Clinical and histologic evaluation of a granular bovine bone biomaterial used as an adjunct to GTR with a bioresorbable bovine pericardium collagen membrane in the treatment of intrabony defects

Background: The aim of the present study is to evaluate the clinical and histologic healing of deep intrabony defects treated with guided tissue regeneration (GTR) with a collagen membrane from bovine pericardium and implantation of granular bovine bone biomaterial. Methods: Thirty patients with one deep, combined 1‐ and 2‐wall intrabony defect exhibiting a probing depth ≥6 mm and an associated intrabony defect ≥3 mm were treated with GTR with a bioresorbable collagen membrane from bovine pericardium and adjunct implantation of a granular bovine bone biomaterial. The clinical results were evaluated 1 and 3 years after surgery. In addition, five teeth fulfilling the inclusion criteria but scheduled for extraction because of advanced periodontitis or restorative considerations were treated similarly and then extracted along with a portion of their surrounding periodontal tissues for histologic evaluation 6 months after surgery. Results: Healing was uneventful in all patients. Significant clinical improvements were observed at 1 and 3 years postoperatively (P <0.01; probing depth averaged 4.4 ± 1.6 and 4.7 ± 1.4 mm and clinical attachment level gain was 3.9 ± 1.4 and 3.5 ± 1.3 mm, respectively). The histologic evaluation revealed formation of new cellular cementum and new periodontal ligament in four of the five cases. In general, the xenograft particles seemed to be mostly embedded in connective tissue without any evidence of new bone formation. Conclusion: GTR treatment of intrabony defects with the collagen membrane from bovine pericardium and adjunct implantation of the new bovine bone biomaterial may result in significant clinical improvements that can be maintained over a period of 3 years, and regeneration of cementum and periodontal ligament, but without bone formation.     

The use of PVP-iodine as an adjunct to non-surgical treatment of chronic periodontitis

OBJECTIVE: The present study was performed to assess the effect of topically-applied PVP-iodine, used as an adjunct both during basic non-surgical therapy and at re-treatment during the long-term maintenance of patients with advanced periodontal disease. MATERIAL AND METHODS: 223 patients with advanced destructive periodontitis were recruited. The participants met the following inclusion criteria: (i) a minimum of 8 non-molar teeth, (ii) probing pocket depth of > or = 6 mm at > or = 2 teeth in each dentate quadrant, and radiographic bone loss exceeding 40% at the same teeth. A baseline I examination included assessment of plaque, gingivitis, probing pocket depth (PPD), probing attachment level (PAL) and radiographic bone height (RxBL). Following baseline I, the patients were stratified into 2 treatment groups; 2 subjects out of 3 were included in a control group and 1 in a test group. All participants, on an individual basis, received a case presentation and were instructed in proper self-performed plaque control measures. Non-surgical therapy was performed by the use of an ultrasonic device. The instrumentation in the test group was combined with the administration of 0.1% PVP-iodine. All subjects were recalled for comprehensive examinations 3, 6 and 12 months (baseline II) after baseline I and then after 3, 5 and 13 years of maintenance therapy. PAL determinations were performed annually. Subjects (losers) who at the re-examinations after 1, 2 and 3 years of maintenance demonstrated an annual further loss of PAL > or = 2 mm at > or = 4 teeth were exited from the study and referred for re-treatment. There were 9 losers in the test and 31 in the control group. In addition, 8 subjects in the test and 25 subjects in the control group withdrew from the trial for reasons unrelated to the study. These 73 subjects were not included in the data presentation from the various examinations. RESULTS: It was demonstrated that non-surgical periodontal therapy resulted in (i) improved gingival conditions, (ii) reduced PPD, (iii) gain in PAL. It was also documented that the topical application of 0.1% PVP-iodine in conjunction with the mechanical root debridement established conditions which further improved the outcome of therapy. This was evidenced by the fact that at the 3, 6, and 12 months re-examinations after baseline I, the test group had significantly lower mean PPD values and significantly more gain of PAL than the control group. During the 12 years of SPT, it was possible for most subjects in both groups to maintain shallow pockets and to avoid marked further loss of PAL. There were, however, a larger number of losers in the control than in the test group. CONCLUSION: PVP-iodine, topically applied during subgingival instrumentation, may improve the outcome of non-surgical periodontal therapy.     

Oily calcium hydroxide suspension (Osteoinductal) used as an adjunct to guided bone regeneration: an experimental study in rats

OBJECTIVES: To evaluate whether an oily calcium hydroxide suspension (OCHS) promotes bone healing when used as an adjunct to guided bone regeneration (GBR). MATERIAL AND METHODS: Rigid, hemispherical, teflon capsules were placed with their open part facing the lateral surface of the ramus on both sides of the mandible in 10 adult Wistar rats. In each animal, one capsule was filled out with an OCHS (test) before placement, while the capsule on the other side was left empty (control). After 4 months of healing, the animals were sacrificed and histological sections containing the capsules and the neighboring soft and hard tissues were prepared. On three to four sections taken by uniformly random sampling from each specimen, the relative volumes of (1) the newly formed bone (mineralized bone and marrow), (2) the soft connective tissue, (3) the residual OCHS, and (4) the acellular (empty) space inside the capsule were estimated by a point-counting technique, and expressed as percentage of the space originally created by the capsule. RESULTS: There was no new bone formation inside the capsules in all but one test specimen, where only a minimal amount of newly formed bone could be observed in continuation with the lateral surface of the ramus. OCHS had a homogenous appearance and occupied the major portion (79.4%) of the space created by the capsule. No signs of active resorption of the material could be observed. On the contrary, 31.5% of the space provided by the capsule was filled out with newly formed bone in the control group. The new bone had a trabecular appearance with large marrow spaces filled with hematopoietic and fatty marrow. The rest of the capsule space in the controls appeared empty. CONCLUSION: OCHS may hamper bone healing when used as an adjunct to GBR.     

High‐power,red‐light‐emitting diode irradiation enhances proliferation,osteogenic differentiation,and mineralization of human periodontal ligament stem cells via ERK signaling pathway

1 Background

Light‐emitting diode (LED) is attracting attention as a new light source for phototherapy. However, its effects on periodontal tissue regeneration remain unknown. The aim of this study was to examine the effects of high‐power, red LED irradiation on human periodontal ligament stem cells (PDLSCs), which play an important role in periodontal tissue regeneration.

2 Methods

PDLSCs were derived from adult human third molars. The light source was red LED (peak wavelength: 650 nm). Energy densities ranging from 0 to 10 J/cm² were tested to determine the optimal dose. PDLSC proliferation was measured using two parameters: live cell protease and ATP levels. After the cells were induced to differentiate, the effect of LED irradiation on osteogenic differentiation and mineralization was examined, with particular focus on the extracellular signal‐regulated kinase (ERK)1/2 signaling pathway using an ERK inhibitor (PD98059).

3 Results

LED irradiation at 8 J/cm² led to a significant increase in PDLSC proliferation and enhanced Runx2 and Osterix mRNA expression, Alkaline phosphatase activity, procollagen type I C‐peptide and osteocalcin production, calcium deposition, and alizarin red S staining. In addition, LED induced the activation of ERK1/2, and the effects of LED on PDLSC proliferation, differentiation, and mineralization could be suppressed by treatment with PD98059.

4 Conclusions

The results of this study show that 650‐nm high‐power, red, LED irradiation increases PDLSCs proliferation, and osteogenic differentiation and mineralization, mediated by ERK1/2 activation. These findings suggest that LED may be a useful tool for periodontal tissue regeneration.     

Efficacy of statin delivery as an adjunct to scaling and root planing in the treatment of chronic periodontitis: A meta‐analysis

The action of statins in stimulating bone formation and having other pleiotropic effects, such as anti‐inflammatory and immunomodulatory effects, has justified their use as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis (CP). The aim of the present study was to evaluate the efficacy of statin delivery as an adjunct to SRP in the treatment of CP. Electronic searches were conducted using the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register, up until July 2017. The primary outcome was probing depth (PD), while the secondary outcomes were changes in clinical attachment level (CAL) and bone defect (BD) fill. Eleven studies were included, and all showed significant PD reduction, CAL gain, and BD fill with adjunctive statin delivery compared to SRP alone. The meta‐analysis showed significant improvement in periodontal parameters for atorvastatin (PD: weighted mean difference [WMD] = ?1.84, ?2.56 to ?1.12, P < .001; CAL: WMD = ?2.31, ?3.58 to ?1.03, P < .001; BD fill: WMD = 2.66, ?3.92 to ?1.39, P < .001), simvastatin (PD: WMD = ?1.91, ?2.27 to ?1.55, P < .001; CAL: WMD = ?1.91, ?2.27 to ?1.55, P = .001; BD: WMD = ?1.52, ?2.20 to ?0.85, P < .001), and rosuvastatin (PD: WMD = ?0.94, ?1.32 to ?0.55, P < .001; CAL: WMD = ?1.00, ?1.41 to ?0.60, P < .001; BD fill: WMD = ?1.30, ?1.80 to ?0.79, P < .001). Adjunctive statin delivery appears to be effective in reducing PD, CAL gain, and BD fill in CP, and therefore, these drugs could be a promising therapeutic option for periodontal regeneration in future.     

Combined photodynamic and low‐level laser therapies as an adjunct to nonsurgical treatment of chronic periodontitis

Lui J, Corbet EF, Jin L. Combined photodynamic and low‐level laser therapies as an adjunct to nonsurgical treatment of chronic periodontitis. J Periodont Res 2011; 46: 89–96. © 2010 John Wiley & Sons A/S Background and Objective: In recent years, there has been a growing interest in the use of dental lasers for treatment of periodontal diseases. The purpose of this short‐term clinical trial was to evaluate the effects of a combination of photodynamic therapy with low‐level laser therapy as an adjunct to nonsurgical treatment of chronic periodontitis. Material and Methods: Twenty‐four nonsmoking adults with untreated chronic periodontitis were randomly assigned in a split‐mouth design to receive scaling and root debridement with or without one course of adjunctive photodynamic therapy and low‐level laser therapy within 5 d. Plaque, bleeding on probing, probing depth and gingival recession were recorded at baseline, 1 and 3 mo after the treatment. Gingival crevicular fluid was collected for assay of interleukin‐1β levels at baseline, 1 wk and 1 mo. Results: The test teeth achieved greater reductions in the percentage of sites with bleeding on probing and in mean probing depth at 1 mo compared with the control teeth (p < 0.05). A significant decrease in gingival crevicular fluid volume was observed in both groups at 1 wk (p < 0.001), with a further decrease at 1 mo in the test sites (p < 0.05). The test sites showed a greater reduction of interleukin‐1β levels in gingival crevicular fluid at 1 wk than the control sites (p < 0.05). No significant differences in periodontal parameters were found between the test and control teeth at 3 mo. Conclusions: The present study suggests that a combined course of photodynamic therapy with low‐level laser therapy could be a beneficial adjunct to nonsurgical treatment of chronic periodontitis on a short‐term basis. Further studies are required to assess the long‐term effectiveness of the combination of photodynamic therapy with low‐level laser therapy as an adjunct in nonsurgical treatment of periodontitis.     

Local minocycline as an adjunct to surgical therapy in moderate to severe, chronic periodontitis

Objective: The aim of the study was to evaluate the effects of minocycline microspheres on periodontal probing depth reduction when used in combination with surgery in adults with moderate to severe, chronic periodontitis. Material and Methods: Sixty patients with a minimum of one non‐molar periodontal site 6 mm in two oral quadrants received either local minocycline microspheres at baseline, immediately following each of two surgical therapies (Weeks 2 and 3), and at Week 5 or surgery alone. Results: The mean probing depth reduction at Week 25 at sites 5 mm at baseline was 2.51 mm in the test group and 2.18 mm in the control group. Smokers in the test group had a significantly greater probing depth reduction (2.30 mm) than smokers in the control group (2.05 mm). The number of sites with probing depth reductions of 2 and 3 mm were significantly higher in the test group than in the control group. Conclusion: Applications of local minocycline as an adjunct to surgery in adults with moderate to severe, chronic periodontitis were associated with statistically significant greater reductions in probing depth than surgery alone.     

The effect of low-level laser therapy as an adjunct to non-surgical periodontal treatment

Background: The aim of this study is to evaluate the effect of low‐level laser therapy (LLLT) as an adjunct to non‐surgical periodontal therapy of smoking and non‐smoking patients with moderate to advanced chronic periodontitis. Methods: All 36 systemically healthy patients who were included in the study initially received non‐surgical periodontal therapy. The LLLT group (n = 18) received GaAlAs diode laser therapy as an adjunct to non‐surgical periodontal therapy. A diode laser with a wavelength of 808 nm was used for the LLLT. Energy density of 4 J/cm² was applied to the gingival surface after periodontal treatment on the first, second, and seventh days. Each of the LLLT and control groups was divided into two groups as smoking and non‐smoking patients to investigate the effect of smoking on treatment. Gingival crevicular fluid samples were collected from all patients and clinical parameters were recorded on baseline, the first, third, and sixth months after treatment. Matrix metalloproteinase‐1, tissue inhibitor matrix metalloproteinase‐1, transforming growth factor‐β1, and basic‐fibroblast growth factor levels in the collected gingival crevicular fluid were measured. Results: The primary outcome variable in this study was change in gingival bleeding and inflammation. At all time points, the LLLT group showed significantly more improvement in sulcus bleeding index (SBI), clinical attachment level, and probing depth (PD) levels compared to the control group (P <0.001). There were clinically significant improvements in the laser‐applied smokers' PD and SBI levels compared to smokers to whom a laser was not applied, between the baseline and all time points (P <0.001) (SBI score: control group 1.12, LLLT group 1.49; PD: control group 1.21 mm, LLLT group 1.46 mm, between baseline and 6 months). Transforming growth factor‐β1 levels and the ratio of matrix metalloproteinase‐1 to tissue inhibitor matrix metalloproteinase‐1 decreased significantly in both groups at 1, 3, and 6 months after periodontal therapy (P <0.001). Basic‐fibroblast growth factor levels significantly decreased in both groups in the first month after the treatment, then increased in the third and sixth months (P <0.005). No marker level change showed significant differences between the groups (P <0.05). Conclusion: LLLT as an adjunctive therapy to non‐surgical periodontal treatment improves periodontal healing.     

Chlorhexidine mouthwash as an adjunct to mechanical therapy in chronic periodontitis: A meta-analysis

Background

Through a systematic literature review, the authors evaluated the use of chlorhexidine (CHX) mouthwash as an adjunct to mechanical periodontal therapy for chronic periodontitis.

Clinical comparison between the bleaching efficacy of light‐emitting diode and diode laser with sodium perborate

The aim of this clinical study was to test the efficacy of a light‐emitting diode (LED) light and a diode laser, when bleaching with sodium perborate. Thirty volunteers were selected to participate in the study. The patients were randomly divided into two groups. The initial colour of each tooth to be bleached was quantified with a spectrophotometer. In group A, sodium perborate and distilled water were mixed and placed into the pulp chamber, and the LED light was source applied. In group B, the same mixture was used, and the 810 nm diode laser was applied. The final colour of each tooth was quantified with the same spectrophotometer. Initial and final spectrophotometer values were recorded. Mann–Whitney U‐test and Wicoxon tests were used to test differences between both groups. Both devices successfully whitened the teeth. No statistical difference was found between the efficacy of the LED light and the diode laser.