Time management in multistep periodontal and implant treatments: a practical guide.

In addition to the proper selection of techniques, appropriate treatment sequencing and prioritization are prerequisites for successful periodontal and implant procedures. The aim of this study was to provide evidence-based time frames for various procedures pertaining to periodontal and implant treatment. A literature review was conducted to collect data on tissue healing; in areas in which data were lacking, the viewpoints of experienced clinicians were solicited to establish a consensus. This review reports recommended time frames for the healing processes associated with surgical crown-lengthening procedures (both functional and esthetic), fresh socket management, alveolar ridge management, soft tissue management, sinus floor augmentation, implant loading, and peri-implant defect management.

In vitro release of silver ions and expression of osteogenic genes by MC3T3-E1 cell line cultured on nano-hydroxyapatite and silver/strontium-coated titanium plates.

Attempts are ongoing to improve the surface properties of dental implants by application of different coatings, aiming to enhance osseointegration, and decrease the adverse effects of titanium and its alloys used in dental implants. Coating of implant surface with hydroxyapatite (HA) is one suggested strategy for this purpose due to its high biocompatibility and similar structure to the adjacent bone. This study aimed to quantify the release of silver ions and expression of osteogenic genes by MC3T3-E1 cells cultured on nano-HA and silver/strontium (Ag/Sr)-coated titanium plates via the electrochemical deposition method. Plates measuring 10 × 10 × 0.9 mm were fabricated from Ti-6Al-4 V alloy, and polished with silicon carbide abrasive papers before electrochemical deposition to create a smooth, mirror-like surface. After applying homogenous nano-HA coatings with/without silver/strontium on the surface of the plates, the composition of coatings was confirmed by energy-dispersive X-ray spectroscopy (EDS), and their morphological properties were analyzed by scanning electron microscopy (SEM). The coated specimens were then immersed in simulated body fluid (SBF), and the concentration of released sliver ions was quantified by spectroscopy at 7-14 days. The MC3T3-E1 osteoblastic cell line was cultured in osteogenic medium for 7-14 days, and after RNA extraction and cDNA synthesis, the expression of runt-related transcription factor 2 (RUNX2), osteocalcin (OCN), and osteopontin (OPN); osteogenic genes was quantified by polymerase chain reaction (PCR) using SYBR Green Master Mix kit. The expression of genes and the released amount of silver ions were compared between the two groups using the Mann-Whitney U test. The two groups were not significantly different regarding silver ion release at 14 days (P > 0.05). However, silver ion release was significantly higher from nano-HA coatings with silver/strontium at 7 days (P = 0.03). The difference in expression of RUNX2 (P = 0.04), OPN (P = 0.04), and OCN (P = 0.03) genes was also significant between nano-HA coating groups with and without silver/strontium at 7 days, and the expressions were higher in nano-HA with silver/strontium group, but this difference was not significant at 14 days. Addition of silver and strontium to specimens coated with nano-HA increased the release of silver ions within the non-toxic range, and enhanced the expression of osteogenic genes particularly after 7 days.

Biological reactions of dental pulp stem cells cultured in presence of new xenograft bone substitutes from different sources: An in vitro study.

Aims: This study aimed to compare the biological reactions of dental pulp stem cells (DPSCs) cultured on new xenograft bone substitutes derived from camel and bovine bones. Materials and Methods: DPSCs were cultured and placed on different xenograft materials including Bone Plus (bovine), Camel Bone, and demineralized bovine bone matrix. The viability and proliferation of cells were evaluated by the methyl thiazolyl tetrazolium assay after 24, 48, and 72 h. The alkaline phosphatase (ALP) test and Alizarin red staining were performed at 7 and 21 days to assess the osteoblastic differentiation of cells. Osteocalcin (OCN) gene expression was evaluated qualitatively at 3-, 7- and 14-days using polymerase chain reaction (PCR). Semi-quantitative PCR was also performed using ImageJ software. Data were analyzed by ANOVA and Tukey's honestly significant difference test. Results: The cell proliferation rate was significantly different among the three xenograft bone substitutes at 24-, 48- and 72 h (P < 0.05). The ALP activity of DPSCs in all three xenograft bone substitute groups was greater than that in the control group (P < 0.05). Alizarin red staining showed no significant difference in the formation of calcified nodules among the groups. Qualitative and semi-quantitative PCR displayed that the expression of OCN gene in the Camel Bone and Bone Plus groups was higher than that in the demineralized bovine bone matrix group. Conclusions: The Camel Bone xenograft caused a high proliferation rate and optimal osteogenic differentiation of DPSCs qualitatively and semi-quantitatively in vitro. Further studies are required on this xenograft bone substitute.

Different techniques in transalveolar maxillary sinus elevation: A literature review.

Dental implant treatment in the posterior maxilla encounters bone quality and quantity problems. Sinus elevation is a predictable technique to overcome height deficiency in this area. Transalveolar sinus elevation is a technique that is less invasive and less time-consuming, first introduced for ridges with at least 5 mm of bone height. Many modifications and innovative equipment have been introduced for this technique. This review aimed to explain the modifications of this technique with their indications and benefits. An exhaustive search in PubMed Central and Scopus electronic databases was performed until December 2020. Articles were selected that introduced new techniques for the transalveolar maxillary sinus approach that had clinical cases with full texts available in the English language. Finally, twenty-six articles were included. The data were categorized and discussed in five groups, including expansion-based techniques, drill-based techniques, hydraulic pressure techniques, piezoelectric surgery, and balloon techniques. The operator's choice for transalveolar approach techniques for sinus floor elevation can be based on the clinician's skill, bone volume, and access to equipment. If possible, a technique with simultaneous implant placement should be preferred.

The Clinical Evaluation of the Effects of Low-Level Laser Therapy on the Donor and Recipient Sites of the Free Gingival Graft: A Case Series.

Introduction: Free gingival grafting is among the most foreseeing procedures for increasing the zone of keratinized attached gingiva and enhancing soft tissue around the teeth and dental implants. Nowadays low-level laser therapy (LLLT) is a promising approach in providing patients with more pleasing results in terms of esthetics and comfort. This study aims to investigate the effects of LLLT on gingival recessions treated with free gingival graft (FGG). Methods: This case series was conducted on 12 individuals requiring a bilateral gingival graft in the mandibular region. There was a 30-day interval between the two operations. The test side was selected randomly and irradiated by a low-level laser (LLL) just before surgery. The patients did not know which side was irradiated. LLLT was applied to the donors' as well as recipients' site immediately after the operation and 48 hours later. The patients were instructed to record their post-operative pain in a visual analogue scale (VAS) 3 and 24 hours and 7 days after the surgical procedure. The clinical photographs were taken immediately and 30 days after surgical treatment were graded by three experienced periodontists for color matching to adjacent tissues. Results: Ten individuals could finish the study. The test group presented significantly better shade matching and wound healing at the palatal donor site on days 7, 14 and 21. There was a significant reduction in post-operative pain after 24 hours (P = 0.007). No statistically significant difference was found between both groups in terms of clinical periodontal indices. Conclusion: LLLT could reduce post-operative pain 24 hours after surgical treatment. Furthermore, the application of LLLT could improve the donors' site healing and the recipients' site color matching.

Effect of one and two sessions of antimicrobial photodynamic therapy on clinical and microbial outcomes of non-surgical management of chronic periodontitis: A clinical study.

Background: This study aimed to compare the effect of one and two sessions of antimicrobial photodynamic therapy (aPDT) as an adjunct to scaling and root planing (SRP) on clinical and microbial parameters in patients with chronic periodontitis. Methods: This study was conducted on 20 patients. The dental quadrants of patients were randomly assigned to SRP at baseline (group 1), SRP at baseline and one month (group 2), SRP plus aPDT at baseline (group 3) and SRP plus aPDT at baseline and one month (group 4). Probing depth (PD), clinical attachment level (CAL) gain, and bleeding on probing (BoP) were measured at baseline, and one and three months later. F. nucleatum counts were determined by PCR. ANOVA was used for the comparison of these variables between the groups. Results: In all the groups, PD reduction and CAL gain increased significantly at 1- and 3-month intervals compared to baseline (P=0.001). At three months, the difference in PD between groups 1 and 3 was statistically significant (P=0.014). CAL gain between groups 2 and 4 at one month (P=0.016) and three months (P=0.001) wasstatistically significant. Reduction in F. nucleatum counts was not significant between the four study groups (P>0.05). Conclusion: A combination of two sessions of aPDT and SRP could improve CAL gain; however, further long-term studies are necessary in this regard.

Finite-Element Analysis of Stress and Strain in Mandibular Overdentures Supported by Splinted versus Nonsplinted Implants.

The objective of the current study is to investigate the relative effect of splinted and nonsplinted implants on stress and strain in the supporting tissue around implants in two-implant-supported mandibular overdentures. Two models of mandibular overdentures using locators (nonsplinted implants) and bar locators (splinted implants) were constructed, and a vertical load of 100 N was placed on the central fossa of the mandibular first molar. Stress and strain values were obtained using three-dimensional finite-element analysis (ANSYS R18.0). Splinting reduced stress in peri-implant bone in the ipsilateral implant by half and in the contralateral implant by a quarter. Greater stress and a rise in strain from 59 to 79 µÎµ in the posterior ridge were also observed with splinting. The model with splinted implants showed more favorable stress distribution in peri-implant bone, perhaps due to better distribution through the bar and the posterior ridge. These findings should be corroborated with clinical studies.

Oral Health Knowledge and Attitudes of Community Health Workers in East Azerbaijan, Iran.

STATEMENT OF THE PROBLEM: Prevention is the key factor in acquiring dental and oral health. Community health workers, as a part of health care networks in Iran, play an important role in delivering primary care and their knowledge and attitude directly affect the population whom they interact with in their service scope. PURPOSE: The aim of this research was to evaluate the knowledge and attitude level of community health workers regarding oral health. MATERIALS AND METHOD: This descriptive analytical study was carried out on 1170 community health workers who were employed in health offices in East Azerbaijan to evaluate their knowledge and attitude level about oral health. Data were acquired through filled out questionnaires and were analyzed by SPSS software. RESULTS: There was no significant statistical relationship between knowledge and gender (p= 0.063), level of education (p= 0.08) and the period spent from the last continuing education course (p= 0.148).However, by increasing age (p= 0.016), work experience (p=0.083) and number of attended continuing education courses (p= 0.023), the knowledge scores were reduced. No statistically significant relationships were found between attitude and any of research variables. CONCLUSION: The level of knowledge and attitude of community health workers in East Azerbaijan regarding oral health was good. There was a reverse relationship between age, work experience, and frequency of participation in continuing education courses and knowledge scores which emphasizes the necessity of continuous training and revising the method of training in education of community health workers and other staffs of health care system.

Clinical comparison of coronally-advanced flap plus amniotic membrane or subepithelial connective tissue in the treatment of Miller's class I and II gingival recessions: A split-mouth study.

Background. The aim of the present study was to compare coronally advanced flap (CAF) plus amniotic membrane (AM) to CAF with connective tissue graft (CTG) in the treatment of Miller's class I and II gingival recessions. Methods. Eleven healthy subjects with thirty Miller's class І and ІІ gingival recessions ≥3 mm, were selevted for this research and randomly assigned to two groups in a split-mouth design. In the control group gingival recessions were treated with CAF and CTG; however, in the test group the lesions were treated with (AM) and CAF. The clinical parameters, including recession depth (RD), recession width (RW), keratinized tissue width (WKT), probing depth (PD) and clinical attachment level (CAL), were measured at baseline and 1, 3 and 6 months postoperatively. Statistical significance was set at P < 0.01. Results. Position changes of RD, RW, CAL, and MGJ were significant between baseline and one month after surgery (P < 0.01) in both the test and control groups and these values remained unchanged at 3- and 6-month follow-ups. There were no statistically significant differences in PD and WKT between baseline and 1-, 3- and 6-months intervals postoperatively. The mean root coverage values after 6 months were 75.5% and 63.1% for two groups, respectively. The mean recession depth reductions were 2.63±0.63 mm and 2±1.4 mm in the test and control groups, respectively. Conclusion. The results of this research showed that application of AM instead of connective tissue decreased surgical operation time and patient discomfort but the amount of root coverage was not significantly different between the two methods.

In vitro effect of mineralized and demineralized bone allografts on proliferation and differentiation of MG-63 osteoblast-like cells.

Due to the extensive use of bone allografts in bone reconstruction and periodontal therapy as suitable alternatives to autografts, they are now marketed under different commercial brands. Considering the controversial reports regarding the osteoinductive properties of bone allografts, this study sought to assess the effect of type (mineralized/demineralized), amount and particle size of several allografts on the proliferation and differentiation of MG-63 osteoblast-like cells. MG-63 cells (24-h culture) were exposed to 20 and 40 mg amounts of nine different commercially available freeze-dried bone allografts. After 24 and 72 h of incubation, the effect of water-soluble allograft released materials on cell viability and proliferation was assessed using methyl thiazol tetrazolium (MTT) assay after 24 and 72 h of exposure. Cell differentiation and mineralization was assessed by real-time quantitative reverse transcription PCR and alizarin red staining after 72 h of exposure. The amount and particle size of understudy allografts had significant effects on cell viability after 24 h of exposure (in contrast to 72 h). Higher rate of proliferation was seen in non-differentiated or slow-differentiated groups. The amount and particle size factors had no significant effect on the amount of calcified nodules or the expression of osteogenic marker genes in most groups. Faster and more distinct differentiation and mineralization was noted in mineralized compared to demineralized groups during the 3-day study period. Based on the results, the understudy mineralized (non-demineralized) bone allografts had greater effect on osteogenic differentiation of the MG-63 cells and showed more in vitro osteoinductive activity compared to partially demineralized and fully demineralized types.

Comparison of the effects of different implant apical designs on the magnitude and distribution of stress and strain in bone: a finite element analysis study.

OBJECTIVES: The aim of this study was to investigate the effects of implant design on the apex area and on stress and stress patterns within surrounding bone. METHODS: Three commercially available implants with the same diameter (3.5 mm), same length (10-11 mm), and same complement abutment were selected for modeling as follows: (1) flat apical design with light tapering degree, (2) dome-shaped apical design with light tapering, and (3) flat apical design with intense tapering in one-third of the apical area. According to human conebeam computed tomography (CBCT), the bone was modeled using a cortical thickness of 2 mm and cancellous bone. Forces of 100 N and 300 N in the vertical and 15° angle directions were applied to the entire abutment surface, and the equivalent stress and strain were calculated using finite element analysis (FEA) methods. RESULTS: In all models, stress was concentrated on the cortical bone around the implant neck; in non-axial loads, stress was concentrated on the buccal side. The maximum strain recorded was a microstrain of 7200 µm µm-1 around the apex of sample C, which also showed the highest level of stress detected in cancellous bone (4.4 MPa). We observed the pathologic overload in the apical area of sample B (with a dome-shaped apex); however, the strain value was less than that of sample C. CONCLUSION: FEA revealed that great sudden changes in diameter along the fixture increases stress and strain in peri-implant bone. Therefore, uniform tapering should be considered as a standard feature for most clinical situations, and a flat apical design, which creates a better stress and strain distribution in surrounding bone than dome-shaped bone, should also be used.

MiR146a and MiR499 gene polymorphisms in Iranian periodontitis and peri-implantitis patients.

AIM: MicroRNAs (MiRs) are small noncoding RNAs that are involved in protein translation, osteoclastogenesis, and immunoregulation. Peri-implantitis and chronic periodontitis are multifactorial diseases. They are the consequence of complex interactions among host response, genetics, and environment. In the present study, we aimed to investigate the possible association between MiR146a/MiR499 gene polymorphisms and periodontitis/peri-implantitis as a first report in oral implantology. METHODS: From 197 individuals referred to Periodontology Department of Shahid Beheshti Dental School, three groups were enrolled in the assessment: 75 patients in the chronic periodontitis (CP) group, 38 patients in the peri-implantitis (PI) group, and 84 healthy subjects. DNA was extracted from fresh blood samples from the arm veins of participants and transferred to KBiosience Institute (Hoddesdon, United Kingdom) for genotyping. Chi-squared and Kruskal-Wallis tests were performed using SPSS software v.19 for statistical analyses. P-value < 0.05 was considered significant. RESULTS: The genotype frequencies in MiR 146a and MiR 499 were significantly different among the three groups. CONCLUSIONS: MiR146a (rs2910146) and MiR499 (rs3746444) gene polymorphisms may be genetic determinants for increased risk of chronic periodontitis and peri-implantitis in Iranians. More studies with larger sample sizes in different populations are necessary for determining the effect of these SNPs.

Clinical Comparison of Autogenous Bone Graft with and without Plasma Rich in Growth Factors in the Treatment of Grade II Furcation Involvement of Mandibular Molars.

BACKGROUND AND AIMS: Plasma rich in growth factors (PRGF) is a concentrated suspension of growth factors, which is used to promote periodontal tissue regeneration. The aim of this randomized, controlled, clinical trial was to evaluate of the treatment of grade II mandibular molar furcation involvement using autogenous bone graft with and without PRGF. MATERIALS AND METHODS: In this double-blind clinical trial, thirty mandibular molars with grade II furcation involvement in 30 patients were selected. The test group received bone graft combined with PRGF, while the control group was treated with bone graft only. Clinical parameters included clinical probing depth (CPD), vertical clinical attachment level (V-CAL), horizontal clinical attachment level (H-CAL), location of gingival margin (LGM), surgically exposed horizontal probing depth of bony defect (E-HPD), vertical depth of bone crest (V-DBC), vertical depth of the base of bony defect (V-DBD), and length of the intrabony defect (LID). After six months, a re-entry surgery was performed. Data were analyzed by SPSS 14, using Kolmogorov, Mann-Whitney U, and paired t-test. RESULTS: After 6 months, both treatment methods led to significant improvement in V-CAL and H-CAL and significant decreases in CPD, E-HPD, V-DBD and LID; there was no significant difference in LGM and V-DBC in any of the treated groups compared to the baseline values. Also, none of the parameters showed significant differences between the study groups. CONCLUSION: Although autogenous bone grafts, with or without PRGF, were successful in treating grade II furcation involvement, no differences between the study groups were observed.

Comparison of pain intensity of anterior middle superior alveolar injection with infiltration anesthetic technique in maxillary periodontal surgery.

PURPOSE: The aim of the present clinical trial was to compare pain during injection of anterior middle superior alveolar (AMSA) technique with that of infiltration injection technique in the maxilla in periodontal flap surgeries of patients referring to the Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Sciences. METHODS: Twenty subjects with an age range of 20 to 40 years were selected for the present study. One side of the maxilla was randomly selected as the test side and the other as the control side using a flip of a coin. AMSA technique was used on the test side and infiltration technique was used on the control side for anesthesia. On both sides 2% lidocaine containing 1:80,000 epinephrine was used for anesthesia. The operator obtained the visual analogue scale for each patient immediately after the injection and immediately after surgery. Data was analyzed using descriptive statistical methods (frequency percentages, means and standard deviations) and Wilcoxon's test using SPSS ver. 13 (SPSS Inc.). Statistical significance was defined at P<0.05. RESULTS: There were no statistically significant differences in pain during injection between the two techniques (P=0.856). There were statistically significant differences in postoperative pain between the two injection techniques (P=0.024). CONCLUSIONS: Postoperative pain in AMSA injection technique was less than that in the infiltration technique. Therefore, the AMSA technique is preferable in the periodontal surgeries for the anesthesia of palatal tissues given the fact that it has other advantages, too.

Subepithelial connective tissue graft with and without the use of plasma rich in growth factors for treating root exposure.

PURPOSE: The aim of this study was to evaluate the clinical efficiency of the subepithelial connective tissue graft (SCTG) with and without plasma rich in growth factor (PRGF) in the treatment of gingival recessions. METHODS: Twenty bilateral buccal gingival Miller's Class I and II recessions were selected. Ten of the recessions were treated with SCTG and PRGF (test group). The rest ten of the recessions were treated with SCTG (control group). The clinical parameters including recession depth (RD), percentage of root coverage (RC), mucogingival junction (MGJ) position, clinical attachment level (CAL), and probing depth (PD) were measured at the baseline, and 1 and 3 months later. The data were analyzed using the Wilcoxon signed rank and Mann-Whitney U tests. RESULTS: After 3 months, both groups showed a significant improvement in all of the mentioned criteria except PD. Although the amount of improvement was better in the SCTG+PRGF group than the SCTG only group, this difference was not statistically significant. The mean RC was 70.85±12.57 in the test group and 75.83±24.68 in the control group. CONCLUSIONS: Both SCTG+PRGF and SCTG only result in favorable clinical outcomes, but the added benefit of PRGF is not evident.

Comparative clinical study of coronally advanced flap with and without use of plasma rich in growth factors in the treatment of gingival recession.

PURPOSE: To evaluate the clinical efficiency of the coronally advanced flap (CAF) with and without plasma rich in growth factors (PRGF) in the management of gingival recession defects. METHODS: 20 bilateral similar recession defects in six healthy non-smoker subjects were included in the present study. The test sites received PRGF as an adjunct to the coronally advanced flap (CAF) while the control sites were treated with CAF only. The clinical parameters including recession depth (RD), percentage of root coverage (RC), recession width (RW), mucogingival junction position (MGJ), width of keratinized tissue (WKT), clinical attachment level (CAL), and probing depth (PD) were measured at the baseline, 1, and 3 months post-operatively. The data were analyzed using Wilcoxon signed rank and Mann-Whitney U tests. RESULTS: After 3 months, the mean root coverage was 43 +/- 34.9% in the CAF group and 61 +/- 23.5%) in the CAF + PRGF. Both treatment protocols led to a significant improvement in all measured variables compared to the baseline values, except the width of keratinized tissue. While PRGF enhanced the outcomes of CAF especially throughout the first month post-operatively, it offered no clinical advantage over CAF alone during the subsequent 2 months.

Evaluation of alteration in mucogingival line location following use of subepithelial connective tissue graft.

AIM AND OBJECTIVE: The aim of this study is to evaluate the positional changes that occur in mucogingival line following the use of subepithelial connective tissue graft (SCTG). MATERIALS AND METHODS: In 19 Miller class I or II gingival recession defects, distance between mucogingival line (MGL) and cemento-enamel junction, also width of keratinized and attached gingiva, and clinical attachment level were measured. SCTG were used for covering the exposed roots. A fore mentioned parameters were repeated at 3, 6 and 12 months after surgery and alterations were measured. Paired t test was used to analyze the results. RESULTS: MGL had been moved in coronal direction (4.39 +/- 0.77 mm on average) during surgical approach. After 1 year, MGL shifted 2.11 +/- 0.7 mm apically. In accordance with this apical shift, a significant increase in the width of keratinized and attached gingival width (2.89 +/- 0.63 mm and 2.82 +/- 0.5 mm, respectively) was seen (P < 0.05). CONCLUSION: MGL tended to revert back to its original position following the use of SCTG, and this reversion is accompanied with an increase in the keratinized and attached gingival width.

Detection of Helicobacter pylori using PCR in dental plaqueof patients with and without gastritis

Objectives: Helicobacter pylori (H. pylori) accounts for gastritis, peptic ulcer and is a probable cause of gastriccancer. Since its detection in the oral cavity, concerns have been raised about dental plaque as a reservoir for reinfection.The aim of this study was to detect the organism in the dental plaque and to determine the association, ifany, between H. pylori gastritis and dental plaque contamination causing H. pylori. Study design: A polymerasechain reaction-based method was used for detection of H. pylori in clinical specimens. Supra and subgingivalsamples were collected from 67 patients with chronic periodontitis, 23 of whom were also suffering from gastritis.The data were analyzed with Chi square and Fisher exact test and the statistical significance was set to 0.05.Results: H. pylori was scarce in patients with periodontitis(5.9%). There was a significant association between thepresence of H. pylori in the dental plaque and gastritis (p=0.012). Conclusions: Although rarely seen, H. pyloriinfected dental plaque may be a source for reinfection. It is therefore suggested that professional plaque removaland oral hygiene procedures be performed, along with the antibiotic treatment of H. pylori (AU)

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Detection of Helicobacter pylori using PCR in dental plaque of patients with and without gastritis.

OBJECTIVES: Helicobacter pylori (H.pylori) accounts for gastritis, peptic ulcer and is a probable cause of gastric cancer. Since its detection in the oral cavity, concerns have been raised about dental plaque as a reservoir for reinfection. The aim of this study was to detect the organism in the dental plaque and to determine the association, if any, between H. pylori gastritis and dental plaque contamination causing H.pylori. STUDY DESIGN: A polymerase chain reaction-based method was used for detection of H. pylori in clinical specimens. Supra and subgingival samples were collected from 67 patients with chronic periodontitis, 23 of whom were also suffering from gastritis. The data were analyzed with Chi square and Fisher exact test and the statistical significance was set to 0.05. RESULTS: H.pylori was scarce in patients with periodontitis(5.9%). There was a significant association between the presence of H.pylori in the dental plaque and gastritis (p=0.012). CONCLUSIONS: Although rarely seen, H.pylori infected dental plaque may be a source for reinfection. It is therefore suggested that professional plaque removal and oral hygiene procedures be performed, along with the antibiotic treatment of H.pylori.

A comparative study of the long term results of root coverage with connective tissue graft or enamel matrix protein: 24-month results

Background: The objective of this study was to compare the 24 month results of coronally advanced flap + enamel matrix derivates (EMD+CAF) and CAF+ connective tissue graft (CTG+CAF) in the treatment of Miller Class I recession defects.
Methods: Twelve patients with bilateral gingival recessions were treated with EMD+CAF or CTG+CAF. Vertical recession depth (VRD), keratinized tissue width (KTW), clinical attachment level (CAL), and clinical probing depth (CPD) were measured preoperatively, 1 and 2 years post surgery. A paired t-test and independent t-test were used to compare differences for the measured characters within and between groups, respectively. Results: After 24 months a significant decrease in VRD was observed in CAF + EMD (3.33±0.30 mm) and CAF + CTG (4.5 ± 0.28 mm) treated sites. There was also a significant increase in KTW (0.83±0.23 mm versus 2.08±0.14 mm in EMD+CAF and CTG+CAF sites, respectively). The gain in CAL was 3.54 ± 0.38 mm and 4.45±0.30 mm in EMD+CAF and CTG+CAF group, respectively. There were significant differences between the treatments for VRD, CAL, and KTW at the end of study. Conclusions: The CTG+CAF procedure seems to provide better long-term results than the EMD+CAF in obtaining root coverage, increasing the KTW and CAL gain (AU)