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... NG can be diagnosed if necrosis is limited to the interdental papilla, presenting with the characteristic 'punched out' appearance. 4 If the inflammatory process is accompanied by rapid alveolar bone loss, along with the formation of a ...

... Routine prescribed medications were eventually be fatal. 4,8,9,10 NPDs are rarely seen in developed countries. Noma almost exclusively occurs in developing countries, where malnutrition and immunocompromise are more widespread. ...

... 5,19,20 The most influential risk factor has been found to be seropositivity to HIV infection. 4,5 Poor oral hygiene increases the risk, but HIV-positive patients can present with these conditions even with good oral hygiene. 5,9 Lack of sleep, stress and smoking have often been reported by patients presenting with NPDs and are also implicated. ...

... NG can be diagnosed if necrosis is limited to the interdental papilla, presenting with the characteristic 'punched out' appearance. 4 If the inflammatory process is accompanied by rapid alveolar bone loss, along with the formation of a pseudomembrane, lymphadenopathy and pyrexia, NG is considered to have progressed to NP. Once the condition spreads to involve the alveolar bone, resulting in osteonecrosis and bony sequestration, this is termed NS. ...

... 5 In extreme cases, NPDs can result in noma (cancrum oris), which leads to extensive destruction of the soft and hard tissues of the face, and may eventually be fatal. 4,8,9,10 NPDs are rarely seen in developed countries. Noma almost exclusively occurs in developing countries, where malnutrition and immunocompromise are more widespread. ...

... 5,19,20 The most influential risk factor has been found to be seropositivity to HIV infection. 4,5 Poor oral hygiene increases the risk, but HIV-positive patients can present with these conditions even with good oral hygiene. 5,9 Lack of sleep, stress and smoking have often been reported by patients presenting with NPDs and are also implicated. ...

'Necrotising periodontal diseases' is an umbrella term for necrotising gingivitis, necrotising periodontitis, necrotising stomatitis and noma. These rapidly destructive conditions are characterised by pain, interdental ulceration and gingival necrosis which, if left untreated, can result in osteonecrosis. Research indicates that patients with a history of alcohol misuse are at an increased risk of malnutrition, which negatively affects the immune response and predisposition to necrotising periodontal diseases. This article will discuss that osteonecrosis of the alveolar bone does not exclusively occur in association with antiresorptive medications, but can occur as a severe form of necrotising gingivitis. In this article, we will describe two cases to highlight the occurrence, presentation and management of necrotising periodontal diseases secondary to alcohol misuse. Raises clinician awareness on the topic of necrotising periodontal diseases and describes diagnosis and treatment modalities.Explores and explains the link between alcohol misuse, malnutrition and necrotising periodontal diseases.Encourages dentists to liaise with healthcare professionals in the management of patients suffering from underlying comorbidities, highlighting the importance of holistic patient care. Raises clinician awareness on the topic of necrotising periodontal diseases and describes diagnosis and treatment modalities. Explores and explains the link between alcohol misuse, malnutrition and necrotising periodontal diseases. Encourages dentists to liaise with healthcare professionals in the management of patients suffering from underlying comorbidities, highlighting the importance of holistic patient care.

... To accomplish it, practitioners use scalers and pocket/root instrumentation in order to approximate the ultimate goal of the therapy, which is to remove microbial deposits and calculus from the supra-and infragingival areas. 1 Besides that, a variety of treatment strategies can modulate the patient's response to the management of periodontitis. This involves the local application of chemotherapeutic agents as an adjunct to NSPT, increasing its ability to ensure satisfactory outcomes. ...

... Any added clinical advantage subgingival irrigation may have over NSPT is probably limited to drugs that can bind to the surface of the root and/or lining of the periodontal pocket, such as tetracyclines or chlorhexidine. 1 Recognizing that the potency of a locally applied medicine hinges on its relatively long-lasting availability at concentrations over the effective minimum, several forms of LDDSs have emerged. They include fibers, strips, films, gels, microparticles, and nanoparticles, all aiming to offer easy application, steadiness and uniform distribution inside periodontal pockets as well as controlled or sustained release. ...

... It is composed of a semi-solid suspension of 25% metronidazole benzoate in the mixture of glyceryl monooleate and sesame oil; its viscosity should increase after placement. 1 One of the microparticle-based subgingival delivery systems is Arestin™ -FDA-approved microspheres synthesized from poly(lactic-co-glycolic acid) (PLGA) for releasing minocycline HCl sustainably inside periodontal pockets. 12 Human insulin − the hormone of β cells in the Langerhans islets of the pancreas − consists of 2 peptide chains called A and B, linked via 2 intermolecular disulfide bridges. ...

• Ali Raeef Abboud
• Ali Mohammad Ali
• Tihama Youssef

Background: The application of local drugs as adjunctive periodontal treatment is a topic of rapidly increasing interest. Consequently, new discoveries are arising, a noteworthy portion of which employ hydrogels as delivery systems due to their high biocompatibility with and similarity to human tissues. In the search for new therapeutic agents capable of aiding periodontal treatment, authors became interested in a unique concept investigated by very few in vitro or in vivo studies concerning the local application of insulin. These studies concluded that insulin promotes the recovery and regeneration of damaged soft and bone tissues. Objectives: The aim of the study was an endeavor to design a linear hydrogel that is injectable into periodontal pockets, and is able to carry a small insulin load through physical bonds and provide sustained release. Material and methods: The chitosan hydrogel as well as blends of polyvinyl pyrrolidone (PVP), polyvinyl alcohol (PVA) and polyethylene glycol (PEG) were prepared and characterized in terms of the hydrogel texture and injectability. Afterward, to study the insulin release kinetics, a specific amount of each formulation was loaded with insulin, and then incubated in phosphate-buffered saline (PBS). Specimens of the incubated samples were withdrawn daily to measure insulin concentrations by means of the ultraviolet (UV)-absorbance method; ultimately the cumulative release was calculated. Results: Out of the 5 formulations, 4 had homogenous one-phasic texture and their insulin release profiles in vitro ranged from a few hours to about 2 weeks. The blend of 26.5 wt% PVP, 6.6 wt% PVA, 0.03 wt% calcium chloride dihydrate (CaCl2.2H2O), and 66.8 wt% water, loaded with 2 IU/g of insulin, had favorable regular sustained release, approaching 13 days. Conclusions: The composition of the hydrogel, the component ratio and the amount of loaded insulin were found to affect the release profile. A linear hydrogel of copolymerized PVP, PVA and CaCl2.2H2O can serve as a local vehicle for the sustained delivery of insulin inside periodontal pockets.

... American dental association (ADA) dişlerin günde iki kere fırçalanmasını ve günde en az 1 kez dişlerin arayüz temizliğinin yapılmasını öneriyor fakat bu konuda tam bir fikir birliği bulunmamaktadır. 31 Yapılacak hareket sayıları için bir yönerge, çalışma veya konsensüs bulunmadığı için ADA'nın günde 2 kez diş fırçalanması önerisinden yola çıkarak çalışmamız günde 2 kez ve her diş arası için 3 kez ileri-geri hareketi yapılacak şekilde dizayn edildi. Kieger ve ark. ...

... Buradan yola çıkarak merkez metalin arayüz temizliği esnasında dişe temas ettiği ve sürtünme sebebiyle plastik kaplamanın soyulup dökülebileceği öngörülmüştür. 31 Üretici firmaların arayüz fırçalarının kullanımları için önerdikleri maksimum süre 1 haftadır. Sosyoekonomik etkenler göz önünde bulundurulduğunda hastaların büyük çoğunluğunun arayüz fırçalarını kırılana kadar kullandıkları öğrenilmiştir. ...

Amaç: Günlük ağız bakımında, tek başına fırçalama sıkı kontağı bulunan dişlerde arayüzlere ulaşmak için yeterli değildir, bu da bu alanların temizlenmemesine neden olur. Arayüz fırçaları ISO 16409 standardına göre dişlerin arayüzeylerini temizlemek için tasarlanmış, manuel olarak etkinleştirilen araçlardır. Bu çalışmada arayüz fırçalarının belli sürelerde kullanımları sonucu yüzeylerinde meydana gelen değişimlerin Taramalı Elektron Mikroskobu (SEM) kullanılarak incelenmesi amaçlandı. Gereç ve Yöntemler: Farklı model, şekil ve büyüklükteki arayüz fırçaları marka ve boyutlarına göre gruplara ayrılarak kullanım öncesi , 1. hafta , 1. ay kullanım sonrası yüzey değişimleri SEM kullanılarak incelendi. Çalışma yumuşak dokulu bir çene modeli üzerinde uygulandı. Deney sonrası işlev gören uç kısımları keski ile kesilerek SEM de incelemeye hazır hale getirildi. Örnekler çeşitli büyütmelerde incelenerek görüntülü kesitleri alındı. Bulgular: SEM görüntülerinde fırça kıllarının, bir metalin telin kendi etrafında burulması ile oluşan aralarındaki boşluklara yerleştirildiği gözlendi. 1 haftalık 1092 hareket ile kullanım sonucunda hızlı bir yıpranma , 1 aylık 4680 hareket ile kullanım sonunda kırılmalar ile karşılaşıldı ve fırça kılları deforme oldu. İncelemelerde merkezdeki metalin bir plastik ile kaplı olduğu ve bu plastiğin kullanım sonucu aşındığı ve döküldüğü gözlemlendi. Sonuç: Arayüz fırçalarının kullanımları diş aralarının temizliği için çok önemlidir. Bu fırçaların kullanım sonucu yüzeylerinden dökülen plastik parçaların dişeti sulkusunda ya da oral mukozanın çeşitli kısımlarında yabancı cisim reaksiyonuna sebep olabileceğini düşünmekteyiz. Kesin yargılar için bu konu üzerinde invivo çalışmalara gerek vardır. ABS TRACT Objective: In daily oral care, brushing alone is not sufficient to reach the interfaces in tightly contacted teeth, so that these areas can not to be cleaned. Interdental brushes are manually activated tools designed to clean the interfaces of the teeth according to the ISO 16409 standard.In this study, it was aimed to investigate the changes in the surface of the interdental brushes by using Scanning Electron Microscopy (SEM). Material and Methods: Interdental brushes of different models, shapes and sizes were divided into groups. Surface changes were examined using SEM before use, 1 week, 1 month after use. After the experiment, the tip of brushes which functioned were cut with chisel and made ready for examination in SEM. Samples were examined at various magnifications and their image sections were taken. Results: In the SEM images, with the use of 1 week and 1092 movements, rapid wear was observed and with 1 month and 4680 movements, breaks were encountered and interdental brushes were deformed. In the investigations, it was observed that the metal in the center was covered with a plastic and this plastic was worn and poured as a result of usage. Conclusion: As a result of the use of these brushes, plastic particles spilled from their surfaces may cause foreign body reaction in gingival sulcus or various parts of oral mucosa. In order to make definite judgments, invivo studies are needed on this subject.

... Periodontitis is a chronic inflammatory disease of infectious origin that causes progressive deterioration and destruction of alveolar bone, periodontal ligament and radicular cement [1]. The extent and severity of bone loss must be diagnosed with radiographs and clinical examination [2]. In periodontitis, there are two types of bone loss: horizontal and vertical [3]. ...

... In periodontitis, there are two types of bone loss: horizontal and vertical [3]. The vertical type involves a lesion placed apical to the residual alveolar bone and is more susceptible to regeneration techniques [2,4,5]. ...

• Mihaela Grigorie
• Ioana Suciu
• Daniela Zaharia
• Monica Voiculeanu

A hopeless tooth from a periodontal point of view, with severe bone resorption, mobility and abnormal tooth migration, is often extracted. In advanced cases, function and esthetics are impaired, and an interdisciplinary treatment is requested. Retaining or not these teeth is based on clinician judgment. A growing body of evidence claims that prognosis has great potential to be improved in a motivated patient with good oral hygiene and regular maintenance. This case report aims to present a periodontal regenerative technique combining enamel matrix protein derivatives and a particulated xenograft to treat intraosseous defects caused by periodontitis. The patient healed uneventfully, and no complications were recorded after the surgical procedure. To correct abnormal tooth migration and improve function and esthetics, orthodontic treatment was instituted. Tooth prognosis improved from hopeless to questionable. This approach extended the life span of a compromised tooth, improving periodontal support and decreasing tooth mobility. This could be an alternative to extraction and implant.

... The soft tissue surrounding the transmucosal dental implant part,is called "peri-implant mucosa" and separates the periimplant bone from the oral cavity is. 1 The attachment of peri-implant mucosato the implant provides a biological seal that prevents the initiation development of peri-implant diseases. 2 This seal is fragile because supracrestal connective tissue attachment as seen with teeth does not exists andthe epithelial attachmentvaries inlength. ...

... 20 Similarly JUN et al., demonstrated CGFe at concentrations ≤ 10% promoted dental pulp cells proliferation and differentiation and promoted human umbilical vein endothelial cells proliferation, migration and vessellike structure formation. 1 Qiao et al. concluded the optimum concentration was medium rather than high for human periodontal ligament cell proliferation. 20 In our study, CGFe at concentrations ≥ 40% promoted cell viability in a dose dependent manner. ...

Objective Attachment of peri- implant mucosa to implant is crucial for long term survival of implant. Soft tissue healing around implants has been of great interest due to its important role in long-term maintenance of implant therapy. Considering the critical role of gingival fibroblasts in periodontal repair, the aim of this study was to evaluate the Concentrated Growth Factor (CGF) as an innovative approach to accelerate wound healing and increase the connective tissue seal around dental implants. Results 40% and 80% Concentrations of CGF significantly improved human gingival fibroblasts (HGF) viability compared to the control group (P value = 0.001). But the comparison of the other group with the control group was not statistically significant. The difference between 40% and 80% concentrations of CGF was not statistically significant (P value = 0.061). Results showed that the viability of HGF treated with CGF on titanium discs(test groups 2) significantly increased as compared to the test groups 1(without CGF) at 24 hours (P value = 0.001).Our results showed that 40% concentration of CGF at 24 hours significantly increased HGF viability.

... Grafting procedures use palatal gingiva and other materials to increase the KM of other oral cavity areas. Free gingival graft (FGG) is a predictable method because it maintains the original characteristics as a firm mucosa of the palate [14]. A previous study has reported that APF and vestibuloplasty in combination with FGG were the most effective procedures for increasing the keratinized tissue [15]. ...

... A previous study has reported that APF and vestibuloplasty in combination with FGG were the most effective procedures for increasing the keratinized tissue [15]. However, the disadvantages of this procedure include pain and bleeding during surgery [14]. CM has been considered as an alternative to overcome the disadvantages of FGG. ...

• In-Kyung Lee
• Hyun-Seok Choi
• Sang-Heon Jeong
• Jung-Tae Lee

Background and Objectives: The purpose of this pilot study was to evaluate the clinical outcomes of three different methods for increasing the keratinized mucosa (KM) surrounding dental implants with peri-implantitis. Materials and methods: Twenty implant sites with peri-implantitis were divided into: (1) porcine collagen matrix (CM) group: seven implant sites; (2) apically positioned flap (APF) group: eight implant sites; and (3) free gingival graft (FGG) group: five implant sites. The KM width and clinical parameters (probing pocket depth (PPD) and bleeding on probing (BOP)) were measured at time points: before surgery (T0) and 30 (T1), 60 (T2), 90 (T3), and 180 (T4) days after surgery. Results: Regarding KM width, all the groups had significant differences for increasing horizontal and vertical KM width. The CM and FGG groups had greater KM than the APF group. There was a decrease in PPD in all three groups. APF and FGG showed significant differences in PPD at T1 and T2 compared to T0. Only the FGG group showed a significant difference in PPD at T3 and T4 compared with that at T0. BOP values were also reduced in all the groups at T1–T4 compared to T0. The APF and FGG groups showed a significant decrease in BOP. Conclusions: Three surgical therapies presented favorable results for increasing the KM surrounding implants. Compared with the FGG group, the CM showed similar results in increasing the KM around the dental implants with peri-implantitis.

... One of the most important challenges of periimplantitis is that symptoms do not appear in the same way for all patients, and usually appear lately at the end of the inflammatory stages (Lang and Lindhe, 2015), this explains why that most cases (72%) were diagnosed as late periimplantitis along with the high rate (40%) of pathological mobility of the implant as a chief patients complaint, such mobility indicates implant-supported bone loss and eventual loss of the implant. Thus, patients are advised to attend regular dental appointments and seek advice from their dentist if they have any concerns about oral health. ...

Determining risk indicators for dental implants is an essential strategy for preventing peri-implant diseases and effective diagnosis of dental implant success. To investigate the impact of certain potential factors on the osseointegrated dental implant. Eighty-four individuals were included in our study, 50 cases as a patient's group and 34 participants as a control group. All cases were diagnosed based on certain criteria, 30 (60%) of patients had peri-implantitis, 20 (40%) with severe peri-implantitis, 36(72%) were generalized, and 15 (30%) as localized peri-implantitis cases. The study has indicated that 44.7% of dental implants were in the anterior maxilla, followed by (27.3%) posterior maxilla, (17.4%) posterior mandible, and (10.4%) anterior mandible. Also results were showed that the anterior maxilla was significantly the highest (P=0.000) in the incidence of PID than any other implantation sites (PMx, PMa, AMa). The most patients' complaint was 28(56%) altered gingival appearance, followed by 20(40%) pathological mobility, 16(32%) halitosis, 16(32%) pain, 12(28%) bleeding, 8(16%) unpleasant taste. The majority of the implants in both groups were long, regular-width, conical and had a rough surface In the patient group, all risk indicators related to implant design were showed a significantly higher than the control group, except for regular-width and screw type implant, which were significantly lower than control. In conclusion, the study improved that many different potential risk indicators contributed to the development of PIDs.

... CHX has been recognized as the gold standard in oral hygiene care and maintenance for over 20 years (56,57). It is an effective ally in the control of plaque and treatment of gum disease, when associated with brushing (57,58), in addition to diseases such as alveolar osteitis and bacteremia after tooth extractions (59). Its use was also considered safe in patients who received implants because it has excellent resistance to titanium corrosion (60). ...

• Pedro Urquiza Jayme Silva
• Luiz R Paranhos
• Daniela Meneses-Santos
• Sérgio Vitorino Cardoso

This study aimed to compare the effectiveness of 0.12% chlorhexidine alone and 0.12% chlorhexidine in combination with toothbrushing to prevent ventilator-associated pneumonia (VAP) in mechanically ventilated patients. The Embase, Latin American and Caribbean Health Science Literature, PubMed, Scientific Electronic Library Online, Scopus, LIVIVO, Web of Science, Cochrane Library, OpenThesis, and Open Access Thesis and Dissertations databases were used. Only randomized controlled trials without restrictions on the year or language of publication were included. Two reviewers assessed the risk of bias using the Joanna Briggs Institute Critical Appraisal Tool. A meta-analysis using a random-effects model estimated the combined relative risk (RR). The Grading of Recommendations, Assessment, Development and Evaluations approach was used to assess the certainty of the evidence. Initially, 2,337 studies were identified, of which 4 were considered in the systematic review and 3 in the meta-analysis (total sample: 796 patients). The studies were published between 2009 and 2017. All eligible studies had a low risk of bias. The meta-analysis revealed that the risk of VAP was 24% lower in patients receiving chlorhexidine combined with toothbrushing than in those receiving chlorhexidine alone (RR: 0.76; 95% confidence interval: 0.55-1.06), with moderate certainty of evidence and without statistical significance. In conclusion, considering the limitations of this study, a standard protocol for the prevention of VAP is not yet recommended. More studies with larger sample sizes are needed to draw strong conclusions. However, considering that toothbrushing is a simple intervention, it should be a common practice in mechanically ventilated patients, especially among patients with coronavirus disease.

... Dental caries are the result of the dynamic process of demineralization and remineralization of dental materials. This process occurs several times a day and is modified by several factors, including oral hygiene, diet, genetics, dental anatomy, intrinsic resistance of tooth structure, saliva flow, buffering capacity, number and type of microbial flora, and fluoride use (1,2)). Streptococcus mutans (S.M.) and Lactobacillus acidophilus (L.A.) are the main bacterial strains involved in the decay process as causative and progressive factors, respectively (3,4). ...

• Banafsheh Soleimani
• Hamidreza Goli
• Mahsa Naranjian
• Azam Nahvi

Background: Topical fluoride products such as varnishes prevent dental caries by limiting demineralization and antibacterial properties. The structural and metabolic characteristics of cariogenic microorganisms are different from each other. Also, the formulation properties, concentration, and release behavior of fluoride vary in different varnishes. Objectives: In this study, we investigated the antibacterial effects of three types of common fluoride varnishes against two cariogenic bacteria of Streptococcus mutans (S.M.) and Lactobacillus acidophilus (L.A.). Methods: In this in vitro study, antibacterial effects of MI varnish [containing calcium phosphopeptide-amorphous calcium phosphate (CPP-ACP)], Polimo (containing xylitol), and FluoroDose varnishes were evaluated using disc diffusion method via measuring the diameter of the inhibition zone. The antibiotics of erythromycin and ampicillin were used as the positive control of the test. Analysis of variance (ANOVA) and post hoc tests were applied to compare the mean of non-growth zone diameter in the studied groups. Data were analyzed by SPSS 16. The statistical significance level was determined as P-value < 0.05. Results: The antibacterial effect of each varnish was optimal against both bacteria. In comparison, the mean diameter of the inhibition zone in MI varnish was significantly (P-value=0.019) higher than Polimo and FluoroDose brands on S.M.; however, this difference was not statistically significant for L.A. Furthermore, Polimo and FluoroDose varnishes showed similar antimicrobial effects against these bacteria. Conclusions: The use of these varnishes seems to be suitable for preventing tooth decay. MI varnish is preferable because of its higher antibacterial properties.

... The etiology of periodontal diseases is dental plaque. Dental plaque is composed of microbial biofilms that adhere to the tooth surface [5]. The susceptibility of an individual to develop periodontal diseases depends on the immune and inflammatory responses to the periodontopathogenic bacteria present in the dental plaque and is modified by environmental factors [6,7]. ...

Periodontal diseases like gingivitis and periodontitis are primarily caused by dental plaque. Several antiplaque and anti-microbial agents have been successfully incorporated into toothpastes and mouthwashes to control plaque biofilms and to prevent and treat gingivitis and periodontitis. The aim of this article was to review recent developments in the antiplaque, anti-gingivitis, and anti-periodontitis properties of some common compounds in toothpastes and mouthwashes by evaluating basic and clinical studies, especially the ones published in the past five years. The common active ingredients in toothpastes and mouthwashes included in this review are chlorhexidine, cetylpyridinium chloride, sodium fluoride, stannous fluoride, stannous chloride, zinc oxide, zinc chloride, and two herbs—licorice and curcumin. We believe this comprehensive review will provide useful up-to-date information for dental care professionals and the general public regarding the major oral care products on the market that are in daily use.

... The interdental papilla is a soft tissue found in the cervical area of the free gingiva, extending from the interproximal alveolar crest to the point of contact [1]. ...

• Arturo Sanchez-Perez
• Tania Rosa Vela-García
• Bibiana Mateos-Moreno
• Carlos Navarro-Cuellar

The absence of interdental papillae leads to the appearance of black triangles. For most patients, the appearance of these triangles is an important reason for concern and affects their social relationships. Multiple reconstruction techniques have been developed with different degrees of success and predictability. The main aim of this study was to evaluate the efficiency of hyaluronic acid (HA) injected into interproximal papillae 6 months after injection and to perform a systematic review and meta-analysis. After a systematic review, seven articles were selected: two clinical randomised controlled trials and five clinical trials. In total, 127 patients with a deficiency in upper papillae in the front of the maxilla and jaw were included in the study. The height variable was evaluated (mm) 6 months after HA injection. In total, 166 interproximal papillae were studied. Four articles showed an important difference in favour of intervention. The total result regarding in the injection of HA was favourable with an approximate average filling of 0.47 mm in the height of the interdental papilla. The injection of HA for the reconstruction of deficient papillae in the region of the upper and lower maxilla was a possible option treatment strategy in mild black triangles.

... The roughness is a parameter very important in clinical practice. For example, the roughness of endosseous dental implants should not exceed the 100 μm [51]. On the other hand, it was reported that the bone grows better on the rough implant sur- faces, as a result of the high interfaces between bone and implant [52][53][54][55]. ...

In this paper, a novel biocompatible alloy defined as FeMoTaTiZr was obtained and functionalized by hydroxyapatite-based coatings (HAP) in order to increase their biocompatibility, bioactivity, and resistance to corrosion for to be used as bone implants. To obtain the surface with antibacterial properties, the HAP coatings were doped with small amount of Zn. The alloy was prepared using the VAR (Vacuum Arc Remelting) equipment, while the coatings by RF magnetron sputtering method. The EDS analysis confirmed the presence of Ca and P in the case of all developed coatings, having Ca/P or Ca/(P+Zn) ratio of about 1.70 and 1.66, respectively. The XRD and ATR-FTIR investigations confirmed the presence of calcium phosphate phases. The roughness of uncoated substrates increased after coating with HAP, and it was considerably increased by the Zn addition. The electrochemical tests showed that the un-doped HAP exhibited good corrosion behavior, while Zn doped HAP coatings have a high dissolution rate in fetal bovine serum, being more proper as a biodegradable material.

... Uncontrolled periodontitis can lead to loss of bone and attachment and even tooth loss [1]. In some instances, chronic periodontitis can create a periodontal furcation defect in multi-rooted teeth, representing alveolar bone destruction that reaches the area located at the root's divergence [2]. ...

Absorbable porcine collagen membrane with a bovine bone graft can be considered for regenerative treatment in periodontal class II furcation defects. We evaluated the clinical efficacy of guided tissue regeneration (GTR) treatment with bovine bone xenograft and a porcine collagen membrane in molars with class II furcations. Probing depth (PD), clinical attachment level (CAL), and bone level (BL) were recorded at baseline and at 3, 6, and 9 months postoperatively. Thirty class II furcation defects from the lower and upper molars were assessed. Significant improvements in PD and CAL were observed from baseline to 9 months in all groups (p < 0.01). BL improved in all groups except group A in the upper molars in radiographic assessment (p < 0.05). The lower and upper molars showed PD reduction of 50.5% ± 7.44% and 46.2% ± 11.2%, respectively, at 9 months (p = 0.044). In furcations of 1–3 mm, the lower and upper molars showed PD reductions of 51.2% ± 4.49% and 36.5% ± 16.14%, respectively (p = 0.035). The lower and upper molars showed a CAL gain of 51.1% ± 4.64% and 33.6% ± 18.8%, respectively (p = 0.037). Thus, GTR with bovine bone graft and porcine collagen membrane yielded good results in class II furcations, with better results in the lower than in the upper molars.

... Although this approach considerably reduces postoperative morbidity, it has narrower indications. The osteotome technique using a crestal approach is recommended only in a flat sinus floor with a residual bone height (RBH) of at least 5 mm and adequate crestal bone width [12]. Furthermore, the osteotome technique allows for only a small and localized membrane elevation in comparison with the LW approach, which is more effective in achieving greater and more homogenous elevation of the sinus membrane [13]. ...

Objectives To compare the clinical and radiographic outcomes of two sinus floor elevation techniques: the conventional lateral window technique versus the transalveolar approach using a hydrodynamic ultrasonic device. Materials and methods The study was designed as a randomized controlled clinical trial, and participants were randomly allocated to the control group (lateral window: LW) or to the test group (hydrodynamic transalveolar approach: HTA). The intraoperative and postoperative data, including procedure duration and patient-reported outcome measures (PROMs), were collected during the surgery and up to 1 year post-surgery. Additionally, qualitative assessment of gained bone volumes and implant survival rates was recorded. Results Twenty-two patients were included in the study. The mean surgical time was significantly longer in the HTA compared to the LW group (48.1 ± 11.2 min vs. 35.2 ± 9.1 min, P = 0.0011). Perforation of the Schneiderian membrane occurred in 2/11 and 5/11 patients in the LW and the HTA group, respectively (P = 0.36). Postoperatively, higher morbidity and consumption of nonsteroidal anti-inflammatory drugs (NSAIDs) were associated with the LW group. However, self-reported satisfaction with surgical procedures was similar in the two groups. At 1 year, implant survival rates of 80% in the HTA group and 100% in the LW group were recorded (P = 0.12). Conclusions Although the new transalveolar approach seems to reduce postoperative morbidity, an increased risk of intraoperative complications compared to the LW approach needs to be considered when choosing a technique. Clinical relevance Our results provide new insights regarding clinical and radiographic outcomes of HTA and may help further determine indications for its use. Trial registration ClinicalTrivals.gov: NCT04499625

... Type of intervention NSPT encompassing scaling+root planning or subgingival debridement as well as provision of antimicrobial adjuvants; antiseptic or antibiotic (locally applied, by subgingival irrigation or mouthwash, or by systemic administration) and complementary oral hygiene education will be considered as intervention. 25 Comparison will be made with no treatment, or routine care practice (supragingival scaling or oral hygiene instruction alone), or the use of placebo. ...

Introduction Non-surgical periodontal therapy consisting of scaling and root planning has been shown to be effective in the improvement of glycaemic control in patients with diabetes with periodontitis for up to 3 months. However, questions remain about this beneficial effect over a longer period of time. This systematic review and meta-analysis aims to determine the long-term effect (at least 6 months from the therapy) of non-surgical periodontal therapy with or without adjuvant on glycaemic control of patients with diabetes with periodontitis. Methods and analysis This systematic review will include randomised control trials with a follow-up period of at least 6 months after initial therapy, with measurement of glycated haemoglobin as the primary endpoint. A literature search will be conducted in MEDLINE, CENTRAL, EMBASE, CINAHL, The Cochrane Oral Health Group Trials Register, and the US National Institutes of Health Trials Registry: ClinicalTrials.gov, from inception to 30 June 2020. Selection of studies, data extraction and bias assessment will be conducted independently by two reviewers. A DerSimonian-Laird random-effect meta-analysis will be conducted to pool studies deemed to be homogeneous. A subgroup analysis will be conducted in case of substantial heterogeneity. Egger's test and observation of the funnel plot will be used to assess publication bias. The statistical analysis will be done using R V.4.0.0 software. Ethics and dissemination Since primary data are not collected, ethical approval is not required. The final report will be published in a peer-reviewed journal. PROSPERO registration number CRD42020192635.

... In daily clinical situations, after tooth extraction, bone resorption is more severe at the buccal side than at the palatal or lingual sites [15]. Therefore, regeneration of the buccal bone wall of the alveolar bone is a key factor in dental implant treatment. ...

• Shuji Nosho
• Mitsuaki Ono
• Taishi Komori
• Takuo Kuboki

Purpose: Bone morphogenetic protein (BMP)-2 is a potent growth factor that is widely used in the orthopedic and dental fields for bone regeneration.However, recombinant human BMP-2 (rhBMP-2) products have not been legally approved in Japan. Recently, our research group succeeded in producing GMP-grade rhBMP-2 using the E. coli system (E-rhBMP-2) at the industrial level and developed E-rhBMP-2 adsorbed onto β-TCP (E-rhBMP-2/β-TCP) as an alternative material to autogenous bone grafts. Previous studies on the toxicity, pharmacokinetics, and optimal doses of E-rhBMP-2 have confirmed its safety and efficiency. However, comparative studies with standard treatment therapies are still necessary before clinical application in humans. Therefore, in this preclinical study, we compared the bone regeneration ability of E-rhBMP-2/β-TCP and autogenous bone grafts in a canine guided-bone regeneration model. Methods: Following extraction of the maxillary third premolar, box-type bone defects (10 mmL × 4 mmW × 9 mmH) were created in the extraction socket area and transplanted with E-rhBMP-2/β-TCP or autogenous bone graft in a canine. After 8 weeks, micro-CT and histological analyses were performed. Results: Transplantation of both E-rhBMP-2/β-TCP and autogenous bone graft significantly promoted bone formation compared to the non-transplantation control group. The bone formation ability of E-rhBMP-2/β-TCP was equal to that of the autogenous bone graft. Histological analysis showed that excessive infiltration of inflammatory cells and residual β-TCP particles mostly were not observed in the E-rhBMP-2/β-TCP transplantation group. Conclusions: This preclinical study demonstrated that E-rhBMP-2/β-TCP and autogenous bone have equal potential to promote bone regeneration.

... The most important signs and symptoms of periodontal disease are related to an increase in count of P. gingivalis, T. forsythia, T. denticola and A. actinomycetemcomitans 2 . Elimination of pathogenic species is particularly important in treatment of periodontal diseases while plaque control plays an important role in preventing them 2,3 . The currently used treatment methods include plaque control, antibiotic therapy and periodontal surgery 4 . ...

... Oral hygiene motivation, scaling and root planing had been the most performed type of non-surgical periodontal treatment, 60.8%. In contrast to our results, Lang and Lindhe prefer that this approach be abandoned in favor of a more structured therapy (Oral hygiene motivation and scaling, later root planing) [25]. However, nonsurgical periodontal treatment remains the gold standard of all periodontal management [26,27]. ...

• M N Patrick Sekele
• I Jacques Bolenge
• Nzudjom Foche
• Koto-Te-Nyiwa Ngbolua

Aim of the Study: To determine the level of adherence of periodontal patients at the University Clinics of Kinshasa (CUK). Methodology: A cross-sectional study on adherence of periodontal patients to supportive therapy was conducted at CUK from 2016 to 2019. Patients who have suffered from periodontitis during the study period and benefited from a non-surgical periodontal treatment, aged at least 18 years, Original Research Article Sekele et al.; AJDS, 4(4): 7-14, 2021; Article no.AJDS.69508 8 answered at least to the three appointments recommended for a period of 6 months for the Supportive periodontal therapy (SPT) and who were available to undergo an interview on the basis of free consent were included. The convenience sampling technique was used. Univariate analyses were performed on socio-demographic, clinical, therapeutic and post-therapeutic variables in order to obtain descriptive statistics. Results: Of 97 periodontal patients, 58.8% were female versus 41.2% male. The most representative age group was 18 to 30 years old (40.2%), 80.4% were incomplete adherents versus 19.6%, almost all periodontal patients were partial third party payers (85.6%); the preponderant reason for visit was pain (55.7%); most periodontal patients had benefited from motivation to oral hygiene, scaling and root planing (60.8%) The most common reason for non-return given by incompletely adherent periodontal patients was the disappearance of the main complaint. The Kolmogorov-Smirnov test for normality of the quantitative variable at the 0.05 probability level revealed that the distribution was not normal. Conclusion and Suggestions: Incomplete adherence of periodontal patients to SPT at CUK was high. Special attention to the development of a therapeutic follow-up protocol deserves to be implemented.

... In addition, toothbrushing trauma, especially in young individuals, can play a role in progression of gingival recession [4]. Gingival recession can compromise smile esthetics and affect the mastication function as well [5][6]. Also, it complicates plaque control [4]. ...

Statement of the problem: The tunnel technique has shown promising results in treatment of gingival recession. Plasma rich in growth factors (PRGF) is considered effective for soft tissue regeneration since it is a rich source of growth factors. Purpose: This clinical trial aimed to assess the efficacy of PRGF along with the tunnel technique and connective tissue graft for treatment of gingival recession. Materials and method: In this controlled clinical trial, 20 areas around anterior and posterior teeth in 3 patients with gingival recession were bilaterally selected. The tunnel technique was used with and without PRGF in the test and control groups, respectively (10 areas in each group). The keratinized gingival width (KGW), clinical attachment level (CAL), clinical probing depth (PD), cementoenamel junction (CEJ) to mucogingival junction (MGJ) distance, and the esthetic visual analog scale (EVAS) score were evaluated preoperatively and at 6 weeks and 3 months, postoperatively. The gingival recession width (RW) and vertical recession depth (VRD) were assessed preoperatively and at 2 weeks and 3 months, postoperatively. The pain visual analog scale (PVAS) score was measured at 1, 3 and 7 days, post-treatment and the healing index (HI) was measured at 1, 3 and 7 days and 1 month, postoperatively. The root coverage percentage was assessed during 3 months. Paired t-test and repeated measures ANOVA were used for statistical analyses. p Value< 0.05 was considered statistically significant. Results: Significant improvements were noted in all tested parameters in both groups (p< 0.05). The mean root coverage percentage after 6 months was 88.68%±20.69% and 78.77%±24.94% in the test and control groups, respectively. None of the tested parameters were significantly different between two groups (p> 0.05). Conclusion: Treatment of gingival recession with the tunnel technique can yield favorable clinical outcome, irrespective of the employment of PRGF.

... According to research, 10-15% of the global population may be suffering from severe periodontitis. Severe periodontitis leads to tooth loss and has negative effects on other systemic diseases [3]. Therefore, it is important to explore the etiology of periodontitis and its treatment. ...

Periodontitis is an inflammatory disease characterized by the destruction of the periodontium. In the last decade, a new murine model of periodontitis has been widely used to simulate alveolar bone resorption and periodontal soft tissue destruction by ligation. Typically, 3-0 to 9-0 silks are selected for ligation around the molars in mice, and significant bone loss and inflammatory infiltration are observed within a week. The ligature-maintained period can vary according to specific aims. We reviewed the findings on the interaction of systemic diseases with periodontitis, periodontal tissue destruction, the immunological and bacteriological responses, and new treatments. In these studies, the activation of osteoclasts, upregulation of pro-inflammatory factors, and excessive immune response have been considered as major factors in periodontal disruption. Multiple genes identified in periodontal tissues partly reflect the complexity of the pathogenesis of periodontitis. The effects of novel treatment methods on periodontitis have also been evaluated in a ligature-induced periodontitis model in mice. This model cannot completely represent all aspects of periodontitis in humans but is considered an effective method for the exploration of its mechanisms. Through this review, we aimed to provide evidence and enlightenment for future studies planning to use this model.

... The bone resorption necessary for orthodontic movement is achieved by applying low intensity mechanical forces in the pressure side of the periodontium, thus the cellular and tissular physiology remain intact. Increased mechanical forces affect the periodontal tissue determining cell necrosis, the appearance of a hyaline tissue and an acellular area between the periodontal ligament and the adjacent bone, thus slowing down the orthodontic movement [8]. ...

• Simina Chelărescu
• Petra Șurlin
• Mioara Decusară
• Mariana Pacurar

Background: The crevicular fluid analysis represents a useful diagnosis tool, with the help of which noninvasive cellular metabolic activity can be analyzed. The aim of the study is to investigate comparatively IL1β and IL6 in the gingival crevicular fluid of clinically healthy adolescents and young adults during the acute phase of orthodontic treatment. Methods: Gingival crevicular fluid was collected from 20 patients (aged between 11 and 28) undergoing orthodontic treatment. Measurements were taken before (T0) and after 24 h after distalization forces were activated (T1). IL1β and IL 6 were analyzed using Elisa tests. The statistical tests used were two-sided t tests. Results: Between the two time periods there was a significant raise both in the crevicular fluid rate (0.57 µL at T0 vs. 0.95 µL at T1, p = 0.001) and in IL1β levels (15.67 pg/µL at T0 vs. 27.94 pg/µL at T1, p = 0.009). We were able to identify IL6 only in a third of the sites. There is a significantly increased level of ILβ at T1 in adolescents, more than in young adults (42.96 pg/µL vs. 17.93 pg/µL, p = 0.006). Conclusions: In the early stage of orthodontic treatment, the periodontal tissues of adolescents are more responsive to orthodontic forces than those of young adults.

... Meanwhile, the amount of bleeding on probing in this group can be explained by effect of periodontal treatment in reducing the wall inflammation and pocket depth. In addition, those who participate consciously in an oral health study observe oral hygiene unconsciously more than before (Hawthorne effect) (28). ...

Introduction: Anemia of chronic disease (ACD) is the second most common form of anemia after iron deficiency anemia. This type of anemia occurs in cases of chronic infections, inflammatory conditions, or neoplastic disorders and even in presence of enough iron and required vitamins. Some previous studies have suggested that periodontitis, as a chronic disease, is likely to be associated with this type of anemia. The aim of this study is to investigate the possible effect of non-surgical periodontal therapy on improvement of blood parameters. Methods: This study was performed on 36 male patients with chronic moderate or severe periodontitis (divided into case and control groups) and 18 men with healthy periodontium. Blood samples such as hematocrit, hemoglobin, MCH, MCHC, MCV and Ferritin were collected from participants. Then periodontal treatment was started for case group. Results: In the case group, there was a significant increase in hematocrit, hemoglobin, MCH, MCHC and MCV after 8 weeks of treatment and there was no significant decrease of Ferritin. No significant differences in blood parameters were observed in periodontally healthy and control groups. Conclusion: According to significant differences in some mentioned blood parameters after non-surgical treatment, it seems that periodontal assessment and subsequent therapy can be recommendable as an adjunctive part in overall treatment plan of anemic patients.

... In addition, S. sanguinis produces hydrogen peroxide which is lethal to Aggregatibacter (A.) actinomycetemcomitans. (4,13,14) Candidiasis is a disease caused by an overgrowth of Candida (C.) albicans. These are usually superficial diseases. ...

• M. Smatanova
• Elena Novakova
• M. Bacinsky
• K. Mikuskova

The oral cavity is a biologically significant and complex site of the human body. It is a gateway into the internal environment of the organism. There are many processes, such as the beginning of digestion, speech creation, and sensory perception of taste. Oral health is closely related to the general health of a person. The oral cavity contains an enormous number of microorganisms that can cause various diseases. Oral bacteria are responsible for diseases in the mouth, but can also seriously harm human health. The oral microbiome also serves as an indicator of health, respectively morbidity of the human organism. Compared to healthy children, mentally disabled children suffer from many congenital and acquired diseases and disorders that affect their overall and oral health. These children require a specific approach to the examination, but also to the therapy. Therefore, it is necessary to pay attention to the prevention of oral diseases in children, whether healthy or mentally disabled.

... Open flap surgery aims to reconstruct the periodontal pocket by removing inflamed tissue and subgingival calculus. Open flap surgery provides the following: (1) accessibility for proper professional scaling and root planing; (2) establishing a gingival morphology that facilitates self-performed infection control; and (3) creating new attachment in the destructive site of the gingiva [1]. GTR is the regenerative procedure using bone graft material and barrier membranes [2,3]. ...

• In-Kyung Lee
• Hyun-Seok Choi
• Sang-Heon Jeong
• Jung-Tae Lee

Background and Objectives: This study aimed to evaluate the change of bone height following treatment of human intrabony defects with guided tissue regeneration (GTR) with bone grafting or access flap alone by cone-beam computed tomography (CBCT) scan. Materials and methods: This study was conducted as a retrospective longitudinal study. In this study, a total of 2281 teeth sites were included: the GTR group had 1210 sites, and the Flap group had 1071 sites. In the GTR group, demineralized freeze-dried bone (DFDBA) particles in combination with resorbable collagen membrane were used. No regenerative material was applied to the Flap group. CBCT images were taken twice at baseline and at least 2.5 months postoperatively. Bone heights were measured using software on CBCT images. Results: The bony change between the GTR and Flap groups was significantly different (p = 0.00001). Both males and females in the GTR group had smaller bone loss than in the Flap group. In age groups, significant differences of bony height between the GTR and Flap groups were observed in the subgroups consisting of those 29-45 and 46-53 years old. The non-smoking subjects in the GTR group had higher bone heights than those in the Flap group. In the absence of systemic disease and medicine, bone formation was higher in the GTR group than in the Flap group. In terms of oral position, the #14-17, #34-37, and #44-47 subgroups of the GTR group showed higher levels of bone heights than those of the Flap group. Conclusions. The results of this study indicated that the GTR procedure offers the additional benefit of higher bone heights than the Flap procedure does.

... however, it has been shown that, early membrane breakdown and downward epithelial growth can affect the treatment outcomes. [10] The membrane used for regenerative treatments should have a number of specific features. Accordingly, an important feature of the membrane is its ability of improving the cell adhesion, proliferation, and differentiation. ...

• BentolHoda Reisie
• ShirinZahra Farhad
• ShirinAmini Sadeh

Background: The tissue engineering has recently shown a significant progress in the fields of membranes and biosynthetic materials. Advanced platelet-rich fibrin (A-PRF) contains functional molecules that have newly shown great interest in regenerative therapies. The purpose of this study was to evaluate the effect of A-PRF on the adhesion of gingival fibroblast cells and osteosarcoma cells to different membranes.Materials and Methods: In this experimental in vitro study, three collagen, alloderm, and mucograft membranes were studied, which were cut into four 5 mm × 5 mm pieces and placed in the bottom of a 24-well culture medium. One milliliter of A-PRF was added to two wells from each group and the other two wells remained without A-PRF. The gingival fibroblasts and osteosarcoma cells were individually added to each well. The cell adhesion was studied using an electron microscope after 24 h. The data were analyzed by independent t-test, one-way analysis of variance, and least significant difference test.Results: In the presence of A-PRF, there was a significant higher osteoblast adhesion to collagen membrane compared to alloderm and mucograft membranes (P < 0.001). In the absence of A-PRF, adhesion of osteoblasts to collagen membrane was significantly higher than alloderm and mucograft (P = 0.019). Moreover, in the presence of A-PRF, fibroblast adhesion to collagen membrane was significantly higher than alloderm and mucograft membranes (P < 0.001). Furthermore, in the absence of A-PRF, no significant difference was found among the study groups (P = 0.830).Conclusion: A-PRF was effective on fibroblast adhesion to the collagen membrane, which is similar to its absence. A-PRF was also found to be very effective on the adhesion of fibroblast cells to the collagen membrane, and in its absence, even less adhesion was observed compared to the other membranes. The presence or absence of A-PRF showed no significant differences in both cells' adhesion for alloderm and mucograft membranes.

... Nowadays, chlorhexidine is still the first-choice solution for prevention of dental biofilm formation, widely used as a broad-spectrum antiseptic. For this reason, chlorhexidine 0.2% was chosen to be the positive control in this investigation to compare the antimicrobial ability of the HAP tested solution(EMILSON, 1977;JONES, 1997;VARONI et al., 2012).However, the long-term use of this solution is not recommended, due to adverse effects such as teeth staining, oral mucosal erosion, and transient taste disturbance(FLOTRA et al., 1971;LANG, LINDHE, 2015;QUIRYNEN et al., 2001;VARONI et al., 2012). Therefore, to achieve reasonable biofilm control and less adverse effects as possible, the search for new biomimetic materials is of utmost importance.5.1.4 ...

Stem cell-based therapy is one of the most thriving fields in tissue regenerative therapeutic approaches. Dental stem cells (DSCs), which are originally derived from neural crest and usually are harvested from tissues that are considered as medical waste, hold considerable promise for regeneration of many tissues. Five different types of DSCs have been isolated and characterized: Stem cells derived from dental pulp of permanent teeth (DPSCs) or exfoliated deciduous teeth (SHEDs), stem cells from apical papillae (SCAPs), dental follicle stem cells (DFSCs), and periodontal ligament stem cells (PDLSCs). These DSCs have demonstrated the capability to differentiate toward distinctive cell lines such as chondrogenic, osteogenic, adipogenic, and neurogenic pathways in vitro. Moreover, various studies have shown their potential for regeneration of the dentine–pulp complex, bone, nerve, blood vessels, muscle, cartilage, and adipose tissues. The application of DSCs for regenerative medicine is as yet in its early stage. This chapter will provide insights regarding the progress being made on utilizing DSCs in tissue regeneration.

• Georgios Romanos

The different effects of certain laser systems can apply for the removal of soft tissue tumors, soft tissue cysts, and precancerous lesions, such as leukoplakia. The indications of the lasers in oral surgery vary from the common excision, biopsies, and coagulation of blood vessels to the complicated therapy of the removal of precancerous lesions and the treatment of vascular tumors and peri‐implantitis, which indeed seems to be very promising for the future. This chapter provides an overview about the application of various laser wavelengths with different clinical indications for the surgically oriented clinician. The removal of vascular lesions and malformations as well as precancerous lesions are separately dealt within this chapter. For more extensive gingival hyperplasias, the excision is carried out in combination with conventional gingivectomy knives, in order to shorten the surgical procedure.

Stem cells are undifferentiated cells, which possess self-renewal properties and can produce specialized cells of multiple lineages. In addition to other stem cells from various anatomical locations within the maxillofacial complex, the oral cavity harbours both epithelial and mesenchymal stem cells, each suited to approaches for treating or managing a variety of specific conditions encountered in routine clinical oral medicine practice. This chapter focusses on stem cell and regenerative medicine approaches related to oral pathology and oral medicine with particular attention paid to oral mucosal diseases, salivary gland disorders, craniofacial and temporomandibular joint disorders, and orofacial pain conditions. The potential roles of stem cells in highlighting the pathogenesis of these conditions in addition to regenerative strategies for their management are outlined. The role of bioprinting as a potential therapeutic approach for both soft and hard tissue defects is discussed. Finally, the limitations of current approaches to regenerative medicine underpinned by imperfect and incomplete understanding of stem cell niches and their properties are summarized.

Developments in engineering and biological science technologies in recent years have increased the capacity of tissue engineering to be utilized in medical and dental disciplines more effectively. Numerous studies have been conducted using stem cells and scaffolding materials to investigate the potential of regenerative periodontal procedures. The scope of this chapter is to review the nature of periodontal regeneration, the current understanding of periodontal regenerative protocols and surgical applications, recent developments in periodontal tissue engineering, variables that affect clinical applications of periodontal regeneration, and to discuss the limitations and the future directions of regenerative periodontal research.

A papila ou gengiva interdentária quando íntegra constitui um importante atributo na arquitetura do sorriso tendo também funções fisiológicas e anatómicas. O incompleto preenchimento da ameia cervical pela papila dá origem aos chamados triângulos negros gengivais. Estes, podem causar problemas fonéticos e estéticos além de propiciar a acumulação de resíduos alimentares e placa bacteriana na zona.(Ziahosseini, Hussain and Millar, 2014). A gestão da papila interdentária é um tema de elevada preocupação para os clínicos, não só devido à sua importância estética, como também pelo seu papel na manutenção da saúde dentária e periodontal, (Al-Zarea et al., 2015) uma vez que a área interdentária é uma zona especialmente suscetível no desenvolvimento de lesões cárie e periodontite (Fig.1).(Singh et al., 2013; Ziahosseini, Hussain and Millar, 2014; Al-Zarea et al., 2015; Yu et al., 2015) A complexa anatomia da zona associada ao fraco aporte sanguíneo torna a correção deste problema difícil e pouco previsível (Ziahosseini, Hussain and Millar, 2014). Deste modo, o domínio e compreensão das principais variáveis que afetam a integridade e morfologia da gengiva interdentária é essencial. É inquestionável que esta temática constitui um dos maiores desafios da atualidade para os médicos dentistas.(Ziahosseini, Hussain and Millar, 2014; Al-Zarea et al., 2015) Procedeu-se a uma pesquisa de artigos relevantes nas bases de dados primárias Medline (PubMed) e Cochrane tendo sido selecionados artigos publicados em língua inglesa e portuguesa. Foram utilizadas as seguintes palavras-chave: black triangles; open embrasures; interdental papilla; etiology; therapeutic approaches para completar esta pesquisa foi realizado um cruzamento manual de referências dos artigos elegíveis para identificar estudos adicionais relevantes.

Objective: Laser treatment has been recently introduced in many fields of implant dentistry. The systematic review tried to address the question: "How does laser modification of titanium surface influence fibroblast adhesion?". Methods: An electronic search of the PubMed and Scopus databases was performed. The following keywords were used: (laser) AND (fibroblast) AND (titanium) AND (implant OR disc) AND (proliferation OR adhesion). Initially, 136 studies were found. Ten studies met the inclusion criteria and were included in the review. All studies chosen to be included in the review were considered to have a low risk of bias. Results: Studies included in the review varied with laser parameters or ways of observing fibroblast behavior. Studies showed that fibroblasts tend to take different shapes and create extensions on modified surfaces and that their metabolic activity is more intense. One study concentrated on laser application and showed that three-directional laser application is the most successful in terms of fibroblast adhesion. Studies which concentrated more on laser parameters showed that too low energy density (lower or equal to 0.75 J/cm2) does not influence fibroblast adhesion. Increasing the energy density over 0.75 J/cm2 causes better cell adhesion of fibroblasts to the laser-modified sample. One included study focused on increasing titanium surface wettability, which also positively influenced cell adhesion. Conclusion: The studies included in the review proved a positive effect of laser-modified titanium surfaces on fibroblast adhesion. However, the application of an appropriate laser energy dose is crucial.

• Muhammad Syafiq Alauddin
• Haslinda Ramli

Introduction This is a clinical case of a healthy woman with a missing upper right central incisor (#8) who requested a permanent prosthetic replacement due to endodontic failure. Clinically, she was presented with thin edentulous ridges and fibrous gingival tissue and minimal or compromised alveolar bone segment on the buccal profile as detected on cone-beam computed tomography (CBCT). Case Report The conventional treatment approach is to add pink porcelain; however, rarely does the prosthetic gingiva substitute blend well with the existing oral profile. Therefore,Guided Bone Regeneration (GBR) was done instead on #8 using the allograft [RegenOss, Neobiotech] and PTFE membrane. Upon examination, membrane exposure was detected, and the size was found to be increased in follow-up visits. The membrane was replaced with a Concentrated Growth Factor [CGF] and sutured at the site of the defect. After 12 months, a vertical and horizontal bone with adequate soft tissue emergence profile was achieved clinically, radiographically, and digitally. The delayed removal of the exposed membrane provided more time for initial bone regeneration in GBR. The replacement barrier of an exposed membrane using CGF is considered an innovative procedure with the cellular content providing vascularization and regeneration. Conclusion This case concludes that CGF can be a viable alternative material to enhance GBR outcome in replacing exposed membranes.

• Novia Septiani Fauzia
• Henri Hartman
• Jeffrey Jeffrey

p>Plak dapat menjadi penyebab kerusakan terhadap struktur gigi maupun jaringan pendukungnya, sehingga perlu dilakukan tindakan kontrol plak. Kontrol plak secara kimiawi dapat dilakukan dengan penggunaan obat kumur seperti povidone iodine dan klorheksidin yang merupakan antiseptik yang efektif dalam menurunkan pembentukan plak. Keduanya terbukti memiliki daya antibakteri terhadap Streptococcus mutans yang merupakan salah satu bakteri penyebab plak. Mengetahui perbedaan efektivitas dari obat kumur povidone iodine dengan klorheksidin terhadap indeks plak. Metode penelitian ini adalah pre-post test control group design dengan memeriksa indeks plak sebelum dan sesudah berkumur. Subjek dalam penelitian ini terdiri dari 32 orang siswa/i SMPN 2 Cimahi yang berusia 13 ̶ 15 tahun yang terbagi menjadi dua kelompok. Penelitian ini dilakukan dengan memeriksa indeks plak sebelum dan sesudah berkumur dengan pemeriksaan indeks plak Silness and Loe . Data diuji normalitasnya menggunakan Chi-square dan dianalisis dengan T-test. Hasil penelitian menunjukkan terdapat perbedaan rerata indeks plak sebelum dan setelah berkumur dengan povidone iodine sebesar 0,68 dan klorheksidin sebesar 0,51 dengan p-value 0,11. Obat kumur povidone iodine dan klorheksidin memiliki efektivitas yang sama terhadap indeks plak.</p

Background Wound healing is a multifactorial procedure involving different cell types and biological mediators. The principles of wound healing are also applicable to periodontal tissues. The formation and stability of blood clots play a vital role in successful healing of wounds in periodontal tissues. The aim of the present review was to highlight the vital factors of periodontal flaps associated with blood clot stability. Highlight The data on periodontal regeneration and wound healing have evolved greatly in light of several factors, including space for blood clots and blood clot stabilization. In periodontal osseous defects, the stability of blood clots seems critical to wound healing. If mechanical forces can be managed by wound stabilization, the gingival flap-tooth root interface may show connective tissue repair. However, compromised adhesion is susceptible to mechanical forces and can cause wound breakage and epithelialization. Conclusion The presence of a thick blood clot may hinder the plasmatic circulation between the recipient bed and graft during the initial stage of healing, which is critical in cases of mucogingival surgery. Root conditioning can also determine the healing consequence by enhancing blood clot adhesion.

Biofilm is an association of microorganisms in which cells stick to each other on a surface encased within matrix of extracellular polymeric substance produced by bacteria themselves. Periodontal disease being biofilm-mediated disease, it is widely accepted that the conversion from periodontal health to disease accompanies a shift in the indigenous flora of the plaque biofilm from gram-positive facultative to gram-negative anaerobic motile microorganisms. Its clinical importance and accessibility for in vivo research make dental plaque one of the most studied and best-understood biofilm communities. Therefore, this literature review provides an understanding of the structure, composition, mechanisms of supra and subgingival biofilm formation, development needs and the multiple interspecies interactions that occur in polymicrobial communities, as they strive to optimize their adaptation to the environmental constraints. In addition, the role of biofilm in periodontal and peri-implant diseases is discussed with various strategies to control its growth to maintain better periodontal health.

• Bappaditya Bhattacharjee
• Ritu Saneja
• Atul Bhatnagar

Aim: Oral stereognosis is an important sensation for a human being to percept any type of materials that are introduced in the oral cavity. It is defined as the ability of an individual to recognize objects using only tactile sensation without using vision, audition, balance, somatic function, taste, or smell. The primary purpose of this review was to evaluate the effect of complete dentures on oral stereognostic ability in edentulous subjects. Settings and design: Systematic review based on PRISMA guidelines. Materials and methods: A systematic search of the electronic databases like PubMed and Web of Science was done using keywords - "stereognosis," "oral stereognosis," "complete denture," and "complete edentulism." In addition to this, a manual search of references mentioned in the articles and gray literature was done. Data extraction and assessment were done by two independent reviewers. Statistical analysis used: Qualitative analysis. Results: The literature search yielded a total of 61 articles. Thirteen duplicate articles were removed and 36 articles were rejected after initial screening of titles and abstracts. A total of 12 articles were selected for full text reading and 5 of them were included for qualitative analysis. Conclusion: All the included studies showed complete denture treatment therapy improved stereognostic ability in terms of correct identification of test pieces and time taken to identify the objects. There is also a direct relationship between the adaptability of dentures and stereognostic ability.

• Felipe Franco Marçal
• João Paulo Mota de Paulo
• Liliana Girão Barreto
• Paulo Goberlânio de Barros Silva

Objective In orthodontic patients submitted to oral hygiene instruction, what is the efficacy of orthodontic toothbrush (O‐TB) versus conventional toothbrush (C‐TB) on plaque and gingival index reduction in randomized and nonrandomized controlled clinical trials? Methods Electronic database search was performed on: PubMed, ClinicalTrials.gov, Cochrane Library, and Google Scholar. Database research, study selection, data extraction and ROBINS‐I and Risk of Bias Tool 2.0 analysis were conducted by two independently examiners in duplicate. Two different meta‐analyses were performed for plaque index and gingival index, followed by the analysis of overall quality of the evidence using GRADE. Results A total of 158 studies were identified for screening, 6 articles were included in qualitative synthesis, and of those, three were subjected to a quantitative synthesis (meta‐analysis). Three non‐randomized studies presented an overall "low", "moderate" and "high" risk of bias for each one of the articles, and the 3 randomized clinical trials presented "low risk" for two articles and "some concerns" quality for the other one. The overall strength of evidence was ranked "very low" quality for plaque index and gingival index subgroups. Conclusions Gingival bleeding is not modified by orthodontic design toothbrush, but there is circumstantial scientific evidence for recommending the use of an O‐TB instead a C‐TB based on the analysis of plaque index control. Although major plaque removal of the O‐TB was validated by meta‐analysis, this improvement is not completely clarified which calls for further clinical studies to assess the effects of using an O‐TB compared to a C‐TB.

• Yue Zhou
• Yufu Liang

Background The role of IL-36 receptor antagonist (IL36RN), a mutated gene expression of IL-36 in periodontitis patients with peripheral blood mononuclear cells (PBMC) and plasma remains to be undetermined. Materials and methods Our study discovered the IL36RN expression through GEO public databases and further validated by PBMC and plasma of periodontitis patients and healthy participants. A total of 194 participants of public datasets, consisting of 97 cases of periodontitis and 97 cases of healthy control were retrospectively evaluated and explored the gene enrichment pathways and clinical significance of IL36RN expression accompanied by three different cytokines. Furthermore, the clinical significance of IL36RN was evaluated in mild-to-severe patients of periodontitis by the receiver operating curve (ROC) using the area under the curve (AUC). Results IL36RN expressions were notably down-regulated in PBMC and plasma of periodontitis patients. Further, a positive correlation of IL36RN expression was significantly observed between PBMC and plasma of periodontitis patients while IL36RN expression was negatively correlated to serum-based three different cytokines of periodontitis patients. Meanwhile, the ROC-AUCs achieved a significantly higher range from 0.80 to 0.87 with PBMC of mild-to-severe and moderate-to-severe periodontitis patients whereas similar patients with plasma obtained a significant AUC range from 0.73 to 0.83. Conclusion IL36RN can distinctively be detectable in periodontitis patients with PBMC and plasma, which can act as a down-regulated mutated gene that might play an effective role in causing periodontitis. IL36RN may involve by other inflammatory cytokines in the pathogenesis of periodontitis.

• Mahmood Dashti
• Maneli Ardeshir Zadeh

Gingival recession is the subjection of the root surface and is one of the reasonably conventional oral ailments witnessed by clinicians worldwide. The etiology is distinct, and there is a probability of multiple prognoses according to etiology. Esthetic considerations regarding tooth removal and hypersensitivity are possible issues for the patient. The clinicians can frame an entire methodology for a favorable cure and outcome if they have access to a separate and comprehensive tooth prognosis.

Mucogingival surgery has become a common procedure for soft gingival tissue reparation in dental clinical practice, which mainly relies on autograft or commercial collagen membranes (CM). However, the autograft faces grand challenges in source availability and long‐term post‐surgery pain management, and the CM is restricted by its poor mechanical properties in an aqueous environment. Here, it is reported that a bio‐inspired lamellar chitosan scaffold (LCS) with long range ordered porous structure, manufactured through a bidirectional freezing method, can serve as a promising gingival tissue engineering material. The LCS not only exhibits excellent mechanical properties in the hydrated state but also accelerates vessel formation and soft tissue regeneration in vivo. Most interestingly, the LCS is found to be capable of inducing macrophage differentiation to M2 macrophages, which is thought to play an important role in tissue regeneration. These advantages combined with its easy and low‐cost preparation process make the LCS a promising candidate for dental clinical applications. A new strategy for soft gingival tissue regeneration is demonstrated by using a bio‐inspired lamellar chitosan scaffold with a unique long range porous lamellar structure manufactured via a bidirectional freezing method. The prepared materials are certified to be perfectly available for soft gingival tissue regeneration through both in vitro cell experiments and in vivo animal experiments.

Intraoral scanning, computer-aided object designing, and 3D printing, collectively known as digital workflow, are gradually becoming an indispensable procedure in modern dentistry. However, this approach has not yet been extensively investigated for the fabrication of oral and maxillofacial tissue substitutes.

Fixed orthodontic appliances are associated with increased retention of dental plaque and thus increased microbial count. Chlorhexidine gluconate is the gold standard chemical agent with antiplaque and antimicrobial property. At the same time chlorhexidine has various side effects. Therefore, it is necessary to identify an alternative chemical agent. Turmeric, a common household ingredient, has a high place in Ayurvedic medicine as an antibacterial and anti-inflammatory agent. The aim of the study is to compare the antimicrobial effect of turmeric mouthwash and chlorhexidine mouthwash against oral microbes in orthodontic patients. It is a prospective study where thirty orthodontic wires were obtained from 15 orthodontic patients. The posterior segments of the wire were cut into 3 segments forming 3 groups. Group 1 was not exposed to any mouthwash. Group 2 and 3 were immersed in chlorhexidine and turmeric mouthwash respectively, for 3 minutes. Swab was obtained from 3 groups and streaked on agar medium. Microbial colony count was performed after 24 hours incubation at 37 0 C. ANOVA and post hoc tests were done to compare the three groups. There was a significant reduction in microbial count with the use of chlorhexidine and turmeric mouthwash. Turmeric mouthwash is a potential antimicrobial mouthwash.Clinical use of turmeric mouthwash can be advocated after long term clinical trial on a large sample.

• Gennady Berchenko
• T. V. Braylovskaya
• N. V. Fedosova
• Z. A. Tangieva

Relevance. The study examines the possibility of using a mathematic model of an artificial neural network (ANN) for comparative quantitative morphological assessment of revascularized autograft remodeling after reconstructive surgery in patients with jaw defects. Materials and methods. Jawbone biopsies of 30 patients were histologically examined during the implant placement stage, 6, 9, 12 months after the reconstructive surgery with a revascularized fibular graft. Histology images were analyzed using a mathematic model created on the basis of GoogLeNet and trained on morphological images of bone maturation. Histology slides were digitized by a scanning microscope Leica SC2 and streamed through the neural network model. Results. During the follow-up period, jaw defect areas demonstrated relatively mature bone tissue formation with various intensity rates of remodeling and maturation of the newly-formed bone. At that, the results of the descriptive histology were consistent with the quantitative results of the ANN mathematic model, created on the basis of the softwarehardware system developed by the authors. The confirmed significance level is 95% or higher. Conclusion. Pathomorphological data of biopsies were studied using an ANN mathematical model, built on a softwarehardware system, which allowed analyzing all microscope fields of view of a histological slide, bypassing random samples, as well as the evaluation by a pathologist of individual microscope fields of view, to exclude the possibility of unrepresentative sampling and the influence of human factor, which significantly increases the significance of the received results.

In this paper, a novel biocompatible alloy defined as FeMoTaTiZr was obtained and functionalized by hydroxyapatite-based coatings (HAP) in order to increase their biocompatibility, bioactivity, and resistance to corrosion for to be used as bone implants. To obtain the surface with antibacterial properties, the HAP coatings were doped with small amount of Zn. The alloy was prepared using the VAR (Vacuum Arc Remelting) equipment, while the coatings by RF magnetron sputtering method. The EDS analysis confirmed the presence of Ca and P in the case of all developed coatings, having Ca/P ratio ranged from 1.69 (undoped HAP) to 1.96 (Zn doped HAP). The (Ca+Zn)/P ration was of about 2.15 for the Zn doped HAP coatings. The XRD and ATR-FTIR investigations confirmed the presence of calcium phosphate phases. After coating with HAP, the roughness of uncoated substrates increased with 1.4 times, and it was considerably increased by the Zn addition with 2.4 times. The electrochemical tests showed that the un-doped HAP exhibited good corrosion behavior, while Zn doped HAP coatings have a high dissolution rate in fetal bovine serum, being more proper as a biodegradable material.

• Denis Vladlenov

Collection of scientific articles published is the scientific and practical publication, which contains scientific articles of students, graduate students, Candidates and Doctors of Sciences, research workers and practitioners from Europe and Ukraine. The articles contain the study, reflecting the processes and changes in the structure of modern science.

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Source: https://www.researchgate.net/publication/312449604_Clinical_periodontology_and_implant_dentistry

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