Localized Piezoelectric Alveolar Decortication for Orthodontic Treatment in Adults: A Randomized Controlled Trial.

This randomized controlled trial aimed to evaluate the benefits and clinical outcomes of piezocision, which is a minimally invasive approach to corticotomy that is used in orthodontic treatments. Twenty-four adult patients presenting with mild overcrowdings were randomly allocated to either a control group that was treated with conventional orthodontics or a test group that received piezo-assisted orthodontics. The piezocisions were performed 1 wk week after the placement of the orthodontic appliances. Neither grafting material nor sutures were used. All patients were followed every 2 wk, and archwires were changed only when they were no longer active. The periods required for the completion of the overall orthodontic treatments were calculated, and the periodontal parameters were evaluated at baseline and at the end of the orthodontic treatment. Patient-centered outcomes were assessed with a visual analog scale; analgesic use following the procedures was also recorded. The patient characteristics were similar between the 2 groups. The overall treatment time was significantly reduced by 43% in the piezocision group as compared with the control group. In both groups, periodontal parameters (i.e., recession depth, pocket depth, plaque index, and papilla bleeding index) remained unchanged between the baseline and treatment completion time points. No increase in root resorption was observed in either group. Scars were observed in 50% of the patients in the piezocision group. Analgesic consumption was similar following orthodontic appliance placement and piezocision surgery. Patient satisfaction was significantly better in the piezocision group than in the control group. In these conditions, the piezocision technique seemed to be effective in accelerating orthodontic tooth movement. No gingival recessions were observed. The risk of residual scars might limit the indications for piezocision in patients with a high smile line (ClinicalTrials.gov NCT02590835).

Teriparatide therapy for denosumab-induced osteonecrosis of the jaw in a male osteoporotic patient.

We report the first case of teriparatide adjuvant role in the management of a denosumab-induced osteonecrosis of the jaw in a male subject with idiopathic osteoporosis. Clinical benefits and CT healing were obtained within 2 months of teriparatide initiation and denosumab withdrawal. Increase in bone turnover previously described, when denosumab treatment is removed, might have a synergistic effect to the stimulating effect of teriparatide on bone remodeling to promptly heal osteonecrosis of the jaw.

Osteonecrosis of the jaw in a male osteoporotic patient treated with denosumab.

Osteonecrosis of the jaw (ONJ) is a clinical condition associated with long-term exposure to inhibitors of bone resorption, mainly bisphosphonates. Denosumab (DMab) is a human monoclonal antibody of the receptor activator of nuclear factor kappa-B ligand. It prevents osteoclast-mediated bone resorption and is widely prescribed for the management of postmenopausal osteoporosis. Whereas ONJ has already been reported in women treated with DMab, we report for the first time the development of ONJ, following tooth extraction, in a male patient treated for idiopathic osteoporosis with DMab. Due to the constant increase in DMab prescription, for the management of osteoporosis, in both genders, physicians should be made aware of this potential risk.

Herpes simplex virus reactivation and dental procedures.

OBJECTIVES: Dental extraction is reported to trigger recurrent herpes labialis (RHL). AIM: This aims to prospectively study the clinical occurrence of RHL and the oral herpes simplex virus type 1 (HSV-1) viral shedding before and 3 days after different dental procedures. MATERIALS AND METHODS: Oral HSV-1 DNA was measured by real-time PCR before and 3 days after dental procedures of the inferior dentition in 57 immunocompetent patients (mean age 32.4 years) who were selected and divided into four distinct subgroups (dental inspection without anesthesia, n = 19; dental filling under local anesthesia, n = 14; molar extraction under local anesthesia, n = 15; and molar extraction under general anesthesia, n = 9) and compared to 32 healthy controls (mean age 33 years). RESULTS: None of the patients suffered from RHL at day 3. Oral HSV-1 DNA was detected before and after procedure in 1.7 % (1/57) and 5.3 % (3/57), respectively [dental inspection without anesthesia, 5.3 % (1/19); molar extraction under local anesthesia, 6.7 % (1/15); and molar extraction under general anesthesia, 11 % (1/9)]. None of the controls presented RHL or detectable oral HSV-1 DNA. There was no statistically significant difference between the study groups and controls. CONCLUSION: Molar extraction increases the risk of oral HSV-1 shedding but not of RHL. Procedure-related nerve damage probably accounts for HSV reactivation. CLINICAL RELEVANCE: Antiviral prophylaxis for RHL is not routinely recommended for dental procedures, regardless of a prior history of RHL.

[Dental biofilms]. / Biofilms bactériens et médecine dentaire.

Orodental pathologies are generally classified into two main groups: caries and parodontopathies. They result from polymicrobial infections based on the dental plaque's theory which has constantly evolved. Therefore, the concept of acquired biological pellicle or biofilm has been described and largely elaborated.A bacterial biofilm is a unit of bacterial microcolonies embedded within an exopolymeric matrix and adherent to an inert or living surface. The aim of this paper is to provide a review of the literature with regard to the formation, and composition of the biofilm, as well as to point out the close link that exists between biofilm and dental medicine.

Comparison of microleakages of photo-cured composites using three different light sources: halogen lamp, LED and argon laser: an in vitro study.

In this study, we compared the microleakage of composite fillings cured with halogen bulb, LED and argon ion laser (488 nm). Twenty-four extracted human molars were divided randomly in three groups. Six cavities were prepared on the coronal part of each tooth. Standard cavities (1.7 x 2 mm) were prepared. Cavities were acid etched, sealed with Scotch Bond 1 and filled by a hybrid composite. Cavities were exposed to one light source, thermocycled and immersed in a 2% methylene blue dye solution. Dye penetration in the leakage of cavities was recorded using a digital optical microscope. Mean values of percentage of dye penetrations in microleakages of cavities were 49.303 +/- 5.178% for cavities cured with LED, 44.486 +/- 6.075% with halogen bulb and 36.647 +/- 5.936% for those cured by argon laser. Statistically significant difference exists between cavities cured by halogen vs LED (P < 0.01), halogen vs laser (P < 0.001) and LED vs laser (P < 0.001). The lowest microleakage was observed in the cavities and composites cured with argon ion laser.

Temperature rise during photo-activated disinfection of root canals.

The aim of this study was to determine whether it is safe to use photo-activated disinfection (PAD) during root canal treatment without heating the periodontal tissues. Root canals of 30 freshly extracted single-rooted teeth were prepared using ProFiles up to size ISO 40 and then filled with photo-sensitiser: tolonium blue (1.2 mg/l). The 635 nm diode laser was used with the manufacturer's endo-tip. Samples were irradiated for 150 s (output power 100 mW, approximate energy density 106.16 J/cm(2)). Temperatures were recorded at working length on the external root surface. After 150 s of PAD irradiation, the average temperature rise was 0.16 +/- 0.08 degrees C. All values were lower than the 7 degrees C safety level for periodontal injury. It was concluded that, regarding the temperature increase, the use of PAD in root canals could be considered harmless for periodontal tissues.

[Antimicrobial peptide in dentisty. Literature review]. / Les peptides antimicrobiens en médecine dentaire. Revue de la littérature.

The use of antimicrobial substances has contributed to the development of multiple antimicrobial resistances (1), challenging the pharmaceutical industry to develop with new, innovative, and effective molecules. Discovered around 1980, molecules called natural antimicrobial peptides (AMPs) appear to hold great potential for the treatment of infections. These cationic peptides are able to stop the bacterial development and to control infections. The purpose of this review is to help improve the understanding of the way AMPs operate in the context of the development of new cures against viruses, bacteria, and mushrooms found in the human body in general and in the oral cavity in particular.

[Origin and treatment of bad breath]. / Origine et traitement de la mauvaise haleine.

Halitosis affects more than 60% of the population. In about 8% of the cases, halitosis is related to an ENT pathology, and in less than 1% to gastric dysfunction. Ninety percent of these problems are associated to an oral disease. Gram-bacteria are often responsible of bad breath. They transform some amino-acids in volatile sulphur compounds. These bacteria are, also, directly associated with periodontal diseases which affect a major part of the adult population. These diseases are the most important cause of tooth loss after the age of thirty-five, with progressive destruction of supporting tissues of the teeth.

[Anti-vitamins K and oral surgery: the end of their prohibition?]. / Les AVK en chirurgie bucco-dentaire: la fin des vieux tabous?

In patients under oral anticoagulation therapy, the risk of haemorrhage following surgery must be balanced with the risk of thrombo-embolism induced by its discontinuation. Dental surgery is usually safe. Indirect anticoagulation may be continued provided rigorous surgical techniques and careful local hemostasis are applied.

Diffuse but unilateral gingival enlargement associated with von Recklinghausen neurofibromatosis: a case report.

BACKGROUND: An 8-year old girl was referred for diagnosis and treatment to the Department of Periodontology Oral Surgery of the University Hospital of Liège with an unusual clinical situation: a major, non-inflammatory, diffuse but unilateral enlargement of the interproximal, marginal and attached gingiva around all teeth of the right side of both the upper maxilla and mandible, whereas the alveolar process of the left side of upper and lower arches appeared strictly normal. METHOD: The clinical examination showed delayed eruption of some permanent teeth in the 1st and 4th quadrants. Except for its asymmetric occurrence, this gingival enlargement strongly resembled phenytoin-induced enlargement or gingival fibromatosis. This unilateral expression was evocative of a vascular or neurologic pathology. Several large "café-au-lait" spots were found disseminated on the body. Several selective surgical removals of thick gingival caps impairing the eruption of some permanent teeth were performed, and the removed tissues were histologically analyzed. RESULTS: Because of the presence of the large "café-au-lait" spots, a clinical diagnosis of Von Recklinghausen's disease was given and later confirmed several times by the histological analysis of the gingival biopsies. Now, 6 years later, this gingival enlargement due to the development of intra-gingival neurofibromas is stable and all permanent teeth have had a normal eruption, but alveolar bone growth has been partly impaired by the presence of the tumor. CONCLUSIONS: The present case of unilateral diffuse hyperplasia is a unique clinical expression of neurofibromatosis type I, a slowly evolving neurodermic dysplasia.

Human periodontal ligament fibroblast behavior on chemically conditioned dentine: an in vitro study.

BACKGROUND: Chemical root conditioning is widely used in an attempt to improve the outcome of regenerative periodontal surgery, but its effect on connective tissue cell proliferation and biosynthetic activity has been poorly studied. The goal of the present study was to test in vitro the consequences of conditioning human dentine by citric acid or minocycline on the behavior of attached human periodontal ligament (HPDL) cells in terms of proliferation, protein synthesis and morphological appearance. METHODS: HPDL cells were seeded on powdered human dentine, either untreated or conditioned for 3 minutes with 3% citric acid or 2.5% minocycline HCI. Scanning (SEM) and transmission (TEM) electron microscopic observations were performed, and 3H-thymidine and 3H-proline incorporation tests were used to evaluate the proliferative and the biosynthetic activities. RESULTS: Cell spreading was already evident and the penetration of cytoplasmic processes into dentinal tubules were frequently observed on all dentine types after 2 hours of attachment. After 24 hours of incubation, citric acid conditioning promoted an intense spreading of the cells, while minocycline HCI conditioning induced the formation of a dense feltwork of cellular processes. HPDL fibrolasts adherent to both types of surface-conditioned dentine exhibited a significantly higher rate of proliferation (P<0.01) as well as a significantly higher level of total protein and of collagen synthesis (P<0.01) than on untreated dentine. CONCLUSIONS: These data suggest that during periodontal surgery a conditioning of the root surface by citric acid or by minocycline HCI could promote the attachment, the proliferation, and the biosynthetic activity of HDPL, prerequisites to periodontal regeneration.

In vitro stimulation of human gingival epithelial cell attachment to dentin by surface conditioning.

BACKGROUND: Chemical root conditioning is widely used to improve the outcome of regenerative periodontal therapies by favoring the attachment of the regenerated periodontal structures. Although the effect of root conditioning on periodontal mesenchymal cells is well documented, very little is known about its potential effect on the re-formation of the junctional epithelium, a crucial event for the protection of the wound. The goal of the present study was to test in vitro the consequences of dentin conditioning with citric acid or minocycline on the attachment kinetics and morphology of human gingival keratinocytes (HGK). METHODS: The attachment kinetics of HGK to samples of powdered human dentin (particle size 44 to 76 microm) were examined by use of 3H-labeled cells. The morphology of attached epithelial cells was then determined by scanning electron microscopy (SEM). RESULTS: When the initial adhesion kinetics of cells on untreated dentin were tested, the percentage of attached HGK proved to be dependent on the number of plated cells and the time of incubation (from 0 to 12 hours). Conditioning the dentin by 3% citric acid or by minocycline-HCl (at 0.01, 0.1, or 2.5%) significantly increased (P <0.005) keratinocyte attachment beyond 6 hours, without notable differences between the 2 substances at any concentration. The attachment kinetics of HGK preincubated for 24 hours by 10 microg/ml minocyline-HCl on untreated dentin was found to be similar to that observed for non-preincubated cells. These results are in agreement with the SEM observations: indeed, the surface conditioning of dentin significantly modified the morphology of attached HGK, whereas the preincubation of these cells with minocyline-HCl did not. CONCLUSIONS: These results suggest that minocycline-HCl does not exert a direct effect on human gingival epithelial cells. In contrast, conditioning the dentin by citric acid or by minocycline stimulates the attachment of HGK, which could lead to a rapid periodontal healing by favoring the re-formation of a junctional epithelium.

The influence of cortical perforations and of space filling with peripheral blood on the kinetics of guided bone generation. A comparative histometric study in the rat.

The aim of the present study was to evaluate the influence of cortical perforations and of peripheral blood addition in guided bone generation beyond the skeletal envelope in rats. A total of 30 isogenic adult rats were divided into 3 equal groups. In each rat, two hollow parallelipipedic titanium chambers were placed bilaterally on the calvaria after a periosteal skin flap was raised. While on the right sides (controls) the osseous surface was left intact and the chambers were empty, the cortical bone under the left-side chambers (test sites) was perforated with nine 0.8 mm-diameter holes (group I), or left intact but with the chambers filled with a clot of peripheral blood (group II). In group III, both procedures were combined in the test sites. The healing was assessed at 4, 8 and 16 weeks after surgery by histologic and computer-assisted histometric analysis. The results demonstrated a substantial augmentation of on average 141% (SD 18) of the skull's thickness after 16 weeks in the controls, indicating that a predictable bone formation can be achieved beneath completely occlusive barriers over a non-injured cortical layer. In all test groups, a significantly larger bone augmentation was observed after 16 weeks compared to the control sites 172.8% (SD 41.7) in group I (P < 0.05), 172.0% (SD 18.4) in group II (P < 0.05) and 221.5% (SD 42.3) in group III (P < 0.001), demonstrating that stimulating blood supply and bone forming cells access by cortical perforations and/or blood clot addition enhances de novo bone formation in this experimental model.

[Halitosis: a multidisciplinary problem]. / La mauvaise haleine: un problème multidisciplinaire.

Bad breath, or halitosis, affects between 50 and 65% of the population. Despite its frequency, this problem is often unaccepted and declared taboo. In about 8% of the cases, bad breath is related to an ENT pathology (sinusitis, tonsillitis, ...). More rarely it is caused by a metabolic (diabetes, trimethylaminuremia, ...) or gastric dysfunction. Ninety percent of the cases however, are associated to an oral disease: either gingivitis due to an inadequate removal of dental plaque, especially from interdental spaces, or periodontitis (alveolar bone destruction), or bacterial accumulation on the dorsum of the tongue. In most cases, an intensive disinfection of the mouth by scaling and root planing and/or instruction of a perfect oral hygiene will be sufficient to solve the problem. Perfumed mouthwashes or toothpastes will only give a short-term masking effect. An effective collaboration between a dentist or a periodontist and an ENT specialist is of great importance to dealt with bad breath.

In vitro modulation of human gingival epithelial cell attachment and migration by minocycline-HCL.

Although the influence of tetracyclines on periodontal connective tissue cells has been the topic of many in vitro and in vivo studies, data regarding their effects on gingival epithelial cells are scarce. The present in vitro study was designed to examine the influence of minocycline, a semi-synthetic analog of tetracycline, on human gingival keratinocyte (HGK) attachment and migration. Attachment tests were performed with HGK prelabeled by tritiated amino-acids. Increasing concentrations of minocycline (10, 50, 100 micrograms/ml) in the medium produced no significant modification of cell adhesion kinetics compared to control conditions, except for 100 micrograms/ml which statistically significantly (p < 0.05) reduced the number of attached cells beyond 6 h. A 24-h cell preincubation in 10 micrograms/ml of minocycline did not alter the kinetics of HGK attachment. Scanning electron microscopic observations of attached HGK showed that the presence of 10 micrograms/ml of minocycline in the "attachment medium" induced the production of multiple filopodial extensions. Migration tests in Boyden chambers for 40 h demonstrated that HGK preincubation for 24 h in a 10 micrograms/ml minocycline-HCl solution increased significantly (p < 0.005) cell migration towards a gradient of fetal calf serum. The presence of 10 micrograms/ml of minocycline in contact with the keratinocytes in the upper compartment of the migration chambers also produced a significant (p < 0.005) result. In contrast, the presence of minocycline in the lower compartments did not produce any chemoattractive effect. Within the limits of their significance, these results suggest that, at concentrations not beyond 50 micrograms/ml, minocycline could fasten the periodontal wound coverage by epithelial cells and allow the normal reformation of a junctional epithelium.

Subgingival minocycline hydrochloride ointment in moderate to severe chronic adult periodontitis: a randomized, double-blind, vehicle-controlled, multicenter study.

The safety and efficacy of subgingivally-applied 2% minocycline ointment was evaluated in a randomized, double-blind study of 103 adults with moderate to severe periodontitis. Two groups were compared; one received the test minocycline ointment and the other a vehicle control. Both groups had scaling and root planing at baseline, after which the test or control ointments were applied with an applicator into the periodontal pockets at baseline, and at 2, 4, and 6 weeks. Assessment of clinical response was made by measuring probing depth and probing attachment level and gingival bleeding. These measurements were made at baseline prior to scaling and root planing, and at weeks 4 and 12. Microbiological assessment of the subgingival flora was carried out with DNA probes at baseline, and at weeks 2, 4, 6, and 12 to identify and quantify Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans. Subgingival minocycline ointment resulted in statistically significantly greater reduction of P. gingivalis at weeks 2, 4, 6, and 12; P. intermedia at weeks 2, 4, 6, and 12; and A. actinomycetemcomitans at weeks 6 and 12. Probing depth reductions were seen for both groups at weeks 4 and 12; however, this reduction was statistically significantly greater in subjects treated with minocycline ointment. Reduction in gingival index and probing attachment gain were seen in both groups, however, the differences between the groups were not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Kinetic aspects of gingival and periodontal ligament fibroblast attachment to surface-conditioned dentin.

An in vitro model has been developed for measurement of initial attachment of 3H-labeled human gingival fibroblasts (HGF) and periodontal ligament cells (HPDL cells) to sieved dentin powder. Reproducible attachment was obtained and was closely related to the number of plated cells, the amount of dentin powder, the temperature, and the time (from 0 to 6 h) of incubation. HGF and HPDL cells had a high affinity for untreated dentin. Heat-denatured BSA coating of the dentin fully inhibited cell attachment, while a fibronectin coating had no significant effect. A surface conditioning of the dentin grains by 3% citric acid or by 2.5% minocycline-HCl increased the initial attachment of HPDL cells significantly (p < 0.05). Minocycline-HCl was more efficient than citric acid in that respect. In addition, HGF attachment to untreated dentin was highly significantly improved (p < 0.005) by a pre-incubation of the cells with 50 micrograms/mL of minocycline, and there was also indication (p = 0.067) of improvement by the presence of minocycline in the attachment medium, with a maximum of efficacy at 110 micrograms/mL. These results suggest that minocycline-HCl directly influenced the attachment properties of fibroblastic cells and that citric acid and minocycline-HCl could act by different mechanisms. HGF and HPDL cells originating from the same patient displayed no significant difference in their attachment to dentin in this model.

[Elimination of carious tissue with the Caridex system: bacteriological study]. / Eviction des tissus cariés par le système Caridex: étude bactériologique.

The Caridex a chimio mechanical removal system of dental caries has been on the European Market since 1986. The purpose of the present investigation was to determine if this procedure can eliminate the totality of the infected dentin through comparative bacteriologic samples taken after the opening of the cavity and the use of the Caridex. The article also covers the use and mechanism of action of the system and evaluates the bacteriocidal effect of the active solution. The results demonstrate the efficiency of the tested solution but seem to show that vigorous curettage is necessary for total eviction of the carious lesion. Besides no bacteriocidal effect has been attributed to the Caridex solution over seventeen bacterial samples cultured from the decay.