Langzeitergebnisse nach Velopharyngoplastik bei Patienten mit Spaltbildungen des Gaumens

Background

Children with cleft palate frequently demonstrate speech and resonance disorders following primary cleft repair. In some patients no improvement can be achieved with conservative therapy and a velopharyngoplasty (VPP) may be indicated. This study was performed to evaluate the long-term results after VPP.

Material and methods

Twenty-six patients were followed up on an average 9 years after VPP (mean age: 16±5 years). Apart from the phoniatric-pedaudiologic findings, the speech intelligibility and nasality were judged by speech pathologists and by laymen. The extent of the speech handicaps was evaluated with a questionnaire. The nasalance was measured with NasalView. The vowels, two test sentences, and three reading texts (LT_1–3) were used as test materials.

Results

The phoniatric-pedaudiologic examination revealed a clear improvement of hearing, language, and speech function. Compared to the previous results, decreased nasality and improved ability in articulation were detected. The judgment of laymen was also positive. The speech intelligibility was mostly evaluated as favorable. A speech handicap was present in only a few patients. The evaluation using NasalView showed significantly increased nasalance values for the LT₂ (p=0.030). Moreover there were lower nasalance values for all the reading texts compared to the control group (LT₁ p=0.257, LT₂ p=0.408, LT₃ p=0.187).

Conclusion

A clear improvement can be achieved with VPP in patients with a high degree of therapy-resistant nasality. In many cases even normal colloquial language is possible. The evaluation of nasalance has proved to be successful for rating surgical outcome.      

Sprechsprachliche Ergebnisse nach einfachen und mehrfachen Gaumenverschlussoperationen

Objectives. If the primary palatal closure in a patient with cleft lip and palate is unsuccessful, defects such as palatal fistulas and a short velum have to be corrected by secondary operations. It is an informal belief among surgeons that these reoperations can have detrimental effects on the patients’ nasal resonance and articulation. It was our aim to critically evaluate the validity of this belief. Material and methods. One hundred and twenty-four patients with cleft lip and palate were divided into three groups. The 70 patients in group 1 had only undergone a primary palatal closure operation. The 33 patients in group 2 had undergone one or more palatal reoperations. The 21 patients in group 3 had undergone an additional pharyngeal flap operation. Resonance and articulation were evaluated perceptually. Nasalance was assessed with the NasalView system, and the mean speech rate was analyzed with the MODIAS software. Results. There were no significant differences for any of the speech measures between groups 1 and 2. Patients in group 3 had significantly worse results for all speech measures. Conclusions. The speech outcomes for patients with multiple palatal reoperations were no different from those of patients with single palatal closure operations. The pharyngeal flap operation did not lead to sufficient improvements in the speech of the patients in group 3.     

Metal–ceramic-fixed dental prosthesis with CAD/CAM-fabricated substructures: 6-year clinical results

Objectives

The aim of this study was to evaluate the clinical performance of fixed dental prostheses (FDPs) with computer-aided design (CAD)/computer-aided manufacturing (CAM)-fabricated titanium substructures veneered with low-fusing porcelain after 6 years.

Materials and methods

Thirty-one FDPs for 23 patients were fabricated. The frameworks were designed and milled using an early version of a dental CAD/CAM system. Checkups were performed annually.

Results

Complications totaled ten porcelain fractures, one substructure fracture, and one biologic failure. The success rate was calculated at 58.6 % and the survival rate at 88 % (Kaplan–Meier analysis).

Conclusion

The clinical performance of the described technique for FDPs with titanium substructures was poor. Therefore, the presented concept cannot be recommended.

Clinical relevance

CAD/CAM-fabricated titanium substructures veneered with the powder build-up technique showed poor clinical outcome after 6 years.     

Evolution der Implantatprothetik

Background

The prosthetic treatment with implants has continually evolved over time. After the complex implant restoration in the initial phase, the current trends are simple solutions with a minimum of aftercare.

Methods

The solutions for removable dentures are for example attachments with resin inserts (locator) or bars that are machined with computer-aided design and computer-aided manufacturing (CAD/CAM) techniques for direct connection to the implant. Permanent dentures are often fixed by screws, especially for complex restorations. With the CAD/CAM technique it is possible to produce frames with an exact fitting so that abutments and cementation are no longer needed.

Conclusion

The immediate insertion of implants is not standard therapy but is becoming more and more popular because of the high level of patient satisfaction. For the dentist this means a significantly higher prosthetic workload and a very close cooperation between dentists and surgeons.     

Auswirkung der Strahlentherapie auf die Lebensqualität

Purpose

The therapy of patients with oral cancer often requires a combination of surgery and radiotherapy. This leads to trauma of healthy tissue. The impact of this side effect on quality of life was investigated. Additionally the impairment of 19 factors was determined (comprehension of speech for unknown others, comprehension of speech for familiar others, eating/swallowing, mobility of the tongue, opening range of the mouth, mobility of lower jaw, mobility of neck, mobility of arms and shoulders, sense of taste, sense of smell, appearance, strength, appetite, respiration, pain, swelling, xerostomia, halitosis).

Methods

This retrospective multicenter study was conducted under the auspices of DOESAK (a German, Austrian and Swiss cooperative group on tumors of the maxillofacial region). The Bochum Questionnaire on Rehabilitation was used to determine 147 items. 3894 questionnaires where sent to 43 clinics in Germany, Austria and Switzerland. 1761 questionnaires where returned, while 1411 of them included all of the answers necessary for this study.

Results

686 of 1411 patients where irradiated. Before the beginning of therapy the impairment of the 19 factors was not significantly higher in the group that later received radiotherapy. After therapy there is a significantly higher impairment of the irradiated patients. The factors that are especially worse are xerostomia, swallowing and understanding of speech. The quality of life was not significantly lower.

Conclusions

Although radiotherapy leads to trauma of healthy tissue this method is indicated as it has no significant impact on quality of life. During the rehabilitation physiotherapists should relieve the impairment of speech, eating and swallowing.     

Influence of CAD/CAM all-ceramic materials on cell viability,migration ability and adenylate kinase release of human gingival fibroblasts and oral keratinocytes

Objectives

The aim of this study was to analyze the influence of four CAD/CAM all-ceramic materials on cell viability, migration ability and adenylate kinase (ADK) release of human gingival fibroblasts (HGF) and oral keratinocytes (HOK).

Materials and methods

HGF and HOK were cultured on disc-shaped CAD/CAM all-ceramic materials (e.max CAD LT, e.max CAD HT, Empress CAD and Mark II) and on discs made of tissue culture polystyrene surface (TCPS) serving as control. Cell viability was analyzed by using an MTT assay, and migration ability was investigated by a scratch assay. A ToxiLight assay has been performed to analyze the effect of all-ceramic materials on ADK release and cell apoptosis.

Results

At MTT assay for HGF, no significant decrease of cell viability could be detected at all points of measurement (p each?>?0.05), while HOK demonstrated a significant decrease in cell viability especially on Empress CAD and Mark II at each point of measurement (p each?<?0.001). Scratch assay demonstrated an increased migration ability for HGF on e.max CAD HT, Empress CAD and Mark II (p each?<?0.001), whereas HOK showed a significantly decreased migration ability on all tested materials at all points of measurement (between ?36 % and ?71 %; p each?<?0.001). At ToxiLight assay, only small cytotoxic effects of the all-ceramic materials could be investigated.

Conclusions

This study disclosed significant differences in cell viability and migration ability of HGF and HOK on CAD/CAM all-ceramic materials.

Clinical Relevance

CAD/CAM all-ceramic materials can influence oral cell lines responsible for soft tissue creation which may affect the esthetic outcome.     

Investigation of trends and characteristics in patients with obstructive sleep apnea

Background

Oral appliance (OA) therapy for obstructive sleep apnea (OSA) has only been part of Japan’s National Health care coverage plan since 2004. Subsequently, not enough time has passed to establish the medical trends and characteristics of OSA patients in Japanese Dental Hospitals.

Aim

The aim of this study was to investigate the medical trends and the characteristics in patients with OSA who visited our clinic, and to compare our findings with previous studies.

Setting and design

Epidemiological survey (retrospective study).

Materials and methods

Two hundred and one patients were recruited at the Internal Medicine Division in the Tsurumi University Dental Hospital from February 2006 to December 2008, consecutively. Patients received a medical interview, and a detailed sleep analysis that included a polysomnography (PSG) to verify the exact nature of their condition. The efficacy of OA was assessed in 49 patients who wore an OA and underwent PSG.

Results

Of all subjects, 141 patients visited the Prosthodontic Division to receive OA therapy, 38 patients were treated or received a follow up examination in the Internal Medicine Division. The dropout rate was 10.4% in the all subjects, 17.0% in patients who visited the Prosthodontic Division. The male-to-female ratio was 3.3:1, 3.0:1 in patients who visited the Prosthodontic Division. In addition, females had a lower rate of OAS severity than males. In our patients, the major complication was hypertension and cardiac disease. The success rate of OA was 75.5%.

Conclusion

This approach allowed us to reveal some of the trends and characteristics in our patients.     

Hogan’s modification of the Sanvenero-Rosselli velopharyngoplasty

Purpose

A competent velopharyngeal mechanism is essential for the production of intelligible speech and the secondary procedure of the posterior pharyngeal flap may be necessary in some patients to achieve this goal. The purpose of this study was to examine short and long-term results between the Sanvenero-Rosselli and Hogan’s modification of the cranially based velopharyngoplasty.

Methods

During a 20-year period, 17 patients underwent secondarily a posterior pharyngeal flap to treat velopharyngeal incompetence. All the patients were treated in the same institution and under the supervision of the same stuff surgeon. Nine patients were operated on according to the Sanvenero-Rosselli method and eight according to Hogan’s modification, which consists of the preparation of two mucosal flaps on the dorsal side of the soft palate. Both mucosal flaps are sutured at the base of the pharyngeal flap and cover its raw surface.

Results

Comparing the post-operative condition of the patients in two groups to their pre-operative state, it was observed that speech and comprehensibility were significantly improved, but Hogan’s technique produced better speech results.

Conclusions

According to our limited experience, additional surgical effort to create mucosal flaps on the nasal surface of the soft palate in Hogan’s technique is compensated for by the reliable and substantial advantages that this technique holds, compared to Sanvenero-Rosselli’s original proposition.     

Outcome measurements after oral cancer treatment: speech and speech-related aspects—an overview

Introduction

Oral cancer and its surgical treatment impair speech quality by an alteration of the vocal tract. Local size and stage of the tumour as well as surgical and adjuvant treatment modalities have an impact on the functional outcome of patients' speech rehabilitation. It was the aim of this overview to specifiy speech and speech-related aspects as well as to delineate measurement methods of speech outcome in patients with oral cancer by a review of the literature.

Methods

The review is based on a Medline Search on ??speech??, ??cancer??, ??oral cancer??, ??malignoma mouth??, ??intelligibility??, ??formant??, ??ultrasound??.

Discussion

In particular, speech intelligibility is inevitable for the social interaction of patients which is highly correlated with the patient's quality of life. However, speech outcome measurement shows a variety of methods without an international standardisation. Additionally, several co-aspects of speech production have to be considered: tongue mobility, voice production, velopharyngeal closure and neural coordination are important influencing factors. Speech assessment is traditionally performed by perceptual methods on a subjective or semi-subjective base. More objective, technical-based methods of speech evaluation are in development and under research.

Purpose

It was the aim of this overview to specify speech and speech-related aspects as well as to delineate measurement methods of speech outcome in patients with oral cancer by a review of the current literature.     

Hyperbare Sauerstofftherapie bei Unterkiefer-Osteomyelitis

Background

Chronic osteomyelitis of the jaw is a relapsing disease with multiple treatment strategies described in the literature. Hyperbaric oxygen therapy is one of them. The purpose of this study was to evaluate the clinical outcome of hyperbaric oxygen therapy in these patients.

Method

All patients with a chronic osteomyelitis of the mandible who received in our department hyperbaric oxygen therapy between 2000 and 2004 were included in this study. The clinical outcome (lack of symptoms e.g. pain, swelling, etc.) was the pivotal evaluation parameter. All patients were divided in three groups according to their medical history. Group 1: All patients with osteomyelitis of the mandible, who received no treatment before. Group 2: All patients with one local relapse, who received only antimicrobial treatment. Group 3: Patients with at least one local relapse after antimicrobial and surgical treatment.

Results

27 patients were evaluated in this study. Seven out of 13 patients in group 1 were relapse free after performing 40 hyperbaric oxygen therapies. However, only 4 of 9 patients in group 3 were relapse free after treatment. In group 2 the hyperbaric oxygen therapy was successful particularly in the younger patients (3 of 4).

Conclusion

Adjuvant hyperbaric oxygen therapy was successful in the treatment of patients with chronic recurrent osteomyelitis of the mandible. Therefore, it is an treatment option which can avoid ablative surgery in some cases.     

Fully automatic CAD design of the occlusal morphology of partial crowns compared to dental technicians' design

Objectives

The aim of this study was to compare the occlusal morphology of partial crown reconstructions made by dental technicians with reconstructions made by a fully automatic software process (biogeneric tooth model) in relation to the original natural tooth shape.

Material and methods

Stone replicas of natural teeth were measured three-dimensionally before preparing inlay and onlay cavities for ceramic restorations (n?=?5). For each preparation, five reconstructions (in total n?=?25) were made by five dental technicians. Additionally, reconstructions were calculated automatically by a software based on the biogeneric tooth model (Cerec 3D). In order to compare the two different kinds of reconstruction, an objective metrical similarity measure (shape similarity value, SSV) based on calculated volumes between compared datasets was used.

Results

In 22 of 25 cases, the reconstructions made by the CAD software were closer to the original situation than the reconstructions made by the technicians. Mean average SSV of reconstructions made by the technicians (310.2?±?78.8 μm) was significantly higher (p?<?0.05) than mean SSV of CAD reconstructions (biogeneric model) (222.0?±?47.7 μm).

Conclusions

In the design of naturally shaped occlusal inlay/onlay surfaces, a fully automatic CAD system can be at least as good as conventional wax-ups by dental technicians.

Clinical relevance

The adjustment of a dental restoration to fit the morphology of surrounding tooth structures, still presents challenges for the dentist.     

Application of computer-aided designed/computer-aided manufactured techniques in reconstructing maxillofacial bony structures

Background

Today, virtually planned surgery and computer-aided designed/computer-aided manufactured (CAD/CAM) tools to reconstruct bony structures are being increasingly applied to maxillofacial surgery. However, the criteria for or against the usage of the CAD/CAM technique are disputable, since no evidence-based studies are available. Theoretically, the CAD/CAM technique should be applied to complex cases. In this case report, we present our experiences and discuss the criteria for application.

Case report

Three cases are reported in which subjects received an osseous reconstruction using CAD/CAM techniques. In the first case, resection of the mandibular body and ramus was carried out, and reconstruction with a vascularised iliac bone transplant was performed. During surgery, a repositioning of the ipsilateral condyle was necessary. The second case comprised a wide mandibular reconstruction together with a repositioning of the condyles and the soft tissue chin using a two-segment osteomyocutaneous fibula flap. In the third case, a two-flap technique consisting of a double-barrelled osseous fibula flap and a radial forearm flap was applied to cover a wide palatine defect.

Conclusion

Our experience suggests that the CAD/CAM technique provides an accurate and useful treatment not only in complex cases, but also in simpler ones, to achieve an anatomically correct shape of the bone transplant and to reposition adjacent structures.     

Three-unit CAD/CAM-generated lithium disilicate FDPs after a mean observation time of 46 months

Objectives

Lithium disilicate can easily be machined by CAM techniques in its metasilicate status. Due to slightly inferior material properties, the material is not yet recommended for three-unit fixed dental prosthesis (FDP) as it is the case for the press material up to the second bicuspid. Therefore, the aim of this clinical study was to evaluate the performance of CAD/CAM-fabricated lithium disilicate FDPs.

Materials and methods

A total of 32 anterior and posterior FDPs were provided for 32 patients. Twelve FDPs were fabricated chair-side. The first recall took place 6 months after insertion and then annually. The FDPs were rated according to biological and technical complications. As failure, those events were defined, which led to the removal of a FDP. The failure-free (survival) rate and the complication-free rate were calculated according to Kaplan–Meier.

Results

After a mean observation time of 46 months (SD?±?8.4 months), three endodontic complications in two FDPs, two minor chippings, and one catastrophic fracture occurred. One FDP had to be removed due to persisting undefined complaints. Thus, the failure-free rate and the complication-free rate were revealed as 93 and 83 %, respectively.

Conclusions

Despite the limited observation period, the results are promising, especially due to the fact that the fractured FDP did not fulfill the recommended connector dimensions.

Clinical relevance

Inserted as a full-contour three-unit FDP within its indications, the CAD/CAM lithium disilicate ceramic offers an appropriate alternative to layered restorations.     

Effectiveness of supervised implementation of an oral health care guideline in care homes; a single-blinded cluster randomized controlled trial

Objectives

The objective of this study was to assess the effectiveness of a supervised implementation of the “Oral health care Guideline for Older people in Long-term care Institutions” (OGOLI) in The Netherlands.

Materials and methods

A sample of 12 care homes in the Netherlands was allocated randomly to an intervention or control group. While the residents in the control group received oral health care as before, the intervention consisted of a supervised implementation of the OGOLI.

Results

At baseline, the overall random sample comprised 342 residents, 52 % in the intervention group and 48 % in the control group. At 6 months, significant differences were observed between the intervention and the control group for mean dental as well as denture plaque, with a beneficial effect for the intervention group. The multilevel mixed-model analyses conducted with the plaque scores at 6 months as outcome variables showed that the reduction by the intervention was only significant for denture plaque.

Conclusions

Supervised implementation of the OGOLI was more effective than non-supervised implementation in terms of reducing mean plaque scores at 6 months. However, the multilevel mixed-model analysis could not exclusively explain the reduction of mean dental plaque scores by the intervention.

Clinical relevance

A supervised implementation of an oral health care guideline improves oral health of care home residents.     

Veränderung der Nasalanz nach Le Fort-I Osteotomie

Background

Nasalance represents a measure of the relative amount of oral and nasal acoustic energy produced by a speaker. Literature shows changes in nasalance after surgery of the oropharynx. The aim of this prospective study was to evaluate the outcome of speech and nasalance scores after Le-Fort-I-Osteotomy.

Patients and methods

A total of 20 individuals with normal speech development were examined preoperatively and 6 weeks postoperatively with the Nasometer 6200 (Kay-Elemetrics, USA) after bimaxillary surgery. The tone materials used comprised the standardized text passage: ?Ein Kindergeburtstag“, the vowels: /a/, /e/, /i/, /o/, /u/ and a syllable repetition subtest.

Results

All patients showed changes in nasalance scores 6 weeks postoperatively. There were no significant changes reading the standard text. The syllable repetition test showed significant changes for repetition of ?ma ma ma“ and ?na na na“ (p?=?0,003, respectively p?=?0,033). Intonation of the vowel /a/ also revealed significant changes regarding the pre- and postoperative values (p?=?0,006). However, the obtained values had no significant impact on the nasality characteristics of speech.

Conclusion

This study confirms that maxillary osteotomies can result in significant changes of nasalance scores. However these changes do not have any impact on normal speech and voice.     

Auricular acupuncture effectively reduces state anxiety before dental treatment—a randomised controlled trial

Objectives

The objective of this study was to analyse whether auricular acupuncture, acupuncture at the outer ear, could reduce state anxiety before dental treatment.

Methods

This prospective, randomised patient-blinded study with 182 patients compared anxiety before dental treatment following auricular acupuncture at the relaxation-, tranquillizer- and master cerebral points (auricular acupuncture group) versus acupuncture at sham points (finger-, shoulder- and tonsil points; sham group) and a non-intervention control group. Anxiety was assessed using the Spielberger State Trait Anxiety Inventory (German version) before auricular acupuncture and 20?min thereafter, immediately before dental treatment.

Results

Auricular acupuncture reduced state anxiety score more effectively from 54.7?±?10.8 to 46.9?±?10.4 (mean ± SD) than sham acupuncture from 51.9?±?10.2 to 48.4?±?10.0. In contrast, state anxiety in the control group increased from 51.0?±?11.7 to 54.0?±?11.6 (mean increase +3.0; CI +4.7 to +1.2). The decrease in state anxiety in both intervention groups was statistically significant (p?<?0.001) when compared to the non-intervention control group. After correcting for group differences in baseline state anxiety, the reduction in anxiety was ?7.3 score points (CI ?9.0 to ?5.6) in the auricular acupuncture group and ?3.7 score points (CI ?5.4 to ?1.9) in the sham group (p?=?0.008).

Conclusion

Auricular acupuncture, a minimally invasive method, effectively reduces state anxiety before dental treatment.

Clinical relevance

Auricular acupuncture could be an option for patients scheduled for dental treatment, who experience an uncomfortable degree of anxiety and request an acute intervention for their anxiety.     

Monolithic and bi-layer CAD/CAM lithium–disilicate versus metal–ceramic fixed dental prostheses: Comparison of fracture loads and failure modes after fatigue

Objectives

The authors analyzed the effect of fatigue on the survival rate and fracture load of monolithic and bi-layer CAD/CAM lithium–disilicate posterior three-unit fixed dental prostheses (FDPs) in comparison to the metal–ceramic gold standard.

Materials and methods

The authors divided 96 human premolars and molars into three equal groups. Lithium–disilicate ceramic (IPS-e.max-CAD) was milled with the CEREC-3-system in full-anatomic FDP dimensions (monolithic: M-LiCAD) or as framework (Bi-layer: BL-LiCAD) with subsequent hand-layer veneering. Metal–ceramic FDPs (MC) served as control. Single-load-to-failure tests were performed before and after mouth-motion fatigue.

Results

No fracture failures occurred during fatigue. Median fracture loads in [N], before and after fatigue were, respectively, as follows: M-LiCAD, 1,298/1,900; BL-LiCAD, 817/699; MC, 1,966/1,818. M-LiCAD and MC FPDs revealed comparable fracture loads and were both significantly higher than BL-LiCAD. M-LiCAD and BL-LiCAD both failed from core/veneer bulk fracture within the connector area. MC failures were limited to ceramic veneer fractures exposing the metal core. Fatigue had no significant effect on any group.

Conclusions

Posterior monolithic CAD/CAM fabricated lithium–disilicate FPDs were shown to be fracture resistant with failure load results comparable to the metal–ceramic gold standard. Clinical investigations are needed to confirm these promising laboratory results.

Clinical relevance

Monolithic CAD/CAM fabricated lithium–disilicate FDPs appeared to be a reliable treatment alternative for the posterior load-bearing area, whereas FDPs in bi-layer configuration were susceptible to low load fracture failure.     

Relationship between occlusal findings and orofacial myofunctional status in primary and mixed dentition

Aim

The aim of this study was to provide basic representative data on the prevalence of malocclusions involving space deficiency in both primary and early mixed dentition and to examine the relationship between these malocclusions and orofacial dysfunctions. The results should be viewed from an orthodontic prevention and early treatment perspective.

Subjects and methods

Orthodontic findings in the maxilla and mandible as well as the myofunctional status of 766 children in primary dentition and 2,209 children in mixed dentition were examined clinically in a cross-sectional study. The following parameters from each jaw were subjected to orthodontic analysis: crowding in the anterior and posterior regions of the maxilla and mandible in primary and mixed dentitions, deviations from normal maxillary arch forms in the primary dentition, deviations from normal anterior maxillary arch width in mixed dentition and maxillary apical base morphology in mixed dentition. Static and dynamic orofacial dysfunctions were documented with reference to specific parameters and clinical tests.

Results

Crowding was observed in every tenth child in primary dentition (10.8%) and in every second child in mixed dentition (49.7%). Habitual open mouth posture, visceral swallowing, articulation disorders and oral habits were statistically significantly more frequent in children in primary dentition presenting a narrow maxillary arch. Reduced anterior maxillary arch width (compression) was statistically more frequent in children in early mixed dentitions with habitual open mouth posture. A narrow maxillary apical base correlated positively with all the orofacial dysfunctions analyzed.

Conclusions

Deviations from a regular arch form become apparent very early during dentition development and coexist with specific orofacial dysfunctions. They are thus important indicators for the early detection of functional abnormalities, causing deviations from normal dentition development. In children with orofacial dysfunctions the development of a narrow maxillary dental arch should be prevented by myofunctional therapy and by educating the parents. Interceptive orthodontic measures to treat a narrow maxillary arch in primary and early mixed dentition should also focus on eliminating functional disturbing factors, such as orofacial dysfunctions. Interdisciplinary cooperation with specialists in other fields of medicine, e.g. otorhinolaryngology and speech therapy, is essential to achieve this goal.     

Non-surgical periodontal therapy influences salivary melatonin levels

Objectives

Melatonin is a hormone, which is involved in the control of the circadian rhythm, but also acts as an antioxidant and immune modulator. Previous studies reported decreased salivary and serum melatonin levels in periodontitis. This prospective cohort trial assessed the effect of non-surgical periodontal therapy on melatonin levels.

Methods

Salivary and serum samples of 60 participants (30 patients suffering from a severe generalized form of periodontitis, 30 healthy controls) were collected at baseline and 19 samples of periodontitis patients after treatment. Salivary and serum melatonin levels were determined by a commercially available ELISA kit and serum C-reactive protein (CRP) by a routine laboratory test.

Results

At baseline, periodontitis patients showed significantly increased serum CRP values and significantly decreased salivary melatonin levels compared to the control group. Clinical periodontal parameters significantly correlated with salivary melatonin levels and serum CRP. Periodontal therapy resulted in a recovery of the decreased salivary melatonin levels and a negative correlation was detected for the changes of salivary melatonin and the inflammatory parameter bleeding on probing. Serum melatonin levels showed no significant differences.

Conclusions

Salivary melatonin levels recovered after periodontal therapy and correlated with a decrease of local periodontal inflammation. This may imply the local involvement of melatonin in the pathogenesis of periodontitis due to its antioxidant abilities. However, the exact role of melatonin in periodontal disease remains to be investigated in future trials.

Clinical relevance

The present results suggest salivary melatonin as a risk indicator for the severity of periodontal disease.