Periodontal Wound Research Articles

Enamel Matrix Derivative Use in Dentistry: An Update

Following a review of periodontal wound healing, this article discusses techniques designed to optimise periodontal wound healing, including guided-tissue regeneration and periodontal regeneration using enamel matrix derivatives. Enamel matrix derivatives are porcine derived, and are thought to stimulate differentiation, proliferation, migration and mineralization in cells found in periodontal tissues. This article charts the development in surgical techniques to optimise outcomes from regenerative techniques, in addition to explaining complications and how they can be avoided. Recent research relating to use of enamel matrix derivatives as an adjunct to non-surgical periodontal therapy is described, and while the evidence is limited to a single research study, the present article discusses the potential use of this technique in practice, accepting that a cost–benefit analysis would be required for individual patients. CPD/Clinical Relevance: An update for practitioners on developments in use of enamel matrix derivatives in dentistry to allow informed decision-making on the utility and value of using flapless techniques.

Periodontal Wound Healing and Regeneration: Insights for Engineering New Therapeutic Approaches

Periodontitis is a widespread inflammatory disease that leads to loss of the tooth supporting periodontal tissues. The few therapies available to regenerate periodontal tissues have high costs and inherent limitations, inspiring the development of new approaches. Studies have shown that periodontal tissues have an inherent capacity for regeneration, driven by multipotent cells residing in the periodontal ligament (PDL). The purpose of this review is to describe the current understanding of the mechanisms driving periodontal wound healing and regeneration that can inform the development of new treatment approaches. The biologic basis underlying established therapies such as guided tissue regeneration (GTR) and growth factor delivery are reviewed, along with examples of biomaterials that have been engineered to improve the effectiveness of these approaches. Emerging therapies such as those targeting Wnt signaling, periodontal cell delivery or recruitment, and tissue engineered scaffolds are described in the context of periodontal wound healing, using keyin vivostudies to illustrate the impact these approaches can have on the formation of new cementum, alveolar bone, and PDL. Finally, design principles for engineering new therapies are suggested which build on current knowledge of periodontal wound healing and regeneration.

Role of molybdenum in material immunomodulation and periodontal wound healing: Targeting immunometabolism and mitochondrial function for macrophage modulation

Recently, strategies that can target the underlying mechanisms of phenotype change to modulate the macrophage immune response from the standpoint of biological science have attracted increasing attention in the field of biomaterials. In this study, we printed a molybdenum-containing bioactive glass ceramic (Mo-BGC) scaffold as an immunomodulatory material. In a clinically relevant critical-size periodontal defect model, the defect-matched scaffold featured robust immunomodulatory activity, enabling long-term stable macrophage modulation and leading to enhanced regeneration of multiple periodontal tissues in canines. Further studies demonstrated that the regeneration-enhancing function of Mo-BGC scaffold was macrophage-dependent by using canines with host macrophage depletion. To investigate the role of Mo in material immunomodulation, in vitro investigations were performed and revealed that Mo-BGC powder extract, similar to MoO42−-containing medium, induced M2 polarization by enhancing the mitochondrial function of macrophages and promoted a cell metabolic shift from glycolysis toward mitochondrial oxidative phosphorylation. Our findings demonstrate for the first time an immunomodulatory role of a Mo-containing material in the dynamic cascade of wound healing. By targeting the immunometabolism and mitochondrial function of macrophages, Mo-mediated immunomodulation provides new avenues for future material design in the field of tissue engineering and regenerative medicine.

Maresins: The Mainstay in Periodontal Resolution.

Not much was known about the resolution of inflammation until the recent past when significant breakthroughs led to the unveiling of the exact mechanism of this. It is now known that the resolution of inflammation involves specific mediators of resolution such as lipoxins, protectins, resolvins, and maresins, making it an active process. Of these mediators, maresins are the latest discovery. Maresins are macrophage-derived mediators that are involved in the resolution of inflammation. Various studies on what maresins do to resolve periodontitis are ongoing. Reportedly, maresins help in periodontal regeneration and wound healing. Having known the numerous roles of these mediators, our current focus is shifting from anti-inflammatory pharmacotherapy to resolution pharmacotherapy.

Stress-Induced Necrotizing Gingivitis Resolved Aesthetically with Laser-Assisted Gingivoplasty

Necrotizing periodontal diseases have a complex etiology. They are non-communicable and run a destructive course in a short period of time. The diagnosis is predominantly based on clinical features. The typical findings are punched-out interdental areas, linear gingival erythema, and a propensity to bleed spontaneously. The predisposing factors often include psychological stress, immunosuppression, malnutrition, smoking, and most importantly poor oral hygiene. If left untreated the necrotizing lesions spread apically into the entire gingival complex and even into bones. Conventionally, necrotizing gingivitis is managed with sequential one-weekly appointments culminating in surgical gingivoplasty. This is a case report about the comprehensive treatment of a 24-year-old male patient presenting with necrotizing gingivitis due to extreme stress and malnutrition. Keeping in mind the key benefits of laser in periodontal wound healing a laser-assisted gingivoplasty was carried out to get the best possible aesthetics.

Photobiomodulation of human gingival fibroblasts with diode laser - A systematic review.

Low-level laser therapy (LLLT) is being extensively studied in the field of periodontics as a noninvasive technique to achieve better results after nonsurgical and surgical therapy. However, there is a lack of definitive guidelines for the use of LLLT to promote gingival and periodontal wound healing. The primary objective of this systematic review was to critically analyze the studies evaluating the effect of low-level diode laser on human gingival fibroblasts in vitro and to develop wavelength-specific guidelines for photobiomodulation of human gingival fibroblasts. A thorough electronic and manual search was conducted for relevant articles published until December 2019. Nine studies were included in the review after the initial screening of 1334 articles. Our data analysis revealed that LLLT with diode laser stimulates human gingival fibroblasts as there was the increase in cell viability, proliferation, migration, and protein synthesis in irradiated cells. The diode lasers in the 600–700 nm spectrum were effective in the 10 mW to 30 mW power range. Lasers in the 700–800 nm range were effective in the 25–50 mW power range and diode lasers in the 800–900 nm range were effective at a power setting of 10 mW. It was possible to ascertain a suitable power setting for a particular wavelength spectrum, but no other parameters could be defined due to a lack of reporting of details. Hence, the authors have developed guidelines for comprehensive reporting of in–vitro studies to facilitate future research and overcome existing lacunae in knowledge.

Histological Evaluation of Gingival and Intrabony Periodontal Defects Treated with Platelet-rich Fibrin Using Different Protocols: A Canine Study.

To histologically compare the effects of platelet-rich fibrin (PRF) produced using different protocols on periodontal wound healing/regeneration in periodontal defects in dogs. Dehiscence-type gingival recession and two-wall intrabony defects were created bilaterally in the maxillary canines and mandibular premolars, respectively, in four beagle dogs. The recession defects were randomly treated with coronally advanced flap (CAF) alone, CAF and PRF produced via fixed-angle centrifugation (F-PRF; Leukocyte and PRF (L-PRF) protocol) or CAF and PRF produced via horizontal centrifugation (H-PRF). After 2 weeks, the two-wall intrabony defects were randomly treated as follows: open flap debridement (OFD), OFD + F-PRF, OFD + H-PRF and OFD + heated albumin with PRF using bio-heat technologies (Alb-PRF). Eight weeks after the 2nd reconstructive surgery, the animals were euthanised for histological evaluation. In the PRF-applied defects, new bone and new cementum formation occurred to varying degrees regardless of the protocols used to produce PRF. Particularly in the two-wall intrabony defects, new bone formation extended from the host bone toward the coronal region of the defects in the H-PRF applied sites compared with those in the OFD, F-PRF and Alb-PRF groups, and the H-PRF group showed the greatest amount of newly formed cementum. PRF induced periodontal regeneration in gingival recession and two-wall intrabony defects in dogs. Further studies are needed to determine the optimal protocol for obtaining predictable periodontal regeneration in periodontal defects in humans.

Efficacy of biocompatible trilayers nanofibrous scaffold with/without allogeneic adipose-derived stem cells on class II furcation defects of dogs' model.

This study aimed to evaluate the regenerative capacity of a newly-developed polycaprolactone (PCL)-based nanofibrous composite scaffold either alone or in combination with adipose-derived mesenchymal stem cells (ADSCs) as a treatment modality for class II furcation defects. After ADSCs isolation and scaffold characterization, the mandibular premolars of adult male mongrel dogs were selected and randomly assigned into three equal groups. In group I, class II furcation defects were surgically induced to the inter-radicular bone. While class II furcation defects of group II were induced as in group I. In addition, the defects were filled with the prefabricated scaffold. Moreover, class II furcation defects of group III were induced as in group II and instead the defects were filled with the prefabricated scaffold seeded with ADSCs. The dogs were sacrificed at 30days or at 60days. Periodontal wound healing/regeneration was evaluated by radiological examination using cone beam computed tomography and histologically using ordinary, histochemical, and immunohistochemical staining. In the two examination periods, group II defects compared to group I, and group III compared to the other groups showed a decrease in defect dimensions radiographically. Histologically, histochemically, and immunohistochemically, they significantly demonstrated better periodontal wound healing/regeneration, predominant collagen type I of newly formed bone and periodontal ligament with a significant increase in the immunoreactivity of vascular endothelial growth factor and osteopontin. The newly fabricated nanofibrous scaffold has enhanced periodontal wound healing/regeneration of class II furcation defects with further enhancement achieved when ADSCs seeded onto the scaffold before implantation. The implementation of our newly-developed PCL-based nanofibrous composite scaffolds in class II furcation defect either alone or in conjunction with ADSCs can be considered as a suitable treatment modality to allow periodontal tissues regeneration.

Periodontal Wound Healing and Tissue Regeneration: A Narrative Review.

Periodontal disease is a major public health issue, and various periodontal therapies have been performed to regenerate periodontal tissues. The periodontium is a complex structure composed of specialized tissues that support the teeth, and most periodontal surgeries are invasive procedures, including a resection of the gingiva or the alveolar bone. The periodontal wound healing process is slightly different from cutaneous wound healing and is similar to fetal healing, being almost scar-free. The aim of this review article is to provide an overview of periodontal wound healing and discuss various surgical and pharmaceutical approaches to achieve stable wound healing and improve the treatment outcomes. In addition, detrimental and limiting factors that induce a compromised prognosis are discussed, along with the perspective and future direction for successful periodontal tissue regeneration.

The Roles of FOXO1 in Periodontal Homeostasis and Disease.

Periodontitis is an oral chronic inflammatory disease that is initiated by periodontal microbial communities and requires disruption of the homeostatic responses. The prevalence of periodontal disease increases with age; more than 70% of adults 65 years and older have periodontal disease. A pathogenic microbial community is required for initiating periodontal disease. Dysbiotic immune-inflammatory response and bone remodeling are characteristics of periodontitis. The transcription factor forkhead box protein O1 (FOXO1) is a key regulator of a number of cellular processes, including cell survival and differentiation, immune status, reactive oxygen species (ROS) scavenging, and apoptosis. Although accumulating evidence indicates that FOXO1 activity can be induced by periodontal pathogens, the roles of FOXO1 in periodontal homeostasis and disease have not been well documented. The present review summarizes how the FOXO1 signaling axis can regulate periodontal bacteria-epithelial interactions, immune-inflammatory response, bone remodeling, and wound healing.

INTRABONY DEFECT TREATMENT WITH PLATELET-RICH FIBRIN, GUIDED TISSUE REGENERATION AND OPEN-FLAP DEBRIDEMENT: A RANDOMIZED CONTROLLED TRIAL

• There was improvement in the periodontal clinical, radiographic and wound healing parameters in the platelet-rich fibrin, guided tissue regeneration, and open-flap debridement groups. • Platelet-rich fibrin yielded similar improvements in the periodontal clinical, radiographic and wound healing parameters as guided tissue regeneration. To comparatively assess the outcomes of the treatment of periodontal intrabony defects with platelet-rich fibrin (PRF) combined with open-flap debridement (OFD), guided tissue regeneration (GTR) or OFD alone based on clinical, radiographic, and wound healing parameters for 12 months of follow-up. Ninety intrabony defects were randomly divided into 3 different groups and treated as group 1 (PRF + OFD), group 2 (GTR), or group 3 (OFD alone). Clinical parameters, including the plaque index, gingival index, bleeding on probing, probing depth (PD), clinical attachment loss (CAL), and tooth mobility were assessed at 3, 6, and 12 months. Additionally, the wound healing index was assessed at 7 and 14 days postsurgery. Radiographic parameters, including bony defect fill and alveolar crestal resorption, were measured at 6 and 12 months postsurgery and calculated using image analysis software. Intragroup comparisons showed consistently significant improvements in all the clinical and radiographic parameters in the 3 groups at 12 months postsurgery. Compared to baseline, in group 1, the PD decreased to 2.37 ± 0.56; 3.30 ± 0.84; 4.80 ± 0.71 mm, and CAL decreased to 2.23 ± 0.90; 3.33 ± 0.71; 5.00 ± 0.46 mm; in group 2, the PD decreased to 2.30 ± 0.60; 3.23 ± 0.86; 4.63 ± 0.67 mm, and CAL decreased to 2.00 ± 0.98; 3.20 ± 0.71; 4.53 ± 0.57 mm); and in group 3, the PD decreased to 1.87 ± 0.68; 2.57 ± 1.36; 3.37 ± 1.00 mm, and CAL decreased to 1.60 ± 0.93; 2.23 ± 1.22; 3.37 ± 1.22 mm at 3, 6, and 12 months postsurgery, respectively. The bone fill percentages in group 1 (26.45 ± 16.47 and 45.25 ± 5.20%), group 2 (22.20 ± 15.76 and 42.15 ± 6.39%) and group 3 (10.21 ± 6.47 and 23.13 ± 6.98%) were observed at 6 and 12 months postsurgery. The alveolar crestal resorption levels were -1.07 ± 0.52 and -1.70 ± 0.60 mm in group 1, -1.03 ± 0.72 and -1.47 ± 0.73 mm in group 2 and 0.37 ± 0.62 and 0.43 ± 0.73 mm in group 3, respectively. The percentages of sites with a WHI score of 1 were 93% and 100% in group 1, 81%, and 94% in group 2 and 45% and 71% in group 3 at 7 and 14 days postsurgery, respectively. Compared to GTR, PRF yielded comparable treatment outcomes and periodontal tissue healing in terms of improvements in clinical and radiographic parameters. Compared to OFD alone, PRF also significantly improved these parameters in the treatment of intrabony defects.

Comparison of the Migration Potential through Microperforated Membranes of CD146+ GMSC Population versus Heterogeneous GMSC Population.

Background Guided tissue regeneration (GTR) is a powerful modality for periodontal regeneration, but it blocks the periosteum and gingival stem cells (GMSCs), from supporting periodontal wound by the nutrients, growth factors, and regenerative cells. The microperforated membrane considered a rewarding solution for this major drawback; GMSCs can migrate through a GTR microperforated membrane toward a chemoattractant, with the blocking of other unfavorable epithelial cells and fibroblasts. In the absence of a sole marker for MSC, a homogeneous population of GMSC is difficult to isolate; using CD146 as confirmatory markers for MSC identification, testing the behaviour of such homogeneous population in migration dynamics was the question to answer in this study. Materials and Methods GMSCs from healthy crown lengthening tissue was isolated (n = 3), its stem cell nature was confirmed, CD146 and CD271 markers were confirmatory markers to confirm homogenous stem cell population, and magnetic sorting was used to isolate GMSC with CD146 markers. A homogenous CD146 population was compared to heterogeneous GMSCs of origin; the population doubling time and MTT test of the two populations were compared. Migration dynamics were examined in a transwell migration chamber through 8 μm perforated polycarbonic acid membrane, and 0.4 μm and 3 μm perforated collagen-coated polytetrafluoroethylene membrane (PTFE) and 10% fetal bovine serum (FBS) were the chemoattractants used in the lower compartment to induce cell migration, were incubated in a humidified environment for 24 hours, then migrated the cell in the lower compartment examined by a light and electron microscope. Results GMSCs fulfilled all the minimal criteria of stem cells and showed low signal 10% for CD146 on average and extremely low signal 2% for CD271 on average. Magnetic sorting optimized the signal of CD146 marker to 55%. GMSC CD146 population showed nonstatistically significant shorter population doubling time. CD146 homogeneous population migrated cell numbers were statistically significant compared to the heterogeneous population, through 0.4 μm and 3 μm perforated collagen membrane and 8 μm perforated polycarbonate membrane. Scanning electron microscopy proved the migration of the cells. Conclusions A subset of the isolated GMSC showed a CD146 marker, which is considered a dependable confirmatory marker for the stem cells. In terms of GMSC migration through the microperforated membrane, a homogeneous CD146 population migrates more statistically significant than a heterogeneous GMSC population.

Combined application of geranylgeranylacetone and amelogenin promotes angiogenesis and wound healing in human periodontal ligament cells.

Amelogenin directly binds to glucose-regulated protein 78 (Grp78). Cell migration activity is expected to increase when human periodontal ligament cells (hPDLCs) overexpressing Grp78 are treated with amelogenin. Geranylgeranylacetone (GGA) is a drug that induces the expression of heat shock protein and is routinely used to treat gastric ulcers. Here, we investigated the changes in the properties and behavior of hPDLCs in response to treatment with GGA and the synergistic effects of amelogenin stimulation in hPDLCs pretreated with GGA for the establishment of a novel periodontal tissue regenerative therapy. We observed that GGA treatment increased Grp78 protein expression in hPDLCs and enhanced cell migration. Microarray analysis demonstrated that increased Grp78 expression triggered the production of angiopoietin-like 4 and amphiregulin, which are involved in the enhancement of angiogenesis and subsequent wound healing via the activation of hypoxia-inducible factor 1α and peroxisome proliferator-activated receptors as well as the phosphorylation of cAMP response element-binding protein and protein kinase A. Moreover, the addition of recombinant murine amelogenin (rM180) further accelerated hPDLC migration and tube formation of human umbilical vein endothelial cells due to the upregulation of interleukin-8 (IL-8), monocyte chemotactic protein 1, and IL-6, which are also known as angiogenesis-inducing factors. These findings suggest that the application of GGA to gingival tissue and alveolar bone damaged by periodontal disease would facilitate the wound healing process by inducing periodontal ligament cells to migrate to the root surface and release cytokines involved in tissue repair. Additionally, supplementation with amelogenin synergistically enhanced the migratory capacity of these cells while actively promoting angiogenesis. Therefore, the combined application of GGA and amelogenin may establish a suitable environment for periodontal wound healing and further drive the development of novel therapeutics for periodontal tissue regeneration.

BMP4 micro-immunotherapy increases collagen deposition and reduces PGE2 release in human gingival fibroblasts and increases tissue viability of engineered 3D gingiva under inflammatory conditions.

BackgroundWe aimed to evaluate the effect of low doses (LD) bone morphogenetic protein‐2 (BMP2) and BMP4 micro‐immunotherapy (MI) in two in vitro models of periodontal wound healing/regeneration.MethodsWe first evaluated the effect of LD of BMP2 and BMP4 MI on a 2D cell culture using human gingival fibroblasts (hGF) under inflammatory conditions induced by IL1β. Biocompatibility, inflammatory response (Prostaglandin E2 (PGE2) release), collagen deposition and release of extracellular matrix (ECM) organization‐related enzymes (matrix metalloproteinase‐1 (MMP1) and metalloproteinase inhibitor 1 (TIMP1)) were evaluated after short (3 days) and long‐term (24 days) treatment with BMP2 or BMP4 MI. Then, given the results obtained in the 2D cell culture, LD BMP4 MI treatment was evaluated in a 3D cell culture model of human tissue equivalent of gingiva (GTE) under the same inflammatory stimulus, evaluating the biocompatibility, inflammatory response and effect on MMP1 and TIMP1 release.ResultsLD BMP4 was able to decrease the release of the inflammatory mediator PGE2 and completely re‐establish the impaired collagen metabolism induced by IL1β treatment. In the 3D model, LD BMP4 treatment improved tissue viability compared with the vehicle, with similar levels to 3D tissues without inflammation. No significant effects were observed on PGE2 levels nor MMP1/TIMP1 ratio after LD BMP4 treatment, although a tendency to decrease PGE2 levels was observed after 3 days.ConclusionsLD BMP4 MI treatment shows anti‐inflammatory and regenerative properties on hGF, and improved viability of 3D gingiva under inflammatory conditions. LD BMP4 MI treatment could be used on primary prevention or maintenance care of periodontitis.

Electrospun Scaffolds in Periodontal Wound Healing.

Periodontitis is a set of inflammatory conditions affecting the tissues surrounding the teeth predominantly sustained by bacterial infections. The aim of the work was the design and the development of scaffolds based on biopolymers to be inserted in the periodontal pocket to restore tissue integrity and to treat bacterial infections. Nanofibrous scaffolds were prepared by means of electrospinning. Gelatin was considered as base component and was associated to low and high molecular weight chitosans and alginate. The scaffolds were characterized by chemico–physical properties (morphology, solid state-FTIR and differential scanning calorimetry (DSC)-surface zeta potential and contact angle), and mechanical properties. Moreover, preclinical properties (cytocompatibility, fibroblast and osteoblast adhesion and proliferation and antimicrobial properties) were assessed. All the scaffolds were based on cylindrical and smooth nanofibers and preserved their nanofibrous structure upon hydration independently of their composition. They possessed a high degree of hydrophilicity and negative zeta potentials in a physiological environment, suitable surface properties to enhance cell adhesion and proliferation and to inhibit bacteria attachment. The scaffold based on gelatin and low molecular weight chitosan proved to be effective in vitro to support both fibroblasts and osteoblasts adhesion and proliferation and to impair the proliferation of Streptococcus mutans and Aggregatibacter actinomycetemcomitans, both pathogens involved in periodontitis.

Periodontal wound healing/regeneration of two-wall intrabony defects following reconstructive surgery with cross-linked hyaluronic acid-gel with or without a collagen matrix: a preclinical study in dogs.

In-vitro data have shown that cross-linked hyaluronic acid (HA) enhances the proliferative and migratory properties of cells involved in periodontal wound healing/regeneration, stabilizes the blood clot, reduces the inflammatory response, and facilitates angiogenesis. The aim of this study was to histologically evaluate the effects of cross-linked HA alone or combined with a collagen matrix (CM) on the periodontal wound healing/regeneration in intrabony defects. Two-wall intrabony defects (5 mm wide, 5 mm deep) were surgically created at the distal and mesial aspects of mandibular premolars in six beagle dogs. The 24 defects were randomly treated as follows: open flap debridement (OFD) + HA, OFD + CM, OFD + HA + CM (HA/CM), and OFD alone (control). At 2 months, the animals were euthanized for histologic evaluation. The HA (2.43 ± 1.25 mm) and HA/CM (2.60 ± 0.99 mm) groups yielded statistically significantly (P < .05) greater formation of new attachment (ie, linear length of new cementum adjacent to newly formed bone, with inserting collagen fibers) compared with the OFD (0.55 ± 0.99 mm) group. Among the four treatment groups, the HA/CM group demonstrated the highest amount of regenerated tissues, although no statistically significant differences in any of the histometric parameters were observed between the HA and HA/CM groups. Within their limits, it can be concluded that cross-linked HA alone or combined with CM promotes periodontal wound healing/regeneration in two-wall intrabony defects in dogs.

A therapeutic oxygen carrier isolated from Arenicola marina decreased P. gingivalis induced inflammation and tissue destruction

The control of inflammation and infection is crucial for periodontal wound healing and regeneration. M101, an oxygen carrier derived from Arenicola marina, was tested for its anti-inflammatory and anti-infectious potential based on its anti-oxidative and tissue oxygenation properties. In vitro, no cytotoxicity was observed in oral epithelial cells (EC) treated with M101. M101 (1 g/L) reduced significantly the gene expression of pro-inflammatory markers such as TNF-α, NF-κΒ and RANKL in P. gingivalis-LPS stimulated and P. gingivalis-infected EC. The proteome array revealed significant down-regulation of pro-inflammatory cytokines (IL-1β and IL-8) and chemokine ligands (RANTES and IP-10), and upregulation of pro-healing mediators (PDGF-BB, TGF-β1, IL-10, IL-2, IL-4, IL-11 and IL-15) and, extracellular and immune modulators (TIMP-2, M-CSF and ICAM-1). M101 significantly increased the gene expression of Resolvin-E1 receptor. Furthermore, M101 treatment reduced P. gingivalis biofilm growth over glass surface, observed with live/dead analysis and by decreased P. gingivalis 16 s rRNA expression (51.7%) (p < 0.05). In mice, M101 reduced the clinical abscess size (50.2%) in P. gingivalis-induced calvarial lesion concomitant with a decreased inflammatory score evaluated through histomorphometric analysis, thus, improving soft tissue and bone healing response. Therefore, M101 may be a novel therapeutic agent that could be beneficial in the management of P. gingivalis associated diseases.

Knowledge and Awareness about Minimally Invasive Surgical Techniques in Periodontics among Dental Students

Minimally invasive surgical techniques (MIST) are performed using magnification from surgical microscopes, surgical telescopes or endoscopic visualization. The exclusive property of MIST is that it reduces the chair time required to perform the procedure and results in limited morbidity to the patient during the surgical procedure. The aim of this study was to evaluate the knowledge and awareness about minimally invasive surgical techniques in Periodontics among dental students. A 6-item questionnaire was prepared and circulated through an online portal among dental students. The results obtained from the survey were tabulated, analysed and represented graphically using SPSS software (Version 23). Frequency distribution and percentage were calculated. In the present study, 56% of them were aware about the implications of MIST in Periodontics, 73% of them knew the advantages of MIST and 53% of them were aware that MIST reduces healing period of the periodontal wounds. However, only 10% of them have performed MIST in periodontal procedures. The present study suggested that even though majority of the undergraduate dental students had adequate knowledge and awareness about MIST and its advantages; only very few had incorporated the technique in their practice. Therefore, this study emphasizes the need for more clinical training programs.

Laser tissue bonding—a new venture into primary periodontal wound closure techniques

To evaluate the efficacy of Laser tissue bonding (LTB) by comparing with the routinely used sutures for closure of intraoral surgical wounds after periodontal surgery. Patients enrolled in the study were divided into 2 groups. Seventeen patients were included for a split mouth study where modified periodontal flap operation was performed, and in test side, LTB was carried out whereas in control, conventional suturing. Laser welding of the gingiva was performed with an 810 diode laser with a power of 1.5 W in contact mode. A highly statistically significant difference was observed in LTB (test) subgroup when compared with conventional suturing, depicting superiority in terms of Power Doppler analysis of vascularisation, wound healing scores, time consumption and microbial colonization. Within the limitations of the study, it was concluded that LTB was effective in achieving wound closure with no morbid complications associated. More long-term randomized controlled trials are required to further prove the efficacy of this novel technique.

Diabetes alters the involvement of myofibroblasts during periodontal wound healing.

Myofibroblasts constitute a specific cell phenotype involved in connective tissue healing. Diabetes alters the wound healing response. However, it is not clear whether diabetes modifies the involvement of myofibroblasts in periodontal wounds. Type I diabetes was induced in rats through streptozotocin injection, and periodontal wounds were performed. Wound healing was evaluated histologically at 2, 5, 7, and 15days by measuring epithelial migration, neutrophil infiltration, and collagen and biofilm formation. Distribution of myofibroblasts was evaluated through immunofluorescence for α-smooth muscle actin. Data analyses were performed using the Shapiro-Wilk, ANOVA, or Kruskal-Wallis tests. Diabetic wounds were characterized by delayed epithelial closure, increased neutrophil infiltration, biofilm formation, and reduced collagen formation. Quantification of the myofibroblasts showed a significant reduction at 5 and 7days in wounds of diabetic rats and an increase at 15days when compared to wounds of non-diabetic rats. Diabetic wound healing was associated with decreased epithelial and connective tissue healing, increased levels of inflammation, and biofilm formation. Myofibroblast differentiation was delayed in diabetic periodontal wounds at early time points. However, myofibroblasts persisted at later time points of healing. The present study suggests that diabetes alters the involvement of myofibroblasts during periodontal wound healing.