Description

The Journal of Periodontology publishes articles relevant to the science and practice of periodontics and related areas. Manuscripts are accepted for consideration with the understanding that text, figures, photographs, and tables have not appeared in any other publication, except as an abstract prepared and published in conjunction with a presentation by the author(s) at a scientific meeting, and that material has been submitted only to this journal.

Publications in this journal

• A Novel Approach for Enhanced Nano Particle Sized Bone Substitute Adhesion to Chemically Treated Peri-implantitis Affected Implant Surfaces (An In-vitro Proof of Principle Study).

  Authors: Ahmed Y Gamal, Khaled A Abdel-Ghaffar, Vincent J Iacono

  Journal of periodontology.

  Background: The objective of this study was to evaluate micro and nano hydroxyapatite blended clot adhesion to citric acid conditioned peri-implantitis affected surfaces. Methods: Forty hopelessBackground: The objective of this study was to evaluate micro and nano hydroxyapatite blended clot adhesion to citric acid conditioned peri-implantitis affected surfaces. Methods: Forty hopeless implants designated for removal were included in this study. Implants were devided into eight groups (5 implants per group); (G1) test areas were coated with hydroxyapatite (HA) of a micro-particle size; (G2) test areas were coated with HA of a nano particle size; (G3) implants were coated with HA of a micro-particle size after surface conditioning using citric acid; (G4) samples were treated in the same manner as in G3 except for the use of HA of a nano particle size; G5 samples were coated without surface treatment with HA of micro-particle size that were mixed with human whole blood (HWB); (G6) implant samples were treated in the same manner as in (G5) except for the use of HA of a nano particle size; (G7) implant samples were treated by the same way as in G5 except for conditioning the implants for 5min. using citric acid before surface coating; (G8) samples were treated in the same manner as in G7 except for the use of HA of a nano particle size. Implants of all groups were agitated for three min. in PBS. All samples were prepared for scanning electron microscopy evaluation. Results: Group 1 and G2 non etched implants that were coated with HA of micro and nano particle sizes were found to be devoid of any bone particle adhesion to the peri-implantitis affected surfaces. Contrary to what was seen in G3, Group 4 acid treated and NHA coated samples revealed nearly complete coverage of the peri-implantitis affected parts by the graft material. G5 non etched clot blended micro-particle sized HA showed few areas of clot blended graft adhesion covering 6.7 % of the examined surfaces. G6 non etched clot blended nano sized HA showed NHA retention within the fibrin strands in areas where the implant surface pores were exposed (24.3 %) Group 7 acid treated and clot blended micro sized HA treated implant surfaces showed partial coverage of the implant surface with detached fibrin clot blended graft material(31.4 %). Group 8 acid treated and NHA clot blended graft coated implants showed complete coverage of the implant surface by the clot blended graft material (93.4 %). Conclusion: Peri-implantitis affected surface conditioning with citric acid improves NHA blended clot adhesion to titanium implant surfaces.

• 1% Alendronate Gel as Local Drug Delivery in the Treatment of Degree II Furcation Defects: A Randomized Controlled Clinical Trial.

  Authors: A R Pradeep, Minal Kumari, Nishanth S Rao, Savitha B Naik

  Journal of periodontology.

  Background: Alendronate (ALN), an aminobisphosphonate is known to stimulate the formation of osteoblast precursors to promote osteoblastogenesis. The present study aimed to explore the efficacy of 1%Background: Alendronate (ALN), an aminobisphosphonate is known to stimulate the formation of osteoblast precursors to promote osteoblastogenesis. The present study aimed to explore the efficacy of 1% ALN gel as local drug delivery system in adjunct to scaling and root planing (SRP) for the treatment of degree II furcation defects in comparison with placebo gel. Material and Methods: 60 mandibular degree II furcation defects were randomized and treated either with 1% ALN gel or placebo gel. Clinical parameters were recorded at baseline, 3 months 6 months and 12 months while radiographic parameters were recorded at baseline, 6 months and 12 months. Defect fill at baseline 6 months and 12 months was calculated on standardized radiographs by using the image analysis software. Results: Mean probing depth (PD) reduction, mean relative vertical clinical attachment level (RVCAL), mean relative horizontal clinical attachment (RHCAL) gain was found to be greater in ALN group than placebo group, both at 3 months ,6 months and 12 months. Furthermore, significantly greater mean percentage of bone fill was found in the ALN group (32.11 ± 6.18%, 32.66 + 5.86%) compared to placebo group (2.71 ± 0.61%, 1.83 + 1.51%) at 6 and 12 months respectively. Conclusions: The results of the present study showed local delivery of 1% ALN into degree II furcation defect stimulated a significant PD reduction, RVCAL, RHCAL gain, and improved bone fill as compared to placebo gel as an adjunct to SRP. ALN can provide a new direction in management of furcation defects.

• Progression of Periodontal Destruction and the Roles of Advanced Glycation End-Products in Experimental Diabetes.

  Authors: Po-Chun Chang, Li-Ying Chien, Jin Fei Yeo, Yi-Ping Wang, Min-Chun Chung, Li Yen Chong, Yen-Ping Kuo, Chun-Hao Chen, Huan-Ching Chiang, Benjamin N Ng, Qi Qi Lee, Yong Kang Phay, Jeffery R Ng, Kok Yong Erk

  Journal of periodontology.

  Aims: Progression of diabetes-associated periodontal destruction and the roles of advanced glycation end-products (AGEs) were investigated. Materials and methods: Diabetes was induced byAims: Progression of diabetes-associated periodontal destruction and the roles of advanced glycation end-products (AGEs) were investigated. Materials and methods: Diabetes was induced by streptozocotin injection, and periodontitis was induced via silk ligature placement with Porphyromonas gingivalis lipopolysaccharide injection in 64 Sprague-Dawley rats for 7-21 days. The quality of alveolar bone and attachment loss was measured by micro-computed tomography and histology. Destruction profiles were evaluated by histology, histochemistry, immunohistochemistry, and quantitative assessments of inflammatory cells, expression of receptors for AGEs (RAGE), tartrate-resistant acid phosphatase (TRAP), and proliferating cell nuclear antigen (PCNA). Results: Without periodontitis induction, there was no obvious morphological change in the periodontium, although slight elevations of AGEs and RAGE levels were noted in diabetic animals. In the experimental periodontitis group, significant periodontal bone loss was noted in both diabetic and non-diabetic animals from day 7, with more progressive bone loss in diabetic animals during days 14-21. Histologically, the disruption of attachment and inflammation were observed from day 7, but subsequently subsided in non-diabetic animals. A stronger and more prolonged response with significant attachment loss was observed in diabetic animals. Stronger inflammation, attenuated and persistent resorptive activity and weaker proliferating potential were demonstrated by diabetic animals. AGE deposition and RAGE expression were noted in non-diabetic periodontitis animals, although levels were considerably elevated in the later stages in diabetic animals. Conclusion: Diabetes augments periodontal destruction by reducing the proliferating capability and activating resorptive activities. Presence of the AGE-RAGE axis without diabetes implies that it is involved in the regulation of inflammation.

• Periodontal Disease, Hypertension and Blood Pressure Among Older Adults in Puerto Rico.

  Authors: Sona Rivas-Tumanyan, Maribel Campos, Juan C Zevallos, Kaumudi J Joshipura

  Journal of periodontology.

  Background: Current scientific evidence addressing the relation between periodontitis and hypertension is limited to a few studies producing inconsistent results. Methods: All participants of anBackground: Current scientific evidence addressing the relation between periodontitis and hypertension is limited to a few studies producing inconsistent results. Methods: All participants of an on-going representative cohort of Puerto Rican elderly who were 70 years and older and residing in San Juan metropolitan area were invited to this cross-sectional study. Periodontal probing depth (PD) and attachment loss (AL) were summarized using CDC-AAP definition for severe periodontitis (≥2 teeth with AL ≥6mm and ≥1 tooth with PD ≥5mm). We averaged three repeated blood pressure (BP) measurements taken using a standardized auscultatory method. Information on hypertension history, use of anti-hypertensive medications and potential confounders (age, gender, smoking, heavy and binge drinking, diabetes, utilization of preventive dental services, flossing, body mass index, fruit and vegetable, whole wheat bread and high-fiber cereal consumption) was collected during in-person interviews. High BP was defined as average systolic BP ≥140 mmHg or diastolic ≥90 mmHg. Multivariate logistic regression models were used to study the relation between severe periodontitis, hypertension history and high BP. Results: The study population comprised 182 adults. In multivariate analysis, there was no association between severe periodontitis and hypertension history (OR=0.99, 95% CI: 0.40-2.48). Severe periodontitis was associated with high BP, with OR of 2.93 (95% CI: 1.25-6.84), after adjusting for age, gender, smoking, and binge drinking. This association was stronger when restricted to those with hypertension or taking anti-hypertensive medications: OR=4.20 (95% CI: 1.28-13.80). Conclusion: Our results suggest that periodontitis may contribute to poor blood pressure control among older adults.

• Clinical Effects of KTP Laser and Photodynamic Therapy on Outcomes of Treatment of Chronic Periodontitis: A Randomized Controlled Clinical Trial.

  Authors: Alparslan Dilsiz, Varol Canakci, Tugba Aydin

  Journal of periodontology.

  Background/Aim: The main objective of periodontal treatment is to control infection and thereby curb disease progression. Recent studies have demonstrated that adjunctive treatment procedures such asBackground/Aim: The main objective of periodontal treatment is to control infection and thereby curb disease progression. Recent studies have demonstrated that adjunctive treatment procedures such as laser irradiation or photodynamic therapy (PDT) may provide some additional benefit in the treatment of chronic periodontitis. The aim of this randomized controlled trial was to clinically evaluate and compare the clinical effects of potassium-titanyl-phosphate (KTP) laser and PDT on outcomes of treatment of chronic periodontitis. Materials and Methods: Twenty-four patients with untreated chronic periodontitis were treated using a split-mouth study design in which the teeth in each quadrant were randomly treated by scaling and root planing (SRP) alone (Group-A), PDT followed by SRP (Group-B), and KTP laser followed by SRP (Group-C). The periodontal pockets were exposed to a KTP laser with the following parameters: output power 0.8W, time on 50ms, time off 50ms, 30s per irradiation, 532nm and fluence 11,7 J/cm(2) with a flexible fiberoptic tip with a diameter of 200μm. The selected pockets were probed with a pressure-controlled probe, guided by stents. Clinical periodontal parameters assessed included plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PD), and probing attachment level (CAL), which were recorded at baseline and at 6 months following therapy. Results: Statistical analysis demonstrated no differences between groups at baseline for all parameters (P>0.05). All treatments yielded significant improvements in terms of BOP and PD decrease and CAL gain compared to baseline values (p<0.05). The Group-C showed a greater reduction in PD compared to the other groups (p<0.05). In addition, the Group-C showed a greater probing attachment gain compared to the other groups (p<0.05). Conclusions: In patients with chronic periodontitis, clinical outcomes from conventional periodontal treatment of deeper pockets can be improved by using adjunctive KTP laser.

• Is Surgical Root Coverage Effective for the Treatment of Cervical Dentin Hypersensitivity? - A Systematic Review.

  Authors: Dhelfeson Willya Douglas de Oliveira, Fernanda Oliveira-Ferreira, Olga Dumont Flecha, Patricia Furtado Gonçalves

  Journal of periodontology.

  Background: Cervical dentin hypersensitivity is characterized by tooth pain arising from root exposure. Aim: The aim of the present systematic review was to survey the literature on the efficacy ofBackground: Cervical dentin hypersensitivity is characterized by tooth pain arising from root exposure. Aim: The aim of the present systematic review was to survey the literature on the efficacy of surgical root coverage techniques at reducing cervical dentin hypersensitivity in cases of gingival recession. Methods: An online electronic search was performed in the Pubmed, Web of Science and Cochrane Library databases. Randomized clinical trials dating from the inception of the respective databases through to November 2011 were selected. Studies addressing clinical parameters of periodontal plastic surgery outcomes and variables related to cervical dentin hypersensitivity in patients aged 18 years or older were included. The studies were evaluated by two independent reviewers. For each article, methodological quality, size effect, the periodontal parameters measured, study design, methods and results were analyzed. Results: Nine relevant articles were analyzed in the present review. A decrease in cervical dentin hypersensitivity was observed after periodontal surgery for root coverage. The risk of bias was considered low in two studies and the size effect was considered large in one study. Conclusion: There is not enough scientific evidence to conclude that surgical root coverage procedures predictably reduce cervical dentin hypersensitivity. Well-conducted clinical trials are needed to establish scientific evidence that allows periodontists to indicate root coverage as treatment for cervical dentin hypersensitivity.

• Severe Clinical Attachment Loss: an Independent Association With Low Hip Bone Mineral Density in Postmenopausal Women.

  Authors: Valéria Gondim, Juliana Aun, Cassia Tiemi Fukuda, Liliam Takayama, Maria do Rosário Latorre, Cláudio Mendes Pannuti, Rosa Maria Rodrigues Pereira, Giuseppe Alexandre Romito

  Journal of periodontology.

  Background: Bone loss is a feature of both periodontitis and osteoporosis, and several studies have analyzed whether the periodontal destruction could have been influenced by systemic bone loss. TheBackground: Bone loss is a feature of both periodontitis and osteoporosis, and several studies have analyzed whether the periodontal destruction could have been influenced by systemic bone loss. The aim of this study was to assess the association between clinical attachment loss and bone mineral density at the lumbar spine and hip, lifestyle, smoking, socio-demographic factors, and dental clinical variables in postmenopausal woman. Methods: One hundred and forty-eight individuals were interviewed using a structured written questionnaire and clinically examined. The periodontal examination, which was performed by calibrated investigators, included clinical attachment loss (CA loss); probing depth (PD); gingival recession (GR); bleeding on probing (BOP); visible plaque; supragingival calculus; and mean tooth loss. The sample was stratified in two groups as follow as: moderate and severe CA loss. The individuals in the moderate group had all sites with clinical attachment loss ≤ 5mm. The individuals in the severe group had at least one site with clinical attachment loss > 5mm. Bone mineral density (BMD) measured using dual-energy X-ray absorptiometry (DXA) was assessed at the lumbar spine, femoral neck and total femur (g/cm(2)). Results: Severe CA loss was identified in 86 individuals (58.1%). The multiple linear regression analysis using CA loss (dependent variable), adjusted by menopause, education and family income, demonstrated an inverse relationship of severe CA loss with the BMD of the femoral neck (p=0.015) as well as a positive association of severe CA loss with tooth loss (p=0.000), bleeding on probing (p=0.004) and heavy smokers (p=0.001). Conclusions: Our study demonstrated that severe clinical attachment loss was associated with low bone mineral density of the femoral neck and deleterious clinical dental parameters and smoking. Our findings suggest that in addition to appropriate oral care, individuals with severe clinical attachment loss may also require additional attention to their systemic bone health.

• Changes in Masticatory Performance and Quality of Life in Individuals With Chronic Periodontitis.

  Authors: Tânia F Borges, Simone C H Regalo, Mário Taba, Selma Siéssere, Wilson Mestriner Júnior, Marisa Semprini

  Journal of periodontology.

  Backgroud: This study evaluates the effect of periodontitis on masticatory performance and quality of life index. Methods: Subjects (n=24; 23-76 years of age) with periodontal conditions ranging fromBackgroud: This study evaluates the effect of periodontitis on masticatory performance and quality of life index. Methods: Subjects (n=24; 23-76 years of age) with periodontal conditions ranging from healthy to generalized disease categorized by the alveolar bone height to tooth length (AB/T) ratio were separated into the following two groups: Control (AB/T<50%) and Test (AB/T>50%). The masticatory performance was evaluated through continuous mastication of a special device named "biocapsule". The OHIP-14br (Oral Health Impact Profile) questionnaire was used to assess the oral health-related quality of life. The Student's t-test was applied for independent samples (p<0.05) to evaluate the masticatory performance, and the Mann-Whitney U test was used to determine quality of life (p<0.05) Results: There was a statistically significant difference in masticatory efficiency between groups (p=0.006). Statistically significant differences were also observed in the following parameters: "physical pain" (p=0.003), "psychological discomfort" (p=0.008), "physical disability" (p=0.033), and OHIP-14Br total score (p=0.001). The control group achieved the best indicators. Both the masticatory performance and quality of life indicators showed significant correlation with the alveolar bone height. Conclusion: The loss of periodontal supporting structures has negative effects on the masticatory performance and quality of life.

• Mast Cells Act as Phagocytes Against the Periodontopathogen Aggregatibacter Actinomycetemcomitans.

  Authors: Heliton G Lima, Karen H Pinke, Taiane P Gardizani, Devandir A Souza-Júnior, Daniela Carlos, Mario J Avila-Campos, Vanessa S Lara

  Journal of periodontology.

  Background: Evidence to date shows that mast cells play a critical role in immune defenses against infectious agents, but there have no reports about involvement of these cells in eliminatingBackground: Evidence to date shows that mast cells play a critical role in immune defenses against infectious agents, but there have no reports about involvement of these cells in eliminating periodontopathogens. In this study, the phagocytic ability of mast cells against A. actinomycetemcomitans in comparison with macrophages was evaluated. Methods: In vitro phagocytic assays were conducted using murine mast cells and macrophages, incubated with A. actinomycetemcomitans, either opsonized or not, with different bacterial load ratios. After one hour, cells were stained with acridine orange and assessed by confocal laser scanning electron microscopy. Results: Phagocytic ability of murine mast cells against A. actinomycetemcomitans was confirmed. In addition, the percentage of mast cells with internalized bacteria in absence of opsonization was higher than those in presence of opsonization. Both cell types showed significant phagocytic activity against A. actinomycetemcomitans. However, the percentage of mast cells with non-opsonized bacteria was higher than those of macrophages with opsonized bacteria, in one of ratios (1:10). Conclusion: This is the first report about the participation of murine mast cells as phagocytes against A. actinomycetemcomitans, mainly in the absence of opsonization with human serum. Our results may indicate that mast cells act as professional phagocytes in the pathogenesis of biofilm-associated periodontal disease.

• Effect of Recombinant Human Bone Morphogenetic Protein 2 Associated With a Variety of Bone Substitutes on Vertical Guided Bone Regeneration in Rabbit Calvarium.

  Authors: Cristiane Ibanhes Polo, Júlio Leonardo Oliveira Lima, Leandro De Lucca, Christiano Borges Piacezzi, Maria da Graça Naclério-Homem, Victor Elias Arana-Chavez, Wilson Roberto Sendyk

  Journal of periodontology.

  Background: A major challenge for dental implantology is to consistently obtain appropriate bone augmentation prior to implant placement. The aim of this study was to evaluate the effect ofBackground: A major challenge for dental implantology is to consistently obtain appropriate bone augmentation prior to implant placement. The aim of this study was to evaluate the effect of recombinant human bone morphogenetic protein 2 (rhBMP-2) associated with bone substitute materials beta tricalcium phosphate (β-TCP), biphasic calcium phosphate (BCP) and bovine bone mineral (BBM), on vertical guided bone regeneration (GBR) in rabbit calvarium. Methods: Four titanium cylinders were fixed to the calvarium of 22 rabbits. In Group 1 (n = 10), 3 cylinders were randomly filled with one of the test materials and 1 cylinder was filled with a blood clot (CL). In Group 2 (n = 12), the cylinders were randomly assigned to the same materials and blood clot, but with the addition of rhBMP-2. Bone labels were injected during 13 weeks, and euthanasia was performed 14 weeks after surgery in both groups. Results: The mean volume and area of tissue growth was greater in Group 2 (with rhBMP-2) than in Group 1 (without rhBMP-2), irrespective of the material used (p < 0.001). The mean volume of tissue growth in the CL cylinder was smaller than that observed with all other materials (p < 0.001) in both groups. The mean area of regenerated bone in the CL cylinder was smaller than that observed in the β-TCP cylinder (p = 0.028). The histological study revealed more lamellar bone in the rhBMP-2 group, with a greater level of biodegradation of all the bone substitute materials tested. Conclusion: The use of rhBMP-2/ACS combined with all of the bone substitute materials tested resulted in a greater amount of bone formation than that produced with the bone substitute materials alone or rhBMP-2/ACS and CL using the rabbit calvarium GBR model.

• Periodontal Condition of Patients with Auto-Immune Diseases and the Effect of Anti-Tnf-A Therapy.

  Authors: Yaniv Mayer, Rina Elimelech, Alexandra Balbir-Gurman, Yolanda Braun-Moscovici, Eli E Machtei

  Journal of periodontology.

  Background: The aim of this study was to evaluate the effect of auto-immune diseases (AI) as well as anti TNF-α therapy on the clinical and immunological parameters of the periodontium. Methods: 36Background: The aim of this study was to evaluate the effect of auto-immune diseases (AI) as well as anti TNF-α therapy on the clinical and immunological parameters of the periodontium. Methods: 36 AI patients [12 Rheumatoid arthritis (RA), 12 Psoriatic arthritis (PA) & 12 Systemic sclerosis (SSc)], were recruited together with 12 healthy (H) and 10 RA patients receiving anti TNF-α therapy (RA+). Periodontal indices including plaque index (PI), gingival index (GI), probing depth (PD), and bleeding on probing (BOP) were measured and gingival crevicular fluid (GCF) was collected from five deepest pockets using papers strips. The TNF-α level was analyzed using Enzyme-Linked Immunosorbent Assay (ELISA). ANOVA test was used for statistical comparison between groups while Pearson's linear correlation coefficient test was used to examine the association between TNF-α and periodontal status indices. Results: The three AI sub-groups were very similar in clinical and immunological parameters. GI was greater in the AI patients compared to the H and RA+ groups (1.91±0.54, 1.21±0.67, 1.45±0.30 respectively, p=0.0005). AI patients exhibited significantly more BOP than H and RA+ (46.45±17.08%, 30.08±16.86% and 21.13±9.51%; respectively, p=0.0002). PD in H and RA+ groups were lower than in the AI (3.47±0.33mm, 3.22±0.41mm, 3.91±0.49mm; p=0.0001). Number of sited with PD above 4 mm was higher in AI patients compared to H and RA+ (42.44±17.5 versus 24.33±15.62 versus 33.3±6.6, p=0.0002). GCF's TNF-α were higher amongst the AI patients (1.67±0.58 ng/site) compared to 1.07±0.33 ng/site for the H and 0.97±0.52 ng/site for the RA+ (p=0.0002). A significant positive correlation was found between PD and TNF-α levels in the GCF (r=0.4672, p=0.0002), BOP (r=0.7491, p=0.0001) and GI (r=0.5420, p=0.0001). Conclusion: Patients with AI diseases have higher periodontal indices & GCF TNF-α than healthy controls. Anti-TNF-α treatment appears to reverse this phenomenon.

• The Effect of a 810 nm Diode Laser on Postoperative Pain and Tissue Response Following Modified Widman Flap Surgery: A Pilot Study in Humans.

  Authors: Javier D Sanz-Moliner, José Nart, Robert E Cohen, Sebastian G Ciancio

  Journal of periodontology.

  Background: The purpose of this single-masked pilot clinical study (P/E0510307E) was to compare the tissue response and postoperative pain following the use of a diode laser (810nm) (DL) as anBackground: The purpose of this single-masked pilot clinical study (P/E0510307E) was to compare the tissue response and postoperative pain following the use of a diode laser (810nm) (DL) as an adjunct to modified Widman flap (MWF) surgery to that of MWF alone. Methods: Thirteen patients with generalized severe chronic periodontitis completed the study. Control sites were randomly selected to receive a MWF and the contra-lateral test sites a MWF in conjunction with a DL. The study tooth/site was treated plus any additional teeth in the quadrant in which the site was located, if needed. Randomization was done using a coin flip. The DL was used to de-epithelialize the inner part of the periodontal flap and photo-biostimulate the surgical area. Pain scale assessment (PS), pain medication consumption (PM), tissue edema (TE), and tissue color (TC) were evaluated one week following surgery. Results: Statistically significant differences were seen for TE (p=0.041), PM (p<0.001) and PS (p<0.001) favoring test sites. TC did not show a statistically significant difference (p=0.9766). Patients rated the first surgical treatment performed as more painful than the second (p<0.002). Conclusion: The use of a 810nm diode laser provided additional benefits to modified Widman flap surgery in terms of less edema and post operative pain.

• Cyanoacrylate Versus Laser in the Treatment of Dentin Hypersensitivity: Controlled, Randomized, Double-Blind and Non-Inferiority Clinical Trial.

  Authors: Olga D Flecha, Camila G S Azevedo, Fabiana R Matos, Natália M V Barbosa, Maria L Ramos-Jorge, Patricia F Gonçalves, Edina M K Silva

  Journal of periodontology.

  Background: Dentin Hypersensitivity (DH) is a painful exaggerated response to normal stimuli such as cold, sweetness and brushing. Objective: The aim of the present controlled, randomized,Background: Dentin Hypersensitivity (DH) is a painful exaggerated response to normal stimuli such as cold, sweetness and brushing. Objective: The aim of the present controlled, randomized, double-blind non-inferiority clinical trial was to evaluate the effectiveness of cyanoacrylate (Super Bonder(®) glue*) in the treatment of DH, when compared with the application of low intensity laser. Methods: The study included 434 sensitive teeth of 62 patients. Two-hundred and sixteen teeth were treated with laser and 218 with Super Bonder(®). A Numerical Rating Scale (NRS) was used to record the parameters of pain related to the stimuli at baseline and after the treatment at intervals of 24 hours, 30, 90 and 180 days. Results: Both groups had significant reductions in DH. However, there was no significant difference between the two groups up to 6 months. Intragroup analysis showed that the effect of cyanoacrylate obtained at 24 hours remained for 90 days in response to air-jet test and 30 days for cold spray test. There was statistically significant difference between all other intragroup comparisons of the time-intervals (p<0.001). Conclusion: It was concluded that cyanoacrylate (Super Bonder(®)) is as effective as low intensity laser in reducing dentin hypersensitivity, in addition it is a more accessible and low cost procedure and can be safely used in the treatment of DH.

• Efficacy of Using Platelet Derived Growth Factor and Xenograft (With or Without Collagen Membrane) for Bone Regeneration Around Immediate Implants With Induced Dehiscence Type Defects: A Micro-Computed Tomographic Study in Dogs.

  Authors: Bann Ahmad Sa'ad Al Hazmi, Khalid Saleh Al-Hamdan, Abdulaziz Al-Rasheed, Nadir Babay, Hom Lay Wang, Khalid Al-Hezaimi

  Journal of periodontology.

  Background: Use of collagen membrane (CM) with xenograft and recombinant human platelet derived growth factor (rhPDGF) in guided bone regeneration (GBR) is debatable.The aim of this micro-computedBackground: Use of collagen membrane (CM) with xenograft and recombinant human platelet derived growth factor (rhPDGF) in guided bone regeneration (GBR) is debatable.The aim of this micro-computed tomographic experiment was to asses the efficacy of using PDGF and xenograft (with or without CM) for GBR around immediate implants with dehiscence defects. Materials and methods: Ten beagle dogs underwent atraumatic bilateral second and fourth premolar extractions from both arches. A standardized dehiscence defect (6mmX3mm) was created on the buccal bone and immediate implants were placed in distal sockets in each site. Animals were randomly divided into three groups: Group-1: Xenograft with rhPDGF was placed and covered with CM. Group-2: Xenograft with rhPDGF was placed over the defects. Group-3: Four immediate implants associated with dehiscence (controls). After 16-weeks, subjects were sacrificed and jaw segments were assessed for buccal bone thickness (BBT), buccal bone volume (BBV), vertical bone height (VBH) and bone-to-implant contact (BIC) using micro-computed tomography. Results: BBT was higher in Group-2 (1.533±0.89mm) than Group-1 (0.745±0.322mm) (P<0.001) and Group-3 (0.257±0.232 mm) (P<0.05). BBV was higher in Group-2 (67.87±19.83mm(3)) than Group-1 (42.47±6.78mm(3)) (P<0.05) and Group-3 (19.12±4.06mm(3)) (P<0.001). VBH was higher in Group-2 (6.36±1.37mm) than Group-3 (0.00±0 mm) (P<0.001). VBH was higher in Group-1 (3.91± 2.68mm) than Group-3 (0.00±0 mm) (P<0.05). BIC was higher Group-2 (67.25±13.42%) than Group-1 (36.25±12.78%) (P<0.05) and Group-3 (30.25±7.27%) (P<0.01). Conclusion: GBR around immediate implants with dehiscence defects using PDGF and xenograft alone resulted in higher BBT, BBV, VBH and BIC than when performed in combination with a CM.

• Efficacy of Varying Concentrations of Subgingivally Delivered Metformin in the Treatment of Chronic Periodontitis: A Randomized Controlled Clinical Trial.

  Authors: A R Pradeep, Nishanth S Rao, Savitha B Naik

  Journal of periodontology.

  Background: Metformin (MF), a second-generation biguanide, is a commonly used oral anti-diabetic drug which has recently shown to stimulate osteoblasts and reduce alveolar bone loss. The presentBackground: Metformin (MF), a second-generation biguanide, is a commonly used oral anti-diabetic drug which has recently shown to stimulate osteoblasts and reduce alveolar bone loss. The present study aimed to explore the efficacy of 0.5%, 1% and 1.5% MF gel as local drug delivery system in adjunct to scaling and root planing (SRP) for treatment of intrabony defects in chronic periodontitis patients. Material and Methods: 118 intrabony defects were treated either with 0.5%, 1%, 1.5% MF gel or placebo gel. Clinical parameters [Modified sulcus bleeding index, Plaque index, probing depth (PD) and clinical attachment level (CAL)] were recorded at baseline, 3 month and 6 month while radiographic parameters were recorded at baseline and 6 month. Intrabony defect (IBD) depth at baseline and at 6 month was calculated on standardized radiographs by using the image analysis software. The mean concentration of MF in gingival crevicular fluid was estimated by reverse-phase high-performance liquid chromatography. Results: Mean PD reduction and mean CAL gain was found to be greater in MF groups than placebo group, both at 3 month and at 6 month. Furthermore, significantly greater reduction of IBD depth was found in the MF groups compared to placebo group with greatest reduction in 1% MF. Conclusions: The results of the present study showed local delivery of MF into periodontal pocket stimulated significant increase in the PD reduction, CAL gain, and improved IBD depth reduction as compared to placebo in adjunct to SRP. This can provide a new direction in the field of periodontal healing.

• Severe Preeclampsia and Maternal Self-Report of Oral Health, Hygiene, and Dental Care.

  Authors: Kim A Boggess, Erica K Berggren, Viktoria Koskenoja, Diana Urlaub, Carol Lorenz

  Journal of periodontology.

  Background: Maternal periodontal disease diagnosed by a detailed oral health examination is associated with preeclampsia. Our objective was to measure the association between maternal self-report ofBackground: Maternal periodontal disease diagnosed by a detailed oral health examination is associated with preeclampsia. Our objective was to measure the association between maternal self-report of oral symptoms/problems, oral hygiene practices, and/or dental service utilization prior to or during pregnancy and severe preeclampsia. Methods: A written questionnaire was administered to pregnant women at the time of prenatal ultrasound, and outcomes ascertained by chart abstraction. Chi square test compared maternal oral symptoms/problems, hygiene practices, and dental service utilization between women with severe preeclampsia versus normotensive women. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for severe preeclampsia. Results: 48 (10%) of 470 women reported > 2 oral symptoms/problems in the 6 months prior to pregnancy and 77 (16%) since pregnancy. 51(11%) reported prior periodontal treatment. 28 (6%) of 470 developed severe preeclampsia. Women with a history of periodontal treatment were more likely to develop severe preeclampsia (aOR, 95%CI: 3.71, 1.40-9.83) than women without a prior history of periodontal treatment. Self-reported oral health symptoms/problems, oral hygiene practices, or dental service utilization prior to or during pregnancy were not associated with severe preeclampsia when considered in the context of other maternal risk factors. Conclusion: Maternal self report of previous periodontal treatment prior to pregnancy is associated with severe preeclampsia.

• Effect of a Collagen Membrane Combined with a Porous Titanium Membrane on Exophytic New Bone Formation in a Rabbit Calvarial Model.

  Authors: Seung-Il Shin, Yeek Herr, Young-Hyuk Kwon, Jong-Hyuk Chung

  Journal of periodontology.

  Background: Previous studies showed that the use of a porous titanium membrane (TM) for exophytic bone regeneration does not effectively inhibit the infiltration of undesired tissue. Therefore, thisBackground: Previous studies showed that the use of a porous titanium membrane (TM) for exophytic bone regeneration does not effectively inhibit the infiltration of undesired tissue. Therefore, this study examined the effect of resorbable collagen membranes, such as cross-linked type I collagen membrane (BA) and double layered porcine collagen membrane (BG), on the promotion of exophytic bone formation in guided bone regeneration when used in conjunction with a porous titanium membrane. Methods: Thirty six male New Zealand white rabbits were used in this study. Six rabbits were allotted to each test group. After decorticating the parietal bone, with or without filling the inner space with a freeze-dried cortical bone allograft (OG), the collagen membranes were fixed with metal pins. The experimental groups were divided into the following 6 groups: TM only, TM+OG, TM+BA, TM+BG, TM+OG+BA, and TM+OG+BG. The experimental animals were sacrificed at 8 and 16 weeks after surgery. Non-decalcified specimens were prepared and processed for histological observations. The newly formed bone (%) was measured histomorphometrically. Results: BG combined with TM promoted new bone formation and maturation by inhibiting the infiltration of connective tissue. However, BA had no significant effect on new bone formation. The amount of new bone formation was higher at 16 weeks than at 8 weeks but the difference was not significant. At 16 weeks the best result for newly formed bone was with TM+OG+BG with a significant difference from TM alone. Conclusions: Regardless of the use of graft materials, BG combined with TM promoted more bone formation than BA combined with TM or TM alone. Thus, using a commercial collagen membrane to cover a TM can promote new exophytic bone formation.

• Immediate Implant Placement in Infected Sites: A Case Series.

  Authors: Simone Marconcini, Antonio Barone, Federico Gelpi, Francesco Briguglio, Ugo Covani

  Journal of periodontology.

  BACKGROUND: Immediate implant placement has several advantages, such a reduction in the number of surgical treatments and reduction of the time between tooth extraction and the placement of theBACKGROUND: Immediate implant placement has several advantages, such a reduction in the number of surgical treatments and reduction of the time between tooth extraction and the placement of the definitive prosthesis. However, there are still some situations which could jeopardize the success of the aforesaid therapy, such as the presence of an infection caused by periodontal disease or peri-apical lesions. The aim of this study was to evaluate the clinical success of implants placed in fresh extraction sockets which showed clinical signs of periodontal disease. MATERIALS AND METHODS: Twenty patients (13 males and 7 females) aged 24 to 65 were included in this study. After the initial examination and the treatment planning, all of the patients selected for the study underwent the periodontal treatment deemed necessary to facilitate wound healing. All the 20 teeth were extracted due to an infection. The second stage surgery was performed 4 months after the initial procedure. The following clinical parameters were evaluated for each patient at the time of implant placement and at the end of the 12 month follow-up period: Attachment level (AL), presence or absence of mobility, presence or absence of pain, presence or absence of suppuration. The bone level was measured as the distance from the implant shoulder to the first bone implant contact (Distance Bone Implant) (DIB) by periapical radiographs. The stability and health of the soft tissue was clinically evaluated by means of the plaque score. RESULTS: The healing period was uneventful for all the patients. All the implants were osseointegrated. At the end of the 12 month follow-up period, patients were asymptomatic and showed no signs of infection or bleeding when probed. The mean attachment level (AL) at the mid-buccal location per implant was 0.8 mm at the baseline and 0.9 mm at the end of the follow-up. The mean width of KM measured at the mid-buccal location per implant at the baseline and 1-year visits was 3.7+\-0.4 mm and 3.3+\-0.5 mm respectively. The mean Attachment level measured at the mid-buccal location per implant was 0.8 mm at the baseline and 0.9 mm at the end of the follow-up. The pariapical radiographs, obtained in a standardized manner, revealed a mean increase of 1 mm in the DIB value. At the 12-month-follow-up, the presence of plaque was observed in 44 of the 80 sites analyzed. CONCLUSIONS: On the basis of this study implants placed in fresh extraction sockets - which were affected by an infection- may be a valid operative technique, which leads to predictable results, if adequate pre- and postoperative care is taken.

• Mast Cell Degranulation in Human Periodontitis.

  Authors: Shiguang Huang, Fangli Lu, Ying Chen, Bo Huang, Man Liu

  Journal of periodontology.

  Background: Mast cells are tissue resident immune cells that participate in a variety of allergic and inflammatory conditions. Limited attention has been given to the role of mast cells inBackground: Mast cells are tissue resident immune cells that participate in a variety of allergic and inflammatory conditions. Limited attention has been given to the role of mast cells in periodontal diseases, and the effects of mast cell degranulation on the chronic stages of non-allergic inflammation, particularly in periodontitis, are not known. The present study was undertaken to analyze the relationship between the mast cell degranulation and human periodontal disease progression. Methods: A total of 50 clinical specimens included moderate periodontitis (n=17), advanced periodontitis (n=18), and healthy control tissues (n=15) were involved in this study. All specimens were fixed in 10% buffered formalin, stained with hematoxylin and eosin for histopathology, with toluidine blue for identifying mast cells, and by immunohistochemistry for the expressions of mast cell tryptase in periodontal tissues. The total and degranulated mast cell densities (per high-power field) were quantified in the specimens. Results: Compared to healthy controls, there were significantly increased both total and degranulated mast cell densities in human moderate (P<0.01) and advanced periodontitis groups (P<0.01) by toluidine blue staining; and there were significantly higher densities of both total and degranulated tryptase-positive mast cell subpopulation in moderate (P<0.01) and even significantly higher subpopulation densities in advanced periodontitis group by immunohistochemical staining, in which both total and degranulated mast cell densities were significantly higher in advanced periodontitis group than those in moderate periodontitis group (P<0.01) by both toluidine blue staining and immunohistochemical staining. There were significantly severer periodontal inflammatory pathology in advanced periodontitis group than those in moderate periodontitis group (P<0.01). Conclusion: These findings indicate a significant correlation between tryptase-positive mast cell density, the degree of their degranulation, and the human periodontitis severity, and our results further indicate that mast cell degranulation appears to be associated with human periodontal disease.

• Quality Assessment of Systematic Reviews on Periodontal Regeneration in Humans.

  Authors: Satheesh Elangovan, Gustavo Avila-Ortiz, Georgia K Johnson, Nadeem Karimbux, Veerasathpurush Allareddy

  Journal of periodontology.

  Background: Systematic reviews represent the highest form of evidence in the current hierarchy of evidence-based dentistry. Critical analysis of published systematic reviews may help to analyze theirBackground: Systematic reviews represent the highest form of evidence in the current hierarchy of evidence-based dentistry. Critical analysis of published systematic reviews may help to analyze their strengths and weaknesses and to identify areas that need future improvement. The aim of this overview was to determine and compare the quality of systematic reviews published in the field of periodontal regeneration using established checklists such as the Assessment of Multiple Systematic Reviews (AMSTAR) guidelines. Methods: A systematic search was conducted to retrieve reviews on periodontal regeneration in humans. A total of 14 systematic reviews were selected using a set of inclusion and exclusion criteria. Two independent reviewers appraised the quality of the selected reviews using AMSTAR guidelines. Each article was given an AMSTAR total score, based on the number of AMSTAR criteria that were fulfilled. The quality of included reviews was further assessed using a checklist proposed by Glenny and collaborators in 2003. Results: Only one of the selected systematic reviews satisfied all the AMSTAR guidelines, while on the other end, two reviews satisfied just 2 of the 11 items. This study shows that published systematic reviews on periodontal regeneration exhibit significant structural and methodological variability. Quality assessment using the additional checklist further confirmed the variability in the way systematic reviews were conducted and/or reported. Conclusion: Consideration of guidelines for quality assessment, such as AMSTAR, when designing and conducting systematic reviews may increase the validity and clinical applicability of future reviews.

• Is there an Interaction Between Polycystic Ovary Syndrome and Gingival Inflammation?

  Authors: Ozgün Ozçaka, Banu Oztürk Ceyhan, Aliye Akcali, Nurgün Biçakci, David F Lappin, Nurcan Budunelı

  Journal of periodontology.

  Aim: The aim of this study was to evaluate the gingival crevicular fluid (GCF), saliva and serum concentrations of tumour necrosis factor-alpha (TNF-α), TNF-α receptor-1, TNF-α receptor-2 andAim: The aim of this study was to evaluate the gingival crevicular fluid (GCF), saliva and serum concentrations of tumour necrosis factor-alpha (TNF-α), TNF-α receptor-1, TNF-α receptor-2 and interleukin-6 (IL-6) in non-obese women with polycystic ovary syndrome (PCOS) and either clinically healthy periodontium or gingivitis. Materials & Methods: Thirty-one women with PCOS and healthy periodontium, 30 women with PCOS and gingivitis and 12 systemically and periodontally healthy women were included in the study. GCF, saliva, and serum samples were collected and clinical periodontal measurements, body mass index (BMI) and Ferriman-Gallwey score (FGS) were recorded. Sex hormones, cortisol and insulin levels were measured. TNF-α, TNF-α receptor-1, TNF-α receptor-2 and IL-6 were determined by enzyme-linked immunosorbent assay (ELISA). Kruskal-Wallis followed by Bonferroni corrected post hoc Mann-Whitney U tests were used to analyse the data. Results: PCOS+gingivitis group revealed significantly higher GCF, saliva, and serum IL-6 concentrations than PCOS+healthy group (p<0.0001). The two PCOS groups exhibited significantly higher saliva TNF-α concentrations than the control group (p=0.014 and p=0.023, respectively). FGS index was significantly higher in PCOS+gingivitis group than PCOS+healthy group (p=0.030). PCOS+gingivitis group revealed significantly higher insulin concentration than PCOS+healthy and control groups (p=0.014 and p<0.0001, respectively). Serum TNF-α, TNF-αRs and serum, GCF and salivary IL-6 levels correlated with the clinical periodontal measurements. Conclusion: PCOS and gingival inflammation appear to act synergistically on the pro-inflammatory cytokines; IL-6 and TNF-α. Thus, PCOS may have an impact on gingival inflammation or vice versa. Further studies are warranted to clarify the possible relationship between PCOS and periodontal disease.

• Effect of the Timing of Restoration on Implant Marginal Bone Loss: A Systematic Review.

  Authors: Fernando Suarez, Hsun-Liang Chan, Alberto Monje, Pablo Galindo-Moreno, Hom-Lay Wang

  Journal of periodontology.

  Purpose: The advancement in implant dentistry has allowed shortened treatment time by restoring the implants earlier. Whether the timing of restoration has an impact on implant marginal bone levelPurpose: The advancement in implant dentistry has allowed shortened treatment time by restoring the implants earlier. Whether the timing of restoration has an impact on implant marginal bone level has not been systematically analyzed. The aim of this study was to compare marginal bone loss (MBL) between implants that were restored with the following protocols: immediate restoration/loading (IR/IL), early loading (EL) and conventional loading (CL). Materials and Methods: An electronic literature search from 3 databases (until Nov. 2011) and a hand search in implant-related journals were conducted. Clinical human studies in English language that had reported a comparison of MBL between implants with IR/L, EL or CL with at least 12 month follow-up were included. In addition, the minimal number of implants had to be 10 for each group. Implants with both immediate (IP) and delayed (DP) placement were included and analyzed separately. An assessment of the publication bias for the included randomized clinical trials (RCT) was performed. Results: The initial search resulted in 1640 articles, of which 27 articles in full text were further evaluated for eligibility. Finally 11 studies (8 RCT, 2 controlled and 1 retrospective study) were qualified and classified into 4 groups: (1) IR/L+DP vs. CL+DP (N=6 articles), (2) IR+DP vs. EL+DP (N=2 articles), (3) EL+DP vs. CL+DP (N=1 article), and (4) IL+IP vs. CL+IP (N=2 articles). A meta-analysis performed for group 1 showed 0.09 mm (95% CI -0.27 to 0.09 mm) difference in the mean MBL, favoring the IR/L protocol but without significant difference (p=0.33). No significant difference in MBL was found for group 2, 3, and 4, after adjusting for the implant placement level. The 8 RCTs were determined to be at moderate to high risk of publication bias. Conclusion: This meta-analysis did not show an effect of the timing of restorations on implant marginal bone level. The selection of restoration protocols should base on factors other than marginal bone level.

• Periodontal Status and Hyperlipidemia: Statin Users vs. Non-Users.

  Authors: Aditi Sangwan, Shikha Tewari, Harpreet Singh, Rajinder K Sharma, Satish C Narula

  Journal of periodontology.

  Background: The association between serum lipids and periodontal disease has been studied predominantly in chronic periodontitis patients with limited data available regarding periodontal status ofBackground: The association between serum lipids and periodontal disease has been studied predominantly in chronic periodontitis patients with limited data available regarding periodontal status of hyperlipidemic subjects. Meanwhile, the impact of statins on the periodontal health of the population also remains largely under-explored. This study aims to assess the periodontal status among hyperlipidemic subjects and statin users. Methods: In this cross-sectional study, 94 hyperlipidemic subjects (50 on statins and 44 on non-pharmacologic therapy), and 46 normolipidemic controls underwent periodontal examination [plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL)]. Biochemical parameters measured included serum triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels. Results: PD and GI were significantly higher in non-statin hyperlipidemics compared to normolipidemic [(P <0.001(PD) and P <0.05 (GI)] and statin group [(P=0.001 (PD) and P <0.05 (GI)]. Periodontal parameters between statin and normolipidemic group did not differ significantly. After adjusting for confounders, positive and significant correlations were observed between PD and TG, TC and LDL while CAL shared correlation with TC and LDL. GI was correlated with TG and TC. Regression analyses revealed that while TC was significantly associated with PD (P <0.001), LDL showed significant association with CAL (P=0.013). TG showed significant association with GI (P=0.020). Conclusions: Our findings suggest that relative to the general population, hyperlipidemic subjects are more prone to periodontal disease. Also, within the limits of this study, it may be stated that statins have a positive impact on periodontal health.

• Innate Immune Receptor Expression in Peri-implant Tissues of Patients With Different Susceptibility to Periodontal Diseases.

  Authors: Theofilos Koutouzis, Dominick Catania, Kathleen Neiva, Shannon M Wallet

  Journal of periodontology.

  Background: While inflammation mediates the pathogenesis of periodontal diseases, the affect of innate immune responses on implant therapies have not been evaluated. Innate immune receptors,Background: While inflammation mediates the pathogenesis of periodontal diseases, the affect of innate immune responses on implant therapies have not been evaluated. Innate immune receptors, including toll-like-receptors (TLRs) and the receptor-for-advanced-glycated-end-products (RAGE), are upregulated within inflammed gingiva and are responsible for initiation of detrimental host responses. The aim of this study was to compare the expression of TLR2, TLR4, and RAGE in gingival tissues from periodontitis and non-periodontitis susceptible participants prior to and following implant therapy. Methods: Periodontally healthy participants received implant therapy for non-periodontal edentulism. Periodontally susceptible participants were diagnosed with chronic periodontitis prior to implant therapy. Gingival biopsies were collected from edentulous ridges prior to implant installation and from peri-implant mucosa two months following treatment. Histology, real-time PCR (qPCR) and western blot were used to evaluate levels of inflammatory infiltrate, TLR2, TLR4 and RAGE expression. Results: Prior to implant therapy elevated levels of RAGE were detected in gingival tissues from periodontally susceptible participants when compared to those from periodontally healthy participants, while no differences in the expression of TLR2 nor TLR4 were detected. Following implant therapy there was an upregulation of RAGE and TLR4 levels which coincided with a downregulation of TLR2 levels in biopsies from peridontally susceptible participants. Levels of RAGE and TLR4 remained unchanged in biopsies from peridontally healthy particpiants, while TLR2 levels were significantly upregulated. Histologically, post-implant biopsies from peridontally susceptible participants displayed higher levels of inflammatory infilatrate. Conclusion: Elevated levels of inflammatory potential were found following implant therapy in periodontal susceptible participants.

• To the editor: re: arginine-nitric oxide-polyamine metabolism in periodontal disease.

  Authors: Arash Poorsattar Bejeh Mir, Mahmood Khosravi Samani

  Journal of periodontology. 83(4):393-4.

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