforatum Oil on Excisional Palatal Wound Healing in Rabbits.

Aim: The aim of this study was to evaluate the effect of Hypericum perforatum (HP) oil on wound-healing process in rabbit palatal mucosa. Materials and Methods: Thirty-six New Zealand albino rabbits were randomly allocated to following groups; (1) HP oil (test, n = 18) and (2) olive oil (control, n = 18). Palatinal excisional wounds were created and the oils were topically applied (0.1 ml, 30 s, twice a day). Gingival biopsies were excised, and analyzed for re-epithelialization (RE) and granulation tissue maturation (GTM) on days 3, 7, and 14 after surgery. Levels of vascular endothelial growth factor (VEGF) and fibroblast growth factor 2 (FGF-2) were assessed using the immunohistochemical method. Apoptotic cells (ACs) were evaluated using TUNEL staining. Enzyme-linked immunosorbent assay was used to assess tissue catalase (CAT) and malondialdehyde (MDA) levels. Results: RE and GTM were completed earlier in the HP oil group than in the control group. The number of positively stained cells/vessels was higher in olive oil than in the test group on day 3 for FGF-2 and on days 3 and 7 for VEGF (p < 0.05). In contrast, on day 14, a higher number of vessels was observed in the HP oil group than in the control group. HP oil treatment reduced the number of ACs compared to olive oil (p < 0.05), but the difference during the healing period did not reach significance. Tissue CAT and MDA levels between groups were not different, and also the results were the same when the levels were analyzed by the evaluated time periods (p > 0.05). Conclusions: The results of this study demonstrated that topical HP oil treatment did not provide an additional benefit to its base, olive oil, in the early phase of secondary wound healing.

Netrin-1 and its receptor Unc5b as markers of periodontal disease.

OBJECTIVES: The aim of this present study was to evaluate the levels of Netrin-1 and Unc5b in periodontal health and disease. BACKGROUND: Netrin-1, acting via its receptor UNC5b, regulates the inflammatory response and takes apart in bone destructive diseases. METHODS: Samples of gingival crevicular fluid (GCF), whole saliva, and serum were taken from systemically healthy, nonsmoking 20 periodontitis , 20 gingivitis patients, and 20 periodontally healthy subjects at baseline and 4 weeks after nonsurgical periodontal treatment (NSPT). Whole-mouth and site-specific clinical periodontal parameters were recorded. Netrin-1 and Unc5b levels were measured by enzyme-linked immunosorbent assay. Data were analyzed by nonparametric tests. RESULTS: Total amount of Netrin-1 in GCF was significantly higher in periodontitis than the others, and the levels were significantly reduced after NSPT. Salivary and serum concentrations of Netrin-1 were significantly different among the study groups (P = .000), and NSPT significantly increased the concentration levels of both salivary and serum Netrin-1 (P < .05). Healthy subjects had significantly lower GCF (P = .001) and conversely, higher salivary and serum levels of Unc5b than the other groups (P = .002). The GCF levels of Unc5b were significantly reduced (P < .01), and conversely, serum concentrations were significantly increased after NSPT (P < .05). GCF Netrin-1 and Unc5b total amounts were positively correlated with clinical parameters (P < .01 and P < .05) whereas salivary Netrin-1 and Unc5b concentrations were negatively correlated with clinical parameters (P < .01 and P < .05). CONCLUSIONS: The results of this study indicate that Netrin-1 and its receptor Unc5b may have essential roles in periodontal inflammation and those can be assumed as useful therapeutic agent to control inflammation and periodontal breakdown.

Free gingival graft adjunct with low-level laser therapy: a randomized placebo-controlled parallel group study.

OBJECTIVES: This study aimed to evaluate the effect of low-level laser therapy (LLLT) in terms of enhancing wound healing, reducing free gingival graft (FGG) shrinkage and postoperative pain. MATERIALS AND METHODS: Thirty patients were randomly assigned to receive either FGG + LLLT (test, n = 15) or FGG + plasebo LLLT (control, n = 15). In the test group, a diode laser (810 nm, 0.1 W, energy density 6 J/cm2) was applied immediately after surgery and 1, 3, 7, and 14 days later. Measurements of the graft surface areas of the groups were made with an image-analyzing software at baseline and first, third, and sixth months. Complete wound epithelialization and visual analogue scale (VAS) for pain score were evaluated after surgery. RESULTS: Shrinkage of the graft was statistically higher in the control than the test group at third and sixth months (p < 0.05). In terms of epithelization of the graft area, the test and control groups did not show any significant difference during the 28-day period (p > 0.05). Besides this, statistically significant differences were observed for VAS pain score and the number of analgesic used (p < 0.05). CONCLUSIONS: The use of an 810-nm diode laser provided additional benefits to FGG in terms of less shrinkage of the graft dimensions and postoperative pain. CLINICAL RELEVANCE: Low-level laser therapy reduced the shrinkage of free gingival graft's surface area after 6 months and enhanced postoperative pain relief.

Frequency of MCP-1 (rs1024611) and CCR2 (rs1799864) gene polymorphisms and its effect on gene expression level in patients with AgP.

OBJECTIVE: To identify the genetic risk markers of aggressive periodontitis (AgP), researchers focus on genetic components that regulate the immune response. Therefore the purpose of this study was to investigate genetic impact of monocyte chemoattractant protein (MCP)-1-2518A/G and CC chemokine receptor 2 (CCR2) -190G/A gene polymorphisms on AgP susceptibility and the effect of this polymorphism on MCP-1 gene expression in patients with AgP. MATERIAL AND METHODS: A total of 215 subjects, 108 AgP and 107 periodontally healthy (H) were recruited in this cross-sectional study (NCT02817568). Gene polymorphisms of MCP-1-2518A/G and CCR2-190G/A were analyzed by a standard polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay. MCP-1 messenger (m) RNA expression was measured using quantitative real-time (RT)-PCR in peripheral blood leukocytes from 26 AgP and 16H controls. Threshold cycles (Ct) values were obtained from the RT-PCR analysis based on SYBR Green detection and data was normalized via ΔCt. RESULTS: There were no differences between AgP and H groups with regard to MCP-1 and CCR2 genotype distribution and allele frequencies (p>0.05). In contrast, the MCP-1 mRNA expression levels were higher in homozygous "AA" control subjects than having G+ genotype and AA homozygous AgP patients. CONCLUSIONS: It can be concluded that MCP-1 and CCR2 polymorphisms are not associated with AgP in Turkish population. Although in AgP patients, there was AA genotype with MCP-1 mRNA expression it can be speculated that gene expression levels in peripheral blood may not reflect the cytokine/chemokine levels of local tissues.