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Introduction Gingivitis is an oral condition characterized by inflammation and bleeding of the gingiva (gums), largely caused by Porphyromonas gingivalis. Oral hygiene options for controlling P. gingivalis include mouthwash containing Commiphora myrrha (myrrh), which has been shown to be effective against the microbe. Silver nanoparticles (SN) have been studied for their antibacterial effect in different oral health applications, including mouthwash. This was an in vitro laboratory study of the anti-microbial actions of myrrh and SN against P. gingivalis. Methods We compared the anti-microbial properties against P. gingivalis of four solutions: a) placebo solution, b) myrrh solution (MS), c) MS mixed with silver nanoparticles (MSN), and d) SN suspension alone. Sixteen agar plates were divided into four groups of four plates, and each group was treated with one of the solutions/suspensions. The solution/suspension was administered on the agar disc diffusion method, and inhibition zones (IZs) were measured after 24 (time 1), 48 (time 2), and 72 h (time 3). To characterize MSN and SN, Fourier-transform infrared spectroscopy (FT-IR) was used. UV–Vis spectroscopy and energy dispersive X-ray (EDX) were used to further characterize MSN. Results After 24 h, the median IZ for the MS plates was 16 mm, and the median IZ for MSN plates was 15 mm. At time 2, the MS median IZ was 15 mm, but the MSN median IZ increased to 18 mm, and the interquartile ranges (IQRs) did not overlap. At time 3, the median IZs was similar again, with MSN and MS having IZs of 16 mm and 15 mm, respectively. SN alone showed no anti-microbial activity. Conclusions Our findings show that MSN displayed superior anti-microbial activity against P. gingivalis compared to MS and SN after 48 h of incubation, but not after 24 h. Also, the increased anti-microbial activity had ceased by 72 h.

Aim The aim was to assess the presence of incidental-findings (IFs) on cone-beam computed tomography (CBCT) scans of faciomaxillary region with emphasis on gender and ethnicity. Materials and methods A retrospective analysis of incidental findings (IFs) in the maxillary sinus was performed. All CBCT-scans were performed using a Cone Beam 3D imaging system and examined using a software program. These images were taken for treatment planning for dental implant therapy of partially edentulous individuals. Four-hundred CBCT scans were retrospectively evaluated. Data regarding age, gender and ethnicity (Saudi Arabian, Egyptian, Filipino and Pakistani) of the patients was recorded. When P-value were lesser than 0.05, the difference was deemed significant. Results Four hundred CBCT-based scans were investigated. The IFs were seen in 30.2%, 32.1%, 35.1% and 34.4% individuals belonging to the Egyptian, Saudi Arabian, Pakistani and Filipino ethnicities, respectively. Mucosal-thickening was more often identified in Saudi-Arabian (P

It is hypothesi sed that systemic calcitonin delivery with adjunct local platelet-rich fibrin (PRF) therapy is more effective in augmenting osseointegration than calcitonin delivery alone under experimental osteoporosis conditions. The primary objective of the present experiment was to assess the effect of systemic calcitonin delivery with and without adjunct local PRF therapy on osseointegration in ovariectomi sed osteoporotic rabbits.Thirty female bilaterally ovariectomized rabbits were used. The animals were fed a low-calcium diet to establish a model for osteoporosis. In each animal, 2 implants were bilaterally placed in tibia. The animals were randomly divided equally into 3 groups. In group 1, no treatment was offered (control group). In groups 2 and 3, the animals received intramuscular injections of calcitonin without and with local PRF delivery prior to implant placement, respectively. All animals were euthanised at 12 weeks, and osseointegration was assessed as the gap widths between the bone and implant surface in the cervical, middle and apical third using scanning electron microscopy and energy-dispersive x-ray spectroscopy. The bone-to-implant contact (BIC) was also measured. p0.05 was defined as statistically significant.Gap widths in the cervical (p0.001), middle (p0.001) and apical third (p0.001) were statistically significantly higher in group 1 than groups 2 and 3. Gap widths in the cervical (p0.001), middle (p0.001) and apical third (p0.001) were significantly higher in group 3 than group 2. The mean BIC was statistically significantly higher in the cervical (p0.001), middle (p0.001) and apical third (p0.001) in group 3 compared with groups 2 and 3.When used as an adjunct to calcitonin, PRF enhanced osseointegration in an experimental osteoporosis model. However, further well-designed studies with inclusion of additional groups (treatment with PRF alone) are needed.

There is a perplexity in the association between interleukin (IL) polymorphisms and periodontitis among patients with and without diabetes mellitus (DM). The aim of the present study was to evaluate indexed data regarding the association between periodontitis and genetic polymorphisms in interleukins among patients with and without DM. The addressed question was “Is there an association between periodontitis and polymorphisms in interleukins among patients with and without DM?” Original studies were included. Indexed databases were searched, and the pattern of the present literature review was customized to summaries’ the pertinent information. Eight studies were included and processed for data extraction. Two studies showed that polymorphisms in IL-1B genes aggravate periodontitis in patients with type-2 DM, and two studies showed that IL-1B genes either do not or are less likely to contribute towards the progression of periodontitis in patients with type-2 DM. Two studies reported that IL genes do not show cross-susceptibility with periodontitis and type-2 DM. One study reported that the primary factor that governs the occurrence and progression of periodontitis in patients with and without type-2 DM is poor routine oral hygiene maintenance. Seven studies had a high risk of bias. The role of IL gene polymorphisms in the development and progression of periodontitis in patients with and without DM remains controversial.

Background There is a debate regarding the significance of problem-based learning (PBL) model in educational systems. The aim of this study was to assess the awareness of dental students at the Princess Nourah Bint Abdulrahman University (PNU), Saudi Arabia, toward PBL. Methods The present cross-sectional study was performed at the College of Dentistry, PNU, Riyadh, Saudi Arabia. An anonymous, standardized and self-administered questionnaire (based on nine items) coded as 1, 2, 3 and 4 was distributed to the first-, second-, third- and fourth-year undergraduate students, respectively, after a seminar that focused on the perceptions of PBL among the students at the end of the academic year 2017. The questionnaire was developed following an exhaustive search of indexed databases. Based on the students' responses (yes/no) to the questions, group mean differences (95% CI) were computed and Pearson's chi-squared test was used for data analysis. Cronbach's alpha coefficient was also determined. The level of significance was set at P Results In total, 238 female undergraduate dental students (61 first-year, 59 second-year, 60 third-year and 58 fourth-year students) were included. The Cronbach's alpha coefficient ranged between 0.82 and 0.93. Group comparisons (95% CI) showed no statistically significant difference in the responses (yes) of students in the first, second, third and fourth year of academic years related to the perceptions listed earlier (P>0.05). Conclusion Perception of female undergraduate dental students at the PNU was inconclusive. Further studies are warranted in this regard.

The aim of the present study was to assess the effect of multiple sessions of antimicrobial photodynamic therapy (aPDT) on bone regeneration around dental implants among patients with peri‑implantitis.Patients with peri‑implantitis were included. Therapeutically, patients were randomly divided into 4 groups: (a) Group-I: Mechanical debridement (MD) alone; (b) Group-II: MD at baseline followed by a single session of adjunct a PDT; (c) Group-III: MD at baseline followed by aPDT at baseline and at 3-months of follow-up; and Group-IV: MD at baseline followed by aPDT at baseline and at 3- and 6-months of follow-up. Demographic data was collected and peri‑implant clinical (plaque index [PI], gingival index [GI], and probing depth [PD]) and radiographic (crestal bone loss [CBL]) parameters were assessed at baseline and after 9 months. Sample-size estimation was done on data from a pilot investigation and group comparisons were done using one-way analysis of variance and Bonferroni post-hoc adjustment tests. Level of significance was set at P0.01.Twenty-two, 22, 22 and 22 patients with peri‑implantitis were enrolled in groups -I, -II, -III and -IV. The mean age of individuals in groups -I, -II, -III and -IV were 59.2 ± 5.3, 60.5 ± 2.8, 59.6 ± 3.1 and 58.7 ± 0.8 years, respectively. Compared with Group-I, there was a statistically significant reduction in PI (P0.01), GI (P0.01) and PD (P0.01) in all groups at 9-months follow-up. There was no significant difference in PI, GI and PD in groups -II, -III and -IV at 9-months follow-up. There was no statistically significant difference in CBL in all groups at baseline and at 9-months-follow-up.The use of aPDT as an adjunct to MD reduces the severity of peri‑implant mucositis but does not contribute towards bone regeneration in peri‑implant osseous defects.

Background To determine whether treatment with antimicrobial photodynamic therapy (aPDT) as an adjunct to scaling and root planing (SRP) yield better clinical periodontal outcomes than antibiotics (AB) as adjunct to SRP in periodontitis. Methods Electronic searches were conducted in databases (MEDLINE, PubMed, EMBASE, SCOPUS, Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials Register databases) up to and including April 2017. Results Five randomized trials were included. All studies used the combined approach aPDT + SRP and AB + SRP in the test and control group respectively. The follow up period ranged from 12 to 48 weeks. All studies used diode lasers. The wavelengths, power density and duration of irradiation used were 670 nanometre, 75 milliwatts per square centimeters and 60 s respectively. None of the studies showed additional benefits of aPDT at follow up. Considering the effects of adjunctive aPDT as compared to AB, a high degree of heterogeneity for periodontal probing depth (PPD) (p 2 = 87.47%) was noticed among both the groups. Meta-analysis showed significant clinical attachment level (CAL) gain (WMD = 0.60, 95% CI = 0.25 to 0.95, p = 0.001), and not PPD reduction (WMD = 0.67, 95% CI = –0.36 to 1.71, p = 0.204) for aPDT as compared to AB at follow up. Conclusion It remains debatable whether aPDT is more effective as compared to adjunctive AB in the treatment of periodontitis, given that the scientific evidence is weak. Precautions must be exercised when interpreting the results of this study due to the small sample size and high heterogeneity among studies.

Purpose: The aim of the present systematic review was to assess the effect of local zoledronate (ZOL) delivery (topical or as implant surface coatings) on osseointegration. Materials and methods: In this systematic review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. To address the focused question, ‘Does local zoledronate delivery enhance osseointegration?’ indexed databases were searched without time or language restrictions up to and including April 2017 using various combination of the following keywords: ‘zoledronate’, ‘bisphosphonates’, ‘osseointegration’ and ‘topical administration’. Letters to the Editor, historic reviews, commentaries, case-series and case-reports were excluded. Results: Initially, 383 articles were identified out of which, 23 experimental studies fulfilled the inclusion criteria. In 18 studies, ZOL was incorporated into implants surfaces as a coating and in five studies ZOL was applied topically (bone graft or irrigation) into the bone cavities. Results from 87% studies reported that local delivery of ZOL (coating or topical) is effective in enhancing osseointegration or new bone formation around implants. Conclusions: Local ZOL delivery (coating or topical) seems to enhance osseointegration in animals; however, from a clinical perspective, further randomized control trials with long-term follow-up are needed in this regard.

The aim of the present 12-weeks follow-up randomized clinical trial was to investigate the outcome of mechanical curettage (MC) with or without adjunct antimicrobial photodynamic therapy (aPDT) in the treatment of peri-implant mucositis in cigarette smokers.Therapeutically, subjects with peri-implant mucositis were divided into 2 groups: (a) Group-A: MC+aPDT; and (b) Group-B: MC alone (control group). In both groups, peri-implant plaque index (PI), bleeding on probing (BOP) and probing pocket depth (PPD) were gauged at baseline and after 12-weeks follow-up. Group comparisons were performed using the Kruskall-Wallis test. P-values less than 0.05 were considered statistically significant.Fifty-four male patients (28 in Group-A and 26 in Group-B) were included. The mean age of individuals in groups A and B were 50.6±0.8 and 52.2±0.5years, respectively. In groups A and B the participants were smoking 16.5±2.7 and 14.2±1.7 cigarettes daily since 25.2±6.5 and 24.6±4.3years, respectively. Periimplant PI, BOP and PPD were comparable among individuals in both groups at baseline. At 12-weeks follow-up, there was a significant reduction in PI (P0.001) and PPD (P0.001) among patients in groups A and B compared with their respective baseline values. At 12-weeks follow-up, PI (P0.001) and PPD (P0.001) were significantly higher among patients in Group-B compared with Group-A (P0.001). BOP was comparable in both groups at baseline and at 12-weeks follow-up.In cigarette smokers, MC with adjunct aPDT is more effective in the treatment of peri-implant mucositis compared with MC alone.

Objective: The aim of the present in-vitro study was to assess antimicrobial efficacy of 0.8% hyaluronic acid (HA) and 0.2% Chlorhexidine gluconate (CHX) against Porphyromonas gingivalis (P. gingivalis). Methods: The study was performed between December 2018 and March 2019 at the College of Dentistry at the Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. The P. gingivalis biofilms were formed and grown for 72 hours at 37°C under anaerobic conditions on glass slides coated with human saliva. The slides were individually positioned and exposed to 0.8% HA or 0.2% CHX. Therapeutically, the biofilms were divided into 3 groups as follows: (a) negative group; (b) 0.8% HA group and (c) 0.2% CHX group. P-values less than 0.05 were considered statistically significant. Results: In the 0.8% HA group, P. gingivalis CFUs/ml were significantly higher at baseline than at 24- (P

There are no studies that have compared the clinical (plaque index [PI], bleeding on probing [BOP], probing depth [PD], clinical attachment loss [AL] and number of missing teeth [MT]) and radiographic (marginal bone loss [MBL]) periodontal parameters and gingival crevicular fluid (GCF) levels of proinflammatory cytokines among cigarette-smokers and individuals using electronic-cigarettes. The aim was to compare the clinical periodontal status and gingival crevicular fluid (GCF) cytokine profile among cigarette-smokers (Group-1), electronic-cigarette users (Group-2) and never-smokers (Group-3).Demographic data including age, gender, duration and reason for smoking and vaping and daily frequency and duration of smoking and vaping was collected using a questionnaire. Clinical (PI, BOP, PD and clinical AL) and radiographic (MBL) periodontal parameters were recorded. The volume of collected GCF was determined and levels of interleukin (IL) 1β, IL-6, tumour-necrosis-factor-alpha (TNF-α), matrix metalloproteinase (MMP)-8 and interferon-gamma (IFN-γ) were investigated.Forty-six cigarette-smokers, 44 electronic-cigarette users and 45 never-smokers were included in groups 1-3, respectively. Mean scores of PI (P 0.05), PD (P 0.05) and clinical AL (P 0.05) were significantly higher among individuals in Group-1 than Group-3. Compared with groups 1 (P 0.05) and 2 (P 0.05), BOP was more often manifested among patients in Group-3. Compared with Group-3, MBL was significantly higher in groups 1 (P 0.01) and 2 (P 0.01). GCF volume was significantly higher in Group-1 compared with groups 2 and 3. The concentrations of IL-1β, IL-6, IFN-γ, TNF-α and MMP-8 were significantly higher in the GCF samples of individuals in Group-1 (P 0.05) than groups 2 and 3.Periodontal status is poorer and GCF levels of proinflammatory cytokines are higher in cigarette-smokers compared with electronic-cigarette smokers and never-smokers. However, the probability of increased periodontal inflammation and GCF proinflammatory cytokine levels in electronic-cigarette users than never-smokers cannot be annulled.

The aim was to compare the peri-implant clinical and radiographic inflammatory parameters and whole salivary cotinine levels among cigarette smokers (CS), waterpipe smokers (WS) and never-smokers (NS). Thirty-four CS (Group 1), 33 WS (Group 2), and 31 NS (Group 3) were included. Peri-implant plaque index (PI), bleeding-on-probing (BOP), and probing depth (PD) were measured, and crestal bone loss (CBL) was assessed on standardized digital radiographs. Unstimulated whole saliva samples were collected and whole salivary cotinine levels were measured. Peri-implant PI and PD were higher in Groups 1 (P < 0.05) and 2 (P < 0.05) than in Group 3. Peri-implant BOP was significantly higher in Group 3 than in Groups 1 (P < 0.01) and 2 (P < 0.01). Peri-implant MBL was significantly higher in Groups 1 (P < 0.05) and 2 (P < 0.05) than in Group 3. There were significant differences in PI, BOP, PD, and CBL between Groups 1 and 2. There was no significant difference in the whole salivary cotinine levels in Groups 1 and 2. Peri-implant sites with plaque accumulation, PD, CBL, and whole salivary cotinine levels were higher in CS and WS than in NS, but did not differ between CS and WS.

The aim of this review was to assess the contribution of herpesviruses in the subgingival oral biofilm in the progression of periodontal and peri-implant diseases in systemically healthy individuals. The literature review was customized to summarize the pertinent information for the following reasons: (1) A systematic review regarding the role of herpesviruses in the etiopathogenesis of periodontal disease has recently been published; and (2) a limited number of studies have assessed the association of herpesviruses with peri-implant diseases. To date, five observational studies have assessed the presence of herpesviruses in the subgingival oral biofilm of individuals with peri-implant diseases. In these studies, dental implants were in place for up to approximately 8 years. In two studies, human cytomegalovirus (HCMV) was more often isolated from the peri-implant sulci of sites with than without peri-implantitis. In one study, a low prevalence of HCMV compared with Epstein-Barr virus (EBV) was associated with the progression of peri-implantitis. In previous studies, the presence of EBV in the subgingival oral biofilm was associated with the onset of peri-implantitis and peri-implant mucositis, respectively. Major limitations of the studies assessed were the absence of blinding and lack of power analysis for sample size estimation. In conclusion, the presence of herpesviruses in the periodontal and peri-implant subgingival oral biofilm is an indicator of periodontal and peri-implant diseases in systemically healthy individuals; however, further studies with a statistically justified sample-size are needed to understand and refine this association.

There are no studies that have assessed the oral soft tissue response to full-mouth ultrasonic scaling (FMUS) among cigarette-smokers (CS) (group 1), individuals vaping electronic-cigarettes (E-cigs) (group 2), and never-smokers (NS) (group 3). The aim was to assess the impact of cigarette smoking and vaping on periodontal tissues following FMUS. In a clinical prospective study, 89 male individuals were divided into three groups: CS (group 1), E-cig users (group 2), and NS (group 3). A questionnaire was used to gather demographic data and information regarding duration and daily frequency of CS and vaping. Full-mouth plaque index (PI), bleeding on probing (BOP), clinical attachment loss (AL), and probing depth (PD) were measured at baseline and 3 and 6 months after FMUS (without root surface debridement). Numbers of missing teeth (MT) were also recorded. In groups 1, 2, and 3, 30, 28, and 31 individuals, respectively were included. In group 1, there was no statistically significant difference in mean PI and PD and numbers of sites with PD ≥ 4 mm at 6 months’ follow-up compared with baseline and 3 months’ follow-up. In groups 2 and 3, there was no significant difference in PI, BOP, and PD at 3 months’ (P > 0.05) and 6-months’ (P > 0.05) follow-up. There were no pockets with PD ≥ 4 mm at 3 and 6 months’ follow-up in groups 2 and 3. There was no difference in the numbers of MT and none of the individuals exhibited clinical AL in all groups. Following FMUS, gingival inflammation is worse in CS compared with individuals vaping E-cigs and NS. Periodontal inflammatory parameters are worse in cigarette-smokers than individuals vaping electronic cigarettes and never-smokers following FMUS. However, these findings should be interpreted with extreme caution as a number of factors may have influenced the present results.

Waterpipe smoking (WS), an emerging trend has major health concerns. It is prevalent worldwide as a recreational activity both indoors and outdoors. The aim of this review was to assess the impact of waterpipe smoke on the oral and respiratory system (oral cavity and pulmonary tissues). A number of studies have shown that periodontal health status is compromised in waterpipe smokers when compared with nonsmokers. Some studies have associated WS with oral premalignant and malignant lesions; however, due to the poor quality of these studies, the presented outcomes should be interpreted with caution. Although cigarette smoking has been considered as a potential risk factor for dental caries; there are no studies in indexed literature that have shown an association to exist between dental caries and WS. Inhaled waterpipe smoke imposes oxidative stress and inflammatory responses and compromises the ventilatory capacity of the lungs and may lead to an increased risk of decline in lung function. WS may cause oral and pulmonary diseases, such as periodontal disease and chronic obstructive airway disease, respectively. The association between WS and development of dental caries and oral pre-cancer and their relationships with chronic airways disease requires investigations. This review discusses the current evidence of waterpipe smoke effects on the oral health and respiratory system based on basic and clinical science and provides future directions for research and regulatory science on how WS can affect the oral cavity and the respiratory/pulmonary system.

The authors hypothesized that peri-implant clinical and radiographic inflammatory parameters are worse in waterpipe smokers (WS) and cigarette smokers (CS) compared with never-smokers (NS). The aim of the present retrospective study is to compare peri-implant clinical and radiographic inflammatory parameters among WS, CS, and NS.Forty-four CS (group 1), 41 WS (group 2), and 43 NS (group 3) were included. Demographic data were collected using a questionnaire. Peri-implant plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were measured, and crestal bone loss (CBL) was assessed on standardized digital radiographs. Sample size was estimated, and statistical analyses were performed using Kruskal-Wallis and Wilcoxon rank-sum tests. For multiple comparisons, Bonferroni post hoc test was performed. P values 0.05 were considered statistically significant.Peri-implant PI and PD were higher in groups 1 (P 0.05) and 2 (P 0.05) compared with group 3. Peri-implant BOP was significantly higher in group 3 compared with individuals in groups 1 (P 0.01) and 2 (P 0.01). Peri-implant total marginal bone loss was significantly higher in groups 1 (P 0.05) and 2 (P 0.05) compared with group 3. There were differences in PI, BOP, PD, and CBL among participants in groups 1 and 2.Peri-implant soft tissue inflammatory parameters and CBL are worse in CS and WS compared with NS. There is no difference in these parameters between CS and WS.

Summary The aim of this systematic review was to determine whether or not assessment of salivary secretory immunoglobulin A (sIgA) levels could be a potential biomarker for immunosuppression in HIV-positive children. The Patient, Exposure, Comparative, Outcome question was “Is sIgA level a potential biomarker for immunosuppression in HIV-positive children?” Electronic and manual literature searches were conducted in indexed databases (MEDLINE, PubMed, EMBASE, ScienceDirect, and SCOPUS databases) up to and including June 2017. The primary outcome was total mean salivary levels of IgA among HIV seropositive and seronegative children (controls). The weighted mean differences (WMD) of outcomes and 95% confidence intervals (CI) for total mean salivary IgA levels were calculated using a random effect model. Six studies were included. Three studies showed significantly lower salivary IgA levels in HIV-infected children compared with controls. Two studies showed comparable IgA levels in HIV infected and controls. One study showed significantly higher levels of salivary IgA in HIV-infected children as compared to controls. Considering the total mean salivary IgA levels among HIV seropositive and seronegative children, a high degree of heterogeneity (Q value = 254.09, P