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Objectives: Periodontitis is one of the most common chronic inflammatory diseases. It causes changes in the biting abilities of individuals. However, periodontal treatment has positive effects on masticatory function. The aim of this study is to determine the effect of periodontitis and periodontal treatment on masticatory abilities by measuring masseter and temporal muscle thicknesses with ultrasonography before and after periodontal treatment in chronic periodontitis patients. Methods: The patients included in the study were determined by clinical and radiological examination. The thickness of the masseter and temporal muscles of the patients were measured by ultrasonography. Periodontal measurements and treatments of the patients were completed by a single physician. IBM SPSS 20.0 (IBM Corp., Armonk, NY) statistical program was used for statistical analysis. Results: A statistically significant difference was found between the values of periodontal measurements before and after treatment (p<0.05). In the ultrasonography measurements of the thickness of masseter and anterior temporal muscles, a statistically significant increase was observed in both rest and contraction values at all time intervals (p<0.05). Muscle thicknesses of male patients were higher than female patients. Conclusions: Periodontitis negatively affects the masticatory performance of individuals. Chronic periodontitis patients should be referred for periodontal treatment without wasting time. [ABSTRACT FROM AUTHOR]

Periodontitis is a widespread oral health problem caused by bacterial infections that lead to tooth loss and other systemic diseases. The aim of this study was to provide an alternative treatment for periodontitis by developing a metronidazole-loaded in situ forming matrix (ISM) using camphor as its matrix former. Five-percent w/w metronidazole dissolved in N-methyl pyrrolidone (NMP) with varying concentrations of camphor (30–50% w/w) and triacetin (0–25% w/w) were used. The physicochemical properties and antimicrobial activities of formulations were evaluated. Results showed that as the percentage of camphor increased, viscosity, density, contact angle, surface tension, and force of injection increased, while water tolerance decreased. The same trend was observed when increasing the triacetin concentration. The optimal metronidazole-loaded ISM was obtained at 40% w/w camphor and 5% w/w triacetin, which prolonged the release of metronidazole up to 6 days with Fickian diffusion release profile. The higher concentration of triacetin slowed down the phase inversion that led to an incomplete formation of the matrix and resulted in an inefficiently prolonged release of the metronidazole. Antimicrobial activities demonstrated that the developed formulation efficiently inhibited periodontitis-induced microorganisms including Porphyromonas gingivalis, Staphylococcus aureus, Escherichia coli, and Candida albicans. The metronidazole-loaded camphor-based ISM has potential as a new drug delivery system for periodontitis treatment. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the influence of the extraction socket (distal or lingual root) and the type of region of interest (ROI) definition (manual or predefined) on the assessment of alveolar repair following tooth extraction using micro-computed tomography (micro-CT). The software package used for scanning, reconstruction, reorientation, and analysis of images (NRecon®, DataViewer®, CT-Analyzer®) was acquired through Bruker < https://www.bruker.com >. The sample comprised the micro-CT volumes of seven Wistar rat mandibles, in which the right first molar was extracted. The reconstructed images were analyzed using the extraction sockets, i.e., the distal and intermediate lingual root and the method of ROI definition: manual (MA), central round (CR), and peripheral round (PR). The bone volume fraction (BV/TV) values obtained were analyzed by two-way ANOVA with Tukey's post hoc test (α = 5%). The distal extraction socket resulted in significantly lower BV/TV values than the intermediate lingual socket for MA (P = 0.001), CR (P < 0.001), and PR (P < 0.001). Regarding the ROI, when evaluating the distal extraction socket, the BV/TV was significantly higher (P < 0.001) for MA than for CR and PR, with a lower BV/TV for CR. However, no significant difference was observed for MA (P = 0.855), CR (P = 0.769), or PR (P = 0.453) in the intermediate lingual extraction socket. The bone neoformation outcome (BV/TV) for alveolar bone repair after tooth extraction is significantly influenced by the ROI and the extraction socket. Using the predefined method with a standardized ROI in the central region of the distal extraction socket resulted in the assessment of bone volume, demonstrating the most critical region of the bone neoformation process. [ABSTRACT FROM AUTHOR]

Arterial hypertension (AH) and periodontitis are among the most common non-communicable chronic diseases worldwide. Besides sharing common risk factors, an increasing body of evidence supports an independent association between the two conditions, with low-grade systemic inflammation acting as the plausible biological link with increased cardiovascular risk. In 2021, the Italian Society of Arterial Hypertension (SIIA) and the Italian Society of Periodontology and Implantology (SIdP) have joined forces and published a joint report on the relationships between AH and periodontitis, reviewing the existing scientific evidence and underlining the need to increase awareness of the strong connection between the two conditions and promote treatment strategies for the control of gums inflammation in patients with AH. The current document extends the previous joint report, providing clinical practical guidelines aimed to support clinicians in the management of patients who suffer from or are at risk of being affected by both conditions. These recommendations are based on careful consideration of the available evidence as well as of the current guidelines on the management of periodontitis and AH and are supported by SIIA and SIdP. [ABSTRACT FROM AUTHOR]

Objective: The aim of this retrospective study was to assess the prevalence of apical periodontitis (AP) in root canal-treated maxillary and mandibular posterior teeth in a Saudi Arabian population based on findings from images taken using cone-beam computed tomography (CBCT). Methods: The sample included 300 CBCT images from patients (150 females and 150 males) aged between 18 and 80 years old and they were analyzed to detect AP in endodontically treated maxillary and mandibular premolars and molars. Also, the correlation between the prevalence of AP and gender along with location (right/left side of jaw) were analyzed. Periapical lesions were defined as lamina dura gaps appearing disrupted around the width of periodontal ligament and apex at the apical third of the roots. Results: There was higher prevalence of AP in maxillary (19.1%) when compared to mandibular posterior teeth (17.3%). Mandibular first and maxillary second molars were the most affected teeth with AP (P = 0.05 and P = 0.04, respectively). Also, there was higher prevalence of AP cases with a predilection toward males (Maxillary P = 0.005; Mandibular P = 0.00) and on the right side of the mandibular jaw (P = 0.03). Conclusion: In this study, the prevalence of AP had a significant association between gender with a predilection in males and location with a tendency to occur on the mandibular right side as observed in endodontically treated maxillary and mandibular posterior teeth using CBCT. [ABSTRACT FROM AUTHOR]

An accumulating body of evidence supports an independent association between high blood pressure (BP) and periodontitis, possibly mediated by low-grade inflammation. This joint report by the Italian Society of Hypertension (SIIA) and the Italian Society of Periodontology and Implantology (SIdP) working group on Hypertension and Periodontitis (Hy-Per Group) provides a review of the evidence on this topic encompassing epidemiology, biological plausibility, relevance, magnitude, and treatment management. Consensus recommendations are provided for health professionals on how to manage BP in individuals showing signs of poor oral health. In summary, (1) large epidemiological studies highlight that individuals with periodontal diseases have increased risk for high/uncontrolled BP independent of confounders; (2) mechanistically, low-grade inflammation might have a causal role in the association; (3) BP profile and control might benefit from periodontal treatment in pre-hypertensive and hypertensive individuals; (4) oral health status should be evaluated as a potential risk factor for high/uncontrolled BP, and effective oral care should be included as an adjunct lifestyle measure during hypertension management. Further research is needed to optimize BP management in individuals with poor oral health. [ABSTRACT FROM AUTHOR]

The treatment of periodontitis has numerous positive effects on established chronic health conditions, including cardiovascular disease and diabetes. However, ethical considerations do limit the establishment of human trials to investigate whether periodontitis promotes the early stages of chronic conditions. Therefore, the aim of this study was to investigate whether periodontitis induces endothelial dysfunction in hyperlipidemic apolipoprotein E gene-deficient (ApoE-/-) mice. Forty-five 8-week-old ApoE-/- mice were challenged by oral lavage with Porphyromonas gingivalis and Streptococcus gordonii for 4 weeks. A subgroup of animals (n = 15–17/group) was placed in a metabolic chamber immediately before euthanasia at 4 weeks to measure VO2/CO2 concentrations and voluntary locomotion. In infected and control animals alveolar bone levels were measured by x-ray imaging and endothelial function was determined by measuring endothelial-dependent vasorelaxation of aortic rings. The mRNA expression levels of serum amyloid A and tumor necrosis factor were determined in liver tissues by qRT PCR and protein concentrations in serum by ELISA. Caecal contents were analysed by sequencing to determine changes to the gut microbiota to investigate linkages between microbiome and systemic changes. The results showed that oral lavage of P. gingivalis and S. gordonii for 4 weeks, initiated periodontitis in ApoE-/- mice, similar to the human situation. The oral inflammation was accompanied by a significant increase in mRNA expression of pro-inflammatory mediators serum amyloid A1 and tumor necrosis factor in the liver. Mice with periodontitis also exhibited impaired endothelial-dependent vasorelaxation responses to acetylcholine. This systemic response was connected to increased energy expenditure, locomotion and respiratory quotient. No differences were detected in caecal microbiota between the infected and control animals. Overall, this is the first report that provide evidence that periodontitis induces endothelial dysfunction in mice. Other systemic responses observed in response to the local reaction need further investigation. The study suggests that early prevention of periodontitis may help limit the early stages of endothelial dysfunction that is linked to atherogenesis in humans. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the effect of diode laser irradiation on Enterococcus faecalis (E. faecalis) and its lipoteichoic acid (LTA). Ninety-six freshly extracted single-rooted teeth were divided into six groups, n = 8 per group. Groups 1, 2, 3, and 4 as laser group (810 nm PILOT™ Diode Laser, 400 μm fiber diameter, continuous mode, 30 s time) with powers at 1.0 W, 1.5 W, 2.0 W, and 2.5 W respectively. Group 5 or positive control group (3 ml of 1% sodium hypochlorite (NaOCl) irrigation) and group 6 or negative control group (3 ml of normal saline (0.9% NaCl) irrigation). Root canal samples were collected before and after receiving laser irradiation and irrigation solution. Cultivable bacteria were determined by counting the colony (CFU/ml). Evaluation of temperature on the external root surface of teeth was done with K type thermocouple using laser at different powers. Enzyme-linked immunosorbant assay (ELISA) was performed to measure the LTA levels and the correlations between E. faecalis count, LTA levels, and rise in temperature were observed using Pearson's correlation test. E. faecalis LTA was subjected to laser irradiation and its structural damage was examined by thin layer chromatography (TLC). Compared with the control groups, all laser groups showed a decreased colony counts and decreased LTA levels with statistically significant difference (p ˂ 0.05). The bactericidal effect and LTA reduction of laser was better at 2.5 W power. Laser at 2.5 W power had temperature rise of more than 7 °C which is beyond the safe thermal threshold level. No statistically significant correlation was found between E. faecalis count, levels of LTA, and rise in external root surface temperature (p ˃ 0.05). TLC results showed a structural damage in the glycolipid moiety of E. faecalis LTA. Diode laser can effectively reduce the E. faecalis count and its LTA levels. [ABSTRACT FROM AUTHOR]

The meta-analysis aimed to systematically evaluate all the available pieces of evidence concerning the clinical effectiveness of Er,Cr:YSGG lasers (erbium, chromium, yttrium scandium gallium garnet laser) in the non-surgical treatment of patients with chronic periodontitis, and provide guidance for clinicians about the application of Er,Cr:YSGG lasers during the process of non-surgical periodontal treatments. The meta-analysis was conducted with data extracted from 16 randomized controlled clinical trials (RCTs) that compare Er,Cr:YSGG lasers adjunct/substitute to scaling and root planing (SRP) with SRP alone for the treatment of chronic periodontitis published in English or Chinese from January 2000 to January 2020. The weighted mean differences (WMDs) and 95% confidence intervals (CIs) were counted for probing depth (PD) reduction, clinical attachment level (CAL) gain, and visual analogue scale (VAS) score. Heterogeneity of each study was evaluated with the Q test. The publication bias was measured using Begg's adjusted rank correlation test. Sixteen RCTs with 606 patients were included in the meta-analysis. There were statistically significant differences between Er,Cr:YSGG lasers adjunct/substitute to SRP and SRP alone in the PD reduction at 1-month follow-up (WMD = ‑ 0.35, 95% CI [− 0.63, ‑ 0.07], P = 0.013), 3-month follow-up (WMD = − 0.342, 95% CI [− 0.552, − 0.132], P = 0.001), CAL gain at 3-month follow-up (WMD = − 0.17, 95% CI [− 0.31, 0.03], P = 0.017), and VAS score (WMD = − 2.395, 95% CI [− 3.327, − 1.464], P = 0.000) immediately after treatment. There were no significant differences of PD reduction and CAL change at 6-month follow-up. The present meta-analysis indicated that Er,Cr:YSGG lasers provided additional effectiveness in PD reduction and CAL gain at short-term follow-ups and there was less pain compared with SRP alone. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effects of toluidine blue-mediated photodynamic therapy (TB-PDT) on the periodontitis-induced bone resorption in periodontitis in rats. Periodontal disease was induced by cotton ligature around the right second maxillary molar in 64 rats. After 4 weeks, the rats were randomly divided into four groups: sterile saline solution (control group); laser therapy (laser group); TB (100 μg/mL); TB plus laser (0.15 W/cm2) irradiation every other day for 240 s (PDT group). All rats were euthanized at 15 days postoperatively. Eight gingival tissue samples were collected from each group. The expressions of receptor activator of nuclear factor kappa-Β ligand (RANKL) and osteoprotegerin (OPG) in gingival tissue samples were detected by real-time quantitative polymerase chain reaction (RT-qPCR). The maxillae from the rest of the rats were taken for histological examination. In the PDT group, the analysis revealed less bone loss than in the control treatment (P < 0.05). No significant difference was found among the control group, TB group, and laser group (P > 0.05). Significantly higher and lower expressions of RANKL and OPG were revealed in the PDT group than that in control group, respectively (P < 0.01). When compared with the control group, the expression of RANKL was significantly reduced by 40.0% in periodontitis in rats treated with TB-PDT for 15 days (P < 0.01). The expression of OPG was increased in the PDT group with TB-PDT for 15 days, when compared with the control group (P < 0.05). TB-PDT treatment significantly reverses the abnormal expression of RANKL and OPG in periodontitis in rats. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the clinical and biochemical efficacy of erbium, chromium:ytrium-scandium-gallium-garnet (Er,Cr:YSGG) laser treatment, in addition to non-surgical periodontal treatment (NSPT), in periodontitis patients. This was a single-centre, split-mouth, randomized, controlled 6-month clinical trial. Twenty-seven patients with moderate to advanced periodontitis were included in the study. The patients were randomly assigned to a debridement and laser treatment group or control group (debridement alone). Clinical measurements were performed at baseline and 1, 3 and 6 months post-treatment. The following parameters were measured: plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), bleeding on probing (BoP), gingival crevicular fluid (GCF) volume and IL-1β and MMP-8 levels in GCF. There were statistically significant clinical improvements in both groups, with no significant between-group differences in PD, CAL, PI and BoP clinical measurements (p < 0.05). As compared with the control group, the GI 1 and 3 months post-treatment and BoP 1 month post-treatment were significantly improved in the laser group (p < 0.05). There was also a significant reduction in IL-1 β levels in both groups at baseline versus those 1, 3 and 6 months later (p < 0.05) There was no statistically significant difference in IL-1β and MMP-8 levels between groups (p < 0.05). Both the treatment modalities resulted in significant improvements in clinical parameters. Within the limitations of this study, Er,Cr:YSGG laser treatment applied in addition to NSPT is indicated to reduce clinical inflammation. [ABSTRACT FROM AUTHOR]

Photobiomodulation therapy (PBMT) is a method currently used in the treatment of hard and soft tissue injuries due to its accelerating and enhancing effects on healing. In this study, we aimed to evaluate the possible additional benefits of applying PBMT with nonsurgical periodontal treatment in type 2 diabetes mellitus (DM) patients with chronic periodontitis (CP). Twenty-two type 2 DM patients with CP were enrolled in this clinical split-mouth study. Probing pocket depth (PPD), gingival index (GI), plaque index (PI), and clinical attachment level (CAL) were measured by intracaliber clinician (H.G.) at baseline and at 1 m, 3 m, and 6 m after treatment. Gingival crevicular fluid (GCF) samples were collected at baseline and at 1 week and 1 m, 3 m, and 6 m after treatment. According to split-mouth design, one randomly selected quadrant was treated with PBMT + nonsurgical periodontal treatment (NSPT) and the other quadrant was treated only non-surgical periodontal treatment. PBMT was applied the test quadrant on NSPT day and first, third, and seventh day after treatment at an energy density of 7.64 J/cm2. Repeated measures analysis of variance test was used for the intragroup comparison and a "paired t test" in the intergroup comparison of the clinical and laboratory findings. Comparing the test and control quadrant after treatment, the test quadrant showed significant decrease in PPD at 1 month, 3 months, and 6 months; in GI at 3 months and 6 months; in CAL at month 6; in GCF at 1 week, 1 month, 3 months, and 6 months; and in IL-1β data at 3 months in comparison to the control quadrant. In contrast, there was no statistically significant difference in PI data at all times. Within the limitation of this study, adjunct use of PBMT on NSPT in patient with DM may positively affect the clinical and biochemical parameters. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the clinical attachment level (CAL) gain of Er:YAG, Er,Cr; YSGG, Nd:YAG; and diode laser (DL) as monotherapy or adjunctive to scaling and root planing (SRP) of chronic periodontitis by network meta-analysis (NMA). Randomized controlled clinical trials (RCTs) about lasers applied in SRP of chronic periodontitis were searched from PubMed, Cochrane Library, Web of Science, Ovid, Science Direct, Wan Fang, and China National Knowledge Infrastructure (CNKI) databases up to September 2018 and from references of selected full-texts and related reviews. Standard mean differences and 95% confidence intervals were counted for CAL gain. The random effects NMA were performed in STATA software. There were 25 RCTs about CAL gain at 3 and/or 6 months after lasers were applied in SRP. No inconsistency was detected. Er:YAG as monotherapy gained significantly more CAL at 3 months than did SRP; no significant differences were detected among other comparisons. In terms of CAL gain at 3 months, the ranking result from best to worst was as follows: Er:YAG as monotherapy, DL adjunctive to SRP, Er:YAG adjunctive to SRP, Er,Cr;YSGG as monotherapy, Nd:YAG adjunctive to SRP, and SRP. In terms of CAL gain at 6 months, the ranking result from best to worst was as follows: DL adjunctive to SRP, Nd:YAG adjunctive to SRP, SRP, Er:YAG adjunctive to SRP, and Er:YAG as monotherapy. Laser-assisted periodontal treatment could be superior to SRP alone and could serve as a good adjunctive treatment tool. [ABSTRACT FROM AUTHOR]

Platelet-rich fibrin (PRF) provides a scaffold for cell migration and growth factors for promoting wound healing and tissue regeneration. Here, we report using PRF in periodontal healing after open flap debridement (OFD) in canine periodontitis. A split-mouth design was performed in twenty dogs. Forty periodontitis surgical sites were randomly categorized into 2 groups; OFD alone and OFD with PRF treatment. Clinical parameters of periodontal pocket depth, gingival index, and the cemento-enamel junction-alveolar bone levels/root length ratio were improved in the OFD + PRF group. The OFD + PRF group also demonstrated a dramatically decreased inflammatory score compared with the OFD group. Collagen accumulation was improved in the OFD + PRF group at later time points compared with baseline. PRF application also significantly reduced inflammatory cytokine expression (TNFA and IL1B), and promoted the expression of collagen production-related genes (COL1A1, COL3A1, and TIMP1) and growth factors (PDGFB, TGFB1, and VEGFA). These findings suggest that PRF combined with OFD provides a new strategy to enhance the overall improvement of canine periodontitis treatment outcomes, especially in terms of inflammation and soft tissue healing. Therefore, PRF use in treating periodontitis could play an important role as a regenerative material to improve canine periodontitis treatment. [ABSTRACT FROM AUTHOR]

Summary: Our goal was to evaluate alveolar bone healing in OVX mice, and to assess the functional utility of a WNT-based treatment to accelerate healing in mice with an osteoporotic-like bony phenotype. Introduction: Is osteoporosis a risk factor for dental procedures? This relatively simple question is exceedingly difficult to answer in a clinical setting, for two reasons. First, as an age-related disease, osteoporosis is frequently accompanied by age-related co-morbidities that can contribute to slower tissue repair. Second, the intervals at which alveolar bone repair are assessed in a clinical study are often measured in months to years. This study aimed to evaluate alveolar bone repair in ovariectomized (OVX) mice and provide preclinical evidence to support a WNT-based treatment to accelerate alveolar bone formation. Methods: OVX was performed in young mice to produce an osteoporotic-like bone phenotype. Thereafter, the rate of extraction socket healing and osteotomy repair was assessed. A liposomal WNT3A treatment was tested for its ability to promote alveolar bone formation in this OVX-induced model of bone loss. Results: Bone loss was observed throughout the murine skeleton, including the maxilla, and mirrored the pattern of bone loss observed in aged mice. Injuries to the alveolar bone, including tooth extraction and osteotomy site preparation, both healed significantly slower than the same injuries produced in young controls. Given sufficient time, however, all injuries eventually healed. In OVX mice, osteotomies healed significantly faster if they were treated with L-WNT3A. Conclusions: Alveolar bone injuries heal slower in OVX mice that exhibit an osteoporotic-like phenotype. The rate of alveolar bone repair in OVX mice can be significantly promoted with local delivery of L-WNT3A. [ABSTRACT FROM AUTHOR]

Broad methodological heterogeneity makes the literature on the clinical effects of laser treatment in periodontitis, both as monotherapy and adjunct to non-surgical therapy, which is difficult to interpret. The present split-mouth study was performed: (i) to determine the efficacy and safety of a photoablative-photodynamic diode laser therapy, including antiseptic LED irradiation, in adjunct to scaling and root planing (iPAPD+SRP) vs. sham-treatment+SRP for the treatment of diffuse severe periodontitis and (ii) to estimate the patient-reported outcomes. Twenty-four patients with severe periodontitis were treated with iPAPD+SRP or sham-treatment+SRP. iPAPD+SRP consisted of the following: (1) intra-/extra-pocket de-epithelization with photoablative λ 810 nm laser, (2) disinfection with λ 405 nm LED, (3) SRP, and (4) 10 weekly antiseptic/anti-inflammatory photodynamic treatments with λ 635 nm laser and 0.1% toluidine blue as photosensitizer. Clinical and cytofluorescent periodontal markers and patient-reported results were analyzed. At 1-year follow-up, both groups showed a significant reduction of several severity markers of periodontitis, namely probing depth (PD) and bleeding on probing (BoP), as well as of bacteria, polymorphonuclear cells, erythrocytes and damaged epithelial cells in exfoliative samples, as compared with day 0. The quadrants subjected to iPAPD+SRP showed significantly better values of these parameters as well as of clinical attachment level (CAL) as compared with those undergoing sham-treatment+SRP. The patients' perceived pain/discomfort, and overall liking was also in favor of the iPAPD+SRP treatment. This study confirms the efficacy of combined phototherapy in adjunct to SRP which had emerged from previous clinical trials, extending its field of application to severe periodontitis. [ABSTRACT FROM AUTHOR]

Objective: The aim of this work was to evaluate the anti-inflammatory and antiresorptive effects of Calendula officinalis (CLO) on alveolar bone loss (ABL) in rats.Material and methods: Male Wistar rats were subjected to ABL by ligature with nylon thread around the second upper left molar. The contralateral hemimaxillae were used as control. Rats received saline solution (SAL) or CLO (10, 30, or 90 mg/kg) 30 min before ligature and daily until the 11th day. The maxillae were removed and prepared for macroscopic, radiographic, micro-tomographic, histopathologic, histometric analysis, and immunohistochemical localization of receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG). The gingival tissues were used to quantify the myeloperoxidase (MPO) activity, tumor necrosis factor-alpha (TNF-α), and interleukin-1β (IL-1β) concentrations by ELISA. Blood samples were collected for leukogram and to evaluate the bone-specific alkaline phosphatase (BALP) activity and serum levels of aspartate and alanine transaminases (AST/ALT).Results: The bone loss induced by 11 days of ligature induced bone loss, reduced levels of BALP, leukocyte infiltration, increased MPO activity, gingival concentrations of TNF-α and IL-1β, and RANKL while reduced OPG immunoexpressions in the periodontal tissue and leukocytosis. Of the CLO, 90 mg/kg reduced bone loss, neutrophilia, the levels of pro-inflammatory mediators, and RANKL expression, while it increased OPG immunopositive cells and BALP serum levels, when compared to SAL. CLO did not affect either kidney or liver function, indicated by serum AST/ALT levels.Conclusion: The present data suggests that CLO reduced inflammatory bone resorption in experimental periodontitis, which may be mediated by its anti-inflammatory properties and its effects on bone metabolism.Clinical relevance: CLO can be a potential therapeutical adjuvant in the treatment of periodontitis. [ABSTRACT FROM AUTHOR]

Introduction: This short-term randomized controlled trial evaluated the effectiveness of photodynamic therapy (PDT) on clinical success (periapical healing) and on the microbiota of primary endodontic infections.Methods: Thirty-two patients presenting mandibular molars with apical periodontitis (one tooth/patient) were selected and randomly allocated into two therapeutic groups: control (chemo-mechanical debridement [CMD]; n = 16) and PDT (CMD + PDT; n = 16). All teeth in both groups had intracanal medication with calcium hydroxide for 7 days before final obturation. Follow-up radiographs were made at 3 and 6 months. Periapical healing was evaluated by the periapical index (PAI). Samples were obtained at baseline, after CMD with or without PDT, and just before root filling to determine the frequency and levels of 37 taxa by checkerboard.Results: Significant decreases in PAI scores were observed in both groups over time, although at 6 months, the PDT group presented a significantly better healing score than the control (p < 0.05). At baseline, the most prevalent species in all samples were Candida albicans (46.9%), Dialister pneumosintes (31.2%), Prevotella nigrescens (28.2%), Prevotella tannerae (28.1%), and Peptostreptococcus anaerobius (25%). Most species reduced over time in both groups, and no significant differences in frequency and levels of the tested species were observed between groups in any time point evaluated. C. albicans and D. pneumosintes were still detected in high frequency in both groups at 3 months post-therapy.Conclusions: Conventional endodontic therapy with or without PDT is effective in reducing microbial load, resulting in periapical healing. Nevertheless, adjunctive PDT provides better periapical healing at 6-month follow-up.Clinical relevance: Teeth with apical periodontitis treated with PDT adjunct to conventional treatment would demonstrate superior healing and reduction of microorganisms. [ABSTRACT FROM AUTHOR]

Objective: Chemotherapeutic agents have been widely used as adjuncts for the treatment of chronic periodontitis (CP). This study investigated and compared a desiccant agent as an adjunct to scaling and root planing (SRP) versus SRP alone for the treatment of CP.Materials and methods: Thirty-six patients with CP were studied. Using a split-mouth design, the maxillary right and left quadrants were randomly assigned to SRP plus desiccant (Hybenx® EPIEN Medical, Inc. St. Paul, MN, USA) or SRP alone. Patients were examined on a regular basis for clinical, microbiological, and inflammatory mediator changes over a 1-year period. Clinical attachment level (CAL) was the primary outcome variable. In addition, the red complex bacteria and gingival crevicular fluid (GCF) inflammatory mediators were monitored.Results: Compared to baseline, both treatments demonstrated an improvement in periodontal parameters. Compared to SRP alone, SRP plus desiccant yielded a significant improvement in probing depth (PD) (SRP: 2.23 ± 0.31 mm vs. desiccant: 3.25 ± 0.57 mm, p < 0.05), CAL (SRP: 3.16 ± 0.29 mm vs. desiccant: 4.21 ± 0.34 mm, p < 0.05 mm) and bleeding on probing (BOP) (SRP: 4.56 ± 1.5% vs. desiccant: 34.23 ± 4.2%, p < 0.001) at 12 months. Similarly, in the SRP plus desiccant group, the bacteria of the red complex were significantly reduced (p < 0.05); and the level of inflammatory mediators was significantly reduced (p < 0.003) compared to SRP alone.Conclusions: SRP plus the desiccant resulted in a greater reduction in clinical, microbial and inflammatory mediators compared to SRP alone.Clinical relevance: Desiccant, when combined to SRP, was demonstrated as a significant approach to control the levels of certain periodontal pathogens, inflammatory mediators in patients with CP. [ABSTRACT FROM AUTHOR]

Meta-analysis of treatment effects of antimicrobial photodynamic therapy (aPDT) adjunct to non-surgical scaling and root planing (SRP) in comparison to SRP alone on patients with chronic periodontitis. The meta-analysis was performed according to PRISMA statement and Cochrane Collaboration guidelines. Electronic search complemented by hand search assured a high yield of randomized controlled trials (RCTs) of aPDT as adjunct modality to SRP. Differences in probing depth (PD) and clinical attachment level (CAL) were calculated with 95% confidence intervals and pooled in a random effects model. Analysis for intra- and inter-study heterogeneity was provided by χ 2 and I 2 tests, and publication bias was checked by funnel plots. Pooled overall effects of 26 RCTs attested significant benefits of aPDT adjunct to SRP with respect to PD reduction (MD 0.37; 95% CI 0.12-0.53; P < 0.0001) and CAL gain (MD 0.33; 95% CI 0.19-0.48; P < 0.00001) after 3 and 6 months. Sensitivity analysis minimized heterogeneity of PD reduction (MD 0.21; 95% CI 0.13-0.30; P < 0.00001) and CAL gain (MD 0.36; 95% CI 0.27-0.46). aPDT adjunct to SRP provides significant PD reduction and CAL gain in treatment of chronic periodontitis. This moderate effect was found after 3 and 6 months which is short from a clinical perspective. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was evaluate the effect of triclosan on citrullination and carbamylation, two important protein posttranslational modifications associated with inflammatory conditions such as periodontitis and rheumatoid arthritis. Materials and methods: A range of triclosan concentrations were incubated in the presence of appropriate substrates used for the generation of either citrullinated or carbamylated proteins. The effect of triclosan on protein citrullination and carbamylation in macrophages was also assessed. Results: Citrullination and carbamylation were both significantly decreased by triclosan at concentrations six times lower than the 0.3% triclosan approved by the FDA to use in mouthwash and toothpaste. When macrophages were exposed to triclosan, carbamylation was significantly deceased ( p = 0.01), and while citrullination also decreased, this reduction was not statistically significant ( p = 0.06). Conclusion: Triclosan reduced the generation of protein citrullination and carbamylation in vitro. Clinical relevance: Triclosan may be useful as an adjunct therapy in the management of inflammatory periodontal diseases and help to reduce posttranslational protein modification citrullination and carbamylation) in these tissues. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to assess the possibility to detect early vascular changes in apical periodontitis (AP) using ultrasound examination with color power Doppler (US-CPD) and to establish a correlation between the early response of AP to treatment and its potential healing. Materials and methods: Twenty-one apical lesions were visualized with US-CPD before endodontic treatment, 1 week after the first access to endodontic system and 4 weeks after root canal obturation. A differential diagnosis between cystic lesions (CLs) and granulomatous lesions (GLs) was attempted. The vascular modifications were then correlated with long-term radiographic follow-up using Fisher's exact test. Results: The decrease or disappearance of vascular flow observed in AP 4 weeks after root canal obturation was significantly related to a healing trend ( p = 0.0206) of the lesions. Combining the data with preoperative US-CPD diagnosis showed a reproducibility for GLs only ( p = 0.0022). Conclusions: This study showed the possibility to detect early vascular changes in AP using US-CPD, correlating them with a healing trend after endodontic treatment. Future investigations should be conducted and more attention should be dedicated to the potential of this alternative and biologically safe imaging technique. Clinical relevance: US-CPD in endodontics may be a helpful tool to identify healing processes after endodontic treatment and to understand the behavior of different forms of AP. [ABSTRACT FROM AUTHOR]

Aim: The aim of this case-series study is to evaluate the prevalence of mucositis, peri-implantitis, and survival and success rates of oxide-coated implants in subjects treated for periodontitis. Materials and methods: Twenty-four subjects treated for generalized chronic periodontitis (GCP) and five treated for generalized aggressive periodontitis (GAP) were orally rehabilitated with a total of 130 dental implants. Subjects were examined 2 to 4 weeks prior to extraction of non-retainable teeth and at insertion of superstructure. Additional examinations were performed during a 3-month recall schedule over a 3- to 6-year follow-up period. Radiographs were taken after insertion of the superstructure and 1, 3, and 5 years later. Results: The results showed implant survival rates of 97.1% in GCP subjects versus 96.2% in GAP subjects. The implant success rate was 77.9% in GCP subjects and 38.5% in GAP subjects. In GCP subjects, mucositis was present in 7.7% and peri-implantitis in 12.5% of the implants. In GAP subjects, 28.0% of the implants showed mucositis and 32.0% peri-implantitis. Implant failure, mucositis, and peri-implantitis were more evident in GAP subjects. Peri-implantitis was more prevalent for implants in the maxilla and implants >10 mm. After 5 years, the mean peri-implant bone loss in GAP subjects was 2.89 mm and in GCP subjects 1.38 mm. Conclusions: Periodontally diseased subjects treated in a supportive periodontal therapy can be successfully rehabilitated with oxide-coated dental implants for a follow-up period of 3- to 6-years. Implants in the maxilla and GAP subjects were more susceptible to mucositis and peri-implantitis, with lower implant survival and success rates. [ABSTRACT FROM AUTHOR]

This study assessed the effect of curcumin as a photosensitizer in antimicrobial photodynamic therapy (aPDT) for the treatment of induced periodontitis in rats. Periodontitis was induced via a ligature around the mandibular first molar on the left side of 96 rats. The ligature was removed 7 days later, and the animals were randomized into four groups: NT, no local treatment; CUR, irrigation with curcumin solution (40 μM); LED, irradiation with a light-emitting diode (LED, InGaN, 465-485 nm, 200 mW/cm2, 60 s); and aPDT, irrigation with curcumin solution (40 μM) followed by irradiation with LED. Eight animals from each group were euthanized at 7, 15, and 30 days post-treatment. Treatments were assessed using alveolar bone loss (ABL) in the furcation region using histological, histometric, and immunohistochemical analyses. Rats treated with aPDT exhibited less ABL at 7 days compared to the NT group, moderate pattern immunolabeling for osteoprotegerin at 30 days, and a pattern of immunolabeling for RANKL from moderate to low. Treatments resulted in smaller numbers of TRAP-positive cells compared to the NT group. aPDT as monotherapy using curcumin as a photosensitizer and LED as the light source was effective in the treatment of induced periodontitis in rats. [ABSTRACT FROM AUTHOR]

This paper discusses regression analysis of clustered failure time data, which occur when the failure times of interest are collected from clusters. In particular, we consider the situation where the correlated failure times of interest may be related to cluster sizes. For inference, we present two estimation procedures, the weighted estimating equation-based method and the within-cluster resampling-based method, when the correlated failure times of interest arise from a class of additive transformation models. The former makes use of the inverse of cluster sizes as weights in the estimating equations, while the latter can be easily implemented by using the existing software packages for right-censored failure time data. An extensive simulation study is conducted and indicates that the proposed approaches work well in both the situations with and without informative cluster size. They are applied to a dental study that motivated this study. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (MetS) is a common chronic condition that increases the cardiovascular disease risk and is also linked to periodontitis. The study aim was to determine if a relationship exists between MetS and chronic periodontitis in adult Colombians. Methods: Participants were 220 healthy-gingivitis subjects and 431 periodontitis patients coming from the three largest Colombian cities. Periodontal status and MetS were determined in subjects. Univariate analysis and odds ratio were calculated within the 95 % confidence intervals and chi test compared the groups. Variables were compared among the clinical periodontal groups and MetS by Wilcoxon and multivariate analysis, and logistic regression was performed for MetS and periodontitis. Results: MetS had higher prevalence in periodontitis group (6.3 %) versus controls (3.2 %). In multivariate analysis, periodontitis was associated with MetS (adjusted OR = 2.72, 95 % CI 1.09-6.79), glucose intolerance with another component of MetS (adjusted OR = 1.78, 1.16 to 2.72), glucose resistance (adjusted OR = 11.46, 95 % CI 1.41-92.88), smoking (OR = 1.72, 95 % CI 1.09-2.71), and city of origin (2.69, 95 % CI 1.79-4.04). Conclusion: The study confirmed the positive association between MetS and periodontitis, being glucose sensitivity the strongly associated component. Clinical relevance: MetS must be taken into account by the dentist when evaluating risk factors for periodontitis, being useful for dentists to evaluate glycemia, lipidic profile, central obesity, and high blood pressure in patients. Interdisciplinary treatment must be recommended when a patient with MetS and periodontitis is being treated. [ABSTRACT FROM AUTHOR]

Objectives: Bacterial infection of the root canal system causes apical periodontitis. Less is known about the role of fungi in these infections. This study aimed to assess the fungal prevalence, abundance, and diversity of root canal infections, as well as the relation between fungi and bacteria present in different parts of the root canal. Materials and methods: Twenty-six teeth with primary apical periodontitis were extracted, split in apical and coronal root segments, and cryo-pulverized. Bacteriome profiles of 23 teeth were analyzed based on the V3-V4 hypervariable region of the 16S ribosomal RNA gene. Mycobiome profiles of six teeth were analyzed based on the internal transcribed spacer (ITS) 1 or ITS2 region. Samples were sequenced on the Illumina MiSeq platform. Results: A total of 338 bacterial operational taxonomic units (OTUs), 28 ITS1 OTUs, and 24 ITS2 OTUs were identified. Candida and Malassezia were the most frequently identified fungi. No differences could be found between the bacteriome and mycobiome profiles of the apical and coronal root segments. The bacteriome of fungi-positive root segments contained more Actinomyces, Bifidobacterium, four different Lactobacillus OTUs, Propionibacterium, and Streptococcus. A Spearman correlation matrix between bacteriomes and mycobiomes identified no correlations, but separate clusters could be observed. Conclusions: A considerable proportion of the root canal infections contain fungi, although fungal diversity is limited. However, when fungi are present, the composition of the bacteriome is clearly different. Clinical relevance: Interaction between bacteria and fungi in root canal infections may complicate the infection and require alternative treatment strategies. [ABSTRACT FROM AUTHOR]

Four aqueous extracts of different plant organs are the following: Artemisia herba-alba, Opuntia ficus-indica, Camellia sinensis and Phlomis crinita were evaluated against two bacterial strains: Porphyromonas gingivalis and Prevotella intermedia, which are implicated in periodontal diseases . By using a disc method, these plant extracts demonstrated powerful bacterial activity against these Gram-negative strains. The minimum inhibitory concentration values of the four plant extracts varied between 0.03 and 590.82 mg/ml for the microbes. Another assay using commercial antibiotics and antibacterials as positive controls was also conducted. Values obtained after statistical analysis of inhibition diameters of all plant extracts demonstrated that for P. gingivalis, the aqueous extracts of A. herba-alba and O. ficus-indica were most effective, followed by those of C. sinensis and P. crinita. For P. intermedia, aqueous extracts of O. ficus-indica and C. sinensis appeared to be more efficient with significantly different ( P > 0.05) inhibition diameters, followed by those of O. ficus-indica and P. crinita. In summary, the statistical results reveal that these plant extracts exert stronger antibacterial activity on P. intermedia germ as compared to P. gingivalis. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate impact of periodontal surgery on periodontal health and on glycaemia control of type 1 and type 2 (T1DM; T2DM) diabetics with severe periodontitis, during 12 months follow-up, in comparison with non-diabetic controls. Materials and methods: A total of 23 T1DM and 10 T2DM patients with respective number of matched non-diabetics were examined prior to, and 3, 6 and 12 months after periodontal surgery. Glycosylated haemoglobin (HbA1c) reflected control of DM. Periodontal parameters were oral debris (DI-S), probing pocket depth (PPD), clinical attachment loss (CAL) and bleeding on probing (BOP). Results: Periodontal status in all diabetics improved after 3 months and remained so during follow-up: mean (SD) DI-S > 1 (T1DM 1.1(0.5)/0.9(0.7); T2DM 1.2(0.4)/0.8(0.4)), PPD >5 mm (T1DM 35.1(32.2)/5.1(7.8); T2DM 46.3(24.2)/13.0(10.9)), CAL ≥6 mm (T1DM 44.4(37.0)/24.52(27.2)); mean % BOP >50 % (T1DM 57.1(25.1)/22.8(20.8)), T2DM 59.4(20.8)/18.9(15.7)), p < 0.05. Mean HbA1c values decreased in T2DM patients after 3 months and remained stable during follow-up. No improvement of glycaemia control was observed in T1DM patients. Positive correlation between mean HbA1c and CAL changes was observed ( r = 0.842, p < 0.05). Mean changes of periodontal parameters did not differ between diabetics and controls. Conclusion: Periodontal surgery improved significantly periodontal status of all patients and metabolic control of T2DM patients. Clinical relevance: Research findings concerning long-term effect of periodontal surgery among patients with diabetes mellitus are scarce. We found that surgical periodontal treatment positively affects periodontal health of all diabetics and improves metabolic control of type 2 DM. There is a positive correlation between clinical attachment loss and glycosylated haemoglobin levels. [ABSTRACT FROM AUTHOR]

Objective: To investigate the outcomes of implant therapy in partially dentate patients treated for aggressive periodontitis (GAgP) in comparison to periodontally healthy (HP) and patients treated for chronic periodontitis (CP) utilizing radiographic and clinical parameters. Material and methods: An electronic search of databases, supplemented by hand searching, was conducted to identify relevant clinical studies. Sequential screenings at the title, abstract and full-text levels were performed independently and in duplicate. A random effects meta-analysis was conducted and bias corrected bootstrap 95 % confidence intervals were estimated for group comparisons. Results: The search strategy revealed a total of 899 results. After title screening, abstract scanning, and full-text reading, seven articles fulfilled the inclusion criteria. The 3-year survival rate for CP and HP patients was 100 % while in GAgP subjects, the respective value was 97.98 %; this difference being statistically significant. The 3-year mean marginal bone loss (MBL) was 1.07 mm for the GAgP group, 0.47 mm for the CP group, and 0.69 mm for the HP group. A significant difference between the GAgP and CP groups was identified ( p < 0.05). The weighted mean differences of MBL concerning the above groups were also calculated and examined for statistical significance in both 1 and 3 years. Conclusions: The 3-year survival rate and peri-implant marginal bone loss was found statistically significantly lower in GAgP subjects (SR 97.98 % vs 100 %) in comparison to HP and CP individuals. Clinical relevance: The outcome of implant therapy in terms of survival rate and marginal bone loss is considered very important for the clinician in decision making when placing implants in patients with a history of aggressive periodontitis. [ABSTRACT FROM AUTHOR]

Eudragit RS (ERS), a quaternary polyacrylate positively charged polymer, exhibits a very low permeability and swells in aqueous media independently of pH without dissolving. Owing to its high solubility in N-methyl pyrrolidone (NMP), it was interesting to apply as polymer matrix for solvent-exchanged in situ forming gel. The aim of this research was to prepare in situ forming gels from ERS to deliver the antimicrobial agents (doxycycline hyclate, metronidazole, and benzoyl peroxide) for periodontitis treatment. They were evaluated for viscosity and rheology, gel formation, syringeability, drug release, and antimicrobial activities. The solvent exchange between NMP and an external aqueous simulated gingival crevicular fluid stimulated the dissolved ERS transforming into the opaque rigid gel. Antimicrobial agent loaded ERS systems exhibited Newtonian flow with acceptable syringeability. The higher-loaded ERS promoted the more prolongation of drug release because of the retardation of water diffusion into the precipitated matrix. Antimicrobial activities against Staphylococcus aureus, Escherichia coli, Candida albicans, Streptococcus mutans, and Porphyromonas gingivalis depended on type of drugs and test microorganisms. Doxycycline hyclate loaded ERS systems showed these activities greater than the others; however, all of them could inhibit all test microorganisms. Thus, the solvent exchange-induced in situ forming gels comprising ERS-antimicrobial drugs exhibited potential use as localized delivery systems for periodontitis treatment. [ABSTRACT FROM AUTHOR]

An in situ forming gel is a dosage form which is promised for site-specific therapy such as periodontal pocket of periodontitis treatment. Ethylcellulose, bleached shellac, and Eudragit RS were applied in this study as a polymeric matrix for in situ forming gel employing N-methyl pyrrolidone (NMP) as solvent. Solutions comprising ethylcellulose, bleached shellac, and Eudragit RS in NMP were evaluated for viscosity, rheology, and rate of water penetration. Ease of administration by injection was determined as the force required to expel polymeric solutions through a needle using texture analyzer. In vitro gel formation and in vitro gel degradation were conducted after injection into phosphate buffer solution pH 6.8. Ethylcellulose, bleached shellac, and Eudragit RS could form the in situ gel, in vitro. Gel viscosity and pH value depended on percentage amount of the polymer, whereas the water diffusion at early period likely relied on types of polymer. Furthermore, the solutions containing higher polymer concentration exhibited the lower degree of degradation. All the preparations were acceptable as injectable dosage forms because the applied force was lower than 50 N. All of them inhibited Staphylococcus aureus, Escherichia coli, Candida albicans, Streptococcus mutans, and Porphyrommonas gingivalis growth owing to antimicrobial activity of NMP which exhibited a potential use for periodontitis treatment. Moreover, the developed systems presented as the solvent exchange induced in situ forming gel and showed capability to be incorporated with the suitable antimicrobial active compounds for periodontitis treatment which should be further studied. [ABSTRACT FROM AUTHOR]

Antimicrobial photodynamic therapy (aPDT) was introduced as a promising adjuvant therapy on the periodontal treatment. The aim of this study was to evaluate the effect of aPDT on inflammatory mediator levels in residual periodontal pockets of patients with severe chronic periodontitis under periodontal maintenance, during 12 months follow-up. A randomized controlled trial study was conducted in 28 patients with severe chronic periodontitis. After non-surgical periodontal treatment, patients with at least four teeth with residual pocket probing depth (PPD) ≥4 mm were randomly assigned to either aPDT or control group. The aPDT (low power laser: 660 nm, 40 mW, 90 J/cm2, methylene blue 0.01 %) was performed at baseline and 3, 6, and 9 months. Clinical parameters were collected before and 3 and 12 months after the intervention, and gingival crevicular fluid was collected in the same times, including 1 week after the intervention. Immunological evaluation was carried out using the Luminex assay which quantified the expression of ten cytokines: interleukin (IL)-1α, IL-1β, IL-8, IL-1ra, fibroblast growth factor (FGF), vascular endothelial growth factor (VEGF), interferon (IFN)-γ, tumor necrosis factor (TNF)-α, IL-4, and IL-10. All clinical variables showed significant improvement for both groups, but there was no statistical difference between groups with no clinical benefits. IL-1α, IL-1β, IL-8, and VEGF showed significant differences (p < 0.05) between groups, whereas IL-1ra mediators, IFN-γ, and IL-10 demonstrated a statistical difference (p < 0.01) over time in the same group. At any time, FGF, IL-4, and TNF-α showed no statistical difference between groups (p > 0.05). aPDT therapy can improve the benefits on inflammation control during the periodontal maintenance. [ABSTRACT FROM AUTHOR]

The purpose of this split-mouth, single-blind, controlled clinical study was to evaluate the impact of low-level laser therapy (LLLT) as an adjunct to non-surgical treatment of chronic periodontitis. Twenty-five systemically healthy and non-smoking adults with chronic periodontitis who had at least two bilateral premolar teeth with probing pocket depth (PPD) of 7 ≥ x ≥ 5 mm were included in the study. In the periodontal examination of these patients, PPD, gingival index (GI), plaque index (PI), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded at the baseline, first, third, and sixth months after treatment. Gingival crevicular fluid (GCF) samples were taken at the baseline, first week, and first month after treatment. The collected GCF samples were analyzed using the MAGPIX™ system with a Bio-Plex Pro™ Human Cytokine 27-plex kit. After non-surgical periodontal treatment, LLLT with an energy density of 7.64 J/cm2 was performed four times: immediately after scaling and root planning (SRP) and on the first, third, and seventh day after treatment. In the first month, PPD levels were significantly (p < 0.05) lower in the SRP + LLLT group than in the SRP group. At the third and sixth months, CAL, PPD, and GI were significantly (p < 0.05) lower in the SRP + LLLT group than in the SRP group. Differences in GCF cytokines levels among the group were not statistically significant. Within the limitations of this study, it is indicated that LLLT as an adjunct to non-surgical periodontal treatment has a positive impact on clinical parameters. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to investigate the effect of alendronate (ALN) on the inhibition of alveolar bone loss in experimental periodontitis in Wistar rats. Materials and methods: Periodontitis was induced by oral inoculation of Porphyromonas gingivalis with Fusobacterium nucleatum. The rats ( n = 80) were randomized as follows: negative control ( n = 10); positive control ( n = 10); ALN groups: test 8 ( n = 10), test 12 ( n = 10), and test 16 ( n = 10); and placebo groups: control 8 ( n = 10), control 12 ( n = 10), and control 16 ( n = 10). Two milligrams per kilogram of ALN or placebo was administered twice weekly for 8, 12, and 16 weeks. Bone loss was determined by morphological and histological analyses. One independent, blinded examiner (ICC, 0.91) performed the measurements. The distance from the cement enamel junction to the alveolar bone crest of the second lower molar was measured: distal-vestibular ( d), furca ( f), mesial-vestibular ( h), and area. Histometry was performed on the second contralateral molar. Sections (6 μm) were used to determine the furcation bone area (A-FB). The following statistical analyses were conducted: Mann-Whitney and Kruskal-Wallis. Results: PC group developed periodontitis ( p < 0.0001). Morphometric analysis determined that ALN was effective in T8 for linear measurements d, f, and h ( p < 0.05). No significant differences occurred at test 8, test 12, and test 16. Analysis of A-FB revealed no significant differences between the ALN and placebo groups at 8 and 16 weeks ( p > 0.05). ALN was effective against bone loss in relation to A-FB after 12 weeks ( p < 0.0001). Conclusions: According to the methodology used, the results suggest that oral administration of ALN could influence alveolar bone loss in rats submitted to experimental periodontitis. Clinical relevance: ALN could be a potential therapeutic approach when associated with periodontal treatment. [ABSTRACT FROM AUTHOR]

Diabetes has become a global epidemic. Its complications can have a significant impact on quality of life, longevity, and public health costs. The presence of diabetes might impair the prognosis of periodontal treatments due to its negative influence on wound healing. Antimicrobial photodynamic therapy (aPDT) is a local approach that can promote bacterial decontamination in periodontal pockets. The aim of this study was to investigate the local effect of adjunct aPDT to ultrasonic periodontal debridement (UPD) and compare it to UD only for the treatment of chronic periodontitis in type 2 diabetic patients. Twenty type 2 diabetic patients with moderate to severe generalized chronic periodontitis were selected. Two periodontal pockets with probing depth (PD) and clinical attachment level (CAL) ≥5 mm received UPD only (UPD group) or UPD plus adjunct aPDT (UPD + aPDT group). Periodontal clinical measures were collected and compared at baseline and 30, 90, and 180 days. After 180 days of follow-up, there were statistically significant reductions in PD from 5.75 ± 0.91 to 3.47 ± 0.97 mm in the UPD group and from 6.15 ± 1.27 to 3.71 ± 1.63 mm in the UPD + aPDT group. However, intergroup analysis did not reveal statistically significant differences in any of the evaluated clinical parameters (p > 0.05). The adjunct application of aPDT to UPD did not present additional benefits for the treatment of chronic periodontitis in type 2 diabetic patients. The ClinicalTrials.gov identifier of the present study is NCT02627534. [ABSTRACT FROM AUTHOR]

Porphyromonas gingivalis ( P. gingivalis) lipopolysaccharide (LPS) can induce the host immune response in periodontitis patients. Human gingival fibroblasts (GFs) play an important role in regulating the host immune response in periodontitis. However, whether GFs isolated from healthy subjects (HGFs) and inflamed ones (IGFs) can modulate different inflammatory response remains problematic. The aim of this study was to investigate the expression of different inflammatory cytokines between HGFs and IGFs after P. gingivalis LPS stimulation. In this study, hematoxylin and eosin (H&E) staining was used to assess the inflammation status of gingiva. HGFs and IGFs were stimulated with 1, 5, and 10 μg/ml P. gingivalis LPS for 6, 12, and 24 h. The amount of inflammatory cytokines, interleukin (IL)-1β, IL-6, IL-8 and tumor necrosis factor (TNF)-α, was determined by enzyme-linked immunosorbent assay (ELISA) and quantitative real-time polymerase chain reaction (qRT-PCR). The results showed that gingiva from periodontitis patients presented epithelial hyperkeratosis and abundant inflamed cells in the connective tissue. HGFs participated in the overproduction of IL-8 and IL-1β in a dose- and time-dependent manner; however, IL-6 and TNF-α just showed a dose-response change when stimulated with LPS after 24 h. In IGFs, IL-6, IL-8, IL-1β, and TNF-α could be induced by lower LPS with shorter time stimulation and the dose-response phenomenon was observed in mRNA levels. In conclusion, the resident IGFs do not exhibit LPS tolerance and play an important role in modulating host immune response, which are critical in the immunopathogenesis of periodontal disease. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate whether apical periodontitis (AP) could cause systemic cytokine elevation and pathological changes in remote organs in an experimental animal model. Materials and methods: AP was induced in 36 Sprague Dawley (SD) rats. Serum levels of C-reactive protein (CRP), interleukin 2 (IL-2), and interleukin 6 (IL-6) were measured by enzyme-linked immunosorbent assays at different time intervals (0, 6, 12, 24, 48, and 96 h and 1, 2, 3, 4, 5, and 6 weeks) after pulp exposure. Multiple organs (the aortic arch, myocardium, liver, and spleen) were collected for histological observation. The results were analyzed by one-way analysis of variance (ANOVA). Results: Serum levels of CRP, IL-2, and IL-6 were significantly elevated at all time points assessed after 6, 24, and 96 h, respectively. The peak values of serum cytokines (CRP 6.363 ± 0.05 ng/ml, IL-2 21.997 ± 0.15 ng/L, and IL-6 2.406 ± 0.02 ng/L) were reached at 1, 4, and 2 weeks, respectively, followed by a decline. Time-dependent reversible histopathological changes were detected in the aortic arch, myocardium, and spleen, whereas irreversible changes were found in the liver. Conclusions: AP elevated the levels of CRP, IL-2, and IL-6 in rat blood serum, causing reversible changes in the aortic arch, myocardium, and spleen as well as irreversible changes in the liver. Clinical relevance: AP may trigger a systemic immune response, impair remote organs, and affect the general health of patients. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to assess the microbiological effects and recolonization patterns after non-surgical periodontal treatment protocol based on the adjunctive use of erbium-doped yttrium aluminium garnet (Er:YAG) laser. Material and methods: Patients diagnosed with chronic periodontitis were randomly assigned to two different treatment protocols: test, full-mouth subgingival ultrasonic instrumentation followed by Er-YAG laser application 1 week later to sites with initial probing pocket depth ≥4.5 mm; and control, full-mouth ultrasonic subgingival instrumentation within 1 week. Clinical (at sampled sites) and microbiological (culture-based) parameters were recorded at baseline and 3 and 12 months. Microbiological variables included total counts, frequency of detection, proportions and counts of target species. Results: Results from 19 test and 21 control patients were compared. Minor changes were observed for total colony-forming units, with no differences between groups. For the frequency of detection, a limited and similar impact in both groups was observed for the most prevalent (over 80 %) periodontal pathogens ( Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum). For proportions, reductions in P. gingivalis occurred at 3 months, both in the test and control groups (from 16.3 to 10 % and 16 to 14.8 %, respectively), although these differences were not statistically significant. At 12 months, the test group showed a statistically significant greater reduction in probing depth for the sampled sites. Conclusions: The adjunctive use of Er:YAG laser when compared with conventional ultrasonic debridement did not provide a microbiological added benefit. Clinical relevance: Even though some clinical benefits with the adjunctive laser application were identified when comparing both treatment protocols, there were no differences in microbiological outcomes or in the bacterial recolonization patterns. [ABSTRACT FROM AUTHOR]

Objective: There is a controversy over the influence of obesity on the periodontal treatment outcome in patients with chronic periodontitis (CP). The aim of the present systematic review was to evaluate the efficacy of non-surgical periodontal therapy (NSPT) in the management of CP among obese and non-obese patients. Materials and methods: The addressed focused question was 'What is the efficacy, of NSPT with respect to clinical, radiographic, biochemical, microbiological, and patient-centered outcomes in obese as compared to non-obese chronic periodontitis patients?' Databases were searched from 1977 up to and including December 2014 using relevant key indexing terms. Unpublished data, experimental studies, letters to the editor, review articles, case reports, and commentaries were excluded. Meta-analysis of three studies was performed. Results: Five clinical studies were included. The total number of patients ranged between 30 and 260 individuals. The mean age of patients was between 42.5 and 48.8 years. In three studies, the clinical periodontal parameters (plaque index (PI), gingival bleeding index (GBI), periodontal pocket depth (PPD), and clinical attachment loss (CAL)) in obese and non-obese patients following NSPT was comparable. Meta-analysis of PPD and CAL among obese and non-obese subjects showed comparable outcomes (PPD P = 0.91, I 67.36 %; CAL P = 0.87, I 77.16 %). However, in three studies, NSPT resulted in a significantly better clinical periodontal outcome among non-obese subjects than obese subjects. The difference in the levels of serum pro-inflammatory cytokine levels (IL-1β, IL-6, TNF-α, IFN-γ, leptin, adiponectin, and CRP) among obese and non-obese patients following treatment for CP was inconsistent. Conclusion: It remains unclear whether NSPT has a significantly higher impact on the clinical periodontal outcomes in obese patients than in non-obese patients with chronic periodontitis, given that the number of selected studies was relatively low and the reported findings were inconsistent. Clinical relevance: Although the effect of obesity on the outcome of NSPT still remains unclear, nevertheless clinicians are prompted to manage obesity prior to and during periodontal treatment [ABSTRACT FROM AUTHOR]

Objectives: The aim of this article is to present an overview of omega-3 fatty acids, their anti-inflammatory properties and potential use as an adjunct for periodontal therapy. Materials and methods: A general literature search was conducted to provide an overview of omega-3 fatty acids, their metabolism and anti-inflammatory properties. A more specific literature search of PubMed and EMBASE was conducted to identify articles dealing studies investigating the effects of omega-3 fatty acids in the treatment of periodontitis in animals and humans and included cross-sectional, longitudinal and intervention designs. Results: To date, there is good emerging evidence that dietary supplementation with fish oil may be of some benefit and this is enhanced if combined with aspirin. All clinical intervention studies to date have been on small sample sizes, and this indicates there is need for larger and more robust clinical trials to verify these initial findings. Conclusions: Dietary supplementation with fish oil could be a cost-effective adjunctive therapy to the management of periodontal disease. Clinical relevance: The host modulatory properties of omega-3 fatty acids warrant further assessment of their use as an adjunct in the management of periodontitis. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to compare the clinical outcomes of a combination of enamel matrix derivatives (EMD) and a synthetic bone graft (biphasic calcium phosphate) with EMD alone in wide and deep one- and two-wall intrabony defects 36 months after treatment. Material and methods: Thirty patients with chronic periodontitis and one wide (≥ 2 mm) and deep (≥ 4 mm) intrabony defect had been recruited in three centres in Germany. During surgery, defects were randomly assigned to EMD/synthetic bone graft (SBG) (test) or EMD (control). Assessments at baseline, after 6, 12 and 36 months, included bone sounding, relative clinical attachment levels, probing pocket depths and recessions. Results: After 36 months, defects in both groups were significantly improved ( p < 0.001) with regard to defect fill, attachment gain and probing pocket reduction. In the EMD/SBG group, a mean defect fill of 2.6 mm (±1.7) was measured, and in the EMD group, the defect fill was 2.3 mm (±1.5). A mean gain in clinical attachment of 4.1 mm (±3.6) and 3.8 mm (±2.2) was observed in the test and in the control group, respectively. There were no statistically significant differences in any of the investigated parameters between the two treatment modalities. Conclusions: The clinical improvements of advanced intrabony defects obtained with both regenerative modalities could be maintained over a period of 3 years. The combination of EMD with SBG did not show any advantage compared to the use of EMD alone. [ABSTRACT FROM AUTHOR]

In order to evaluate whether nonsurgical periodontal treatment with/without diode laser (DL) decontamination improves clinical parameters, the levels of IL-1β, IL-6, IL-8, intercellular adhesion molecule (ICAM), and vascular cell adhesion molecule (VCAM) in gingival crevicular fluid and metabolic control (HbA1c) in chronic periodontitis (CP) patients with diabetes mellitus type 2 (DM2). Sixty patients with DM2 and CP were randomly assigned into two groups to receive scaling and root planing (SRP, n = 30) or SRP followed by diode laser application (SRP + DL, n = 30). Clinical periodontal and gingival crevicular fluid (GCF) parameters were assessed at baseline, 1, and 3 months after periodontal treatment. HbA1c levels were evaluated at baseline and 3 months post-therapy. Total amounts of cytokines and molecules were analyzed by ELISA. Nonsurgical periodontal treatment with/without DL appeared to improve clinical, biochemical parameters, and glycemic control in DM2 patients (BMI < 25 kg/m(2)) with CP. The SRP + DL group provided better reductions in probing depth (PD) and clinical attachment level (CAL) parameters compared to the SRP group (P < 0.05). Significant reductions were found in the total amounts of GCF levels of IL-1, IL-6, IL-8, ICAM, and VCAM after treatment (P < 0.05). HbA1c levels decreased significantly at 3 months after treatment (P < 0.05). SRP + DL reduced HbA1c levels more significantly compared to SRP alone (0.41 vs. 0.22 %, P < 0.05). SRP, especially in combination with DL, shows improvement of glycemic control for DM2 patients with CP. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the use of antimicrobial photodynamic therapy (aPDT) as an adjunct to scaling and root planing (SRP) in the treatment of experimentally induced periodontitis in female rats that were systemically treated with or without nicotine. Female rats (n = 180) were divided into two groups: vehicle administration (Veh) and nicotine administration (Nic). Mini-pumps containing either vehicle or nicotine were implanted in the rats 30 days before the induction of experimental periodontitis (EP). EP was induced by placing a cotton ligature around the left mandibular first molar. After 7 days, the ligature was removed, and the rats were randomly divided into three treatment subgroups: SRP (only SRP), DL (SRP plus diode laser), and aPDT (SRP plus aPDT). The aPDT consisted of phenothiazine photosensitizer deposition followed by diode laser irradiation. Ten rats from each subgroup were euthanized at 7, 15, and 30 days after treatment. Alveolar bone loss (ABL) in the furcation region was evaluated using histological, histometric, and immunohistochemical analyses. The rats that were treated with nicotine showed more ABL compared to those treated with vehicle. In both the Veh and Nic groups, SRP plus aPDT treatment resulted in reduced ABL, smaller numbers of both TRAP- and RANKL-positive cells, and higher numbers of PCNA-positive cells compared to SRP treatment alone. aPDT was an effective adjunctive therapy for the treatment of periodontitis in female rats regardless of whether they received nicotine. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy of the adjunctive laser therapy in conventional non-surgical treatment of chronic periodontitis, an electronic search was performed through the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, MEDLINE, EMBASE, Scopus, Web of Science, China National Knowledge Infrastructure (CNKI), and China Biology Medicine (CBM) Disc, for relevant randomized controlled trials (RCTs) or quasi-RCTs. All the 12 included studies (11 RCTs and 1 quasi-RCT) were qualified for descriptive and quantitative analysis. Outcomes were divided into two groups according to the length of follow-ups (long term and short term). Subgroup analyses were performed based on the mode of laser (inside and outside mode). Among all included researches, reduction in probing depth (PD) and gain in clinical attachment level (CAL) were presented with the mean value and 95 % confidence interval, while bleeding on probing (BOP) was assessed descriptively. Meta-analysis suggested that adjunctive laser therapy reduced PD at 3 months [mean difference (MD) = -0.26, 95 % confidence interval (CI) range = -0.43 to -0.09, p = 0.003] but did not demonstrate significant effect on the CAL at either 3 months (MD = -0.03, 95 % CI range = -0.25 to 0.19, p = 0.79) or 6 months (MD = -0.11, 95 % CI range = -0.38 to 0.16, p = 0.43). Subgroup analyses indicated that laser therapy would be more effective when the probes were set up outside the periodontal pockets. [ABSTRACT FROM AUTHOR]

Peri-implant diseases present in two forms: peri-implant mucositis and peri-implantitis. The prevalence of peri-implant complications is significantly rising. The aim of this study was to compare conventional treatment of inflamed peri-implant tissues with conventional treatment together with diode laser application. Twenty-seven patients (age 36 to 67, 15 women and 12 men, 12 smokers and 15 non-smokers) requiring treatment for mucositis or peri-implantitis were taken into account for this preliminary study. Plaque index (PI), pocket depth (PD), and bleeding on probing (BoP) were recorded at baseline evaluation. Patients in control group (CG) received conventional non-surgical periodontal treatment. Patients in test group received conventional non-surgical periodontal treatment together with diode laser application (810 nm, 30 s, 1 W, 50 Hz, t on = 100 ms, t off = 100 ms, energy density = 24.87 J/cm(2)). Paired t test was used to evaluate the difference in repeated measurements of considered indexes at T 0 and T 1 (1 year) in both groups. A total of 606 sites were taken into account in the test group (TG) and 144 in the CG. PD mean variation in the TG was 2.66 mm ± 1.07, while mean PD variation in the CG was 0.94 ± 1.13 mm. Paired t testing of the variation in PD in CG and TG revealed a statistically significant difference between the two groups (p < 0.0001). A reduction of pathological sites from 89 % (T 0) to 14.35 % (T 1) was achieved in the TG, while reduction obtained in the CG was from 75.69 % (T 0) to 50 % (T 1); BoP scores at time T 1 had fallen below 5 % in the TG and decreased to 59.7 %, in the CG. Within the limitations of this study, diode laser seems to be an additional valuable tool for peri-implant disease treatment. [ABSTRACT FROM AUTHOR]

Background: Azithromycin may be an alternative adjunctive systemic antibiotic in non-surgical periodontal therapy. Objective: This study aims to identify randomized controlled trials evaluating non-surgical periodontal treatment of chronic and/or aggressive periodontitis supplemented with systemically administered azithromycin. Materials and methods: A systematic literature search was performed for publications published by 31 March 2014 using electronic databases and hand search. Randomized controlled trials published in English or German language, with a follow-up ≥6 months were included. From 231 titles identified, nine publications were eligible for inclusion. Results: Among the studies included, showing some risk of bias, seven reported on patients with chronic periodontitis and two with aggressive periodontitis. Minor adverse events were described in five studies. A synthesis of results using a vote counting method was applied. Significant ( p < 0.05) beneficial effects of azithromycin were shown in six studies for probing depth changes and in five studies for clinical attachment level changes. Conclusion: In contrast to aggressive periodontitis patients, data from this analysis indicate a potential benefit of systemic azithromycin as adjunctive to non-surgical periodontal therapy in chronic periodontitis patients. Clinical relevance: When contraindications for the standard antibiotics are present, azithromycin (AZM) may be considered as alternative systemically administered antibiotic drug in selected cases of chronic periodontitis. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this systematic review was to assess the study design and reporting of studies on periodontal regeneration, with respect to the effect of the provision of non-surgical periodontal therapy (NSPT) before surgery. Materials and Methods: A systematic search of the literature was conducted for studies on periodontal regeneration on Medline and EMBASE, complemented by a manual search. Initially, 3310 potentially eligible articles were identified. Results: A total of 293 studies were included in the review. Nearly 10 % of studies did not include NSPT in the study protocol before regenerative surgery, while 14 % of papers did not report this aspect. Seventy-six percent of studies reported that non-surgical subgingival debridement was performed before periodontal surgery (2 weeks to 6 months before surgery according to the different studies). However, no papers reported clinical and radiographic data before and after NSPT prior to periodontal surgery. Only 45 % of papers reported timing of reassessment following NSPT, prior to proceeding with regenerative surgery. Conclusions: This review highlights the lack of reporting information on non-surgical periodontal therapy prior to periodontal regenerative surgery, calling for a revision of the current clinical protocols and of the study designs of periodontal regenerative surgery studies. Clinical relevance: Periodontal regenerative surgery protocols should take into account the possible effects of non-surgical periodontal therapy in the clinical and radiographic healing of intrabony defects. [ABSTRACT FROM AUTHOR]

A controlled-release device (CRD) containing chlorhexidine gluconate, such as PerioCol™CG (Eucare Pharmaceuticals Pvt. Ltd,, Chennai, India), for subgingival application has little reported data with clinical as well as antimicrobial efficacy. This study evaluated clinical and subgingival microbial changes on using indigenously developed PerioCol™CG as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. Forty posterior first molar sites having probing pocket depth ≥5 mm were selected and divided into two groups, with 20 sites in each group, in a split-mouth design. Group A (test site) was treated with SRP and PerioCol™CG, while group B (control site) was treated with SRP alone. Subgingival microbial samples were collected at baseline and 1 month after the initial SRP, while probing depth (PD), clinical attachment level (CAL) and gingival index (GI) were recorded at baseline, after 1 month and after 3 months. Microbial detection of Porphyromonas gingivalis ( P. gingivalis) and Tannerella forsythia ( T. forsythia) was done by means of polymerase chain reaction (PCR). A significant improvement was observed in all clinical measures in sites treated with PerioCol™CG as compared to the control sites during the study period. Also, there was a statistically significant reduction in the proportion of occurrence of P. gingivalis and T. forsythia after intervention in test sites as compared to control sites. Our data suggest that SRP combined with subgingival administration of PerioCol™CG has a significantly better and prolonged effect compared to SRP alone on the PD, clinical attachment loss and elimination of periodontopathogens. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the effect of subgingival ultrasonic scaling followed by repeated (three times) antimicrobial photodynamic therapy (PDT), ultrasonic scaling alone (US), and scaling and root planing with hand instruments (SRP) for initial periodontal treatment. Twenty-seven non-smoking systemically healthy chronic periodontitis patients were included. Residual pockets ≥4 mm deep and bleeding on probing were debrided either with SRP, US alone, or US followed by a single episode of PDT during supportive periodontal treatment. Probing pocket depth (PPD), bleeding on probing (BOP), and clinical attachment level (CAL) were monitored over 12 months. The presence of five periodontal pathogens in the pockets was determined by a commercially available micro-IDent test. Intergroup and intragroup statistical analysis was performed. All three treatments resulted in a significant clinical improvement. Additional application of PDT to US failed to result in further improvement in terms of PPD reduction and CAL gain. However, it resulted in a higher reduction of BOP at 3 and 12 months comparing to US alone or SRP (PDT from 25 to 13 and to 9 %, US from 23 to 16 and to 12 %, and SRP from 17 to 10 and to 9 %, respectively). PDT reduced the proportion of positive sites after 6 months for Treponema denticola (TD) significantly more effectively than US or SRP ( p < 0.0001). Additionally, PDT resulted in a greater reduction of Aggregatibacter actinomycetemcomitans (AA), Tannerella forsythia (TF), and TD in medium pockets (4-6 mm) ( p < 0.02) and of TD in deep pockets (>6 mm) compared to mechanical debridement alone ( p < 0.05). [ABSTRACT FROM AUTHOR]