Systematic review of treatment modalities for gingival depigmentation: a random-effects poisson regression analysis.

OBJECTIVE: Repigmentation variably occurs with different treatment methods in patients with gingival pigmentation. A systemic review was conducted of various treatment modalities for eliminating melanin pigmentation of the gingiva, comprising bur abrasion, scalpel surgery, cryosurgery, electrosurgery, gingival grafts, and laser techniques, to compare the recurrence rates (Rrs) of these treatment procedures. MATERIAL AND METHODS: Electronic databases, including PubMed, Web of Science, Google, and Medline were comprehensively searched, and manual searches were conducted for studies published from January 1951 to June 2013. After applying inclusion and exclusion criteria, the final list of articles was reviewed in depth to achieve the objectives of this review. A Poisson regression was used to analyze the outcome of depigmentation using the various treatment methods. RESULTS: The systematic review was based on case reports mainly. In total, 61 eligible publications met the defined criteria. The various therapeutic procedures showed variable clinical results with a wide range of Rrs. A random-effects Poisson regression showed that cryosurgery (Rr = 0.32%), electrosurgery (Rr = 0.74%), and laser depigmentation (Rr = 1.16%) yielded superior result, whereas bur abrasion yielded the highest Rr (8.89%). CONCLUSIONS: Within the limit of the sampling level, the present evidence-based results show that cryosurgery exhibits the optimal predictability for depigmentation of the gingiva among all procedures examined, followed by electrosurgery and laser techniques. CLINICAL SIGNIFICANCE: It is possible to treat melanin pigmentation of the gingiva with various methods and prevent repigmentation. Among those treatment modalities, cryosurgery, electrosurgery, and laser surgery appear to be the best choices for treating gingival pigmentation.

Lifestyle and psychosocial factors associated with chronic periodontitis in Taiwanese adults.

BACKGROUND: The development of chronic periodontitis (CP) is a multifactorial process and variation in severity cannot be explained by just a few risk factors. The aims of this study were: 1) to explore the lifestyle and psychosocial factors of CP patients and 2) to estimate the proportion of total CP cases attributable to one or more risk factors considered. METHODS: A case-control study of 250 cases of CP patients and 250 controls were matched by age (within 3 years) and gender. Complete dental examinations were performed based on the clinical criteria for CP for both groups. Structured questionnaires were conducted to collect lifestyle and psychosocial factors. Multivariate logistic regression was applied to assess the association between risk factors and chronic periodontitis. RESULTS: Conditional multivariable logistic regression analysis showed that toothbrushing frequency (odds ratio [OR]: 5.77, if rarely; OR: 3.50, if once a day), mental illness (OR: 5.32, if Chinese Health Questionnaire scores were > or = 6), and smoking (OR: 3.93, if pack years smoked was > 21) are significantly and independently associated with chronic periodontitis. In addition, all these variables reflected a dose-response effect (P trend = <0.001, 0.004, and 0.005, respectively). CONCLUSIONS: For Taiwanese adults, 36.10% of CP cases were presumably attributable to toothbrushing frequency, mental illness, and smoking. These three factors should be the first priorities in establishing a preventive program to improve the periodontal health status.

Treatment of intrabony defects associated with interradicular root proximity/fusion in molar furcations.

To treat furcation involvement is a crucial challenge to periodontists, not only because of the limitation in pocket reduction by osteoplasty and apically positioned flap, but also because of the unpredictability in regenerative approaches. Therefore, if the first molar is absent and the second molar has to be retained strategically for prosthetic reasons, very few alternatives besides nonsurgical/surgical debridement can be taken in treating the furcation of the second molar, where the interradicular root proximity and fusion frequently occur. On the other hand, root amputation/hemisection has long been considered a contraindication in treating furcations with two close roots; however, this impression is only empirical. A series of clinical cases involved in the treatment of intrabony defects associated with interradicular root proximity and fusion by root amputation/hemisection has been reported. Without any help of regenerative material, thorough root debridement and pocket reduction were attained. Based on these cases, we suggested that the cut surface created by odontoplasty during root amputation was compatible for periodontal healing and the extraction socket provided striking potential for defect repair. We re-examined the clinical feasibility and benefit of treating intrabony defects associated with interradicular root proximity and fusion in molar furcations by root amputation/hemisection, and suggested that its role should be favorably reconsidered on case basis. The short-term success in periodontal and prosthetic aspects needed to be further evaluated at long-term follow-up.

Gm (23) allotypes and Fcgamma receptor genotypes as risk factors for various forms of periodontitis.

OBJECTIVES: Given the diversity of the distribution of the Gm (23) allotypes and FcgammaR genotypes in different ethnic groups, it was our purpose to examine their clinical significance in periodontitis in Taiwan. MATERIAL & METHODS: Genomic DNA of 50 patients with chronic periodontitis (CP), 30 patients with generalized aggressive periodontitis (G-AP) and 74 healthy controls were harvested. The Gm (23) allotypes were determined by radial immunodiffusion test, and the FcgammaR IIa (CD32) and IlIb (CD16) genotypes were determined by polymerase chain reaction-based allele-specific oligonucleotide hybridization. RESULTS: The overall carrier rate of the Gm (23+) allotype was higher than 85%, and the Gm (23-) allotype was statistically over-represented in patients with CP compared to the controls. There were no differences in the distributions of the three genotypes of FcgammaR IIa and IIIb among the three tested groups. The frequency of the R131 allele of the FcgammaR IIa polymorphisms was higher in G-AP than in CP when R/H allelic frequencies (p = 0.01) were examined by the chi2 test. CONCLUSION: The Gm (23-) allotype might be a potential risk factor for CP. Although the R131 allele of FcgammaR IIa occurred more frequently in G-AP than in CP, its clinical significance could not be justified in this study.

Immunoglobulin G profiles in different forms of periodontitis.

BACKGROUND: Races and Gm(23) allotypes can modify the serum levels of IgG subclasses. The average serum levels of IgG subclasses of African-Americans have been reported to be higher than those of Caucasians in both healthy young adults and patients with aggressive periodontitis; Gm(23)-positive subjects generally had higher IgG2 levels than Gm(23)-negative subjects. OBJECTIVE: We examined serum immunoglobulin G (IgG) concentrations in Taiwanese patients with different forms of periodontitis. METHODS: The serum levels of four IgG subclasses were determined by enzyme-linked immunosorbent assay and Gm(23) allotypes were verified by radial immunodiffusion tests in 50 patients with chronic periodontitis, 30 patients with aggressive periodontitis, and 74 healthy controls. RESULTS: There were no differences in the concentrations of four IgG subclasses in patients with chronic periodontitis compared with age-matched controls. However, in subjects younger than 35 years, levels of IgG2 were significantly elevated in patients with aggressive periodontitis compared with controls. We also found significant differences in IgG2 levels within the control group when stratified by age (< or = 35 years and > 35 years). Gm(23) allotypes were not correlated with the serum levels of IgG2 in either patient group. CONCLUSION: Microbial challenge might not provoke significant changes in systemic IgG response in patients with chronic periodontitis. However, in patients with aggressive periodontitis, IgG2 levels were increased when compared with age-matched controls. Gm(23) allotypes had no influence on IgG2 levels in well-established generalized chronic periodontitis or aggressive periodontitis.