Assessment of myocardial strain in hypertensive patients with periodontitis

BACKGROUND

Left ventricular (LV) relaxation is affected by hypertension. The inflammatory mediators produced in response to systemic inflammation, such as in periodontal disease, may also alter ventricular mechanics and the existing ventricular dysfunction. Thus, the systemic inflammatory burden which occurs in response to chronic periodontitis may alter myocardial activity.

OBJECTIVES

The current study aimed to assess the myocardial strain among controlled hypertensive patients with periodontitis by using two-dimensional (2D) echocardiography.

MATERIAL AND METHODS

The study involved 150 controlled hypertensive patients, equally divided into group A (without periodontitis) and group B (with periodontitis). The cardiac strain was measured with 2D echocardiography and represented as global longitudinal strain (GLS), while the periodontal inflamed surface area (PISA) score quantified the systemic inflammatory burden experienced by these individuals due to chronic periodontitis.

RESULTS

In the multiple linear regression model, the adjusted R2 for group B indicated that 88% of the variation in GLS was due to the independent variable (PISA). Thus, with every one-unit rise in PISA, there was a mild alteration in GLS of 7.54 × 10-5. A scatter plot depicted a positive correlation between PISA and GLS.

CONCLUSIONS

Within the limitations of the study, it can be concluded that an increase in the PISA score may cause mild alterations in the GLS score, which could indicate the possible influence of periodontitis on myocardial activity.

Clinical and radiographic effects of ascorbic acid-augmented platelet-rich fibrin versus platelet-rich fibrin alone in intra-osseous defects of stage-III periodontitis patients: a randomized controlled clinical trial

Aim

To assess platelet-rich fibrin (PRF) with ascorbic acid (AA) versus PRF in intra-osseous defects of stage-III periodontitis patients.

Methodology

Twenty stage-III/grade C periodontitis patients, with ≥ 3 mm intra-osseous defects, were randomized into test (open flap debridement (OFD)+AA/PRF; n = 10) and control (OFD+PRF; n = 10). Clinical attachment level (CAL; primary outcome), probing pocket depth (PPD), gingival recession depth (RD), full-mouth bleeding scores (FMBS), full-mouth plaque scores (FMPS), radiographic linear defect depth (RLDD) and radiographic defect bone density (RDBD) (secondary-outcomes) were examined at baseline, 3 and 6 months post-surgically.

Results

OFD+AA/PRF and OFD+PRF demonstrated significant intragroup CAL gain and PPD reduction at 3 and 6 months (p < 0.001). OFD+AA/PRF and OFD+PRF showed no differences regarding FMBS or FMPS (p > 0.05). OFD+AA/PRF demonstrated significant RD reduction of 0.90 ± 0.50 mm and 0.80 ± 0.71 mm at 3 and 6 months, while OFD+PRF showed RD reduction of 0.10 ± 0.77 mm at 3 months, with an RD-increase of 0.20 ± 0.82 mm at 6 months (p < 0.05). OFD+AA/PRF and OFD+PRF demonstrated significant RLDD reduction (2.29 ± 0.61 mm and 1.63 ± 0.46 mm; p < 0.05) and RDBD-increase (14.61 ± 5.39% and 12.58 ± 5.03%; p > 0.05). Stepwise linear regression analysis showed that baseline RLDD and FMBS at 6 months were significant predictors of CAL reduction (p < 0.001).

Conclusions

OFD+PRF with/without AA significantly improved periodontal parameters 6 months post-surgically. Augmenting PRF with AA additionally enhanced gingival tissue gain and radiographic defect fill.

Clinical relevance

PRF, with or without AA, could significantly improve periodontal parameters. Supplementing PRF with AA could additionally augment radiographic linear defect fill and reduce gingival recession depth.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00784-021-03929-1.

Reduction of inflammation in a chronic periodontitis model in rats by TNF-α gene silencing with a topically applied siRNA-loaded calcium phosphate paste

We developed a calcium phosphate-based paste containing siRNA against TNF-α and investigated its anti-inflammatory and bone-healing effects in vitro and in vivo in a rat periodontitis model. The bioactive spherical CaP/PEI/siRNA/SiO₂ nanoparticles had a core diameter of 40-90 nm and a positive charge (+23 mV) that facilitated cellular uptake. The TNF- α gene silencing efficiency of the nanoparticles in J774.2 monocytes, gingival-derived cells, and bone marrow-derived cells was 12 ± 2%, 36 ± 8%, and 35 ± 22%, respectively. CaP/PEI/siRNA/SiO₂ nanoparticles cancelled the suppression of alkaline phosphatase (ALP) activity in LPS-stimulated bone marrow-derived cells. In vivo, ALP mRNA was up-regulated, TNF-α mRNA was down-regulated, and the amount of released TNF-α was significantly reduced after topical application of the calcium phosphate-based paste containing siRNA-loaded nanoparticles. The number of TNF-α-positive cells in response to CaP/PEI/siRNA/SiO₂ nanoparticle application was lower than that observed in the absence of siRNA. Elevated ALP activity and numerous TRAP-positive cells (osteoclasts) were observed in response to the application of all calcium phosphate pastes. These results demonstrate that local application of a paste consisting of siRNA-loaded calcium phosphate nanoparticles successfully induces TNF-α silencing in vitro and in vivo and removes the suppression of ALP activity stimulated by inflammation. STATEMENT OF SIGNIFICANCE: We developed a calcium phosphate-based paste containing nanoparticles loaded with siRNA against TNF-α. The nanoparticles had a core diameter of 40-90 nm and positive charge (+23 mV). The anti-inflammatory and osteoinductive effects of the paste were investigated in vitro and in vivo in a rat periodontitis model. In vitro, the TNF-α gene silencing efficiency of the nanoparticles in J774.2 monocytes, gingival-derived cells, and bone marrow-derived cells was 12 ± 2%, 36 ± 8%, and 35 ± 22%, respectively. The ALP activity of bone marrow-derived cells was recovered. In vivo, TNF-α mRNA was down-regulated and the amount of released TNF-α was significantly reduced, whereas the ALP mRNA was up-regulated. Elevated ALP activity and TRAP-positive cells were observed by immunohistochemistry.

Assessing periapical dental radiographs as a screening parameter for early indications of osteoporosis in postmenopausal periodontal patients and root surface evaluation using spectrochemical analysis

Objectives:

To assess the usefulness of periapical dental radiograph as a screening tool aimed at early signs of osteoporosis in postmenopausal periodontal patients and root surface evaluation using spectrochemical analysis.

Methods:

This study was conducted at the Department of Periodontics, Riyadh Elm University, Riyadh, Saudi Arabia, for 12 months between December 2016 and November 2017. Two groups consisted healthy postmenopausal women having chronic periodontitis and postmenopausal women having chronic periodontitis with osteoporosis. Osteoporosis were evaluated for plaque index (PI); gingival index (GI); clinical attachment level (CAL); probing pocket depth (PPD), and bone mineral density (BMD). A standardized digital dental periapical radiographs were taken for every patient. The spectrochemical analysis was carried out using the self-assembled Laser-Induced Breakdown Spectroscopy (LIBS) system used for qualitative and quantitative analysis of Calcium (Ca), Potassium (K), Phosphorus (P), Fluoride (F), and Magnesium (Mg)

Results:

There was no statistically significant difference between both groups for GI and PI. Similarly PPD and CAL were showing the difference but statistically, significant difference was only for CAL. Value of distance starting from cement enamel junction to the alveolar crest (CEJ-AC) and BMD were having a statistically significant variance between both groups. The differences between osteoporotic and control group were statistically significant regarding Ca with the mean higher in the control group. Furthermore, the variances between the groups in both K and Mg were statistically significant with higher mean in the osteoporotic group (p<0.05).

Conclusion:

The clinical, radiographic, and experimental findings of this study indicated that osteoporosis has a direct effect on the progression rate of periodontal tissue destruction and dental radiographic can be suggested as a screening tool for an early sign of osteoporosis.

Clinical and CBCT Evaluation of Combined Periodontal Regenerative Therapies Using Enamel Matrix Derivative and Deproteinized Bovine Bone Mineral With or Without Collagen Membrane

Use of collagen membrane (CM) with deproteinized bovine bone mineral (DBBM) and enamel matrix derivative (EMD) in periodontal regenerative therapy was evaluated. A total of 40 intrabony defects in periodontitis patients were treated. Clinical parameters and filled bone volume (FBV) and rate (FBR) were assessed. Probing pocket depth (PPD) was reduced significantly at 12 months with CM treatment, while clinical attachment level (CAL), FBV, and FBR showed similar improvements. In stratified analyses, CM-treated thick-biotype patients showed significant improvement in PPD and CAL. Regenerative therapy with the use of EMD and DBBM showed similar improvements in periodontal tissue regeneration with or without CM. The combination with CM appeared to influence the healing of soft tissue and was effective in decreasing pocket depth.

Clinical and CBCT-based diagnosis of furcation involvement in patients with severe periodontitis

OBJECTIVE

The aim of this study was to compare the use of periodontal probing and cone beam computed tomography (CBCT) images in the diagnosis of furcation involvement (FI) in patients with chronic generalized severe periodontitis.

METHOD AND MATERIALS

Fifteen patients with chronic generalized severe periodontitis were included in this study. In total, 174 furcation sites (all in molar teeth) were analyzed. FI was assessed at three sites (buccal, mesiopalatal, and distopalatal) of maxillary molars, and at two sites (buccal and oral) of mandibular molars. FI was assessed both clinically (periodontal probing) and on CBCT images, using a dichotomous scale (present/absent). The agreement between clinical and CBCT-based findings was calculated.

RESULTS

FI were more often detected by means of CBCT than by means of clinical examination. Agreement between the evaluation methods was present in 46.9% of cases (63.3% in maxilla, 45.0% in mandible). FI detected clinically was confirmed by means of CBCT in 24% of the evaluated sites. The largest agreement (73.7%) in FI detection was found in the distopalatal maxillary sites between CBCT and clinical probing. The smallest agreement (36.6%) was found in the buccal sites of the mandibular molars, in which 63.3% of FI were detected using CBCT only, but not clinically.

CONCLUSION

The number of FI detected by means of CBCT was larger than by means of periodontal probing. In those cases in which chronic generalized severe periodontitis is clinically diagnosed, and surgical treatment is necessary, CBCT may be suggested as an adjunct tool for FI assessment.

Saving Single-rooted Teeth with Combined Endodontic-periodontal Lesions

INTRODUCTION

Teeth affected by combined endodontic-periodontal lesions are usually considered by all prognosis classifications as hopeless teeth. The development of new biomaterials combined with modern endodontic and periodontal regeneration techniques may improve dental prognosis and maintain the affected teeth. Moreover, 1 of the replacement options for those teeth, dental implants, has shown an increasing number of biological and technical complications.

METHODS

Five patients were included in this case series study. Full periodontal and radiographic examination revealed generalized chronic periodontitis. Moreover, endodontic-periodontal lesions affecting single-rooted teeth were detected in those patients with tissue destruction beyond the apex. After splinting those teeth, conventional endodontic and nonsurgical periodontal treatment was performed. Three months later, periodontal regeneration was applied at those teeth in order to reconstruct supporting tissues and to improve dental prognosis.

RESULTS

After a follow-up period ranging from 14 months to 17 years, it was observed that all teeth remain asymptomatic and in normal function. No signs of apical pathosis were observed, and the periodontium was stable. All patients were included in a strict maintenance program to check the periodontal and apical status.

CONCLUSIONS

This case series shows that it is possible to change the prognosis of teeth affected by combined endodontic-periodontal lesions, even if the periodontal support is destroyed beyond the apex.

Clinical and radiographic evaluation of effect of risedronate 5 mg as an adjunct to treatment of chronic periodontitis in postmenopausal women (12-month study)

Bisphosphonates are beneficial to women, after menopause, in treatment of gum diseases. In this study, significant improvement in the disease condition was found and that no further progress was noted, and no side effects were reported. Bisphosphonates can be safely and successfully be used to support oral health procedures.

INTRODUCTION

The purpose of this study was to evaluate host modulating effect of bisphosphonate adjunct with the treatment of chronic periodontitis in osteopenic and osteoporotic postmenopausal women.

METHODS

Twenty-two osteopenic and osteoporotic postmenopausal women with moderate to severe chronic periodontitis were selected for the study. On intraoral examination, periodontal parameters like probing depth (PD), clinical attachment level (CAL), Plaque Index (PI) and Gingival Index (GI) were recorded. Scaling and root planing were done. Intraoral periapical X-rays were taken, and alveolar bone density (ABD) was measured with cone beam computed tomography (CBCT), and then, medications (risedronate 5 mg once daily (OD), calcium citrate 250 mg OD, vitamin D 400 IU OD) were given. Patients were recalled for follow-up at 3, 6 and 12 months. Intraoral periapical (IOPA) X-rays were taken at 6 and 12 months and ABD was measured at baseline and 12 months.

RESULTS

There was a significant improvement in all the parameters. There was an increase of 0.02 ± 0.001 cm on CT scan and 0.38 ± 0.005 mm on IOPA in bone height over 12 months from baseline. Bone density increased by 118.56 ± 3.251 Hounsfield units (HU). There was no progress in the disease, and further bone loss was not noticed. This is in correlation with clinical parameters which showed highly significant gain in CAL (3.57 ± 0.234 mm) and reduction in PD (2.20 ± 0.229 mm)

CONCLUSIONS

Bisphosphonate therapy as an adjunct to scaling and root planing may have significant beneficial clinical effects on the periodontium of postmenopausal women with moderate to severe chronic periodontitis.

Identification of the anatomical elements used in periodontal diagnosis on 40 MHz periodontal ultrasonography

Gingival inflammation is highly prevalent among adult populations in all regions of the world. High rates of chronic periodontitis have been reported worldwide. The methods for assessing the gingival inflammation and periodontal disease would need more precision and less user-dependence. The aim of this study consists in identifying the information for diagnosis and staging of periodontal disease using 40 MHz periodontal ultrasonography. Our in vivo study has been made on 49 teeth of 10 patients with marginal periodontal disease. Standard clinical and radiological periodontal examinations were performed. Afterwards the results were compared with the information obtained from images recorded with Ultrasonix SonoTouch used at 40 MHz. On the ultrasound images, were performed very accurate measurements between the cortical bone and the cement-enamel junction or the root wall compared with the measurements made on intraoral digital radiographs. Those measurements could be used to diagnose the bone resorption. In order to monitor the gingival inflammation could be recorded the width of the attached gingival mucosa and the height of the gingival margin on ultrasound images. 40 MHz periodontal ultrasonography is a reliable imagistic method for identifying the necessary anatomical elements in order to make an accurate periodontal diagnosis for the examined area.

[An application of cone-beam CT in the diagnosis of bone defects for chronic periodontitis]

OBJECTIVE

To evaluate the accuracy of cone-beam CT (CBCT) for detection of bone defects in chronic periodontitis and its consistency with periapical film, panoramic radiograph and clinical examination.

METHODS

Seventy-five patients with periodontitis were selected in the study. Each patient received clinical examination, periapical film, panoramic radiograph and CBCT examination one week after supragingival scaling. The distance from the alveolar ridge crest to enamelo-cemental junction was measured. The data were statistically analyzed.

RESULTS

A total of 1 494 teeth and 8 964 sites were included in the study. Among the three kinds of imaging methods only CBCT could detect the lip (buccal) or tongue (palatine) side of alveolar bone destruction. Compared with panoramic radiographs[mesial: (4.9±0.4) mm, distal: (4.9±0.8) mm] and periapical film [mesial: (5.1±0.6) mm, distal: (5.1±0.8) mm], CBCT [mesial: (5.5±0.4) mm, distal: (5.6±0.8) mm] showed significant differences (P < 0.01) in alveolar bone defect measurements in detecting mesial and distal alveolar bone defect. There was no significant difference between clinical probing [mesial: (5.5±0.6) mm, distal: (5.5±0.6) mm] and CBCT.

CONCLUSIONS

CBCT have the highest consistency with clinical probing in detecting the alveolar bone loss in chronic periodontitis.

Evaluation of relative efficacy of β-tricalcium phosphate with and without type I resorbable collagen membrane in periodontal infrabony defects: a clinical and radiographic study

BACKGROUND AND OBJECTIVES

To compare clinically and radiographically, the regenerative potential of a β-tricalcium phosphate bone graft, Cerasorb(®) with and without a bioresorbable type I collagen membrane, BioMend Extend™, in treating periodontal infrabony osseous defects.

MATERIALS AND METHODS

A total of 20 sites from 10 patients showing bilateral infrabony defects were selected and selected sites were randomly divided into experimental site A (Cerasorb(®)) and experimental site B (Cerasorb(®) and BioMend Extend™) by using split mouth design. The clinical parameters like plaque index, gingival index, probing pocket depth, clinical attachment level and gingival recession were recorded at baseline, 6 weeks, 3, 6 and 9 months. Radiographic evaluation (Linear CADIA) at 6 and 9 months; and intrasurgical measurements at baseline and 9 months were carried out to evaluate the defect fill, change in alveolar crest height and defect resolution.

RESULTS

Significant reduction in all clinical parameters was observed in both the groups. On comparison no statistical significance was observed between the two groups. Radiographically, in site A there was significant defect fill of 78.4 and 97.2% at 6 and 9 months respectively. Whereas in site B reduction was 78.4 and 97.2% at 6 and 9 months respectively. After surgical re-entry, there was significant defect fill of 89.2 and 74% in both groups.

INTERPRETATION AND CONCLUSION

Individually both the graft and membrane have shown promising results in the management of periodontal intrabony defects. But the added benefit by combining Cerasorb(®) with BioMend Extend™ was not observed statistically in both clinical radiographic findings.

[Evaluation of alveolar bone defect in chronic periodontitis by cone-beam computed tomography]

OBJECTIVE

To evaluate the morphological characteristics of alveolar bone defects of the patients with chronic periodontitis using cone-beam CT (CBCT).

METHODS

Sixty patients with chronic periodontitis were included in this study. CBCT was used to scan the alveolar bone and NNT software to measure the alveolar bone defects and bone loss types in different regions.

RESULTS

Seventy-five percent (45/60) of the alveolar bone defect was the generalized type, 25% (15/60) was the localized type. In incisor and canine area, the defect of the mandibular alveolar bone was more severe than in the same sites of maxilla. There was less bone loss in the premolar area of mandible than in the same site of maxilla. In the mesial and buccal sites of mandibular molars and in the lingual site of maxillary molars, the most severe alveolar bone loss was found.

CONCLUSIONS

The obvious alveolar bone defect areas in chronic periodontitis were the palatal side of maxillary molars and the lingual side of mandibular incisors. CBCT can clearly demonstrate the degree of alveolar bone defects in different regions of chronic periodontitis.

A retrospective study of edentulous patients rehabilitated according to the 'all-on-four' or the 'all-on-six' immediate function concept using flapless computer-guided implant surgery

PURPOSE

To report the outcome of an implant therapy protocol using 4 or 6 implants supporting immediately loaded fixed prostheses following 3D software planning and flapless guided surgery.

MATERIALS AND METHODS

A total of 30 patients (24 women, 6 men), mean age of 53 years (range 35-84 years) were treated with 195 immediately loaded implants (97 NobelSpeedy Groovy and 98 Brånemark MKIII Groovy) supporting 25 maxillary and 17 mandibular fixed full-arch acrylic prostheses and followed for 1 year. The Procera Software v1.6 and v2.0 was used to plan implant position and to obtain a surgical template for the guided flapless implant placement. To perform immediate loading, the implants had to be inserted with torque of at least 35 Ncm. Provisional prostheses were made before surgery using software planning and were placed in the same session as the implants. Definitive restorations were delivered 6-12 months after surgery. Outcome measures were failures of the prosthesis and of the implants, marginal bone level changes, complications, clinical time and patient satisfaction.

RESULTS

Four patients with full edentulism and 26 with advanced periodontitis were enrolled in this study. A total of 195 implants were immediately loaded (128 implants were placed in the maxilla and 67 implants were placed in the mandible). Four implants out of 195 failed in three patients during the healing period: 2 in the maxilla (1 straight and 1 tilted), and 2 in the mandible (both of them tilted). Three of them were successfully replaced. One year after loading there were no dropouts and no failure of the definitive prosthesis occurred. In three cases, the surgical template fractured during surgery. In one patient, a new impression had to be taken to fit the provisional prosthesis onto the implants. Three patients were subjected to surgery and systemic antibiotics to treat apically infected implants.

CONCLUSIONS

The 'all-on-four' and 'all-on-six' treatment protocol combined with computer-guided flapless implant surgery could be a viable and predictable treatment. Some complications occurred that were successfully treated. However, this technique could be sensitive to the experience of the surgeon and a learning curve is required.

[Densitometric investigation of the dynamics of bone defects regeneration in surgical treatment of chronic periodontitis]

Apicotomy of 105 teeth of 78 patients with chronic periodontitis has been performed. The periapical defect were filled with two kinds of osteoplastic matter: the first group was treated with demineralised bone matrix of newborn pigs (DBMNP), the second group with artificial hydroxyapatite, while both matters were enriched with platelet rich plazma (PRP).As a third, control group, cases. The defects of which were not filled with osteoplastic matter, were investigated. The dynamics of the regeneration of bone defects was studied based on the data of densitometric investigation. The results of objective observations have revealed high efficiency of surgical treatment of chronic periodontitis with the filling with DBMNP in combination with PRP.