Tooth loss assessment during periodontal maintenance in erratic versus complete compliance in a periodontal private practice in Shiraz, Iran: a 10-year retrospective study.

BACKGROUND: Several studies have demonstrated the efficacy of periodontal maintenance (PM), but there are conflicting data regarding tooth loss following patient compliance. METHOD: Seventy-two periodontal patients (52 women, 20 men), 86% of whom had been diagnosed with chronic moderate to severe periodontitis, were included in this retrospective study. Clinical variables such as tooth loss, bleeding on probing (BOP), plaque index and probing depth were collected from patients after 10 years of PM. The periodontal status of regular compliers (RCs) and erratic compliers (ECs) were compared in a private practice. RESULTS: The statistical analysis showed that clinical variables were not significant between RCs and ECs except for BOP (p = 0.038). During PM, 24 teeth (a mean of 1.5 teeth per participant) were lost in the RC group, and 80 teeth (a mean of 1.43 teeth per participant) were lost in the EC group. Molars were the most frequently lost teeth and canines the least. In general, those patients with less BOP lost fewer teeth (p = 0.002) and attended more recall visits (p = 0.001). CONCLUSIONS: In the present sample, RCs and ECs did not show significant differences in rates of tooth loss. However, a significant difference between RCs and ECs in regard to BOP was observed at the final examination (p = 0.038). There was also a strong relationship between BOP and recall visits: the patients with less BOP attended more recall visits (p = 0.001).

Effect of periodontal surgery on the salivary Herpes simplex virus-1 levels-a pilot study.

Background and aim: Herpes simplex viruses (HSV) are one of the most important groups of human pathogenic viruses. The prominent characteristic of this virus is latency and the ability to reactivate. One of the possible factors for reactivation of this virus is dental procedures. The aim of this study was to evaluate the salivary level of Herpes simplex viruses, before and after periodontal (crown lengthening) surgery and its relation with age and sex. Materials and methods: 30 HSV seropositive patients, who needed the crown lengthening surgery and accepted to cooperate in this research, were included as experimental group of this study. Unstimulated Saliva samples of the patients were collected in 1.5 ml micro-tubes, before and 24 h after the surgery, and were analyzed by Premix EX taq probe qpcr, using PCR real-time method. Results: No significant statistical differences were observed in the salivary level of HSV before and after crown lengthening procedure (p = 0.18). However, the level of HSV in saliva after surgery was significantly higher than its level before surgery in women as compared to men (p = 0.003). The differences in virus level did not have any significant relationship with patients' age (p = 0.9). Conclusion: It seems that periodontal (crown lengthening) surgery does not affect the level of HSV in saliva yet, but it could be one of the stimulators of increased HSV level after surgery in women as compared to men; but age does not play an important role in changes of level of virus before and after the surgery.

Zimmermann-Laband syndrome: Clinical and cytogenetic study in two related patients.

BACKGROUND: Zimmermann-Laband Syndrome (ZLS) is an extremely rare autosomal dominant congenital disorder. It is a craniofacial malformation syndrome with predominant intraoral involvement consisting of gingival fibromatosis diffusion in early development. The molecular basis of ZLS is still unknown. Although familial aggregation with different inheritance patterns is detected in ZLS patients, most of the cases are sporadic. MATERIAL AND METHODS: We report on two sibling patients with clinical manifestations of ZLS. Blood samples of both patients were obtained in EDTA-tubes followed by performing cytogenetic study using Cyto2.7M array. Analysis of the copy number was performed using the Chromosome Analysis Suite Software (version 1.0.1, annotation file na 30, Affymetrix) and interpreted with recourse to the UCSC genome browser (http://genome.ucsc.edu/; Human Mar. 2006NCBI Build 36.1/hg18 assembly). RESULTS: The array analysis revealed overlapping regions of chromosomal aberrations in both patients. We detected a 258-kb deletion at 3q13.13, a 89-kb duplication at 1q25.2 as well as two 67-kb duplications at 1p12 and 19q12. These altered regions do not contain any known genes and protein-coding sequences. CONCLUSIONS: In conclusion, the findings of this report revealed new chromosomal aberrations, including a deletion at 3q13.13 and duplications at 1q25.2, 1p12 and 19q12, in the two patients with ZLS. Such findings indicate that whole genome screening for genomic rearrangements is fruitful in typical and atypical patients with ZLS. Key words:Zimmermann-Laband syndrome, cytogenetic array, whole genome screening, chromosomal aberration, gingival fibromatosis.

The Impact of Calcium Hydroxide on the Osteoinductive Capacity of Demineralized Freeze-Dried Bone Allograft: an In-Vitro Study.

STATEMENT OF THE PROBLEM: A great challenge in periodontal therapy is the regeneration enhancement of osseous defects through applying osteoinductive materials. Demineralized freeze-dried bone allograft (DFDBA) has already been introduced as an allograft with osteoconductive and variable osteoinductive properties. Calcium hydroxide [Ca(OH)2] is an available well-known material in dentistry, which induces hard tissue formation. PURPOSE: This study evaluated the efficiency of combination of DFDBA and Ca(OH)2 in improving the quality of osteoinduction of DFDBA. MATERIALS AND METHOD: Human bone marrow-derived mesenchymal stem cells were taken from volunteers' iliac crest. Cell proliferation was determined by MTT test at 18, 24 and 48 hours post-culture in 10 groups. The employed material were 0.5, 1.0 mg/ml Ca(OH)2 in two forms of suspension and pH-adjusted solution, 10mg/ml DFDBA per se and in combination with 0.5 and 1.0 mg/ml Ca(OH)2. Mineralization was assessed by Alizarin red staining in 10 mg/ml DFDBA, DFDBA+ 0.5 and 1 mg/ml Ca(OH)2 in solution and suspension forms. The data were statistically analyzed by using one-way ANOVA and Tukey's post-hoc test (p< 0.05). RESULTS: The pH-adjusted solutions exhibited better cell proliferation compared with the suspension groups. The combination of 0.5mg/ml Ca(OH)2 solution and DFDBA increased the cell proliferation and mineralization compared with DFDBA per se (p= 0.033). CONCLUSION: The combination of Ca(OH)2 with DFDBA improved the osteoinductivity of DFDBA.

Antimicrobial Activity of Peganum Harmala L. on Streptococcus mutans Compared to 0.2% Chlorhexidine.

STATEMENT OF THE PROBLEM: Dental caries is one the most prevalent diseases that affects humans throughout their lives. Streptococcus mutans (S. mutans) is recognized as the most important microorganism during tooth cariogenicity. Reducing this germ in oral cavity can reduce the rate of tooth decays in humans. PURPOSE: The present study compared the antimicrobial activity of ethanolic extract of Peganum harmala L. seeds and 0.2% chlorhexidine on S. mutans. MATERIALS AND METHOD: Agar diffusion technique and micro broth dilution method were employed to test the antimicrobial effects of these two agents on S. mutans. Moreover, the cytotoxicity of ethanolic extract of P. harmala was studied on Vero cells by MTT (thiazolyl blue tetrazolium dye) colorimetric method. The data were analyzed with descriptive methods. RESULTS: Concentrations of 50, 25, and 12.5 mg/mL of the extract made inhibition zones of bacterial growth around the wells; but, lower concentrations could not inhibit the growth of S. mutans. Besides, the antimicrobial effect of 0.2% chlorhexidine was more than 50 mg/mL of the extract. Minimum inhibitory concentration (MIC) of the extract on S. mutans was 1.83±0.6 mg/mL and minimum bactericidal concentration (MBC) was 4.3±1 mg/mL. The MIC and MBC for 0.2% chlorhexidine were reported to be 0.19 mg/mL, and 0.78 mg/mL, respectively. The extract concentrations more than 0.5 mg/mL were toxic and caused more than 50% Vero cell death. CONCLUSION: Despite the remarkable antimicrobial effects of high concentrations of P. harmala on S. mutans, high cell toxicity of this plant would restrict its in vivo therapeutic use.

Quantification of Epstein-Barr Virus and Human Cytomegalovirus in Chronic Periodontal Patients.

BACKGROUND: Although studies focused mainly on the identification of periopathogenic bacteria, recent reports have suggested that various herpes viruses may also be involved in the occurrence and progression of different forms of periodontal diseases. OBJECTIVES: This study aimed to compare the prevalence and load of Epstein-Barr Virus (EBV) and Human Cytomegalovirus (HCMV) in subgingival tissue specimens between chronic periodontitis and healthy sites. PATIENTS AND METHODS: A total of 60 samples from the systematically healthy patients with chronic periodontitis participated in this study (mean age, 35 ± 7). Clinical periodontal evaluation included the plaque index (PI) (Loe and Silness), bleeding on probing (BOP) (O'Leary), bleeding index, periodontal pocket depth (PPD) and clinical attachment level measurement. Tissue specimens harvested from > 6 mm periodontal pockets and from ≤ 3 mm sulcus depth in a quadrant of the same patient using periodontal curettes. Moreover, the unstimulated whole saliva was gathered as a shedding medium. A Taq-man Real-Time Polymerase Chain Reaction assay was used to identify genomic copies of periodontal HCMV and EBV. Data were analyzed by the Wilcoxon-signed ranks and Friedman tests using the SPSS 16 software. RESULTS: Out of 60 samples of subgingival tissues taken from the patients with chronic periodontitis, EBV count was the highest in saliva and the least in the tissue sample with PD < 3 mm (P < 0.05). The highest HCMV count was in saliva and tissue samples with PD > 6 mm (P < 0.05). CONCLUSIONS: According to the results of this study, quantification of HCMV and EBV observed in this study is high in periodontal tissue samples of severe chronic periodontitis.

Treatment of Intrabony Defects by DFDBA Alone or in Combination with PRP: A Split-Mouth Randomized Clinical and Three-Dimensional Radiographic Trial.

OBJECTIVES: The efficacy of adding platelet-rich plasma (PRP) to demineralized freeze-dried bone allograft (DFDBA) in order to improve the clinical and radiographic results obtained in treatment of deep periodontal intrabony defects has yet to be fully elucidated. MATERIALS AND METHODS: This double blind, split-mouth randomized controlled clinical trial was conducted on 12 patients with two comparable bilateral intrabony defects. Each pair of defects was randomly treated with DFDBA+PRP (test) or DFDBA alone (control). Clinical attachment level (CAL), intrabony defect depth (IDD), distance from the stent to the alveolar crest and pocket depth (PD) as well as radiographic parameters including the radiographic defect depth, width and angulation were measured at baseline and six months post-operatively. The paired t-test was used to compare the pre and post-treatment values and the unpaired t-test compared the test and control groups. RESULTS: The mean reductions in PD and CAL were 4.5 ±1.3 mm and 3.6±1.6 mm in sites treated with DFDBA+ PRP, respectively (P<0.01); these reductions were 4.1±1.4 mm and 3.5±1.3 mm, respectively in DFDBA group (P<0.01). Radiographic evaluation revealed 2.5±1.1 mm reduction in the radiographic defect depth in the test and 2.1±1.2 mm in the control sites. The defect angulation increased at both sites. Statistically, there were no significant differences between the two treatment modalities (P<0.01). CONCLUSION: This study showed that both treatments resulted in significant PD reduction, CAL gain and IDD reduction. Also, PRP failed to enhance the results obtained by DFDBA.

Evaluation of knowledge and practice behaviours of a group of Iranian obstetricians, general practitioners, and midwives, regarding periodontal disease and its effect on the pregnancy outcome.

BACKGROUND: Periodontal disease is considered as a risk factor for poor pregnancy outcomes, including preterm birth and low birth weight. Only few studies have assessed the knowledge and practice behaviours of healthcare providers, concerning oral health during pregnancy, periodontal diseases and their role in adverse pregnancy outcomes. The present study aimed to compare the knowledge and practice behaviours of a group of Iranian obstetricians, general practitioners, and midwives about periodontal disease. DESIGN AND METHODS: A cross-sectional study was conducted using a self-administered, structured questionnaire that was previously used in North Carolina. The questionnaire was translated into Persian language and was randomly distributed among 200 obstetricians, general practitioners, and midwives participating in an international congress. Data were analysed by Chi-square and spearman correlation tests using SPSS statistical software (version PASW 18). RESULTS: A total of 150 completed the questionnaires, achieving a response rate of 75%. Totally, the knowledge of the obstetricians was more accurate compared to the two other groups and the midwives were the worst. More experienced general practitioners (P=0.002) and obstetricians (P=0.049) did less dental examinations for their patients during their first visit or periodically. More experienced obstetricians also referred their patients for dental examinations during pregnancy less than their less experienced colleagues (P<0.001). CONCLUSIONS: Although the participants had some knowledge about periodontal disease and its association with adverse pregnancy outcomes, there is much space for improvements. The participants' attitude and knowledge were consistent. Significance for public healthPreterm labour and low birth weight are considered to be one of the greatest problems in obstetrical medicine and are one of the most prevalent risk factors for death during the neonatal period. On the other hand, periodontal diseases are considered as important factors affecting pregnant women and their new-born children. Therefore it seems quite important to find out whether the healthcare providers who are most visited by pregnant women are aware of the periodontal disease and its relationship with poor pregnancy outcomes. The present study aimed to assess and compare the knowledge and beliefs of a group of Iranian obstetricians, general practitioners, and midwives regarding periodontal disease, and to assess whether their practice behaviours reflected their beliefs. The authors hope that publication of this paper would provide an evidence to plan for these health professionals' education on the importance of pregnant women's oral health promotion.

Association of IL-8 (-251 a/t) gene polymorphism with clinical parameters and chronic periodontitis.

OBJECTIVE: To investigate the correlation between IL-8 (-251 A/T) gene polymorphism and susceptibility to chronic periodontitis as well as different clinical parameters and severity of the condition in patients referred to dental school, Shiraz University of Medical Sciences, Shiraz, Iran. MATERIALS AND METHODS: In this randomized cross sectional study, 227 non-smoking patients with chronic periodontitis (test) and 40 healthy individuals (control) were enrolled in this experiment and the following clinical parameters were employed in the study: Periodontal Pocket Depth (PPD), Clinical Attachment Level (CAL) and Bone Loss (BL). All participants underwent the PCR (Polymerase Chain Reaction) test to detect 251 A/T Single Nucleotide Polymorphism of IL8 gene. RESULTS: No significant correlation was perceived between different genotypes of IL-8 and the severity of the periodontal condition (P= 0.164), neither did we detect any substantial association between different IL-8 genotypes and the mean PPD (P=0.525), CAL (P=0.151), BL (P=0.255), PI (P=0.087), BOP (P=0.265) and the average number of teeth (P=0.931). CONCLUSION: The results implied that there was no explicit correlation between 251 (A/T) IL-8 gene polymorphism and the severity of the chronic periodontal disease or to the susceptibility to it.

Assessing the Antimicrobial Effect of the Essential Oil of Myrtus communis on the Clinical Isolates of Porphyromonas gingivalis: An in vitro Study.

BACKGROUND: One of the major diseases affecting the oral health is periodontal disease. Various therapeutic methods have been introduced to eliminate the periodonto-pathic subgingival microflora. Among these, Porphyromonas gingivalis (P. gingivalis) has a major role in the pathogenesis of different forms of periodontal diseases. OBJECTIVES: The present study investigated the antimicrobial effect of the essential oil of Myrtus communis on Porphyromonas gingivalis (P. gingivalis) as the most destructive periodontal pathogens. MATERIALS AND METHODS: The subjects included 27 male and 3 female patients with advanced chronic periodontitis. The mean age of the patients was 47.6 ± 2.0 years old. P. gingivalis was isolated from the samples and identified by various diagnostic tests, including Gram staining, Indol test, and fluorescent test. Minimum inhibitory concentration (MIC) of the essential oil against isolated P. gingivalis was determined by broth micro-dilution method. RESULTS: In this study, 0.12 - 64 µL/mL Myrtus communis essence were used for 30 P. gingivalis isolates and the MIC50 and MIC90 concentration of Myrtus communis essence against the isolates was equal to 1 and 8 µL/mL respectively. CONCLUSIONS: The results showed that Myrtus communis has antimicrobial effects against P. gingivalis. Further studies are suggested to include this essence in therapeutic protocols of periodontal disease.

Assessing the Effect of Pineapple Extract Alone and in Combination With Vancomycin on Streptococcus sanguis.

BACKGROUND: Periodontitis is a major problem that affects a large number of patients in the society. Various treatment alternatives have been proposed to control this pathologic condition. Streptococcus sanguis is one of the countless pathogens involved in periodontitis. OBJECTIVES: The current study aimed to assess the efficacy of pineapple extract per se and in synergy with vancomycin on the growth activity of S. Sanguis. MATERIALS AND METHODS: An experimental study was designed to determine the minimum inhibitory concentration (MIC) of Pineapple extract per se and in conjunction with vancomycin. The study was carried out in three stages. Serial concentrations of the aqueous pineapple extract, vancomycin, and pineapple plus vancomycin were prepared by broth microdilution technique respectively and were exposed to the standard laboratory strain of S. sanguis (10556 ATCC). The lowest concentration of the pineapple extract and the mixed pineapple/vancomycin solution which inhibited bacterial growth was recorded as the MIC. RESULTS: The minimum inhibitory concentration of vancomycin was determined 1 µg/ ml. The pineapple extract failed to show any inhibitory effects per se, however, once added to vancomycin, it reduced the MIC to 0.5µg/ml. CONCLUSION: Prescription of pineapple extract along with antibiotics increases the antibacterial effects of the drug, therefore reduces the minimum inhibitory concentration of the antibiotic.