Evaluation of the efficacy of combined device strategies for long femoropopliteal artery disease

One of the major problems associated with bare nitinol stent implantation is stent fracture, particularly in the popliteal artery. The purpose of this study was to determine whether drug coated balloons (DCB), interwoven stents (IWS), or plain old balloon angioplasty (POBA) would be suitable for use in distal femoropopliteal (FP) long lesions when an Eluvia stent was implanted proximal to a lesion. This was a multi-center retrospective study enrolling patients undergoing concomitant use of Eluvia with DCB, IWS or POBA for symptomatic atherosclerotic femoropopliteal disease (lesion length > 15 cm) [Rutherford category 2-6] between January 2018 and September 2021. 79 patients with 89 femoropopliteal lesions were enrolled in this study. The mean lesion length and the percentage of the popliteal artery involvement was 24.3 ± 6.4 cm vs 24.0 ± 9.0 cm vs 26.6 ± 6.2 cm and 65.8% vs 89.4% vs 67.8% for the Eluvia + DCB, Eluvia + IWS, and Eluvia + POBA groups, respectively. The 1-year Kaplan-Meier estimates of primary patency and freedom from major adverse limb events (MALEs) were 53.3% vs 44.1% vs 24.2% and 62.4% vs 51.0% vs 28.1%, respectively. Eluvia + POBA was associated with a lower rate for 1-year primary patency (HR 2.49; 95% confidence interval (CI): 1.28-4.87; p = 0.007 and HR 2.38; 95% CI: 1.13-5.77; p = 0.04). In SFA long lesions with proximal Eluvia implantation, distal implantations of either a DCB or IWS were comparable, as opposed to POBA alone which generated worse results.

Improvement of periodontal parameters following intensive diabetes care and supragingival dental prophylaxis in patients with type 2 diabetes: A prospective cohort study

AIM

This study aimed to investigate the effects of diabetes care on periodontal inflammation.

MATERIALS AND METHODS

This prospective cohort study included 51 Japanese patients with type 2 diabetes who underwent intensive diabetes care including educational hospitalization and regular outpatient treatment for 6 months. Dental prophylaxis without subgingival scaling was provided three times during the observational period. Associations between changes in periodontal parameters and glycaemic control levels were evaluated using multiple regression analysis.

RESULTS

Overall, 33 participants (mean age: 58.7 ± 12.9) were followed up for 6 months. At baseline examination, 82% were diagnosed with Stage III or IV periodontitis. Haemoglobin A1c (HbA1c) level changed from 9.6 ± 1.8% at baseline to 7.4 ± 1.3% at 6 months. The ratio of probing pocket depth (PPD) ≥4 mm, bleeding on probing (BOP), full-mouth plaque control record (PCR), periodontal epithelial surface area (PESA) and periodontal inflamed surface area (PISA) also significantly improved. The reduction in PPD and PESA was significantly associated with changes in both HbA1c and fasting plasma glucose (FPG) levels, and the reduction in PISA was significantly associated with an improvement in FPG after adjusting for smoking, change in body mass index and full-mouth PCR.

CONCLUSIONS

This is the first study to report a significant improvement in PPD and BOP after intensive diabetes care and dental prophylaxis without subgingival scaling.

CLINICAL TRIAL REGISTRATION NUMBER

UMIN000040218.

Novel Flowchart Guiding the Non-Surgical and Surgical Management of Peri-Implant Complications: A Narrative Review

Peri-implant diseases, such as peri-implant mucositis and peri-implantitis, are induced by dysbiotic microbiota resulting in the inflammatory destruction of peri-implant tissue. Nonetheless, there has yet to be an established protocol for the treatment of these diseases in a predictable manner, although many clinicians and researchers have proposed various treatment modalities for their management. With the increase in the number of reports evaluating the efficacy of various treatment modalities and new materials, the use of multiple decontamination methods to clean infected implant surfaces is recommended; moreover, the use of hard tissue laser and/or air abrasion techniques may prove advantageous in the future. Limited evidence supports additional effects on clinical improvement in antimicrobial administration for treating peri-implantitis. Implantoplasty may be justified for decontaminating the implant surfaces in the supracrestal area. Surgical treatment is employed for advanced peri-implantitis, and appropriate surgical methods, such as resection therapy or combination therapy, should be selected based on bone defect configuration. This review presents recent clinical advances in debridement methods for contaminated implant surfaces and regenerative materials for treating peri-implant bone defects. It also proposes a new flowchart to guide the treatment decisions for peri-implant disease.

Assessment of bone defect morphology for the adjunctive use of bone grafting combined with enamel matrix derivative: A 3-year cohort study

BACKGROUND

There have been limited studies with statistically sufficient sample sizes for assessment of suitable bone defect morphology for combination therapy with enamel matrix derivative (EMD) and bone grafting. The aim of this study was to investigate the appropriate feature of intrabony defects, such as bone defect angle (DA) and the containment by bony wall, for yielding the additional benefit of bone grafting in combination with periodontal regenerative therapy using EMD.

METHODS

Following periodontal regenerative therapy using EMD with or without autologous bone grafting, 282 intrabony defects of 177 participants were maintained for 3 years. Multilevel linear regression analysis was performed to evaluate the radiographic bony defect depth (RBD) reduction after adjusting for confounders.

RESULTS

The baseline parameters, except for the proportion of contained bony defects and tooth mobility, did not differ significantly between the groups with and without bone grafts. There was no significant difference in the improvement of clinical parameters between the groups. The 1- and 3-year reduction of RBD showed significant inverse correlations with preoperative DA only in the group without bone graft. Furthermore, multivariate analysis showed a significant interaction between DA at baseline ≥40° and adjunctive bone grafting in the reduction of RBD, regardless of the number of bony walls.

CONCLUSION

Adjunctive autologous bone grafting with enamel matrix derivative might be significantly beneficial for defect depth improvement in the case of DA at baseline ≥40°.

Er:YAG laser-assisted comprehensive periodontal pocket therapy for residual periodontal pocket treatment: A randomized controlled clinical trial

BACKGROUND

This study evaluated the effectiveness of a novel pocket therapy (Er:YAG laser-assisted comprehensive periodontal pocket therapy [Er-LCPT]) for residual pocket treatment, compared with conventional mechanical treatment alone, in a randomized controlled clinical trial.

METHODS

Two sites in 18 patients having residual periodontal pockets of ≥5 mm depth, extant following initial active therapy, or during supportive therapy, were randomized into two groups in a split mouth design: the control group received scaling and root planing (SRP) by curette, and the test group received Er-LCPT using curette and laser. With Er-LCPT, after root debridement, inflamed connective tissue on the inner gingival surface and on the bone surface/within extant bone defects was thoroughly debrided. Furthermore, removal of proximate oral epithelium and coagulation of the blood clot in the pocket entrance were performed with laser. Clinical parameters were evaluated, before and after treatment, through 12 months.

RESULTS

Both groups showed significant improvements in clinical parameters. With Er-LCPT, pocket debridement was thoroughly and safely performed, without any adverse side effects and complications, and favorable healing was observed in most of the cases. At 12 months, Er-LCPT demonstrated significantly higher probing pocket depth reduction (2.78 mm vs. 1.89 mm on average; p = 0.012, Wilcoxon signed-rank test), clinical attachment gain (1.67 mm vs. 1.06 mm; p = 0.004) as primary outcomes, and reduced BOP value (0.89 vs. 0.56; p = 0.031), compared with SRP alone.

CONCLUSION

The results of this study indicate that Er-LCPT is more effective for residual pocket treatment, compared with SRP alone.

Antibacterial activity of lysozyme-chitosan oligosaccharide conjugates on two periodontal bacteria

OBJECTIVE

This study aimed to evaluate the in vitro antibacterial effects of lysozyme-chitosan oligosaccharide conjugates (LYZOX) against Streptococcus gordonii and Porphyromonas gingivalis.

MATERIALS AND METHODS

Planktonic S. gordonii and P. gingivalis were treated with various concentrations of LYZOX for 10 min. The treated bacteria were incubated on trypticase soy agar plates, and colony-forming unit (CFU) was calculated. The antibacterial effect of LYZOX was compared with that of lysozyme, chitosan, physiological saline, and benzalkonium chloride solution. Cell morphology before and after LYZOX treatment was observed using a scanning electron microscope (SEM). The antibacterial effect of LYZOX with decanoic acid against the biofilm-like bacteria was also examined via crystal violet staining. The Kruskal-Wallis test and post hoc Dunn tests were performed to compare the difference in antibacterial activity of each treatment.

RESULTS

Bacterial CFU numbers were reduced after LYZOX treatment in a concentration-dependent manner. The reduction in CFUs was smaller for corresponding concentrations of chitosan or lysozyme alone. SEM analyses revealed bacterial cells shrank following LYZOX treatment. The combined use of LYZOX and decanoic acid yielded an even higher antibacterial effect against bacterial biofilms.

CONCLUSION

LYZOX exhibits antibacterial activity against two periodontal bacteria and may be a promising plaque control agent.

Malnutrition- inflammation- atherosclerosis (MIA) syndrome associates with periodontitis in end-stage renal disease patients undergoing hemodialysis: a cross-sectional study

Malnutrition-inflammation-atherosclerosis (MIA) syndrome is a significant risk factor for mortality in patients undergoing hemodialysis. This study aimed to investigate the association between MIA syndrome and oral health status in hemodialysis patients. A cross-sectional study was conducted on 254 hemodialysis patients. Comprehensive medical and dental examinations were performed. Three components were included to define MIA syndrome: Geriatric Nutritional Risk Index, serum high-sensitivity C-reactive protein, and history of cardiovascular events as indicators of malnutrition, inflammation, and atherosclerosis, respectively. The association of MIA syndrome components with periodontitis and occlusal support was examined by multiple-ordered logistic regression analysis. Of 254 participants, 188 (74.0%) had at least one component of MIA syndrome. After adjusting for possible confounding factors, severe periodontitis was significantly associated with presence of more components of MIA syndrome (odds ratio [OR]: 2.64, 95% confidence interval [CI], 1.44-4.84, p = 0.002) and inflammation and malnutrition components (OR: 2.47 and 3.46, 95% CI 1.16-5.28 and 1.70-7.05, p = 0.020 and 0.001). On the other hand, occlusal support, evaluated by Eichner index, was not significantly associated with MIA syndrome or any of its components. In conclusion, periodontitis is associated with MIA syndrome, particularly with inflammation and malnutrition in hemodialysis patients, independent of occlusal support.

The Potential of a Saliva Test for Screening of Alveolar Bone Resorption

Oral health screening is important for maintaining and improving quality of life. The present study aimed to determine whether patients with a certain level of alveolar bone resorption could be screened by salivary bacterial test along with their background information. Saliva samples were collected from 977 Japanese patients, and the counts of each red-complex, that is, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia, were measured using quantitative polymerase chain reaction analysis. Mean bone crest levels (BCLs) were measured using a full-mouth periapical radiograph. Multiple logistic regression analysis was used to determine associations between BCLs (1.5-4.0 mm in 0.5 mm increments) and explanatory variables, such as the number of each red-complex bacteria and the patients' age, sex, number of teeth, stimulated saliva volume, and smoking habits. When the cutoff BCL value was set at 3.0 mm, the area under the curve, sensitivity, and specificity values were optimal at 0.86, 0.82, and 0.76, respectively. In addition, all tested explanatory variables, except sex and T. denticola count, were significantly associated with BCLs according to a likelihood ratio test (p < 0.05). Additionally, the odds ratio (OR) was substantially increased when a patient was >40 years old and the bacterial count of P. gingivalis was >10⁷ cells/µL (OR: >6). Thus, P. gingivalis count and patients' background information were significantly associated with the presence of a certain amount of bone resorption, suggesting that it may be possible to screen bone resorption without the need for radiography or oral examination.

Utility of a haemoglobin test of gingival crevicular fluid: A multicentre, observational study

OBJECTIVE

The purpose of this study was to verify the accuracy and utility of clinical parameters (plaque index, gingival crevicular fluid volume, probing depth, clinical attachment level, bleeding on probing and gingival index) and biochemical parameters (aspartate aminotransferase, protein and haemoglobin) in a longitudinal analysis during the supportive periodontal therapy period.

SUBJECTS AND METHODS

A total of 279 test sites of 128 patients were investigated clinically and biochemically. After the first examination of clinical and biochemical parameters, periodontal support treatments were administered immediately and performed once every three months up to the second examination.

RESULTS

All of the clinical and biochemical parameters were significantly lower at the second examination than at the first, except for the plaque index and bleeding on probing. Of these parameters, in particular, aspartate aminotransferase and haemoglobin in the gingival crevicular fluid were significantly reduced compared to those of the first examination in both the ≤4 and ≥5 mm probing depth groups, and they clearly suggested that periodontitis tended to recover.

CONCLUSION

Adding the haemoglobin test to the bleeding on probing test strongly improves the accuracy of measurement of clinical parameters after periodontal treatment.

Prediction Models for Two Year Overall Survival and Amputation Free Survival After Revascularisation for Chronic Limb Threatening Ischaemia

OBJECTIVE

The aim of this study was to create prediction models for two year overall survival (OS) and amputation free survival (AFS) after revascularisation in patients with chronic limb threatening ischaemia (CLTI).

METHODS

This was a retrospective analysis of prospectively collected multicentre registry data (JAPAN Critical Limb Ischaemia Database; JCLIMB). Data from 3 505 unique patients with CLTI who had undergone revascularisation from 2013 to 2017 were extracted from the JCLIMB for the analysis. The cohort was randomly divided into development (2 861 patients) and validation cohorts (644 patients). In the development cohort, multivariable risk models were constructed to predict two year OS and AFS using Cox proportional hazard regression analysis. These models were applied to the validation cohort and their performances were evaluated using Harrell's C index and calibration plots.

RESULTS

Kaplan-Meier estimates of two year OS and AFS post-revascularisation in the whole cohort were 69% and 62%, respectively. Strong predictors for OS consisted of age, activity, malignant neoplasm, chronic kidney disease (CKD), congestive heart failure (CHF), geriatric nutritional risk index (GNRI), and sex. Strong predictors for AFS included age, activity, malignant neoplasm, CKD, CHF, GNRI, body temperature, white blood cells, urgent revascularisation procedure, and sex. Prediction models for two year OS and AFS showed good discrimination with Harrell's C indexes of 0.73 (95% confidence interval [CI] 0.69 - 0.77) and 0.72 (95% CI 0.68 - 0.76), respectively CONCLUSION: Prediction models for two year OS and AFS post-revascularisation in patients with CLTI were created. They can assist in determining treatment strategies and serve as risk adjustment modalities for quality benchmarking for revascularisation in patients with CLTI at each facility.

Influence of the bone graft materials used for guided bone regeneration on subsequent peri-implant inflammation: an experimental ligature-induced peri-implantitis model in Beagle dogs

Purpose

We aimed to histologically evaluate the influence of bone materials used during guided bone regeneration (GBR) on subsequent peri-implantitis in an experimental ligature-induced peri-implantitis model in beagle dogs.

Methods

Bilateral mandibular premolars (PM2-4) were extracted from six beagle dogs. After 3 months, standardized bone defects (3 mm [mesio-distal width] × 2 mm [bucco-lingual width] × 3 mm [depth]) were created in the experimental group, with simultaneous dental implant placement at the center of the defects. The defects were randomly filled with either autograft (AG) or deproteinized bovine bone mineral (DBBM) and covered with a collagen membrane. In the control group, implant fixtures were placed without creating an intrabony defect. After 3 months, a healing abutment was placed. Four weeks later, a 3–0 silk thread was ligated around the implants to induce peri-implantitis. After 4 weeks, the specimens were dissected and histologically examined.

Results

There were no clinical findings of inflammation until silk thread ligation. Four weeks after the onset of peri-implantitis, gingival redness and swelling were seen with mild resorption of the peri-implant bone on dental radiographs. There were no significant differences between the AG, DBBM, and control groups for the following parameters: bone-to-implant contact, distance from the implant shoulder to the base of the bone defect, area of bone defect, and area of new bone.

Conclusions

Within the limitations of this study, it can be concluded that peri-implant tissues after GBR using AG and DBBM underwent the same degree of bone resorption by peri-implantitis as the no defect group.

Pathological and immunological differences of arterial thrombi and wall caused by three different periodontal bacterial injections in rat models and proposals on the pathogeneses of vascular diseases

OBJECTIVES

Periodontal bacteria that have been studied show a strong connection to various vascular diseases. Among the many kinds of periodontal bacteria, Porphyromonas gingivalis (Pg) is well examined in the general aspects and in a rat model. However, whether other periodontal bacteria work or react differently is not studied well.

MATERIAL AND METHODS

We chose Aggregatibacter actinomycetemcomitans (Aa) and Prevotella intermedia (Pi) as different types of periodontal bacteria. Low-density and high-density bacterial solutions were injected in the small artery of rats' groins using our rat model. Eighteen limbs of 9 SD male rats (500-650 g) were used. After 7 days, 14-18 days, and 28 days, the rats were sacrificed. A pathological and an immuno-histochemical study was conducted and reported on the low-density group with 12 limbs because the Pi group lacked a high-density study. Immuno-histochemical staining of live Pg was performed on three limbs of three rats at 1 h, 3 h, and 1 week after injection.

RESULTS

The appearances from the acute, at 7 days, to chronic phases, at 28 days, were observed. The differences of the species were certainly observed in the internal elastic lamina (IEL), and immuno-histochemical reactions. The inflammatory reactions, such as cellular distribution or intra-thrombus materials, were similar in all. One week later, we could not see any living bacteria in the specimen or immunological observation.

CONCLUSIONS

The three species were essentially the same, except for Aa's stronger disruption of IEL, and more CD3 (Pan T cell) in Pi and more CD79a (Pan B cell) in Pg. We propose a new concept of a possible mechanism of vascular diseases, in which the work of LPS (lipopolysaccharides) and a toll-like receptor (TLR) is emphasized.

Influence of aging on periodontal regenerative therapy using enamel matrix derivative: A 3-year prospective cohort study

AIM

To investigate the influence of chronological aging on periodontal regenerative therapy (PRT) outcomes with enamel matrix derivative (EMD).

MATERIALS AND METHODS

In total, 253 intra-bony defects (151 patients) including 44 furcation involvement were prospectively investigated for 3 years after regenerative therapy with EMD by evaluating probing pocket depth (PPD), clinical attachment level (CAL), and radiographic bone defect depth (RBD). The influence of age on these outcomes was assessed using multilevel regression analyses adjusting for confounders.

RESULTS

Participants' mean age was 55.9 ± 12.3 years (range: 22-85). Baseline PPD, CAL, and RBD were 6.14 ± 1.82, 7.22 ± 2.14, and 5.08 ± 2.04 mm, respectively. Significant improvement was observed with PPD reductions of 2.84 ± 1.73 and 2.87 ± 1.87 mm, CAL gains of 2.40 ± 1.87 and 2.47 ± 1.89 mm, and RBD gains of 1.76 ± 1.98 and 2.39 ± 2.41 mm at 1- and 3-year examinations, respectively. At the 1-year examination, multivariate analysis revealed a significant negative association between age and improvement in PPD and CAL (coefficients: -0.13, -0.23 mm per 10 years). However, by the 3-year examination, no significant association was noted between age and improvement in PPD, CAL, or RBD.

CONCLUSION

Although the statistical difference was detected with age at 1-year examination, PRT with EMD significantly improved clinical outcomes on long-term observation, irrespective of the patient's age.

CLINICAL TRIAL REGISTRATION NUMBER

UMIN000039846.

Er:YAG Laser-Assisted Bone Regenerative Therapy for Implant Placement: A Case Series

In order to achieve favorable ridge preservation (RP) or ridge augmentation (RA) in substantial vertical and/or horizontal bone defects and extraction sockets, a barrier membrane is usually employed. Recently, it was reported that a novel surgical technique for periodontal regenerative surgery applying Er:YAG laser (ErL) irradiation to form blood coagulation on the grafted bone surface, without using a membrane, resulted in sufficient bone regeneration in bone defects. This case series aims to present clinical and radiographic outcomes of ErL-assisted bone regenerative therapy (Er-LBRT), without use of membranes, for RP/RA before or after implant placement. In 10 cases, ErL irradiation was applied (50 mJ/pulse and 20 Hz without water spray in noncontact, defocused mode for approximately 60 seconds) to enhance the blood clot on the entire surface of the grafted bovine bone mineral before suturing. Wound healing was favorable without any postoperative complications such as wound gaping or infection of the grafted material. In all cases, dramatic bone regeneration was observed. After prosthetic treatment, peri-implant tissue and regenerated bone were stable and well-maintained during the follow-up period in each case. This novel technique of Er-LBRT without using a membrane resulted in favorable and stable RP/RA with sufficient bone regeneration for implant therapy.

Association between periodontal inflammation and serum lipid profile in a healthy population: A cross-sectional study

AIMS

The impact of periodontal inflammation on lipid metabolism is controversial. This study aimed to investigate the association between full-mouth periodontal inflammation and serum lipid levels.

MATERIALS AND METHODS

In this cross-sectional study, we performed periodontal and bacteriological examinations during medical checkup on 131 subjects. The association between the periodontal inflamed surface area (PISA) and the lipid markers was analyzed by multiple linear regression, adjusting for age, sex, smoking, and body mass index.

RESULTS

Overall, 118 medically healthy participants were analyzed. The proportions of none, mild, moderate, and severe periodontitis were 37.3%, 32.2%, 25.4%, and 5.1%, respectively. Multivariate analysis showed that high-density lipoprotein cholesterol was significantly higher in participants with the lowest tertile of PISA values (PISA low, coefficient: 7.94; 95% confidence interval [CI]: 1.63, 14.26, p = .01) compared to those in other tertiles (PISA high). Low-density/high-density lipoprotein cholesterol and total/high-density lipoprotein cholesterol ratios were significantly lower in the PISA-low group than the PISA-high group (coefficient: -0.26 and -0.30; 95% CI: -0.50, -0.02, and -0.59, -0.0002; p = .04 and .0498). Serum high-sensitivity C-reactive protein level, but not serum Porphyromonas gingivalis antibody titer, partly explained the association between PISA and high-density lipoprotein cholesterol. A significant interaction between female sex and PISA values toward high-density lipoprotein cholesterol level was detected.

CONCLUSION

Periodontal inflammation was inversely associated with higher high-density lipoprotein cholesterol, especially in females. Elevated serum C-reactive protein partly explained this association.

Ambulatory Status Over Time after Revascularization in Patients with Chronic Limb-Threatening Ischemia

Aim: Maintaining functional status through revascularization is a major goal in patients with chronic limb-threatening ischemia (CLTI). Nevertheless, there is a lack of clarity on the impact of revascularization on mobility over time. This study examined ambulatory status over time after revascularization and predictors of ambulation loss in CLTI patients.

Methods: We used a clinical database established by the Surgical reconstruction versus Peripheral INtervention in pAtients with critical limb isCHemia study, a prospective, multicentre, observational study including patients with CLTI. The primary endpoint was mobility over time.

Results: Of the 381 patients, the ambulatory proportion at baseline was 71%. The proportion gradually decreased, finally reaching 40% at 36 months. In non-ambulatory patients at revasacularisation, approximately 20-40% of patients achieved ambulation. Multivariate analysis confirmed that age, impaired mobility before CLTI onset and at revascularization, renal failure on dialysis, and WIfI clinical stage 4 were positively associated with ambulation loss at either specific or all time points, whereas male sex and surgical reconstruction were inversely associated with the outcomes at specific time points.

Conclusion: Mobility in the overall population gradually decreased, whereas the number of deceased patients increased. Advanced age, impaired mobility before CLTI onset and at revascularization, renal failure on dialysis, and WIfI stage 4 were associated with ambulation loss at almost all points after revascularization.

Porphyromonas gingivalis, the most influential pathogen in red-complex bacteria: A cross-sectional study on the relationship between bacterial count and clinical periodontal status in Japan

BACKGROUND

Porphyromonas gingivalis is a key pathogen in microbiota associated with periodontitis. The purpose of the present study was to assess the association between salivary counts of red-complex bacteria and clinical periodontal status in a Japanese population.

METHODS

A total of 977 subjects who visited a general dental clinic in Japan from 2003 to 2006 were enrolled in the study. Stimulated saliva was obtained, and the amounts of major periodontal bacteria were measured using real-time polymerase chain reaction. Probing pocket depth (PPD), bleeding on probing (BOP), and each subject's average proximal bone crest level (BCL) on dental radiographs were measured.

RESULTS

The number of P. gingivalis strongly associated with percentage of 4 mm or more PPD sites, BOP positive percentage, and 1.5 mm or more BCL sites. The detection of P. gingivalis with Treponema denticola and/or Tannerella forsythia showed a high rate of three positive clinical parameters, whereas the only P. gingivalis detected group and those without P. gingivalis had a low rate of three positive clinical parameters.

CONCLUSION

Among red-complex bacteria, the amount of P. gingivalis showed the strongest association with the severity of periodontal condition, and co-occurrence of P. gingivalis with T. denticola and/or T. forsythia showed heightened progression of periodontitis.

Association of periodontal pocket area with type 2 diabetes and obesity: a cross-sectional study

INTRODUCTION

The aim was to investigate the relationship of full-mouth inflammatory parameters of periodontal disease with diabetes and obesity.

RESEARCH DESIGN AND METHODS

This cross-sectional study conducted diabetes-related examinations and calculated periodontal inflamed and epithelial surface area (PISA and PESA) of 71 Japanese patients with type 2 diabetes. Multiple linear regression analyses were performed to evaluate associations between PISA or PESA and diabetes and obesity parameters.

RESULTS

Median value of body mass index (BMI), hemoglobin A1c (HbA1c) level, fasting plasma glucose (FPG) level, and visceral fat area (VFA) were 25.7 kg/m2, 9.1%, 151 mg/L, and 93.3 cm2, respectively. PISA and PESA were significantly associated with HbA1c after adjusting for age, sex, BMI, smoking status, and full-mouth plaque control level (PISA: coefficient=38.1, 95% CI 8.85 to 67.29, p=0.001; PESA: coefficient=66.89, 95% CI 21.44 to 112.34, p=0.005). PISA was also significantly associated with the highest FPG tertile (>175 mg/dL) after adjusting for confounders (coefficient=167.0, 95% CI 48.60 to 285.4, p=0.006). PISA and PESA were not significantly associated with BMI or VFA.

CONCLUSION

PISA was associated with FPG and HbA1c, but not with obesity parameters, independent from confounders such as full-mouth plaque control level in patients with type 2 diabetes.

A large-scale observational study to investigate the current status of diabetic complications and their prevention in Japan (JDCP study 6): baseline dental and oral findings

Japan Diabetes Complication and Prevention prospective (JDCP) study was conducted to examine the association between glycemic control and oral conditions in a large database of Japanese patients with diabetes. It included a total of 6099 patients with diabetes (range, 40-75 years) who had been treated as outpatients between 2007 and 2009. The mean number of present teeth at baseline was 19.8 and women with type 2 diabetes had fewer teeth than men with type 2 diabetes. Within the previous year, 17% of all patients had lost teeth. At baseline, 32% had experienced gingival swelling, 69% had brushed more than twice a day, 37% had used interdental cleaning aids, and 43% had undergone regular dental checkups. Multiple logistic regression analysis indicated that type 1 patients with HbA1c ≥ 7.0% were at higher risk of having fewer than 20 teeth (odds ratio [OR] 2.38; 95% confidence interval [CI] 1.25-4.78), and type 2 patients with HbA1c ≥ 8.0% also were at high risk of having fewer than 20 teeth (OR 1.16; 95% CI 1.00-1.34), after adjustment for nine possible confounding factors. In conclusion, patients with diabetes were found to be at high risk of tooth loss, and the poorer the glycemic control, the higher the risk of tooth loss in these patients.

Effects of combined use of recombinant human fibroblast growth factor-2 and β-tricalcium phosphate on ridge preservation in dehiscence bone defects after tooth extraction: A split-mouth study in dogs

BACKGROUND AND OBJECTIVE

Following tooth extraction, bone resorption is especially severe in cases complicated with buccal dehiscence bone defects. To minimize this, various bone graft materials have been used for alveolar ridge preservation. This study aimed to evaluate additional effects of the concomitant use of recombinant human fibroblast growth factor-2 (rhFGF-2) with β-tricalcium phosphate (β-TCP) on ridge preservation in a dehiscence defect model after tooth extraction in dogs.

MATERIALS AND METHODS

The maxillary first premolars of six beagle dogs were extracted and dehiscence defects of 4 × 4 × 5 mm (mesio-distal width × bucco-palatal width × depth) were created. Bilateral defects were filled with β-TCP combined with 0.3% (w/v) rhFGF-2 (test sites) or the scaffold alone (control sites). Twelve weeks post-surgery, histologic and histometric evaluations were performed.

RESULTS

Morphological measurements using micro-computed tomography revealed a significantly greater bone volume at the test sites (48.9 ± 9.06 mm³ ) than at the control sites (38.8 ± 7.24 mm³ ). Horizontal widths of the alveolar ridge at the coronal and middle position at the test sites (2.18 ± 0.71 mm, 2.93 ± 0.53 mm) were significantly greater than those at the control sites (1.47 ± 0.41 mm, 2.36 ± 0.45 mm, respectively). Regarding the histological parameters, the occupation rate of mineralized bone in the original defects was slightly higher at the test sites (44.07 ± 10.19%) than that at the control site (41.15 ± 6.56%).

CONCLUSIONS

These results indicate that the adjunct use of rhFGF-2 with β-TCP is effective for alveolar ridge preservation in fresh extraction sockets with dehiscence defects.

Periodontal regenerative therapy in patients with type 2 diabetes using minimally invasive surgical technique with enamel matrix derivative under 3-year observation: A prospective cohort study

BACKGROUND

Information regarding periodontal regenerative therapy in patients with diabetes mellitus (DM) is limited. This pilot study compared the regenerative outcomes of minimally invasive periodontal surgery using enamel matrix derivative (EMD) between DM and non-DM patients.

METHODS

This prospective study included deep intrabony defects in patients with or without type 2 DM. Minimally invasive surgical technique (MIST) or modified MIST (M-MIST) using EMD, without bone graft materials, was performed. Periodontal examination and intraoral radiography were performed at baseline, 6 months, and 1 and 3 years after surgery.

RESULTS

Ten sites of 10 subjects in the DM group, and 20 sites of 18 subjects in non-DM group were evaluated (mean age; 67.5 ± 7.6 and 63.1 ± 9.7, respectively). Probing depth significantly decreased from 7.1 ± 1.6 and 7.0 ± 1.3 mm to 2.2 ± 0.9 and 2.3 ± 1.1 mm at the 1-year examination in the DM and non-DM groups, respectively. Clinical attachment level (CAL) gain and radiographical defect fill at the 3-year examination were 3.8 ± 1.1 mm and 58.3% ± 10.4%, respectively, in the DM group, and 4.1 ± 1.1 mm and 65.5% ± 18.8%, respectively, in the non-DM group, showing no significant differences between the groups. Multiple regression analysis showed no significant association of CAL gain with DM or age after adjustments for relevant confounders.

CONCLUSIONS

This is the first documented study of successful periodontal tissue regeneration in patients with DM. Minimally invasive surgery combined with EMD yielded significant clinical attachment gain and bone fill in the DM and non-DM groups at comparable levels.

A multicenter prospective cohort study on the effect of smoking cessation on periodontal therapies in Japan

Few prospective studies have reported the effects of periodontal therapy on patients who attempted to quit smoking. This study aimed to assess how smoking cessation affects periodontal therapy. Twenty-five smokers with periodontitis were investigated by dividing them into two groups, a smoking cessation support group and a continued smoking group. Those in the support group received counseling and nicotine replacement therapy, followed by periodontal treatment conducted by dentists who had completed an e-learning course on smoking cessation. Clinical parameters were measured at baseline, 3, and 6 months. Most clinical parameters improved for those in the smoking cessation support group. There were no significant improvements in bleeding on probing (BOP) or the number of severe periodontal disease sites in the continued smoking group. Probing pocket depth (PPD) and clinical attachment levels (CAL) at sites that received scaling and root planing (SRP) significantly improved in all subjects. BOP did not improve at reevaluation in the smoking relapse subgroup. Patients in the smoking cessation support program led by dental professionals showed more improvement in BOP than those in the continued smoking group.

Dental implant care and trouble among dependent patients based on the questionnaire survey among Japanese dental practitioners

Background

Self-care and professional care of implants may prove difficult for elderly people who require nursing care. However, the actual state of care and problems remains unknown. In this study, we investigated the actual state of implant problems in elderly people living in their own home or in a nursing home who received visiting dental treatment.

Methods

We mailed questionnaire survey forms to 2339 representatives or specialists who were members of the Japanese Society of Oral Implantology, the Japanese Society of Gerodontology or the Japan Prosthodontic Society. We narrowed down the respondents to those who provided visiting dental treatment, and analyzed the actual state of implants observed during visiting dental treatment (type, care, problems, countermeasures, etc.).

Results

Of the 924 dentists who responded to the questionnaire survey, 291 (22%) provided visiting dental treatment. While the majority of implant types encountered in the previous 12 months were root-form implants, there were still a certain number of blade and subperiosteal implants. Daily implant care involved mostly cleaning with a toothbrush + auxiliary tools. The most frequent implant problems encountered in the past were difficulty in cleaning and peri-implantitis. Medication and antiphlogistic treatment were most frequently adopted as countermeasures to implant problems, followed by observation. When we classified the results into those for the dentists who provided implant treatment and those for the dentists who did not, we found that many of the dentists who did not provide implant treatment opted for observation or medication, while those who provided implant treatment also implemented removal of superstructure, retightening of screws, repair and so forth.

Conclusions

We found that many of the implant troubles encountered by dentists who provided visiting dental care were difficulty in cleaning or peri-implantitis, and that the actions taken against these troubles varied depending on the experience of the dentist performing the implant treatment. Our study also revealed that dentists who provide visiting dental care need to acquire knowledge and skills of implant treatment, to have actions prepared in case they encounter such cases, or to closely coordinate with dentists who specialize in implants.

The effects of intensive oral care before surgery for gastric cancer patients

OBJECTIVES

Oral function management has been recognized as important strategy for preventing postoperative complications. In this historical cohort study, we focused on the patients who planed gastrectomy, and investigated the appropriate duration and frequency of preoperative oral care to prevent complications after surgery.

METHODS

Patients who planed surgery for gastric cancer between 2012 and 2018 were enrolled. We defined intensive oral care (IOC) as initial intervention at least three weeks before surgery and follow-up intervention within a week before surgery. As the primary outcome, the incidence of postoperative infectious complications was compared between the IOC and non-intensive oral care groups.

RESULTS

A total of 576 patients were enrolled, including 66 with IOC. The incidence of infectious complications was 2/66 (3.0%) in the IOC group and 64/510 (12.5%) in the non-intensive oral care group. After adjusting for confounding factors, patients with IOC exposure had a lower chance of developing postoperative infectious complications (odds ratio; 0.217, 0.051-0.927).

CONCLUSIONS

Intensive oral care can help prevent postoperative infectious complications after gastrectomy. These findings suggest that appropriate preoperative oral care includes at least two interventions: three weeks or more before and within one week before surgery.

Oral infectious bacteria in dental plaque and saliva as risk factors in patients with esophageal cancer

BACKGROUND

High levels of periodontopathic bacteria as well as Streptococcus anginosus were detected in cancer tissue from patients with esophageal cancer. An association between oral infectious bacteria and esophageal cancer has been reported.

METHODS

Characteristics of the oral microbiota and periodontal conditions were studied as clinicopathologic factors in patients with esophageal cancer. The study included 61 patients with esophageal cancer and 62 matched individuals without any cancers. Samples of subgingival dental plaque and unstimulated saliva were collected to evaluate the prevalence and abundance of the following oral bacteria using a real-time polymerase chain reaction assay: Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, Treponema denticola, and S. anginosus.

RESULTS

In the cancer group, the prevalence of all bacteria, with the exception of F. nucleatum, in dental plaque; the prevalence of A. actinomycetemcomitans in saliva; the abundance of all bacteria, with the exception of F. nucleatum and P. intermedia, in dental plaque; and the abundance of A. actinomycetemcomitans and S. anginosus in saliva were significantly higher. Furthermore, a logistic regression analysis suggested that the prevalence of T. forsythia and S. anginosus in dental plaque and of A. actinomycetemcomitans in saliva, as well as a drinking habit, were associated with a high risk of esophageal cancer, with a high odds ratio.

CONCLUSIONS

The current findings have potential implications for the early diagnosis of esophageal cancer.

Clinical comparison of an electric-powered ionic toothbrush and a manual toothbrush in plaque reduction: A randomized clinical trial

OBJECTIVES

This study aimed to evaluate the plaque removal efficacy of a newly developed electric-powered ionic toothbrush vs. a manual toothbrush.

MATERIALS AND METHODS

Manual or electric-powered ionic toothbrushes were randomly assigned to 30 healthy volunteers divided into two groups (Phase I). After 2 min of brushing, all tooth surfaces were stained with a plaque staining solution, and blinded examiners performed scoring using the Rustogi Modification of the Navy Plaque Index. Plaque removal rate was calculated at the central incisors, first premolar and first molar, as representative teeth, in the maxilla and mandibula. One week following Phase I, the same examinations were repeated in all subjects using another toothbrush (Phase II), as a crossover design.

RESULTS

Electric ionic toothbrushes demonstrated a significantly higher plaque removal rate than manual toothbrushes in the premolar and molar areas (p < .05). However, in the central incisor area, no statistically significant difference was observed.

CONCLUSIONS

Compared with manual toothbrushes, electric-powered ionic ones were significantly efficient in removing plaque in the premolar and molar areas.

The effect of antimicrobial photodynamic therapy using yellow-green LED and rose bengal on Porphyromonas gingivalis

INTRODUCTION

This study aimed to investigate the effects of a new antimicrobial photodynamic therapy (aPDT) system using yellow-green light-emitting diode (YGL) and rose bengal (RB) on Porphyromonas gingivalis (Pg) in vitro.

MATERIALS AND METHODS

Pg suspension mixed with RB was irradiated with YGL (565 nm) or blue light-emitting diode (BL, 470 nm) at 428 mW/cm² in comparison with chlorhexidine (CHG) treatment. The cells were cultured anaerobically on agar plates, and the number of colony-forming units (CFU) was determined. The treated suspension was anaerobically incubated, and the cell density (OD_600nm) was monitored for 24 h. Also, the viability of treated human gingival fibroblast (HGF-1) was measured using WST-8 assay. Pg morphology was observed with a scanning electron microscope. The RNA integrity number of aPDT-treated Pg was determined and gene expressions were evaluated by quantitative real-time polymerase chain reaction.

RESULTS

RB + YGL (aPDT) demonstrated a significantly higher reduction of CFU, compared to RB + BL (aPDT) and CHG, furthermore the OD value rapidly decreased. Morphological changes of Pg with RB + YGL were more severe than with CHG. Although RB + YGL reduced HGF-1 viability, aPDT's impact was significantly lower than CHG's. With RB + YGL treatment, RIN values decreased; furthermore, gene expressions associated with DNA replication and cell division were remarkably decreased after 12 h.

CONCLUSION

The results of this study demonstrated that a novel aPDT system using RB + YGL may have potential as a new technical modality for bacterial elimination in periodontal therapy.

Association between circulating tumor necrosis factor receptors and oral bacterium in patients receiving hemodialysis: a cross-sectional study

BACKGROUND

High levels of tumor necrosis factor (TNF) receptors (TNFRs; TNFR1 and TNFR2), markers of inflammation, have been reported as significant predictors of mortality in hemodialysis patients. Porphyromonas gingivalis is a major pathogenic bacterium involved in periodontitis, which induces systemic inflammation. We investigated the association between the abundance of P. gingivalis in saliva and serum TNFR levels in hemodialysis patients.

METHODS

A cross-sectional study was conducted on 121 hemodialysis patients visiting a clinic in the Tokyo metropolitan area. Medical interviews and examinations, comprehensive dental examinations, bacterial examinations for P. gingivalis in saliva, and measurements of circulating TNFR levels were conducted. Multiple linear regression analysis was performed to evaluate the association between the number of P. gingivalis and circulating TNFR levels.

RESULTS

TNFR1 and TNFR2 were positively correlated with high-sensitivity C-reactive protein (hsCRP). Severe periodontitis was significantly associated with the number of P. gingivalis in saliva but not serum TNFR levels. The number of P. gingivalis was significantly associated with both TNFR1 and TNFR2 levels in sera after adjusting for age, sex, body mass index, smoking status, history of diabetes, prior cardiovascular disease events, serum levels of hsCRP and albumin, and severity of periodontitis [for TNFR1: coefficient 0.76, 95% confidence interval (CI) 0.14-1.37, p = 0.02; for TNFR2: coefficient 0.95, 95% CI 0.09-1.80, p = 0.03].

CONCLUSION

Circulating TNFR levels are associated with the number of P. gingivalis in saliva after adjusting for relevant clinical factors.

Detection of hepatocyte growth factor in oral rinses using water for possible periodontal diagnosis

The aim of this study is to analyze the relationship between Hepatocyte Growth Factor (HGF) levels in oral rinses using water and clinical parameters of periodontitis; and furthermore, to evaluate the potential of a prototype HGF immunochromatographic paper test strip (HGF-TS) for screening of periodontitis, in comparison with a commercially-available occult blood (hemoglobin) test strip (Hb-TS). Clinical periodontal parameters were recorded, and oral rinses were collected, from 125 subjects. Then, the presence of HGF, and hemoglobin (Hb), in each sample was detected using a prototype HGF-TS and an Hb-TS. In addition, the concentrations of HGF and Hb were also determined in each sample is necessary HGF concentrations in oral rinses showed significant correlations with clinical parameters of periodontitis. The positive rate and read value on HGF-TS showed significantly high values in cases of severe periodontitis compared to healthy subjects. Hb-TS showed generally higher positive rates than HGF-TS; however, it showed false positive results in healthy subjects. The concentration of HGF in oral rinses showed close association with the severity of periodontitis, suggesting that the prototype HGF-TS has potential for use in the diagnosis of periodontitis, although further refinement of the test strip is required to increase the sensitivity.

Phylogenetic diversity in fim and mfa gene clusters between Porphyromonas gingivalis and Porphyromonas gulae, as a potential cause of host specificity

Background

Periodontopathic bacteria Porphyromonas gingivalis in humans and Porphyromonas gulae in animals are phylogenetically close and commonly have FimA and Mfa1 fimbriae. However, little is known about how fimA and mfa1 are phylogenetically different between P. gingivalis and P. gulae. Here, we examined phylogenetic diversity in their fim and mfa gene clusters.

Methods

Twenty P. gulae strains were isolated from the periodontal pocket of 20 dogs. For their genomic information, along with 64 P. gingivalis and 11 P. gulae genomes, phylogenetic relationship between the genotypes of fimA and mfa1 was examined. Variability of amino acid sequences was examined in the three-dimensional structure of FimA. The distance between strains was calculated for fim and mfa genes.

Results

Some fimA genotypes in P. gulae were close to particular types in P. gingivalis. Two types of mfa1 were classified as 70-kDa and 53-kDa protein-coding mfa1. The variable amino acid positions were primarily at the outer part of FimA. The genes encoding the structural proteins and the main component were similarly distant from the reference strain in P. gingivalis, but not in P. gulae.

Conclusions

The differences in the gene clusters between P. gingivalis and P. gulae may result in their host specificity.

The periodontopathic bacteria in placenta, saliva and subgingival plaque of threatened preterm labor and preterm low birth weight cases: a longitudinal study in Japanese pregnant women

OBJECTIVES

This study determined the quantity of periodontopathic bacteria in saliva, subgingival plaque, and placenta on the threatened preterm labor (TPL) and preterm low birth weight (PLBW) subjects in order to identify specific periodontal pathogens with high association to adverse pregnancy outcomes.

METHODS

We used real-time PCR with TaqMan probe and ELISA to detect the amount of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum, and Prevotella intermedia in subgingival plaque, saliva, and placenta tissue, in addition to serum IgG titers against these bacteria in 28 patients with TPL and 36 healthy pregnant women.

RESULTS

Thirteen of 64 births delivered PLBW infants. All 6 periodontopathic bacteria were detected in the placenta samples. The amount of F. nucleatum and detection frequency of T. denticola in placental samples was significantly higher in the TPL group than in the healthy group. Meanwhile, the age, anti-P. gingival IgG in serum, amount of P. gingivalis and T. forsythia in plaque samples, detection frequency of P. intermedia in saliva, and percentage of pocket probing depth ≥ 5 mm were higher in TPL-PLBW births than those in TPL-Healthy delivery (HD) group and/or in H-HD group. Ordinal logistic regression analysis revealed that the presence of F. nucleatum in placental tissues was significantly associated with TPL, while the maternal age was significantly associated with PLBW in TPL.

CONCLUSION

Our findings suggested all 6 bacteria may access the placenta. The increased presence of F. nucleatum in placenta might be related to TPL, while advanced maternal age might be associated with PLBW in TPL.

CLINICAL RELEVANCE

Periodontal therapy should be applied to reduce the deep periodontal pocket sites and the colonization of periodontal pathogens in high-risk population.

Enhanced new bone formation in canine maxilla by a graft of electrically polarized β-tricalcium phosphate

We succeeded in the electrical polarization of β-tricalcium phosphate (β-TCP) granules and performed an unprecedented attempt to implant them into maxillary bone defects in canines to confirm their ability to facilitate new bone formation. Two holes were drilled into each maxilla half of a canine and filled with electrically polarized and nonpolarized β-TCP granules (grouping assignment was decided randomly). The implanted specimens were dissected en bloc and used for microcomputed tomography (μCT) observations and histological analyses 4 and 8 weeks after the operation. New bone ingrowth in the bone hole progressed over time from the superficial layer of the cortex toward the inner cancellous bone. The percentage area of new bone in the bone hole, as measured by μCT in the sagittal plane, was significantly larger after 4 and 8 weeks, and that measured by H&E-stained specimens in the transverse plane after 4 weeks was significantly larger in the polarized group than in the nonpolarized group. In addition to the structural stability and chemical characteristics of the β-TCP granules, electrical stimulation bears influence not indirectly but directly on osteogenic and vessel cells, which might work cooperatively for the early initiation of the bone formation process.

The relationship between the anti-Porphyromonas gingivalis immunoglobulin G subclass antibody and small for gestational age delivery: a longitudinal study in pregnant Japanese women

BACKGROUND

Maternal serum IgG antibody against Porphyromonas gingivalis is an indicator of both periodontitis and adverse pregnancy outcomes. This study aims to evaluate the anti-P. gingivalis IgG and IgG subclasses1-4 in threatened preterm labour (TPL) patients and their association with small for gestational age (SGA).

METHODS

Serum, saliva and subgingival plaque samples were collected from 47 TPL patients compared with 48 healthy pregnant women. The amount of P. gingivalis was measured in saliva and plaque using real-time polymerase chain reaction. The serum anti-P. gingivalis IgG titre and anti-P. gingivalis subclasses IgG 1-4 concentration were measured using enzyme-linked immunosorbent assay.

RESULTS

The amount of anti-P. gingivalis IgG-1 was significantly lower in the TPL group than in the healthy group. Fourteen subjects delivered SGA infants in the TPL group. The pocket probing depth (PPD), clinical attachment loss, PPD ≥ 5 mm%, amount of P. gingivalis in plaque, anti-P. gingivalis IgG and anti-P. gingivalis IgG-4 were significantly higher in the TPL-SGA group than in the TPL-normal weight group. Moreover, logistic regression analysis revealed the detection frequency of P. gingivalis in plaque and placenta weight were significantly correlated with SGA in TPL. In the receiver operating characteristic curve analysis, an amount of P. gingivalis in plaque ≥ 86.45 copies showed a sensitivity of 0.786 and a specificity of 0.727 (AUC 0.792) for predicting SGA in TPL.

CONCLUSION

Lower anti-P. gingivalis IgG-1 amounts are related to TPL, while higher anti-P. gingivalis IgG and IgG-4 are related with SGA in TPL. Further, greater colonisation of P. gingivalis in plaque might increase the risk of SGA and can be useful in prediction of SGA in TPL.

Ex Vivo Evaluation of Gingival Ablation with Various Laser Systems and Electroscalpel

Objective: The aim of this study was to perform a systematic and multifaceted comparison of thermal effects during soft tissue ablation with various lasers and an electroscalpel (ES). Materials and methods: Er:YAG, Er,Cr:YSGG, CO₂, Diode, Nd:YAG lasers (1 W, pulsed or continuous wave), an ES, and a scalpel (Sc; control), were employed for porcine gingival tissue ablation. Temperature changes during ablation were measured by using an infrared thermal imaging camera and a thermocouple. After ablations, the wounds were observed using stereomicroscopy and scanning electron microscopy (SEM), and histological sections were analyzed. Compositional analysis was also performed on ablated sites by SEM wavelength dispersive X-ray spectroscopy. Results: The surface temperature during irradiation was highest with CO₂ (over 500°C), followed by Diode (267°C) and Nd:YAG (258°C), Er:YAG (164°C), ES (135°C), and Er,Cr:YSGG (85°C). Carbonization was negligible (Er:YAG), slight (Er,Cr:YSGG), moderate (Nd:YAG and ES), and severe (CO₂ and Diode). Under SEM observation, Er:YAG and Er,Cr:YSGG showed smooth surfaces but other devices resulted in rough appearances. Histologically, the coagulated and thermally affected layer was extremely minimal (38 μm in thickness) and free from epithelial collapse for Er:YAG. Compared with other devices, less compositional surface change was detected with Er:YAG and Er,Cr:YSGG; additionally, the use of water spray further minimized thermal influence. Conclusions: Among various power devices, Er:YAG laser showed the most efficient and refined gingival ablation with minimal thermal influence on the surrounding tissues. Er:YAG and Er,Cr:YSGG lasers with water spray could be considered as minimally invasive power devices for soft tissue surgery.

Salivary and serum interleukin-17A and interleukin-18 levels in patients with type 2 diabetes mellitus with and without periodontitis

OBJECTIVE

Interleukin (IL)-17A and IL-18 have been proposed to play important roles in periodontitis and type 2 diabetes mellitus (DM), but human data are conflicting. The present study aimed to investigate the roles of IL-17A and IL-18 in periodontitis and DM by measuring salivary and serum levels, respectively.

MATERIALS AND METHODS

A total of 49 participants with type 2 DM and 25 control subjects without type 2 DM were recruited. A periodontal screening and recording (PSR) index (0, 1-2, 3, and 4) was used to classify whether these subjects had periodontitis. Salivary and serum IL-17A and IL-18 levels were measured by enzyme-linked immunosorbent assay. Multiple linear regression analyses were used to evaluate the associations between these cytokines and clinical parameters.

RESULTS

Salivary IL-17A levels were not significantly different between patients with DM and controls, however, the levels were significantly higher in controls with periodontitis than those without periodontitis (p = 0.031). Salivary IL-17A levels were significantly associated with the PSR index (β = 0.369, p = 0.011). Multiple linear regression analyses revealed the association of salivary IL-18 levels and fasting plasma glucose (β = 0.270, p = 0.022) whereas serum IL-18 levels were associated with HbA1C (β = 0.293, p = 0.017). No correlation between salivary and serum levels of IL-17A and IL-18 was found.

CONCLUSION

Salivary IL-17A was strongly associated with periodontitis, whereas salivary IL-18 was associated with FPG and serum IL-18 was associated with HbA1C. These results suggest the role of these cytokines in periodontal inflammation and DM.

Ridge reconstruction in damaged extraction sockets using tunnel β-tricalcium phosphate blocks: A 6-month histological study in beagle dogs

OBJECTIVE

The present study aimed to evaluate the histological outcome of tunnel β-TCP blocks grafting in extraction sockets missing the buccal bone wall, after 6 months of healing.

BACKGROUND

Tunnel β-tricalcium phosphate (β-TCP) blocks made of randomly organized tunnel-shaped β-TCP ceramics appeared promising for alveolar ridge preservation in tooth extraction sockets missing the buccal bone, in a previous study in dogs, with a 2-month healing time.

METHODS

In six beagle dogs, the maxillary first premolars were extracted and the buccal bone was surgically removed to create bone defects of 4 mm (mesio-distal) × 5 mm (apico-coronal) × 4 mm (bucco-palatal). Thus, extraction sockets missing the buccal bone plate were grated with tunnel β-TCP blocks (test) or left empty for spontaneous healing (control). Histology/histomorphometry was performed after 6 months of healing.

RESULTS

The horizontal bucco-palatal width of the alveolar ridge was significantly greater at test sites than at control sites. The amount of mineralized tissue was greater at test sites (57.8% ± 11.1%) than at control sites (28.9% ± 8.5%), while the amount of connective tissue was significantly greater at control sites (41.7% ± 6.4%) than at test sites (19.6% ± 9.2%). No significant difference was found between sites in terms of basic multicellular units and bone marrow. Residual β-TCP at test sites was 5.8% ± 3.2%.

CONCLUSION

Grafting with tunnel β-TCP block significantly limited the resorption of the alveolar ridge at extraction sockets missing the buccal bone compared with sites left to heal spontaneously, even after 6-month follow-up.

Accuracy of cone beam computed tomography in evaluation of palatal mucosa thickness

AIM

The purpose of this study was to investigate the accuracy of the measurement of palatal mucosa thickness using cone beam computed tomography (CBCT) and to create a conversion formula to evaluate palatal mucosa thickness more accurately. We then evaluated the palatal mucosa thickness in a Japanese population using CBCT and the conversion formula.

MATERIALS AND METHODS

We evaluated palatal mucosa thickness in 10 healthy subjects at 15 sites using CBCT, digital impression, and K file. Multiple regression analysis was performed to create a conversion formula to measure thickness accurately. We then obtained CBCT data from 174 patients retrospectively, applied the conversion formula, and evaluated palatal mucosa thickness.

RESULTS

Sites of measurement affected measurement error. Measurement using CBCT was 0.34 ± 0.04 mm smaller than actual measurement; therefore, a conversion formula was created. Male, age ≥60 years, and probing pocket depth ≥4 mm had significant and positive associations with palatal mucosa thickness; however, no association was observed between bleeding on probing and palatal mucosa thickness.

CONCLUSION

CBCT is useful for the noninvasive and accurate measurement of palatal mucosa thickness.

The bacterial association with oral cavity and intra-abdominal abscess after gastrectomy

BACKGROUND

Perioperative oral management has been reported to be effective for preventing postoperative infectious complications. In addition, severe periodontal disease was identified as the significant risk factor for complications after gastrointestinal surgery. We investigated the bacteriological association between the periodontal pocket, stomach mucosa and drainage fluid to determine whether oral bacteria directly cause intra-abdominal infection after gastrectomy.

METHODS

Patients who were scheduled to undergo surgery for gastric cancer were prospectively enrolled. We evaluated the similarity of bacterial strains in periodontal pocket, stomach mucosa and fluid from drainage tube. Gingival crevicular fluid and dental plaque were collected from the periodontal pocket and cultured to detect bacteria. Specimens from the resected stomach were collected and used for bacterial culturing. Drainage fluid from the abdominal cavity was also cultured.

RESULTS

All of 52 patients were enrolled. In the periodontal pocket, α-Streptococcus spp., Neisseria sp., and Prevotella sp. were mainly detected. Bacterial cultures in the stomach mucosa were positive in 26 cases. In 20 cases (76.9%), the detected strains were the same as those in the periodontal pocket. Six patients had the postoperative intra-abdominal infection after gastrectomy, and the same bacterial strains was detected in both of drainage fluid and periodontal pocket in two patients with severe periodontal disease.

CONCLUSIONS

We found the bacteriological association that same strain detected in periodontal pocket, stomach and in intra-abdominal drainage fluid after gastrectomy in patients with periodontal disease.

P1363 Risk factors of severe tricuspid regurgitation after left-sided valve surgery

Background

Tricuspid regurgitation (TR) sometimes deteriorate late after left-sided valve surgery. The recent guidelines recommend tricuspid valve repair at the same time as the left-sided valve surgery. However, little is known about the pathophysiology that leads to severe TR after left-sided valve surgery.

Purpose

To clarify the risk factors of the patients with severe TR after left-sided valve surgery.

Methods

We retrospectively investigated consecutive 526 patients diagnosed as severe TR from January 2004 to December 2018 at our hospital. Clinical background, echocardiographic parameters were evaluated. Demographic information and clinical data (including age, electrocardiograms, type of left-sided valve surgery, underlying valve diseases and history of pacemaker or ICD implantation) were obtained by chart review.

Results

Of the 526 patients with severe TR, 107 patients were after a left-sided valve surgery. Patients developed severe TR at a mean of 14.8 ± 8 years after surgery.The surgical indications were as follows: mitral valve stenosis (74 patients, 69%), mitral valve regurgitation (43 patients, 40%), aortic valve stenosis (37 patients, 35%) and aortic regurgitation (28 patients, 26%), respectively. The mean age at diagnosis of severe TR was 74 ± 10 years and 75 were female (70%). Among those patients, 32 patients (30%) had a tricuspid annuloplasty (TAP) with the first left-sided valve surgery. Ninety-five patients (88%) had atrial fibrillation (AF), 75 patients (70%) were diagnosed as rheumatic heart disease, 64 patients (60%) had pulmonary artery hypertension (PH) and 28 patients (26%) had a permanent pacemaker or ICD implantation.

There were only 12 patients who had severe TR without AF. Eight of 12 patients without AF had PH, and permanent pacemakers were implanted in remaining 4 patients.

Conclusions

Almost all patients with severe TR after left-sided valve surgery present with AF and prevalence of rheumatic heart disease were about 70 percent. These two factors may be one of the important risk factors for severe TR after left-sided valve surgery.

Oral-bacterial-induced arterial and venous thrombus in rats: Pathological and immunological studies

Objectives

Our study investigated the pathological outcome of experimental thrombi that incorporate oral bacteria.

Material and methods

A small artery and vein in the rats' groins were injected with a solution containing periodontal bacteria Porphyromonas gingivalis and followed up for 28 days. In all, 18 limbs of nine male rats (500-650 g) were used for the arterial study, and eight limbs of four rats were used for the veins. Two densities of the bacterial solution and two arterial thicknesses sizes were used in the arterial study. Both proximal and distal arteries and veins were ligated loosely using a monofilament nylon suture before bacterial suspensions or control solutions were injected into the ligated vessels.

Results

After 7, 14-18, and 28 days, the rats were sacrificed. Pathology and immunohistochemistry were performed. All specimens exhibited thrombus formation and an acute inflammation reaction with granulocytes at 7 days and then settled down to chronic fibrous change with plasma cells or macrophages at 28 days in the arterial thrombus. CD3 (Pan T-cells), CD79a (Pan B cells in the rats), and IgG were observed in the process of the healing of the arterial thrombus. Venous changes showed relatively clear recanalization that appeared at 7 days, which is slightly different from the artery. Granulocytes were present from 7 to 28 days.

Conclusions

Periodontal bacteria act as an inflammatory core in the vessels, but not as an infectious agent, in our experiments, because of their low ability to invade tissues.

Japanese subgingival microbiota in health vs disease and their roles in predicted functions associated with periodontitis

The present study aimed to identify and compare the microbial signatures between periodontally healthy and periodontitis subjects using 454 sequences of 16S rRNA genes. Subgingival plaque samples were collected from ten periodontally healthy subjects and ten matched chronic periodontitis patients. Bacterial DNA was extracted and next-generation sequencing of 16S rRNA genes was performed. The microbial composition differed between healthy subjects and periodontitis patients at all phylogenetic levels. Particularly, 16 species, including Lautropia mirabilis and Neisseria subflava predominated in healthy subjects, whereas nine species, including Porphyromonas gingivalis and Filifactor alocis predominated in periodontitis. UniFrac, a principal coordinate and network analysis, confirmed distinct community profiles in healthy subjects and periodontitis patients. Using predicted function profiling, pathways involved in phenylpropanoid, GPI-anchor biosynthesis, and metabolism of alanine, arginine, aspartate, butanoate, cyanoamino acid, fatty acid, glutamate, methane, proline, and vitamin B6 were significantly over-represented in periodontitis patients. These results highlight the oral microbiota alterations in microbial composition in periodontitis and suggest the genes and metabolic pathways associated with health and periodontitis. Our findings help to further elucidate microbial composition and interactions in health and periodontitis.

Increased Heart Failure Prevalence in Patients with a High Antibody Level Against Periodontal Pathogen

The aim of this study was to assess whether a specific cardiovascular disease was related to an increased antibody level against a periodontal pathogen.A strong association between cardiovascular disease and periodontitis was shown, however, the causal relationship was not proven. Increased inflammatory reaction of patients with periodontitis was a possible factor, which connected periodontal infection and vascular diseases.We assessed medical history, blood data, and periodontal conditions in patients with cardiovascular diseases. Serum IgG antibody titers against major periodontal pathogens and existence of salivary periodontal bacteria were analyzed.In total, 348 subjects were enrolled in this study. The patients who exhibited 10,000 counts/mL or more of salivary Porphyromonas gingivalis were divided into two groups according to the antibody level of the pathogen. Patients with a high antibody level against Porphyromonas gingivalis exhibited a high rate of heart failure compared to the low antibody group. Mean probing pocket depth and clinical attachment level significantly increased in the high antibody group. We found that the high anti-Porphyromonas gingivalis antibody group also experienced enhanced antibody levels against other periodontal bacteria.An increased heart failure prevalence was found in patients with a high antibody level against a major periodontal pathogen, Porphyromonas gingivalis.

Analysis of factors related to needle-stick and sharps injuries at a dental specialty university hospital and possible prevention methods

Needle-stick and sharps injuries (NSIs) can happen even when dental health care workers (DHCWs) act in compliance with standard precautions to prevent transmitting blood-borne infections. The objective of this study was to investigate causes of NSIs that had occurred at a dental specialty university hospital during the past 12 academic years. A total of 215 NSIs were reported during the investigation period, and NSIs ascribed to female DHCWs (n = 148; 68.8%) were significantly (P < 0.05) more common than those ascribed to male DHCWs (n = 67; 31.2%). One hundred twenty-six NSIs (58.6%) were caused by DHCWs with little experience (P < 0.05), and 37 of those (17.2% of the total) were ascribed to undergraduate students during clinical training (P < 0.05). The NSIs occurred both during treatment (n = 119; 55.3%) and during cleaning up used devices (n = 89; 41.4%). The NSIs at the dental hospital occurred with a probability of 0.004% of total therapeutic opportunities. Prevention of NSIs should be the responsibility of dental students and DHCWs, and should be a part of education about infection control to prevent the nosocomial transmission of blood-borne pathogens.