Periodontal Pockets Research Articles

Comparing the Effectiveness of Traditional Periodontal Surgery Versus Non-Surgical Therapy: A Randomized Controlled Trial

ABSTRACT Background: Periodontal disease, characterized by inflammation and infection of the supporting structures of teeth, poses a significant oral health challenge. Traditional periodontal surgery and non-surgical therapy, such as scaling and root planing, are established treatment approaches for addressing periodontal disease Materials and Methods: The study enrolled 120 adult patients diagnosed with moderate to severe periodontal disease. Participants were randomly allocated to one of two groups: the traditional surgery group (TSG) or the non-surgical therapy group (NSTG). In the TSG, patients underwent traditional periodontal surgery, which included flap surgery and grafts when deemed necessary. The surgical procedures were performed by experienced periodontal surgeons. In contrast, the NSTG received non-surgical therapy in the form of scaling and root planing administered by trained dental hygienists. Outcome measures encompassed clinical parameters and patient-centered outcomes. Periodontal pocket depth and clinical attachment level, both measured in millimeters, were assessed at baseline, 3 months, and 6 months. Patient-reported outcomes, including pain, discomfort, and satisfaction, were collected through standardized questionnaires at each follow-up visit. Results: Patients in the TSG experienced a notable reduction in pocket depth from a baseline of 6.8 mm to 3.7 mm at the 6-month mark, resulting in a change of -3.1 mm. Conversely, the NSTG exhibited a reduction from 6.7 mm to 4.0 mm, with a change of -2.7 mm. In the TSG, the baseline attachment level of 7.2 mm decreased to 5.1 mm at 6 months, indicating a change of -2.1 mm. In the NSTG, the attachment level decreased from 7.1 mm to 5.5 mm, resulting in a change of -1.6 mm. Patients in the TSG reported an average pain score of 3.6 on a 1–10 scale, discomfort of 4.2, and satisfaction of 7.8. In contrast, patients in the NSTG reported lower pain (2.1) and discomfort (2.9) scores but similar satisfaction levels (8.4) Conclusion: In this randomized controlled trial (RCT), both traditional periodontal surgery and non-surgical therapy demonstrated improvements in clinical parameters and patient-reported outcomes. Traditional surgery resulted in greater reductions in periodontal pocket depth and clinical attachment loss at the 6-month follow-up.

СПЕКТР МИКРОФЛОРЫ ПАРОДОНТАЛЬНОГО КАРМАНА У ПАЦИЕНТОВ С ХРОНИЧЕСКИМ ПАРОДОНТИТОМ СРЕДНЕЙ СТЕПЕНИ ТЯЖЕСТИ

The purpose of the study. To evaluate the quantitative composition of the microflora of the periodontal pocket in patients with chronic generalized periodontitis of moderate severity. Materials and methods. The study group included 39 patients, of which: 41% (16/39) were men, 59% (23/39) were women, with chronic generalized periodontitis of moderate severity at the age of 48.9±2.3 years. To determine the dental status, clinical research methods were used (questioning, examination), determination of the Green-Vermillion Oral Hygiene Index (OHI-S), (PMA) modified by Parma, the Mulleman-Cowell bleeding index, the degree of pathological tooth mobility was determined using the Miller scale (Miller) modified by Flesar, the complex periodontal index (CPI), identified furcation defects according to the classification of Lindhe J. (1983).Quantitative assessment of the periodontal pockets microflora was performed. Reagent kits “RIBO-prep” (Next-Bio LLC, Russia), DENTOSKRIN® (NPF Litech LLC, Russia) were used to isolate RNA/DNA from clinical material and subsequent analysis by polymerase chain reaction. Spectrum of identifiable bacteria: Porphyromonas endodontalis, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Treponema denticola, Fusobacterium nucleatum, Prevotella intermedia, Tannerella forsythia.The results of the study and their discussion. Fusobacterium nucleatum was found in 84.6% (33) of patients in periodontal pockets, 30.8% (12) – Treponema denticola, 28.2% (11) – Prevotella intermedia, 17.9% (7) – Porphyromonas gingivalis and Porhyromonas endodontalis. Aggregatibacter actinomycetemcomitans was isolated only in 5.1% (2) of individuals, Tannerella forsythia – in 2.6% (1). Combinations of 4 microorganisms were detected in 20.5% (8), from 3 - in 12.8% (5), from 2 - 15.4% (6). In 12.8% (5) of the examined patients were not isolated from any of the studied periodontal pathogens. When checking correlations between the level of hygiene and the number of pathogenic microorganisms detected, a moderate direct relationship was established between the value of the OHI-S index and the amount of Fusobacterium nucleatum r=0.36 (p<0.05) and Prevotella intermedia r=0.30 (p<0.05), as well as a moderate direct relationship between the value of the PMA index and the amount of Porphyromonas gingivalis r=0.33 (p<0.05), Porphyromonas endodontalis r=0.31 (p<0.05), Prevotella intermedia r=0.30.Conclusion. In patients with chronic periodontitis of moderate severity, a microbial biofilm is formed on the surface of the periodontium, represented by anaerobic bacteria. In periodontal pockets, the amount of Fusobacterium nucleatum and Prevotella intermedia increases with the deterioration of the hygienic condition of the oral cavty. With the development of inflammation in the gum tissues, periodontal pathogens Porphyromonas gingivalis and Porphyromonas endodontalis are more often detected, having more aggressive invasive and toxic properties in relation to periodontal tissues.

Interspecies metabolite transfer fuels the methionine metabolism of Fusobacterium nucleatum to stimulate volatile methyl mercaptan production.

The major oral odor compound methyl mercaptan (CH3SH) is strongly associated with halitosis and periodontitis. CH3SH production stems from the metabolism of polymicrobial communities in periodontal pockets and on the tongue dorsum. However, understanding of CH3SH-producing oral bacteria and their interactions is limited. This study aimed to investigate CH3SH production by major oral bacteria and the impact of interspecies interactions on its generation. Using a newly constructed large-volume anaerobic noncontact coculture system, Fusobacterium nucleatum was found to be a potent producer of CH3SH, with that production stimulated by metabolic interactions with Streptococcus gordonii, an early dental plaque colonizer. Furthermore, analysis of extracellular amino acids using an S. gordonii arginine-ornithine antiporter (ArcD) mutant demonstrated that ornithine excreted from S. gordonii is a key contributor to increased CH3SH production by F. nucleatum. Further study with 13C, 15N-methionine, as well as gene expression analysis, revealed that ornithine secreted by S. gordonii increased the demand for methionine through accelerated polyamine synthesis by F. nucleatum, leading to elevated methionine pathway activity and CH3SH production. Collectively, these findings suggest that interaction between S. gordonii and F. nucleatum plays a key role in CH3SH production, providing a new insight into the mechanism of CH3SH generation in oral microbial communities. A better understanding of the underlying interactions among oral bacteria involved in CH3SH generation can lead to the development of more appropriate prophylactic approaches to treat halitosis and periodontitis. An intervention approach like selectively disrupting this interspecies network could also offer a powerful therapeutic strategy.IMPORTANCEHalitosis can have a significant impact on the social life of affected individuals. Among oral odor compounds, CH3SH has a low olfactory threshold and halitosis is a result of its production. Recently, there has been a growing interest in the collective properties of oral polymicrobial communities, regarded as important for the development of oral diseases, which are shaped by physical and metabolic interactions among community participants. However, it has yet to be investigated whether interspecies interactions have an impact on the production of volatile compounds, leading to the development of halitosis. The present findings provide mechanistic insights indicating that ornithine, a metabolite excreted by Streptococcus gordonii, promotes polyamine synthesis by Fusobacterium nucleatum, resulting in a compensatory increase in demand for methionine, which results in elevated methionine pathway activity and CH3SH production. Elucidation of the mechanisms related to CH3SH production is expected to lead to the development of new strategies for managing halitosis.

Oral health status and associated factors among 12 to 15-year-old Chinese adolescents in Southeast China: A cross-sectional study.

This study assessed oral health conditions and associated factors (including sociodemographic characteristics and self-reported oral health-related behaviors) among Chinese adolescents. This cross-sectional study enrolled 3840 adolescents aged 12 to 15 years from 12 middle schools in Foshan, Southeast China, in 2016, using multistage, stratified cluster sampling. Participants underwent a clinical oral examination and completed a questionnaire. The prevalence of dental caries, probe bleeding, and calculus was 37.6%, 46.2%, and 39.7%, respectively; the mean decayed/missed/filled teeth index was 0.86 ± 1.58. A mean of 2.09 ± 3.65 and 1.85 ± 3.52 teeth showed probe bleeding and calculus, respectively. Only 0.3% and 0.1% of adolescents aged 15 years had periodontal pockets (depth ≥ 4 mm) and attachment loss, respectively, which were most common in tooth positions 46 and 36 (Federation Dentaire International 2-digit system). Regarding oral health-related behavior, 49.1% of the participants failed to brush their teeth at least twice daily, 98.5% never or rarely used dental floss, and 58.7% reported middle-high frequency sugar consumption. Older age, female, administrative region, maternal education lower than university, brushing teeth less than twice daily, flossing less than once daily, and frequent sugar consumption were significant risk factors of caries. Older age, female, administrative region, brushing less than twice daily, and flossing less than once daily significantly increased periodontal risk. Despite the overall low prevalence of adverse dental conditions among adolescents in Foshan, their oral hygiene habits were undeveloped. Thus, their identified risk factors need close monitoring, and families, schools, communities, and the government should jointly promote adolescents' oral health.

Small Extracellular Vesicles Laden Oxygen-Releasing Thermosensitive Hydrogel for Enhanced Antibacterial Therapy against Anaerobe-Induced Periodontitis Alveolar Bone Defect.

Periodontitis is a bacterially induced chronic destructive inflammatory disease that leads to irreversible destruction of the tooth supporting structure, including connective tissue destruction, bone resorption, and even tooth loss. Until now, there has been no effective treatment to repair inflammatory bone loss in periodontitis. Recently, small extracellular vesicles (sEVs) emerged as the essential paracrine factors of mesenchymal stem cells (MSCs) that mediated tissue regeneration. However, limitations of antimicrobial activity associated with the use of sEVs have led to the urgency of new alternative strategies. Currently, we investigated the potential of a biocompatible oxygen-releasing thermosensitive hydrogel laded with sEVs secreted by bone marrow MSCs (BMMSCs) for the alveolar bone defect in periodontitis. The hydrogel composed of different polymers such as chitosan (CS), poloxamer 407 (P407), and cross-linked hyaluronic acid (c-HA) conglomerating is a kind of nanoporous structure material. Then, the gel matrix further encapsulated sEVs and calcium peroxide nanoparticles to realize the control of sEVs and oxygen release. Furthermore, ascorbic acid was added to achieve the REDOX equilibrium and acid-base equilibrium. The experiments in vivo and in vitro proved its good biocompatibility and effectively inhibited the growth of the periodontal main anaerobe, relieved periodontal pocket anaerobic infections, and promoted the periodontal defect regeneration. Therefore, this finding demonstrated that it was a promising approach for combating anaerobic pathogens with enhanced and selective properties in periodontal diseases, even in other bacteria-induced infections, for future clinical application.

Evaluate the effect of the metranidazole gel on healing of partial thickness flap in rats (serum TNF-a)

Background: Metronidazole is a broad-spectrum antimicrobial activity against protozoan infections and anaerobic bacteria. In the late 1950s, Metronidazole was first introduced for the treatment of trichomoniasis. At present, the antimicrobial metronidazole is one of the most widely used as antibacterial compounds in the treatment of periodontal disease 9. Beside the periodontal pocket debridement (subgingival scaling and curettage), topical application of metronidazole seems to be very efficacious. Metronidazole efficiently inhibited anaerobic microorganisms in the periodontal pockets 10.
 Objective: Evaluating the effect of metronidazole gel into surgically healing process of the partial thickness flap, throughout immunological study and comparing it with the chlorhexidine gel
 Animals and methods: The present study was carried out in Hawler Medical University, Medical research center, College of Dentistry
 Chemicals and Reagents:- (Rat TNF-a ELISA) kit for estimation of serum tumor necrosis factor (TNF-a), KOMA BIOTECH INC. USA)

Impact of Suturing Techniques on the Periodontal Health Status of Mandibular Second Molar After Extraction of Fully Impacted Third Molars

Mandibular third molars are appeared to be the most common congenitally impacted teeth the fact that may cause many problems in different fields of dentistry. surgical removal of the impacted tooth seems to be the only solution for these problems. An important complication to address is the risk of developing periodontal breakdown ( loss of attachment) and deep periodontal pocket on the distal aspect of the adjacent mandibular second molar after surgical removal of third molar. The aim of the present study is to evaluate and compare the effect of 4 suturing techniques: (Simple loop , Figure 8 suture, Anchor suture and Closed anchor suture) on the periodontal health status on the distal aspect of the adjacent mandibular second molar after surgical removal of lower impacted third molar.Forty patients having fully impacted mandibular third molars were enrolled in this study and divided to 4 groups (Group A: Simple loop , Group B: Figure 8 suture, Group C: Anchor suture and Group D: Closed anchor suture), each group consisted of 10 patients. Surgical extraction of impacted third molars were carried out for them. Probing pocket depth (PPD) and clinical attachment level (CAL) were recorded preoperatively and 6 months after surgery. On 6 months after surgery the mean values of PPD and CAL were significantly increased on the distal surface of the adjacent mandibular second molar in simple loop & figure 8 techniques. On the other hand, no significant difference has been noticed between anchor & closed anchor techniques in comparison with preoperative values. After 6-months, PPD and CAL values of were significantly higher in thesimple loop and figure 8 techniques compared to anchor andclosed anchor techniques. The present study concluded that closedanchor suture & anchor suture techniques are preferable to closethe flaps in surgical removal of impacted mandibular third molarsto maintain a good health status on the distal side of the adjacentmandibular second molar.

An Adult with Untreated Isolated Cleft Palate Since Birth: A Rare Case Report

Introduction: Orofacial clefts are one of the most common congenital anomalies involving the craniofacial region. An isolated cleft palate is the rarest (33% of all orofacial clefts) among individuals with female predominance. Individuals born with these clefts manifest craniofacial, functional, and psychological anomalies. Sometimes, patients cannot receive the required therapies due to a lack of awareness and lack of medical access or economic factors. Untreated clefts may adversely impact the patient’s life both physically and psychologically.
 Case Description: This study presents a case report of a 45-year-old male with an untreated cleft palate since birth due to a low socioeconomic background, leading to several oro-dental anomalies, speech defects, and psychological and social challenges.
 Results: Extraoral examination revealed mild facial asymmetry, dry and incompetent lips, and underdeveloped philtrum. Intraorally, there was a cleft palate, macroglossia, soft and edematous gingiva with bleeding on probing, gingival recession, and periodontal pockets, along with various dental anomalies. Full mouth orthopantomogram showed discontinuity of the palatal line, collapsed maxillary arch, root stumps, and crowding. The final diagnosis of isolated cleft palate was made. The patient was advised for surgery regarding the cleft palate, dental treatment, speech therapy, and psychological counseling. However, the patient refused all treatments except a few dental aids due to economic difficulties.
 Conclusion: The present case report highlights the need for these patients to receive particular concerns. Patients must be motivated to get proper treatment at a suitable stage to prevent future complications. Cleft teams must be advised to initiate some encouraging steps in imparting treatment aids to such patients, especially in rehabilitation therapy, considering their surrounding environment, psychological makeup, socioeconomic status, and motivation. In addition, social groups should also treat these patients with a positive approach, helping them to live healthy and normal lives just like any other individual.

Efficacy of Intra-Pocket Application of Two Antimicrobial Agents as an Adjunct to Mechanotherapy of Chronic Periodontitis (a Comparative Study)

Numerous studies have been performed to evaluate the effectiveness of the use of locally delivered antimicrobials as an adjunct to mechanotherapy in treatment of chronic periodontitis. Some studies were resulted in improved clinical outcomes and others were not. The aim of this study is evaluation of the efficacy and safety of subgingival application of a (10 mg metronidazole gel), (1% chlorhexidine collagen gel) and (CHLOSITE® GHIMAS, Italy) gel which is a combination of two chlorhexidine formulations: 0.5% chlorhexidine digluconate and 1.0% chlorhexidine dihydrochloride), as an adjunct to mechanical treatment (scaling and root planing) (SRP) of chronic periodontitis. A total of 120 sites from 15 patients with age range of (24-55 years), who had periodontal pockets measuring 5-9 mm and had been diagnosed as chronic periodontitis cases, were selected for the study. The 4-quadrant split-mouth design was used in this study. The pocket sites in each patient were randomly assigned to 4 groups (30 sites for each):(Group A) GA=(SRP) only.(Group B) GB=(SRP) + 10 mg metronidazole gel.(Group C) GC=(SRP) + 1% chlorhexidine collagen gel. (Group D) GD=(SRP) + CHLOSITE®Clinical parameters including (plaque index PI), (gingival index GI), (gingival bleeding index) GBI, (probing pocket depth PPD) & (clinical attachment level CAL) were measured and recorded at baseline before any treatment at (day 0) then the treatment was performed at the same day, The clinical parameters were also recorded at (day 30) & (day 90), in the selected sites of the four groups. The results of this study obviously showed a statistically significant reduction of all clinical parameters in all groups at (day 30 & day 90) from the base line (day 0). GD=(SRP) + CHLOSITE® revealed a reduction of the clinical parameters than groups (A, B and C) and the differences were highly statistically significant.

Analysis of influencing factors of anxiety and depression in patients with periodontitis.

Periodontitis is a chronic oral disease caused by pathogenic microorganisms that corrode tooth tissue, form periodontal pockets, absorb alveolar bone, and finally lead to tooth loss. During treatment, patients are prone to anxiety, tension, and other negative emotions, which affect their ability to face the disease and may also lead to aggravation of the original condition and affect oral health. Therefore, it is important to improve the negative psychology of patients with periodontitis to clarify the factors that may lead to negative psychological emotions. To investigate the risk factors that may lead to anxiety and depression in patients with periodontitis. One hundred patients with periodontitis were selected between March 2022 and March 2023 at our hospital. All patients were assessed with the Zung Self-rating Depression Scale (SDS) (≥ 53 points indicate a depressive state) and Zung Self-rating Anxiety Scale (SAS) (≥ 50 points indicates an anxious state). In this study, patients who experienced anxiety or depression were included in the occurrence group and those without anxiety or depression were included in the non-occurrence group. The baseline data of the two groups were compared to explore the risk factors for anxiety and depression in patients with periodontitis. A total of 100 patients with periodontitis were included in this study. According to the SDS, 38 patients (38.00%) developed depression, with an average SDS score of (68.52 ± 5.85) points. According to the SAS, 40 patients (40.00%) developed anxiety, and the average SAS score was (72.15 ± 4.15) points. In this study, 56 patients with anxiety or depression were included. Compared with the non-occurrence group, the occurrence group had higher ages (≥ 60 years), lower level of hope (low level), educational level (high school or below), disease perception (poor), and sleep disorder (yes). The negative coping dimension scores of the simplified coping style questionnaire (SCSQ) and Dental Fear Scale (DFS) in the occurrence group were higher, whereas the score of the positive coping dimension of the SCSQ was significantly lower (P < 0.05). There were no significant differences in the other data between the groups (P > 0.05). The results of multiple logistics regression analysis showed that age (≥ 60 years), level of hope (low level), educational level (high school or below), disease perception (poor), sleep disorder (yes), high negative coping dimension scores of SCSQ, high score of DFS, and low positive coping dimension scores of SCSQ were all factors contributing to the anxiety and depression in patients with periodontitis (odds ratio > 1, P < 0.05). Age, hope level, educational level, disease perception, sleep disorders, coping style, and dental fear were all associated with anxiety and depression in patients with periodontitis.

MMP-7 Levels Decrease in Gingival Epithelium Exposed to Porphyromonas Gingivalis after Curcumin administration

Periodontitis is an irreversible inflammatory disease of the periodontal tissues. The leading cause of periodontitis is Porphyromonas gingivalis bacteria, which secretes virulence factors, namelyLipopolysaccharide (LPS) and proteases, which cause the inflammation of gingival junctional epithelium and loss of attachment, resulting in the formation of a periodontal pocket. The most common type of MMP found in the junctional epithelium is MMP-7. Invasion of Porphyromonas gingivalis bacteria causes an increase in proteolytic activity on the expression and activation of MMP-7, which causes loss of attachment. Efficacious plant extracts, namely irrigated curcumin 1%, have an anti-inflammatory effect. This research is independent research using experimental white rats (Rattus norvegicus) male strain Wistar, 20 weeks old, with a body weight of 325-350 grams. This research is to see the levels of MMP-7 with the ELISA method. Forty-eight periodontitis model rats were divided into two groups. Twenty-four periodontitis model rats as the control group were exposed to Porphyromonas gingivalis, and another twenty-four periodontitis model rats as the treatment group were exposed to Porphyromonas gingivalis and 1% curcumin irrigation. Each group was observed at 24 hours, on days-7 and days-14. The results showed that MMP-7 levels in the treatment group were significantly lower than in the control group on on days-7 and days-14. In the treatment group, MMP-7 levels at 24 hours were significantly lower than on the on days-7 and days-14. In the treatment group, MMP-7 levels did not experience a significant difference between the on days-7 and days-14. The results of this study indicate that 1% curcumin can reduce MMP-7 levels in cases of chronic periodontitis due to Porphyromonas gingivalis bacteria.

Correlation Between the Severity of Chronic Periodontitis and Coronary Artery Stenosis Involvement in Coronary Heart Disease (CHD) Patients

Periodontitis is independently related to coronary heart disease and significantly impacts the quality of human life. The aim of this study was to investigate the relationship between the severity of chronic periodontitis and the severity of coronary artery stenosis in CHD patients. A total of 75 subjects were recruited for this study. The severity of the coronary artery was measured by coronary angiography. Quantitative coronary angiography (QCA) was conducted to determine 1 vessel disease (VD), 2 VD, and 3 VD, followed by stenosis. The severity of chronic periodontitis was determined based on the mean periodontal pocket depth (Mean PPD). The &lt; 4 mm and 4 mm scores were categorized as mild and moderate-severe, respectively. Statistical analysis was conducted to determine the relationship between periodontitis and coronary artery by chi-square and followed by multivariate analysis using an ordinal regression test with a 95% confidence interval. P value &lt; 0.05 was considered statistically significant. The proportion of moderate-severe periodontitis was more dominant than mild periodontitis. 79.20% and 20.80% of subjects were categorized as moderate-severe periodontitis and mild periodontitis in the 3 VD group. In groups 1 and 2 VD, the proportion of mild periodontitis was higher than moderate-severe periodontitis (61.30% vs. 38.7%) and (70% vs. 30%), based on bivariate analysis of the involvement of the coronary artery. Multivariate analysis showed chronic periodontitis and dyslipidemia had estimates of 1.084 (95% CI range 0.162 - 2.006) and 1.141 (95% CI range 0.217 - 2.066) for the severity of coronary artery involvement with p-values of 0.021 and 0.016, respectively. Gender, age, smoking, DM, hypertension, and obesity were not statistically significant. A significant relationship between moderate-severe chronic periodontitis was found, followed by an increase in the severity of coronary artery compared to mild chronic periodontitis.

Oxytocin alleviates periodontitis in adult rats.

The objective of the study was to evaluate the expression of oxytocin receptors in normal and inflamed gingiva, as well as the effects of systemic administration of oxytocin in bone loss and gum inflammatory mediators in a rat model of experimental periodontitis. Current evidence supports the hypothesis of a disbalance between the oral microbiota and the host's immune response in the pathogenesis of periodontitis. Increased complexity of the microbial biofilm present in the periodontal pocket leads to local production of nitrogen and oxygen-reactive species, cytokines, chemokines, and other proinflammatory mediators which contribute to periodontal tissue destruction and bone loss. Oxytocin has been suggested to participate in the modulation of immune and inflammatory processes. We have previously shown that oxytocin, nitric oxide, and endocannabinoid system interact providing a mechanism of regulation for systemic inflammation. Here, we aimed at investigating not only the presence and levels of expression of oxytocin receptors on healthy and inflamed gingiva, but also the effects of oxytocin treatment on alveolar bone loss, and systemic and gum expression of inflammatory mediators involved in periodontal tissue damage using ligature-induced periodontitis. Therefore, anti-inflammatory strategies oriented at modulating the host's immune response could be valuable adjuvants to the main treatment of periodontal disease. We used an animal model of ligature-induced periodontitis involving the placement of a linen thread (Barbour flax 100% linen suture, No. 50; size 2/0) ligature around the neck of first lower molars of adult male rats. The ligature was left in place during the entire experiment (7 days) until euthanasia. Animals with periodontitis received daily treatment with oxytocin (OXT, 1000 μg/kg, sc.) or vehicle and/or atosiban (3 mg/kg, sc.), an antagonist of oxytocin receptors. The distance between the cement-enamel junction and the alveolar bone crest was measured in stained hemimandibles in the long axis of both buccal and lingual surfaces of both inferior first molars using a caliper. TNF-α levels in plasma were determined using specific rat enzyme-linked immunosorbent assays (ELISA). OXT receptors, IL-6, IL-1β, and TNF-α expression were determined in gingival tissues by semiquantitative or real-time PCR. We show that oxytocin receptors are expressed in normal and inflamed gingival tissues in male rats. We also show that the systemic administration of oxytocin prevents the experimental periodontitis-induced increased gum expression of oxytocin receptors, TNF-α, IL-6, and IL-1β (p < .05). Furthermore, we observed a reduction in bone loss in rats treated with oxytocin in our model. Our results demonstrate that oxytocin is a novel and potent modulator of the gingival inflammatory process together with bone loss preventing effects in an experimental model of ligature-induced periodontitis.

Deep Margin Elevation - A Retrospective Clinical Study.

The aim of this retrospective study was to assess the short- to mid-term restorative and periodontal outcome of deep margin elevation (DME) performed using resin composite. Twenty-eight teeth treated with DME and indirect adhesive restorations were followed-up for a mean of 25.4 months (minimum: 12 months). Clinical and radiographic examination assessed the adaptation of the DME material and indirect restorations, presence of recurrent caries or discoloration, periodontal health at DME and non-DME sites, and periapical health. The overall success rate was 96.6%. One tooth showed signs and symptoms of apical pathology after 34 months following DME. No caries, discoloration, or periodontal pockets were detected in any of the treated teeth. DME had no detrimental effect on the gingival/periodontal health or plaque accumulation. There was no correlation between the distance from the DME material to the marginal bone level and pocket depth, gingival inflammation, and plaque accumulation (p > 0.05). Deep margin elevation might be considered a safe procedure for teeth with deep subgingival proximal caries in the short- and mid-term.

Comparison of the effectiveness of Morus alba and chlorhexidine gels as an adjunct to scaling and root planing on stage II periodontitis - A randomized controlled clinical trial.

The present study aimed to assess and compare the effect of Morus alba and chlorhexidine gel as an adjunct to scaling and root planing (SRP) in treating stage II periodontitis. A single-blind, randomized controlled trial was conducted on 180 patients with stage II periodontitis who received full-mouth SRP. They were randomly assigned to receive chlorhexidine digluconate (CHX) gel, Morus alba (MA) and placebo gel for Groups A, B and C, respectively, at the baseline, 15 days and 30 days. Plaque index (PI), Gingival index (GI), periodontal pocket depth (PPD) and quantitative analysis (culture) of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia were assessed at baseline and 45 days. Analysis of variance was used to compare the significant difference in PI, GI, PPD and microbiological parameters between the three groups after the intervention, followed by post hoc Mann-Whitney U and Tukey's HSD test for clinical and microbiological parameters, respectively. Intergroup comparison of the PI, GI and microbiological parameters between the MA and CHX groups at the end of 45 days did not show a statistically significant difference (p > 0.05), whereas a statistically significant difference was observed for PPD between MA and CHX groups with the mean difference of 0.18 mm (p = 0.002). Morus alba gel was found to be effective in decreasing PPD. However, there was no difference between Morus alba and chlorhexidine gel as an adjunct to SRP in treating stage II periodontitis.

To intrude or not to intrude? A systematic review of the controversy surrounding orthodontic intrusion on reduced periodontium

The main objective of this review was to evaluate the effects of orthodontic intrusion on patients with reduced periodontium. Additionally, this review aims to explore the potential for attachment gain and tissue regeneration in these patients and identify optimal therapeutic conditions to mitigate any negative effects of intrusion. A systematic review was conducted according to the PRISMA 2020 statement. Duplicate electronic searches of the PubMed, Cochrane, EMC Premium, and Science Direct databases were performed by two independent reviewers. Data extraction and quality assessments, including risk of bias evaluation using the Cochrane and ROBINS-I tools were conducted. From an initial pool of 418 articles, 29 were selected after title and abstract screening for full-text review. Following thorough full-text reading, 15 studies were ultimately included in the analysis. The total number of patients included in the studies is 528, who underwent orthodontic intrusion on reduced periodontium. Studies indicated a decrease in periodontal pocket depth and an increase in clinical attachment with ortho-periodontal treatment. Alveolar bone level outcomes varied, showing both increases and losses. Authors generally observed improved papillary regeneration and reduced gingival recessions. Clinical studies involving combined ortho-periodontal treatment showed that orthodontic intrusion on a reduced but healthy periodontium can be considered a beneficial treatment for the periodontium, provided that potential adverse effects are carefully monitored.

Association between periodontal disease and malignant soft tissue sarcomas.

Malignant soft tissue sarcoma (MSTS) is a rare disease, but is seen in patients undergoing orthopedic surgery. Although the association of periodontal disease with various cancers occurring in the oral cavity, gastrointestinal tract, lungs, and prostate, has been reported, the association between periodontal disease and MSTS remains unclear. This study investigated the association between periodontal disease and MSTS in patients undergoing orthopedic surgery. One hundred fifteen patients who underwent orthopedic surgery between 2017 and 2021 were retrospectively enrolled (mean age = 66.8 ± 10.7 years). The patient background was adjusted by the propensity score (PS). Subsequently, the association of periodontal disease with MSTS was analyzed using PS inverse probability of treatment weighting (IPTW). Periodontal status was determined by evaluating the periodontal inflamed surface area, which was calculated by measuring the periodontal probing pocket depth and detecting bleeding on probing. Multivariate logistic regression analysis after adjustment by the PS showed that severe periodontitis was significantly associated with MSTS (odds ratio 2.81, p = 0.04). Furthermore, IPTW showed that severe periodontitis was significantly associated with MSTS (odds ratio 3.21, p = 0.01). The results indicate an association between periodontal inflammation and MSTS.

Effectiveness of novel oral hygiene instruction avoiding inattentional blindness using an application for unique plaque control record calculation: A randomized clinical trial.

This study was performed to estimate the effectiveness of novel oral hygiene instruction (OHI) focusing on areas with deep periodontal pockets for reduction of periodontal inflammation. Because stained areas on the plaque chart do not always correspond to the areas with deep periodontal pockets, conventional OHI based on O'Leary's plaque control record (PCR) often provides guidance inconsistent with the target area. This randomized clinical trial involved two groups: (1) OHI based on the PCR limited in deep pocket sites (novel OHI group) and (2) OHI based on O'Leary's PCR (conventional OHI group). The unique PCR (aggressive target for PCR [agPCR]; only counting the plaque-stained areas with PD at ≥4 mm sites) for the novel OHI was calculate by dedicated expression program. The probing depth (PD), bleeding on probing (BOP), and periodontal inflamed surface area (PISA) were obtained at the baseline and 5 to 6 months later. The approximation curve with PISA before and after instruction indicated that the PISA converged to a lower value after instruction in the novel OHI group. The approximation curve with the improvement rate of the PISA and agPCR showed a positive correlation in the novel OHI group but no correlation in the conventional OHI group. Control of inflammation was more effective in the novel OHI group. These results suggest that this novel OHI technique using our developed application could be used as a strategy to improve the effectiveness of brushing instruction.

Investigating the anti-inflammatory and bone repair-promoting effects of an injectable porous hydrogel containing magnesium ions in a rat periodontitis mode

Periodontitis is associated with several systemic diseases, and advanced periodontitis is often linked to an extensive inflammatory microenvironment and irregularly shaped alveolar bone defects. However, eliminating periodontal inflammation in a minimally invasive manner while repairing irregularly shaped bone defects is clinically challenging. In comparison to traditional bone grafts, a thermo-sensitive hydrogel can be injected into deep periodontal pockets, forming and filling the alveolar bone defects in situ. In this study, porous injectable thermo-sensitive hydrogels containing magnesium ions were prepared by adding magnesium particles (MPs) to a glycerophosphate solution and combining this mixture with a chitosan solution. The incorporation of MPs created interconnected pores in the hydrogel, exhibiting high cytocompatibility and maintaining cell viability, proliferation, spreading, and osteogenesis in vitro. Evaluation on an experimental periodontitis rat model, using micro-computed tomography and histological analyses, demonstrated that this Mg2+-containing hydrogel effectively reduced periodontal inflammation, inhibited osteoclast activity, and partially repaired inflammation-induced alveolar bone loss. These results suggest that Mg2+-containing thermo-sensitive porous hydrogels might be promising candidates for treating periodontitis.

Evaluation of Sterify Gel as an Adjunctive Treatment to Scaling and Root Planing in Promoting Healing of Periodontal Pockets: A Split-Mouth Randomized Controlled Trial.

Periodontal disease is a common infectious disease that leads to the destruction of tooth-supporting structures. Current treatments, such as scaling and root planing (SRP), have limitations in deep and complex pockets, and antibiotic use carries the risk of resistance. Sterify Gel, a medical device composed of polyvinyl polymers, hydroxytyrosol, nisin, and magnesium ascorbyl phosphate, offers a new approach to periodontal care. This study aims to evaluate the safety and efficacy of Sterify Gel as an adjunctive treatment to SRP in promoting the healing of periodontal pockets. The study includes 34 patients with moderate to advanced chronic periodontal disease. Randomization assigned one site for SRP alone (control) and the other site for SRP with Sterify Gel (treatment). Periodontal parameters were evaluated at baseline, 1, 2, and 3 months after treatment bacterial contamination was assessed through quantitative PCR at baseline and 3 months after treatment. Statistical analysis was conducted using ANOVA and Wilcoxon test. Treatment with Sterify Gel and SRP demonstrated significant improvements in pocket depth, gingival recession, and clinical attachment level compared with SRP alone. Bleeding and plaque indexes, pain perception, tooth mobility, and furcations showed no significant differences between the two groups. The treatment group showed a reduction in bacterial contamination at 3 months. Sterify Gel in combination with SRP shows the potential for improving periodontal health by promoting healing and reducing periodontal pockets. It may offer benefits in preventing bacterial recolonization and reducing reliance on antibiotics.