Treatment of plaque-induced gingivitis, chronic periodontitis, and other clinical conditions

Systemic management and periodontal treatment of HIV-necrotizing periodontitis: A case report

BACKGROUND

Necrotizing periodontitis (NP) is a rare form of periodontal disease. It can manifest in immunocompromised patients and present as painful and rapidly progressing destruction with necrotic and ulcerated periodontal tissues. This case report describes a rare case of severe NP in human immunodeficiency virus (HIV)-positive patient including medical management and periodontal treatment.

METHODS

A 28-year-old male presented to the periodontal clinic with chief complaint of severe oral pain leading to loss of chewing ability, spontaneous gingival bleeding, generalized gingival recession, tooth mobility, and dentinal hypersensitivity. Clinical and radiographic examination revealed generalized tissue necrosis with severe periodontal destruction, extensive bleeding, spontaneous suppuration, and heavy biofilm.

RESULTS

Medical history was positive for perinatal HIV infection, which was treated and patient was asymptomatic until he discontinued antiviral medications nine years ago. Following initial examination, patient was referred to the Infectious disease clinic and multidisciplinary management was initiated with comprehensive management of primary disease including systemic antiviral, antibiotic, and antifungal therapy to establish immunocompetence compatible with providing mechanical nonsurgical periodontal treatment.

CONCLUSIONS

This case report highlights a severe and generalized form of NP in an HIV patient due to the cessation of antiviral therapy. Favorable course of interdisciplinary medical and periodontal therapy resulted in significant improvement in patient's systemic, oral, and periodontal health.

Effects of interdental aids on clinical periodontal indices

BACKGROUND

Removal of plaque and food particle between teeth represent interdental cleaning. Every patient's self-care program includes plaque removal efficiently and systematically. Periodontal disease, tooth decay and tooth loss may result from the absence of interdental cleaning or even an irregular and unsuccessful interdental cleaning.

AIM

The aim of the current study was to assess the effect of inter-dental aids, including dental floss and toothpicks, on gingival and plaque indices.

METHODS

A questionnaire including age, gender, education level and other information was obtained from 150 male subjects who were systemically and periodontally healthy. Clinical periodontal parameters (including plaque index and gingival index) were taken from each subject. The participants were categorized into different groups according to the use of inter-dental aids (dental floss, dental picks and without any interdental aids). The participants were divided into the toothbrush-alone group, including participants who did not use either dental floss or toothpicks; the dental floss group, including participants who used dental floss; and the toothpick group including participants who used toothpicks. Plaque and gingival indices compared among groups.

RESULTS

Statistical analysis showed that the maximum mean of Plaque index was found in the toothbrush-alone group (1.09 ± 0.43), while the lowest mean of Plaque index was found in the dental floss group (0.87 ± 0.39). Plaque index of the toothpick group was (0.99 ± 0.41) with statistically significant difference among groups (p-value = 0.04*).

CONCLUSION

In conclusion, dental floss is the most effective mean of removing interdental plaque.

A Comparative Review of Water Flossers in Periodontal Therapy

This study investigated the efficacy of water flossers (WFs), devices used to irrigate the interdental and subgingival areas, compared to other interdental care methods, in the management of periodontal disease. A computerized PubMed search was conducted by the author, encompassing the years 1962 to 2023. The year 1962 was selected due to it being the introduction of the first WF. Keywords included "oral irrigator", "efficacy," and "water flossers." The review provided a broad comparative assessment of WFs, rather than an exhaustive detailed article review. We discussed the history and evolution of commercially available WFs and introduced a novel classification system. The research also evaluated the performance of WFs in comparison to traditional and novel interdental care methods, focusing on crucial clinical parameters such as plaque removal efficiency and reduction in gingival inflammation. The results of the study reveal that WFs appear to be superior in the management of periodontal disease and have demonstrated effectiveness in a variety of indices. However, it's worth noting that the author did not statistically analyze any of the data. We identified gaps in the literature and found opportunities for further clinical studies. These findings hold implications for optimal periodontal disease prevention and management, addressing the evolving landscape of oral care practices.

Effect of a multichannel oral irrigator on periodontal health and the oral microbiome

Oral biofilms or dental plaques are one of the major etiological factors for diverse oral diseases. We aimed to evaluate the effect of a multichannel oral irrigator (MCOI) on periodontal health in 29 participants randomly divided into two groups: the MCOI group and the control group. To evaluate the effect of the MCOI on periodontal health, the modified Quigley Hein Plaque Index (PI), Mühlemann-Son Sulcus Bleeding Index (SBI), bleeding on probing (BOP), and swelling were evaluated and compared before and after MCOI use for 3 days. Although PI and SBI showed statistically significant increases in the control group, the MCOI group showed no significant changes in either parameter. Moreover, the percentage of BOP was significantly lower in the MCOI group. Saliva samples were analyzed by 16s rRNA amplicon sequencing to investigate changes in the oral microbiome. Sequencing results showed that Porphyromonas spp. were significantly increased in the control group, whereas no significant change was detected in the MCOI group. Using the MCOI, enriched populations and functional pathways were detected in pioneer species comprising non-mutans streptococci. These findings provide evidence of the effectiveness of the MCOI in maintaining periodontal health and a healthy microbial ecology in the oral cavity.

Green Alternatives as Antimicrobial Agents in Mitigating Periodontal Diseases: A Narrative Review

Periodontal diseases and dental caries are the most common infectious oral diseases impacting oral health globally. Oral cavity health is crucial for enhancing life quality since it serves as the entranceway to general health. The oral microbiome and oral infectious diseases are strongly correlated. Gram-negative anaerobic bacteria have been associated with periodontal diseases. Due to the shortcomings of several antimicrobial medications frequently applied in dentistry, the lack of resources in developing countries, the prevalence of oral inflammatory conditions, and the rise in bacterial antibiotic resistance, there is a need for reliable, efficient, and affordable alternative solutions for the prevention and treatment of periodontal diseases. Several accessible chemical agents can alter the oral microbiota, although these substances also have unfavorable symptoms such as vomiting, diarrhea, and tooth discoloration. Natural phytochemicals generated from plants that have historically been used as medicines are categorized as prospective alternatives due to the ongoing quest for substitute products. This review concentrated on phytochemicals or herbal extracts that impact periodontal diseases by decreasing the formation of dental biofilms and plaques, preventing the proliferation of oral pathogens, and inhibiting bacterial adhesion to surfaces. Investigations examining the effectiveness and safety of plant-based medicines have also been presented, including those conducted over the past decade.

Oral health status and barriers to oral healthcare among children with cerebral palsy attending a health care center in Kampala, Uganda

BACKGROUND

Cerebral palsy (CP) is a non-progressive neuromuscular condition diagnosed in childhood. CP as a form of disability, does not cause any specific oral disease. However, some oral conditions are more commonly associated with people with CP compared to the general population. The overarching aim of the current study was to determine the oral hygiene status, gingival status, and the prevalence of dental caries in children with CP attending a leading hospital institution for children with disabilities in Kampala, Uganda. Additionally, we determined the barriers faced by children with CP in accessing oral healthcare.

METHODS

This cross-sectional study was carried out at the Comprehensive Rehabilitation Services Uganda hospital in Kampala, Uganda. Our study population consisted of a convenient sample of 90 children diagnosed with CP aged 3-17 years and their caregivers. A validated and interviewer administered structured questionnaire was used to collect socio-demographic data of the participants. A modified World Health Organization oral health assessment form for those aged 3-17 years was used to gather data on oral health status (plaque score, gingival bleeding and dental caries.) The data was subjected to statistical tests with critical value set up at 5%.

RESULTS

Only 32.2% of the children evaluated had adequate oral hygiene, while 44.4% of the children experienced gingival bleeding. The prevalence of dental caries for both deciduous and permanent dentition was 63.3%, with DMFT values of 3.8 ± 4.5. The most common barrier reported by the caregivers was the challenge in modality of transportation availability from the children's homes to the health facilities (34.4%).

CONCLUSIONS

Children with CP in the study population have a significant prevalence of oral diseases and face several barriers to oral healthcare. Results from this study aim to provide relevant support to advocate for a nationwide change in policy to improve access to dental care to decrease the burden of oral diseases in children with special healthcare needs.

Comparative Evaluation of Surface Roughness of Porcelain Fused to Metal and Stainless-Steel Crown Following Ultrasonic and Hand Scaling: A Comparative Study

Introduction

Surface roughness encourages plaque retention and causes mechanical, chemical, and biological irritation to surrounding soft tissues. Hence, a smooth surface of restoration is preferred for optimal plaque control and the health of the periodontium.

Aim

The aim is to evaluate and compare the surface roughness of porcelain fused to metal and stainless-steel crowns following ultrasonic and hand scaling techniques.

Material and methods

An in-vitro study was conducted on 30 porcelain fused to metal crowns and 30 stainless-steel crowns. Their surface roughness following instrumentation was evaluated by scanning electron microscope (SEM) and profilometry.

Results

Evaluation by profilometry indicated that porcelain fused to metal following ultrasonic instrumentation has a statistically more significant surface roughness and indentation as compared to hand scaling with p-values < 0.05.

Conclusion

The surface roughness of any restoration may act as a plaque retentive factor which would affect the health of the periodontium. Ultrasonic scaling is capable of creating roughness to a more extent as compared to hand scaling and porcelain fused to the metal type of restorations is more vulnerable to roughness.

Efficacy of Chitosan and Chlorhexidine Mouthwash on Dental Plaque and Gingival Inflammation: A Systematic Review

Mouthwash is the effective chemical plaque control mechanism being practiced globally. Teeth and tongue discoloration, a temporary change in taste perception, an increase in calculus deposits, a burning sensation, and genotoxicity of buccal epithelial cells are all possible side effects. This review evaluates the efficacy of chitosan mouthwash in comparison to chlorhexidine mouthwash in combating plaque accumulation and gingival inflammation. Electronic databases such as Medline, Cochrane, LILACS, TRIP, Google scholar, and clinical trial registries (CTRI) for ongoing trials were searched with appropriate medical subheadings (MeSH) and search terms. Randomized clinical trials comparing the efficacy of chitosan mouthwash and chlorhexidine mouthwash on dental plaque accumulation and gingivitis were included. The outcome variables of interest were plaque index, gingival index, gingival bleeding index, and colony-forming unit (CFU/ml). All data from the included studies were extracted in a customized extraction sheet. The risk of bias across the studies was assessed using the Cochrane tool for intervention (ROB-2), which consisted of six domains. Of the included three studies, we found one study with an overall low risk of bias and two studies with an overall high risk of bias across the domains. Though there was a significant reduction in plaque accumulation, gingival inflammation, and colony-forming units on the use of chitosan mouthwash and chlorhexidine mouthwash separately, all three included studies reported that a combination of both be more effective.

Association between periodontitis and chronic kidney disease

Periodontitis and chronic kidney disease are chronic conditions with high community prevalence across the world. Patients with chronic kidney disease have been noted to have a high burden of periodontitis, and several shared risk factors have been associated with the prevalence and severity of both conditions. However, the precise relationship between the two conditions, and the extent to which each may contribute to the development of the other, remains a matter of debate. The goals of the present work were to: (a) provide the most current and relevant literature overview of the association between periodontitis and chronic kidney disease; (b) explore mechanisms underlying this association; and (c) determine if evidence exists for an independent association between these conditions. We also assessed whether improved oral hygiene and periodontal treatment could reduce the risk of developing chronic kidney disease and, if so, what protocols these strategies involve. Finally, we aimed to reveal gaps in our current knowledge to delineate the directions of future research. Although the exact relationship between these two conditions has not yet been defined, we highlight the importance of the interprofessional interaction between dental practitioners and the nephrology team and the importance of oral health assessment in the management of chronic kidney disease.

Inflammation and Periodontal Regeneration

Technological innovations in cellular and molecular aspects of tissue engineering --scaffolds, stem cells and 3D printed tissues --have been dramatically increased in the last decade. However, regenerative treatment still has challenges in translation to clinic. This is partly due to failure of addressing an essential element of wound healing, inflammation. It is now well-recognized that inflammation is an active process. This paradigm shift opened up a new avenue of therapeutic approaches called "host-modulation." Host-modulation therapies capable of modulating inflammatory response at multiple levels and mimicking the natural sequence of wound healing offer a new direction and promising clinical translation.

Effect of Aloe vera as a local drug delivery agent in the management of periodontal diseases: A systematic review and meta-analysis

Background:

Aim of the present meta-analysis was to evaluate the effect of Aloe vera in various forms such as gel, mouthwash, and dentifrice on gingival and plaque index (PI) in comparison to various allopathic products such as chlorhexidine, metformin, chlorine dioxide, fluoridated toothpaste, and alendronate.

Materials and Methods:

A comprehensive electronic search was conducted on PubMed/MEDLINE, GOOGLE SCHOLAR, and HAND SEARCH of reference list of archived articles published till January 2020. Randomized controlled trials were searched comparing the Aloe vera product with other products which used PI and gingival index (GI) to evaluate the outcomes. Finally, nine studies assessing PI and four studies evaluating GI were considered for the meta-analysis. After extracting the information, a risk of bias was estimated. The standardized mean differences (SMDs) and fixed and random effect models were obtained from the mean treatment differences.

Results:

The estimates of SMD of PI from fixed effects (SMD = 0.271, 95% confidence interval [CI] = 0.00134–0.407, P < 0.001) and random effects (SMD = 0.288, 95% CI = 0.048–0.529, P = 0.019) were found slightly different, the models showed consistent results yielding positive and significant treatment effects. For GI fixed effects (SMD = 0.27, 95% CI = −0.035–0.575, P = 0.0803, not significant) and random effects (SMD = 0.259, 95% CI = 0.049–0.469, P = 0.016, significant) were found slightly different and positive. However, one model showed significant and another model showed nonsignificant treatment effects.

Conclusion:

Results from our meta-analyses confirmed the beneficial effects of A. vera in improving the periodontal parameters and hence may be considered as a safe alternative drug delivery agent for the management of periodontal diseases in future.

Ameliorative effects of crocin on the inflammation and oxidative stress-induced kidney damages by experimental periodontitis in rat

Objective(s):

The present study aimed to investigate the effects of periodontitis on kidneys and the protective role of crocin in periodontitis-induced kidney damage.

Materials and Methods:

Ethics committee approval was obtained and 30 Wistar rats were randomly divided into 3 groups of 10 rats: Control (C), Periodontitis (P), and Periodontitis + Crocin (P + Cr). After the treatments, rat kidney tissues were incised under anesthesia and blood samples were collected. Biochemical and histopathological analyses were conducted on the samples.

Results:

Malondialdehyde (MDA), total oxidant status (TOS), and oxidative stress index (OSI) increased in P group rat kidney tissues; urea, creatinine, Tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin 1β (IL-1β) levels increased in the serum; glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) and total antioxidant status (TAS) levels were reduced in rat kidney tissues, and renal histopathology deteriorated. In the P + Cr group, we observed improvements in biochemical and histopathological parameters when compared with the P group.

Conclusion:

Periodontitis (P) led to deterioration in oxidative stress parameters and histopathology by increasing the oxidants in kidney tissue. P also led to inflammation in the blood of the rats. Periodontitis + Crocin (P + Cr) administration alleviated the effects of P due to powerful antioxidant anti-inflammatory properties. Cr could be employed as a protective agent in P-induced inflammation and oxidative damage.

Antibiotic prescribing at a periodontal residency practice in Connecticut

BACKGROUND

Antibiotics are important in the treatment of odontogenic infections and the prevention of infection following dental procedures in high-risk situations. Little is known about antibiotic prescribing in periodontal practice. This study describes prescribing practices by periodontal faculty and residents in an academic setting in order to identify opportunities to optimize prescribing behaviors.

METHODS

This cross-sectional study analyzed all antibiotic prescriptions from residents or faculty in an academic periodontal clinic from 2014-2017. Information was manually extracted from the electronic health record. Antibiotic prescriptions were stratified into three indication categories: pre-procedural prophylaxis, post-procedural prophylaxis, and treatment.

RESULTS

Out of 275 prescriptions analyzed, 266 met inclusion criteria. The most frequent antibiotic indication was post-procedural prophylaxis (n = 130, 48.87%). Amoxicillin was the most frequently prescribed antibiotic across all groups (n = 236, 88.72%), followed by clindamycin (n = 22, 8.27%). Most patients presented in a non-emergent setting (n = 200, 75.19%), without pain (n = 210, 78.95%), and had restorative/endodontic-related clinical findings (n = 55, 20.68%). Among the 35 patients receiving antibiotics for infection treatment, 8 (22.86%) underwent a surgical intervention on the date of antibiotic prescription. Of the 130 patients receiving post-procedural prophylaxis, 121 (93.08%) received surgical interventions on the day of antibiotic prescription.

CONCLUSIONS

Antibiotics are prescribed in various situations in periodontal practice, most frequently as post-procedural prophylaxis, an indication for which data is limited. There is an urgent need to study the role of post-procedural prophylactic antibiotics and understand antibiotic prescribing in the management of periodontal disease in order to optimize prescribing practices.

The composition of microbial communities in inflammatory periodontal diseases in young adults Tatars

Host susceptibility and environmental factors are important for the development of gingivitis and periodontitis, but bacterial biofilms attached to the teeth and gingival tissues play a crucial role. We have analyzed and compared the subgingival microbial communities between subjects with dental plaque biofilm-induced generalized chronic gingivitis (CG), localized initial (Stage I) periodontitis (IP) and healthy controls (HC) of young people aged 18-19 years permanently residing in the city of Kazan (Tatarstan, Russia). The results showed that the α-diversity in groups with CG and IP was higher than in the healthy group. In a course of periodontal disease, a decrease in the relative abundance of dominates genera Rothia and Streptococcus was observed along with increase of class TM7-3 (Candidatus Saccharibacteria phylum) representatives. Also, the increase of red complex representatives Porphyromonadeceae, Treponema and Tannerella was detected together with statistically significant increase of Filifactor, Parvimonas, Peptostreptococcaceae, Veillonellaceae, Tissierelaceae and Mogibacteriaceae. Analysis of our data suggests that transition from HC to IP may be accompanied by a decrease in microbial diversity and a reduction in the abundance of family Rs-045 (Candidatus Saccharibacteria phylum), Desulfovibrionaceae Corynebacterium, Campylobacter and Selenomonas in young adults Kazan Tatars.

Severe Necrotizing Periodontitis in an HIV-Infected Patient: Case Report and Non-Surgical Treatment

INTRODUCTION

Necrotizing periodontitis (NP) is an atypical and painful form of periodontal disease, it is described by a promptly progress of ulceration and destruction of periodontal tissues; the NP is commonly linked to HIV-positive patients. The aim of this report is to present a rare case of severe necrotizing ulcerative periodontitis treated non-surgically.

CASE PRESENTATION

A 28-year-old dark skin female patient was referred to a dentistry college with the main complaint of spontaneous gingival bleeding and enlargement, oral pain during deglutition and dental hypersensitivity. Clinical and radiographic examination revealed generalized severe periodontal destruction, extensive bleeding, increased biofilm presence and spontaneous suppuration. Medical exams were requested, red and white blood cells were evaluated and among those exams an enzyme-linked immunosorbent assay for HIV-1 antibodies, the result reveled reagent to HIV-1. The diagnosis of NP was assigned based on periodontal parameters such as necrosis and ulceration of the coronal portion of interdental papillae and gingival margin. Treatment established was scaling and root planning plus antibiotics. At 3 months of treatment the clinical and periodontal condition were stable.

CONCLUSION

This case report highlights a severe and generalized form of NP, where periodontal non-surgical associated with antimicrobials resulted in elimination of the gingival enlargement, necrosis and ulceration of the coronal portion of interdental papillae and significant improvement of periodontal parameters.

Antibacterial activity of disodium succinoyl glycyrrhetinate, a derivative of glycyrrhetinic acid against Streptococcus mutans

Streptococcus mutans is a cariogenic bacterium that localizes in the oral cavity. Glycyrrhetinic acid (GRA) is a major component of licorice extract. GRA and several derivatives, including disodium succinoyl glycyrrhetinate (GR-SU), are known to have anti-inflammatory effects in humans. In this study, the antimicrobial effect of GRA and its derivatives against the S. mutans UA159 strain were investigated. Minimum inhibitory concentrations (MICs) of GRA and GR-SU showed antibacterial activity against the S. mutans strain, whereas other tested derivatives did not. Because GR-SU is more soluble than GRA, GR-SU was used for further experiments. The antibacterial activity of GR-SU against 100 S. mutans strains was evaluated and it was found that all strains are susceptible to GR-SU, with MIC values below 256 µg/mL. A cell viability assay showed that GR-SU has a bacteriostatic effect on S. mutans cells. As to growth kinetics, sub-MICs of GR-SU inhibited growth. The effect of GR-SU on S. mutans virulence was then investigated. GR-SU at sub-MICs suppresses biofilm formation. Additionally, GR-SU greatly suppresses the pH drop caused by the addition of glucose and glucose-induced expression of the genes responsible for acid production (ldh and pykF) and tolerance (aguD and atpD). Additionally, expression of enolase, which is responsible for the carbohydrate phosphotransferase system, was not increased in the presence of GR-SU, indicating that GR-SU suppresses incorporation of sugars into S. mutans. In conclusion, GR-SU has antibacterial activity against S. mutans and also decreases S. mutans virulence.

An Overview of Different Interdental Cleaning Aids and Their Effectiveness

Optimisation of plaque control is essential for the success of non-surgical and surgical periodontal therapy. This cannot be achieved with brushing alone; hence, there is a need for adjunctive interdental cleaning aids. The aim of this paper is to provide an overview of different interdental cleaning aids and review the literature for consensus on their effectiveness. A literature search of articles in English, up to December 2018, was conducted in Pubmed. High-quality flossing is difficult to achieve, and ineffective routine use of floss may not confer significant benefits over brushing alone. Interdental brushes are more effective than brushing as a monotherapy. They are at least as good if not superior to floss in reducing plaque and gingivitis. Although they are effective for patients regardless of their periodontal status (healthy or active), they are especially indicated in periodontal patients where widened embrasures are common. Added benefits include ease of use, patient acceptance, and recontouring of interdental tissues. Rubberpiks do not demonstrate inferiority to conventional interdental brushes. Wooden interdental aids appear to offer no significant advantage over brushing with respect to plaque removal; they may, however, reduce gingival bleeding. Oral irrigators are a promising tool for reducing gingival inflammation, despite minimal changes to plaque levels. For cleaning around dental implants, oral irrigators and interdental brushes are preferred over floss.

Evaluation of calculus imaging on root surfaces by spectral-domain optical coherence tomography

OBJECTIVE

The aim of this in vitro study was to evaluate the ability of optical coherence tomography (OCT) to display calculus on root surfaces.

MATERIAL AND METHODS

Ten teeth with calculus on the root surface were embedded in resin, omitting the root surface. A region of interest (ROI) was marked by small drill holes coronally and apically of the calculus and imaged by spectral-domain optical coherence tomography ([SD OCT], Telesto SP5, centre wavelength 1310 nm) and light microscopy (LM). To evaluate the impact of different fluids on calculus visualisation, using OCT, root surfaces were covered by a layer of NaCl and blood and displayed by OCT. Subsequently, teeth were completely covered with resin and sectioned for histological evaluation. Within the ROI, lengths of root surface and calculus were measured by LM and OCT, and the ratio [%] was calculated. In addition, at three sites of each ROI, agreement of presence and length of calculus was evaluated. Both methods were compared using Pearson's correlation.

RESULTS

Regarding the presence of calculus, agreement between LM and OCT was strong (κ_i = 0.783, p = 0.033), and measurements regarding the length of the calculus were strongly correlated (r_i >0.906; p_i <0.001). However, the values differed for dry (p = 0.023) and NaCl-covered root surfaces (p = 0.035).

CONCLUSION

Calculus on the root surface can be displayed by SD-OCT, which therefore may be suited as imaging technology for subgingival calculus in periodontal pockets.

Asymmetric Collagen/chitosan Membrane Containing Minocycline-loaded Chitosan Nanoparticles for Guided Bone Regeneration

Infections caused by pathogens colonization at wound sites in the process of bone healing are considered as one of the major reasons for the failure of guided bone regeneration (GBR). The objective of this study was to prepare a novel asymmetric collagen/chitosan GBR membrane containing minocycline-loaded chitosan nanoparticles. The morphologies of the membranes and nanoparticles were observed by SEM and TEM, respectively. The characterization and biocompatibility of the membranes was evaluated. The effect of the membrane on bone regeneration was assessed using the critical-size at cranial defect model. TEM images showed the spherical morphology of the nanoparticles. The results of SEM indicated that the asymmetric membrane contained a dense collagen layer and a loose chitosan layer. An in vitro experiment showed that the membrane can inhibit bacterial growth and promote osteoblasts and fibroblasts growth. The membrane showed the ability to promote angiogenesis and enhance bone regeneration in vivo. An asymmetric collagen/chitosan GBR membrane can be fabricated by loading minocycline encapsulated chitosan nanoparticles, and shows satisfactory biocompatibility and barrier function, which enhances bone regeneration. Therefore, this antibacterial GBR membrane is a promising therapeutic approach to prevent infection and guide bone regeneration.

Effect of Long-Term Periodontal Care on Hemoglobin A1c in Type 2 Diabetes

This was a prospective cohort study evaluating 126,805 individuals with diabetes and periodontal disease receiving care at all Veterans Administration medical centers and clinics in the United States from 2005 through 2012. The exposures were periodontal treatment at baseline (PT0) and at follow-up (PT2). The outcomes were change in HbA1c following initial treatment (ΔHbA1c1) and follow-up treatment (ΔHbA1c2), and diabetes control was defined as HbA1c at <7% and <9% following initial and follow-up treatment, respectively. Marginal structural models were used to account for potential confounding and selection bias. The objective was to evaluate the impact of long-term treatment of periodontal disease on glycemic control among individuals with type 2 diabetes. Participants were 64 y old on average, 97% were men, and 71% were white. At baseline, the average diabetes duration was 4 y, 12% of participants were receiving insulin, and 60% had HbA1c <7%. After an average 1.7 y of follow-up, the mean HbA1c increased from 7.03% to 7.21%. About 29.4% of participants attended their periodontal maintenance visit following baseline. Periodontal treatment at baseline and follow-up reduced HbA1c by -0.02% and -0.074%, respectively. Treatment at follow-up increased the likelihood of individuals achieving diabetes control by 5% and 3% at the HbA1c <7% and HbA1c <9% thresholds, respectively, and was observed even among never smokers. HbA1c reduction after periodontal treatment at follow-up was greater (ΔHbA1c2 = -0.25%) among individuals with higher baseline HbA1c. Long-term periodontal care provided in a clinical setting improved long-term glycemic control among individuals with type 2 diabetes and periodontal disease.

Antibacterial Activity of Partially Oxidized Ag/Au Nanoparticles against the Oral Pathogen Porphyromonas gingivalis W83

Advances in nanotechnology provide opportunities for the prevention and treatment of periodontal disease. While physicochemical properties of Ag containing nanoparticles (NPs) are known to influence the magnitude of their toxicity, it is thought that nanosilver can be made less toxic to eukaryotes by passivation of the NPs with a benign metal. Moreover, the addition of other noble metals to silver nanoparticles, in the alloy formulation, is known to alter the silver dissolution behavior. Thus, we synthesized glutathione capped Ag/Au alloy bimetallic nanoparticles (NPs) via the galvanic replacement reaction between maltose coated Ag NPs and chloroauric acid (HAuCl₄) in 5% aqueous triblock F127 copolymer solution. We then compared the antibacterial activity of the Ag/Au NPs to pure Ag NPs on Porphyromonas gingivalis W83, a key pathogen in the development of periodontal disease. Only partially oxidized glutathione capped Ag and Ag/Au (Au:Ag≈0.2) NPs inhibited the planktonic growth of P. gingivalis W83. This effect was enhanced in the presence of hydrogen peroxide, which simulates the oxidative stress environment in the periodontal pocket during chronic inflammation.

Acute periodontal lesions

This review provides updates on acute conditions affecting the periodontal tissues, including abscesses in the periodontium, necrotizing periodontal diseases and other acute conditions that cause gingival lesions with acute presentation, such as infectious processes not associated with oral bacterial biofilms, mucocutaneous disorders and traumatic and allergic lesions. A periodontal abscess is clinically important because it is a relatively frequent dental emergency, it can compromise the periodontal prognosis of the affected tooth and bacteria within the abscess can spread and cause infections in other body sites. Different types of abscesses have been identified, mainly classified by their etiology, and there are clear differences between those affecting a pre-existing periodontal pocket and those affecting healthy sites. Therapy for this acute condition consists of drainage and tissue debridement, while an evaluation of the need for systemic antimicrobial therapy will be made for each case, based on local and systemic factors. The definitive treatment of the pre-existing condition should be accomplished after the acute phase is controlled. Necrotizing periodontal diseases present three typical clinical features: papilla necrosis, gingival bleeding and pain. Although the prevalence of these diseases is not high, their importance is clear because they represent the most severe conditions associated with the dental biofilm, with very rapid tissue destruction. In addition to bacteria, the etiology of necrotizing periodontal disease includes numerous factors that alter the host response and predispose to these diseases, namely HIV infection, malnutrition, stress or tobacco smoking. The treatment consists of superficial debridement, careful mechanical oral hygiene, rinsing with chlorhexidine and daily re-evaluation. Systemic antimicrobials may be used adjunctively in severe cases or in nonresponding conditions, being the first option metronidazole. Once the acute disease is under control, definitive treatment should be provided, including appropriate therapy for the pre-existing gingivitis or periodontitis. Among other acute conditions affecting the periodontal tissues, but not caused by the microorganisms present in oral biofilms, infectious diseases, mucocutaneous diseases and traumatic or allergic lesions can be listed. In most cases, the gingival involvement is not severe; however, these conditions are common and may prompt an emergency dental visit. These conditions may have the appearance of an erythematous lesion, which is sometimes erosive. Erosive lesions may be the direct result of trauma or a consequence of the breaking of vesicles and bullae. A proper differential diagnosis is important for adequate management of the case.

Effects of curcumin on crevicular levels of IL-1β and CCL28 in experimental gingivitis

BACKGROUND

Curcumin has anti-inflammatory properties. The aim of this study was to compare interleukin-1β (IL-1β) and chemokine (C-C motif) ligand 28 (CCL28) levels following a topical application of curcumin (CRM), chlorhexidine (CHX) and chlorhexidine-metronidazole (CHX-MTZ) in an experimental gingivitis human model.

METHODS

Sixty systemically healthy selected subjects were randomly assigned to one of three topical antigingivitis gels. Each gel was applied twice daily for 10 minutes as the sole method of oral hygiene for 29 days on the test quadrant only. Modified gingival index (MGI), plaque index (PI), bleeding on probing (BOP) and probing depth (PD) were assessed at baseline, 29 days and 60 days. Estimation of IL-1β and CCL28 levels in gingival crevicular fluid was done at baseline and at 29 days.

RESULTS

The increase of IL-1β in the CRM (14.52 ± 16.6 pg/ml) and CHX-MTZ (31.63 ± 15.96) groups was significantly less than that of the CHX group (70.55 ± 38.81). Similar results were also observed for CCL28 (CRM: 8.12 ± 8.78 pg/ml; CHX-MTZ: 12.81 ± 18.68; CHX: 41.15 ± 22.82). All groups had a significant increase in MGI, PI and BOP at 29 days.

CONCLUSIONS

The anti-inflammatory potential of topical curcumin was similar to CHX-MTZ but superior to CHX in affecting IL-1β and CCL28 levels.

Detection of subgingival periodontal pathogens--comparison of two sampling strategies

OBJECTIVE

The aim of the study is to compare detection frequency of periodontal pathogens in patients with aggressive/severe chronic periodontitis using pooled plaque samples from the deepest pockets per quadrant/per sextant.

METHODS

In 100 patients with aggressive/chronic periodontitis, subgingival plaque was sampled from the deepest pockets per quadrant (MT4) and per sextant (MT6). Plaque samples were taken using two sterile paper points simultaneously. One paper point from each pocket was pooled with the three other paper points of the pockets (MT4). Subsequently, the remaining four paper points were pooled with two paper points from the deepest pockets from the two remaining sextants (MT6). The content of each vial was analyzed with nucleic-acid based methods for Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Porphyromonas gingivalis, Treponema denticola, Prevotella intermedia, Parvimonas micra, Fusobacterium nucleatum, Campylobacter rectus, Eubacterium nodatum, Eikenella corrodens, and Capnocytophaga sp.

RESULTS

The detection frequency of A. actinomycetemcomitans (MT4/MT6) at 22/24 %, T. forsythia at 93/96 %, P. gingivalis at 78/79 %, T. denticola at 88/90 %, P. intermedia at 40/46 %, P. micra at 75/79 %, F. nucleatum at both 99 %, C. rectus at 84/89 %, E. nodatum at 62/65 %, E. corrodens at 80/87 %, and Capnocytophaga sp. at 49/58 % was higher with MT6 than with MT4. None of these differences were statistically significant.

CONCLUSION

The detection frequency of the investigated periopathogens was statistically insignificant higher with the sampling method MT6 compared with MT4.

CLINICAL RELEVANCE

In daily dental practice, the plaque sampling of the deepest pockets per quadrant seems to be sufficient.

Antimicrobial photodynamic therapy combined with periodontal treatment for metabolic control in patients with type 2 diabetes mellitus: study protocol for a randomized controlled trial

Background

The relationship between diabetes mellitus (DM) and periodontal disease is bidirectional. DM is a predisposing and modifying factor of periodontitis, which, in turn, worsens glycemic control and increases proteins found in the acute phase of inflammation, such as C-reactive protein. The gold standard for the treatment of periodontal disease is oral hygiene orientation, scaling and planing. Moreover, systemic antibiotic therapy may be employed in some cases. In an effort to minimize the prescription of antibiotics, photodynamic therapy (PDT) has been studied as an antimicrobial technique and has demonstrated promising results. The aim of the proposed study is to determine whether PDT as a complement to periodontal therapy (PT) is helpful in the metabolic control of individuals with type 2 diabetes and the reduction of acute-phase inflammatory markers.

Methods/Design

The patients will be randomized using a proper software program into two groups: 1) PT + placebo PDT or 2) PT + active PDT. All patients will first be examined by a specialist, followed by PT performed by two other healthcare professionals. At the end of each session, PDT (active or placebo) will be administered by a fourth healthcare professional. The following will be the PDT parameters: diode laser (660 nm); power output = 110 mW; exposure time = 90 s per point (9 J/point); and energy density = 22 J/cm². The photosensitizer will be methylene blue (50 μg/mL). The patients will be re-evaluated 15, 30, 90 and 180 days after treatment. Serological examinations with complete blood count, fasting glucose, glycated hemoglobin and salivary examinations to screen for tumor necrosis factor alpha, interleukin 1, interleukin 6, ostelocalcin, and osteoprotegerin/RANKL will be performed at each evaluation. The data will be statistically evaluated using the most appropriate tests.

Discussion

The results of this study will determine the efficacy of photodynamic therapy as an adjuvant to periodontal treatment in diabetic patients.

Trial registration

The protocol for this trial was registered with Clinical Trials registration number NCT01964833 on 14 October 2013.

Association between Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis in subgingival plaque and clinical parameters, in Argentine patients with aggressive periodontitis

BACKGROUND

Aggregatibacter actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg) have been associated with aggressive (AgP) and chronic periodontitis.

OBJECTIVE

The aim of this study was to evaluate the levels of Aa and Pg in gingival crevicular fluid (GCF) of patients with AgP and its relation with clinical parameters.

DESIGN

Sixteen females and fourteen males with clinical diagnosis of AgP aged 17-23 years and their match's controls, were included in this study. Clinical recording concerning probing pocket depth, clinical attachment level, plaque index and gingival bleeding index were performed at baseline, 30 and 60 days after baseline. After clinical examination GCF samples were analyzed for Aa and Pg with a real-time polymerase chain reaction technique. Patients group was treated with a combined of mechanical and oral antibiotic therapy (doxycycline 100 mg/day, during 21 days). A multivariate analysis was used to determine the relationship between Aa and Pg counts with clinical parameters.

RESULTS

GCF from all subjects was positive for Aa and PG. In controls Pg concentration was higher than Aa (Pg: 42,420 ± 3,034 copies/ml; Aa: 66.6 ± 5.4 copies/ml p < 0.001) while in patients both microbes showed the same concentration (Aa: 559,878 ± 39,698 Pg: 572,321 ± 58,752). A significant and positive correlation was observed between counts of Aa and Pg (R square: 0.7965, p < 0.0001). Female showed more counts/ml. Aa might be closely associated with clinical parameters while Pg did not. At 30 and 60 days Aa counts in patients were similar to controls while Pg counts were equal to baseline. However, in spite of Pg presence a clinical improvement was observed in all patients.

CONCLUSIONS

In our population the presence of Aa may be associated with AgP while Pg may be in GCF as an opportunistic pathogen which might caused disease when the ecological balance was favorable.

The effect of various ultrasonic and hand instruments on the root surfaces of human single rooted teeth: A Planimetric and Profilometric study

Background:

The purpose of this study was to compare the effectiveness of different ultrasonic scalers and a periodontal curette on the root surfaces for calculus removal and root surface roughness.

Materials and Methods:

40 single rooted teeth with subgingival calculus destined for extraction were assigned to one of three experimental groups (n = 10, in each group) and one control group (untreated, n = 10). Experimental groups were: Group 1: Piezoelectric ultrasonic group; Group 2: Magnetostrictive ultrasonic group; Group 3: Hand instrumentation group (Curette). After instrumentation, the teeth were extracted and the presence of residual deposits and root surface roughness were analyzed using Planimetric analyzing tool (Tool that measures the area of a plane figure as a mechanically coupled pointer traversing the perimeter of figure) and Surface Profilometer (Instrument used for profiling of an object). Root surface characteristics were evaluated qualitatively using SEM. Standardization of force, angulations and adaptation of instrument couldn’t be achieved in our study due to in vivo study design rather than in vitro design in previous studies where procedure was done on the extracted teeth samples.

Results:

The results of the study showed that residual deposits were similar in all experimental groups. With respect to roughness parameters, Rq (Root mean square roughness) and Rt (Total roughness) a significant difference was observed (P < 0.001) among hand instrumentation and ultrasonic devices. SEM analysis revealed a similar root surface pattern for the ultrasonic devices, but curette showed many instrument scratches, gouges, and removal of large amount of cementum.

Conclusions:

Curette produced the rougher root surfaces than two ultrasonic devices used in the study and caused more root surface removal. Piezoelectric devices produced minimum root surface roughness but caused more root substance removal and more cracks than Magnetostrictive ultrasonic devices.

Adjunctive dental therapy via tooth plaque reduction and gingivitis treatment by blue light-emitting diodes tooth brushing

The efficacy of blue light-emitting toothbrushes (B-LETBs) (405 to 420 nm, power density 2  mW/cm(2)) for reduction of dental plaques and gingival inflammation has been evaluated. Microbiological study has shown the multifactor therapeutic action of the B-LETBs on oral pathological microflora: in addition to partial mechanical removal of bacteria, photodynamic action suppresses them up to 97.5%. In the pilot clinical studies, subjects with mild to moderate gingivitis have been randomly divided into two groups: a treatment group that used the B-LETBs and a control group that used standard toothbrushes. Indices of plaque, gingival bleeding, and inflammation have been evaluated. A significant improvement of all dental indices in comparison with the baseline (by 59%, 66%, and 82% for plaque, gingival bleeding, and inflammation, respectively) has been found. The treatment group has demonstrated up to 50% improvement relative to the control group. We have proposed the B-LETBs to serve for prevention of gingivitis or as an alternative to conventional antibiotic treatment of this disease due to their effectiveness and the absence of drug side effects and bacterial resistance.

Additional effects of homeopathy on chronic periodontitis: a 1-year follow-up randomized clinical trial

BACKGROUND AND OBJECTIVE

The aim of this study was test the hypothesis that homeopathy (H) enhances the effects of scaling and root planing (SRP) in patients with chronic periodontitis (CP).

MATERIALS AND METHODS

50 patients with CP were randomly allocated to one of two treatment groups: SRP (C-G) or SRP + H (H-G). Assessments were made at baseline and after 3 and 12 months of treatments. The local and systemic responses to the treatments were evaluated by clinical and serologic parameters, respectively.

RESULTS

Both groups displayed significant improvements, however, using clinical attachment gain and reductions in HDL, LDL and Total Cholesterol, Triglycerides, Glucose and Uric acid, from baseline to 1 year, as criteria for treatment success, H-G performed significantly better than C-G.

CONCLUSION

The findings of this 1-year follow-up randomized clinical trial suggest that homeopathic medicines, as an adjunctive to SRP, can provide significant local and systemic improvements for CP patients.

Subgingival plaque sampling after combined mechanical and antibiotic nonsurgical periodontal therapy

AIM

This study aimed to make a comparison of two sampling strategies of subgingival plaque after combined mechanical-antibiotic periodontal therapy.

METHODS

Thirty patients (18 female) suffering from aggressive (n = 12) or generalised severe chronic (n = 18) periodontitis were included. Aggregatibacter actinomycetemcomitans had been detected subgingivally in all prior to anti-infective therapy (AT) and combined mechanical-antibiotic AT had been rendered. After AT clinical examinations were performed and subgingival plaque was sampled from the same four sites as prior to AT (ASPRE) as well as from the four deepest sites after AT (DEEP). Per patient two pooled samples (ASPRE/DEEP) were generated and analysed for A. actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola using a commercial 16S rRNA test.

RESULTS

ASPRE failed to detect A. actinomycetemcomitans, DEEP detected A. actinomycetemcomitans only in two patients (7 %). Only for T. forsythia DEEP (53 %) provided higher detection frequencies than ASPRE (27 %; p = 0.005). Detection frequencies of P. gingivalis and T. denticola ranged from 47 to 53 %.

CONCLUSION

After combined mechanical-antibiotic AT sampling the deepest sites revealed higher detection rates. Combined mechanical-antibiotic AT suppresses A. actinomycetemcomitans to a higher extent than P. gingivalis, T. forsythia and T. denticola.

Synthesis and characterization of a POSS-PEG macromonomer and POSS-PEG-PLA hydrogels for periodontal applications

A novel water-soluble macromonomer based on octavinyl silsesquioxane has been synthesized and contains vinyl-terminated PEG 400 in each of the eight arms to promote water solubility. The macromonomer was characterized by NMR and FTIR and its aqueous solution properties examined. In water it exhibits an LCST with a cloud point at 23 °C for a 10 wt % aqueous solution. It is surface active with a CMC of 1.5 × 10(-5) M in water and in 20:80 v/v acetone/water the CMC is 7.1 × 10(-5) M, and TEM images showed spherical 22 nm aggregates in aqueous solution above the CMC. The macromonomer was copolymerized in a 20:80 v/v acetone/water mixture with a vinyl-terminated, triblock copolymer of lactide-PEG-lactide to form a library of cross-linked hydrogels that were designed for use as scaffolds for alveolar bone repair. The cross-linked copolymer networks were shown to contain a range of nm-μm sized pores and their swelling properties in water and PBS at pH 7.4 were examined. At pH 7.4 the hydrogel networks undergo a slow hydrolysis with the release of principally PEG and lactic acid fragments. The hydrogels were shown to be noncytotoxic toward fibroblast cultures at pH 7.4, both initially (days 1-5) and after significant hydrolysis had taken place (days 23-28).

Bioerodible system for sequential release of multiple drugs

Because many complex physiological processes are controlled by multiple biomolecules, comprehensive treatment of certain disease conditions may be more effectively achieved by administration of more than one type of drug. Thus, the objective of the present research was to develop a multilayered, polymer-based system for sequential delivery of multiple drugs. The polymers used were cellulose acetate phthalate (CAP) complexed with Pluronic F-127 (P). After evaluating morphology of the resulting CAPP system, in vitro release of small molecule drugs and a model protein was studied from both single and multilayered devices. Drug release from single-layered CAPP films followed zero-order kinetics related to surface erosion of the association polymer. Release studies from multilayered CAPP devices showed the possibility of achieving intermittent release of one type of drug as well as sequential release of more than one type of drug. Mathematical modeling accurately predicted the release profiles for both single layer and multilayered devices. The present CAPP association polymer-based multilayer devices can be used for localized, sequential delivery of multiple drugs for the possible treatment of complex disease conditions, and perhaps for tissue engineering applications, that require delivery of more than one type of biomolecule.

Prolonged delivery of ciprofloxacin and diclofenac sodium from a polymeric fibre device for the treatment of periodontal disease

In vitro analysis of drug release and antimicrobial activity of the coblended crosslinked polymeric fibre device (PFD) were investigated. The fibre loaded with ciprofloxacin and diclofenac sodium was comprised of alginate and glycerol crosslinked with barium cations. The pH dependent drug release was evident with ciprofloxacin and diclofenac sodium diffusing from the fibre at pH 4.0 compared to pH 6.8, where the fibre swelled and eroded resulting in zero-order drug release. Agar diffusion studies followed by minimum inhibitory assays were conducted to determine the antimicrobial activity of the device against Escherichia coli, Enterococcus faecalis, and Streptococcus mutans. The antimicrobial activity of the PFD was confirmed in both test assays against all test pathogens. The MIC ranges at pH 4.0 for E. coli, E. faecalis, and S. mutans were 0.5-0.8, 0.4-1.1, and 0.7-2.1 μg/mL, respectively. At pH 6.8, similar efficacies (0.3-0.5 μg/mL for E. coli and E. faecalis and 0.6-1.0 μg/mL for S. mutans) were observed. The effect of varying the plasticizer and crosslinking ion concentration on drug release profile of the fibers was further elucidated and conceptualized using molecular mechanics energy relationships (MMER) and by exploring the spatial disposition of geometrically minimized molecular conformations.

Design of a multiple drug delivery system directed at periodontitis

Periodontal disease is highly prevalent, with 90% of the world population affected by either periodontitis or its preceding condition, gingivitis. These conditions are caused by bacterial biofilms on teeth, which stimulate a chronic inflammatory response that leads to loss of alveolar bone and, ultimately, the tooth. Current treatment methods for periodontitis address specific parts of the disease, with no individual treatment serving as a complete therapy. The present research sought to demonstrate development of a multiple drug delivery system for stepwise treatment of different stages of periodontal disease. More specifically, multilayered films were fabricated from an association polymer comprising cellulose acetate phthalate and Pluronic F-127 to achieve sequential release of drugs. The four types of drugs used were metronidazole, ketoprofen, doxycycline, and simvastatin to eliminate infection, inhibit inflammation, prevent tissue destruction, and aid bone regeneration, respectively. Different erosion times and adjustable sequential release profiles were achieved by modifying the number of layers or by inclusion of a slower-eroding polymer layer. Analysis of antibiotic and anti-inflammatory bioactivity showed that drugs released from the devices retained 100% bioactivity. The multilayered CAPP delivery system offers a versatile approach for releasing different drugs based on the pathogenesis of periodontitis and other conditions.

Periodontal diagnosis affected by variation in terminology

BACKGROUND

The randomized case presentation (RCP) study is designed to assess the degree of diagnostic accuracy for described periodontal cases. This is to lay the basis for practitioner calibration in the Practitioners Engaged in Applied Research and Learning (PEARL) Network for future clinical studies.

METHODS

The RCP consisted of 10 case scenarios ranging from periodontal health to gingivitis and mild, moderate, and severe periodontitis. Respondents were asked to diagnose the described cases. Survey diagnoses were compared to two existing classifications of periodontal disease status. The RCP was administered via a proprietary electronic data capture system maintained by the PEARL Data Coordinating Center. Standard analytic techniques, including frequency counts and cross-tabulations, were used for categorical data with mean and standard deviation and median values reported for continuous data elements.

RESULTS

Demonstrable variations in periodontal assessment for health, gingivitis, and mild, moderate, and severe periodontitis were found among the 130 PEARL general practitioners who participated in the RCP survey. The highest agreement for diagnosis among dentists was for severe periodontitis (88%) and the lowest for gingivitis (55%). The highest percentage of variation was found in cases with health and gingivitis.

CONCLUSIONS

There was variation among PEARL practitioners in periodontal diagnosis that may affect treatment outcomes. Our findings add clinical support to recent publications suggesting a need for standardization of terminology in periodontitis diagnosis.

Biocompatibility and cytotoxic evaluation of drug-loaded biodegradable guided tissue regeneration membranes

BACKGROUND

In periodontology, Guided Tissue Regeneration (GTR) is based on the concept of providing a space for entry of cells with regenerative potential into the wound environment to initiate the regeneration of structures lost due to periodontal disease. First generation GTR membranes were primarily non-absorbable membranes like expanded polytetrafluorethylene which required a second surgery for its removal. This led researchers to explore absorbable materials like collagen and synthetic biodegradable polymers to fabricate GTR membranes. In the present study, biodegradable Polylactic acid (PLA) is used to fabricate membranes with the potential to be used for GTR therapy.

MATERIALS AND METHODS

Biocompatibility of the PLA membranes were evaluated in a subcutaneous guinea pig model. Antimicrobial effect of the drug-loaded PLA membranes were assessed against a drug-resistant Staphylococcus aureus bacterial isolate. The cytocompatibility of the drug-loaded membranes were evaluated using HeLa cell lines.

RESULTS

The PLA membranes were shown to be biocompatible. The drug-loaded PLA membranes showed significant activity against the bacterial isolate. Among the drug-loaded membranes, tetracycline-loaded membrane showed minimal cellular toxicity.

CONCLUSION

The results of this study indicate that biodegradable drug-releasing polylactide membranes have the potential to be used for periodontal regeneration. It has the necessary characteristics of a GTR membrane like biocompatibility, space maintaining ability, and tissue integration. Among the various antimicrobial agents loaded in the PLA membranes, tetracycline-loaded membranes exhibited minimal cellular toxicity against HeLa cells; at the same time showing significant activity against a pathogenic bacterium.

The effects of scaling and root planing on the marginal gap and microleakage of indirect composite crowns prepared with different finish lines: an in vitro study

The present in vitro study aimed to assess the effects of root surface mechanical instrumentation on the marginal integrity and adaptation of resin composite crowns. The following null hypotheses were tested: no differences exist between finish line and 1) marginal gap or 2) marginal microleakage before and after manual mechanical periodontal maintenance. A total of 56 intact human mandibular molars were randomly distributed into four groups and subjected to standardized tooth preparations for indirect composite crowns with different marginal finish lines (90° shoulder, beveled 90° shoulder, feather edge, chamfer). One-half of the specimens was used as a control and remained untreated, and the remaining half was subjected to root surface procedures simulating five years of semestral mechanical supportive periodontal treatment. The marginal gap and microleakage were evaluated and statistically analyzed. The specimens used as controls showed lower mean marginal gaps than those subjected to the simulated periodontal treatment, whereas the latter showed lower microleakage than the control crowns. Statistically significant differences were recorded for both the experimental variables. The root surface procedures resulted in altered surfaces of the composite crowns. The marginal gap increased after the treatment, whereas the marginal microleakage was reduced. The 90° shoulder and the chamfer preparation could be considered a viable option to fabricate composite crowns, but the beveled 90° shoulder and the feather edge should not be recommended.

Intraperiodontal pocket: An ideal route for local antimicrobial drug delivery

Periodontal pockets act as a natural reservoir filled with gingival crevicular fluid for the controlled release delivery of antimicrobials directly. This article reflects the present status of nonsurgical controlled local intrapocket delivery of antimicrobials in the treatment of periodontitis. These sites have specialty in terms of anatomy, permeability, and their ability to retain a delivery system for a desired length of time. A number of antimicrobial products and the composition of the delivery systems, its use, clinical results, and their release are summarized. The goal in using an intrapocket device for the delivery of an antimicrobial agent is the achievement and maintenance of therapeutic drug concentration for the desired period of time. Novel controlled drug delivery system are capable of improving patient compliance as well as therapeutic efficacy with precise control of the rate by which a particular drug dosage is released from a delivery system without the need for frequent administration. These are considered superior drug delivery system because of low cost, greater stability, non-toxicity, biocompatibility, non-immunogenicity, and are biodegradable in nature. This review also focus on the importance and ideal features of periodontal pockets as a drug delivery platform for designing a suitable dosage form along with its potential advantage and limitations. The microbes in the periodontal pocket could destroy periodontal tissues, and a complete knowledge of these as well as an ideal treatment strategy could be helpful in treating this disease.

Surgical treatment of gingival overgrowth with 10 years of follow-up

Background

In some pathological conditions, gingivitis caused by plaque accumulation can be more severe, with the result of an overgrowth. Nevertheless, the overgrowth involves the gingival margin with extension to the inter-dental papilla. The lesion may involve the inter-proximal spaces, and become so extensive that the teeth are displaced and their crowns covered. Severe overgrowth may lead to impairment in aesthetic and masticatory functions, requiring surgical excision of the excessive tissue. Aim of this study is to describe an operative protocol for the surgical treatment of localized gingival overgrowth analyzing the surgical technique, times and follow-up.

Methods

A total of 20 patients were enrolled and underwent initial, non surgical, periodontal treatment and training sessions on home oral hygiene training. The treatment plan involved radical exeresis of the mass followed by positioning of an autograft of connective tissue and keratinized gingiva.

Results

During 10 years of follow-up, all the grafts appeared well vascularized, aesthetically satisfactory, and without relapse.

Conclusions

Periodontal examinations, surgical procedures, and dental hygiene with follow-up are an essential part of the treatment protocol. However, additional effort is needed from the patient. Hopefully, the final treatment result makes it all worthwhile.