Optical coherence tomography follow‐up of patients treated from periodontal disease

Optical coherence tomography (OCT) is one of the most important imaging modalities for biophotonics applications. In this work, an important step towards the clinical use of OCT in dental practice is reported, by following‐up patients treated from periodontal disease (PD). A total of 147 vestibular dental sites from 14 patients diagnosed with PD were evaluated prior and after treatment, using a swept‐source OCT and two periodontal probes (Florida probe and North Carolina) for comparison. The evaluation was performed at four stages: day 0, day 30, day 60 and day 90. Exceptionally one patient was evaluated 1‐year after treatment. It was possible to visualize in the two‐dimensional images the architectural components that compose the periodontal anatomy, and identify the improvements in biofilm and dental calculus upon treatment. In the follow‐up after the treatment, it was observed in some cases decrease of the gingival thickness associated with extinction of gingival calculus. In some cases, the improvement of both depth of probing with the traditional probes and the evidence in the images of the region was emphasized. The study evidenced the ability of OCT in the identification of periodontal structures and alterations, being an important noninvasive complement or even alternative for periodontal probes for treatment follow‐up. OCT system being used in a clinical environment. Above OCT image (left) prior treatment and (right) 30 days after treatment.      

Short- and long-term effects of IL-1 and TNF antagonists on periodontal wound healing

The present study tested the effects of local injection of IL-1 and TNF soluble receptors on a periodontal wound-healing model in nonhuman primates. In this model, periodontal lesions were developed for 16 wk, followed by open flap surgery. Starting at the time of surgery, groups of animals received localized injections of both soluble cytokine receptors or else PBS three times per week for 3, 14, or 35 days. Periodontal wound healing was analyzed for each group at the end of the treatment regimen. Fourteen days after surgery, a significant decrease was observed between the animals treated with soluble receptors and the untreated group with respect to recruitment of inflammatory cells in deep gingival connective tissue. Concurrent apoptosis of inflammatory cells in those tissues increased significantly in treated animals compared with untreated animals. All other outcome parameters of periodontal wound healing were likewise significantly improved in treated animals compared with untreated animals. In marked contrast, however, 35 days after surgery, there was a significant increase in the number of inflammatory cells that had infiltrated into deep gingival connective tissue in treated compared with untreated animals. Outcome parameters of periodontal wound healing worsened in treated animals when compared with untreated. These results indicate that proinflammatory cytokines may play different functional roles in early vs late phases of periodontal wound healing. Short-term blockade of IL-1 and TNF may facilitate periodontal wound healing, whereas prolonged blockade may have adverse effects.     

Antiproliferative effect of topic hyaluronic acid gel. Study in gingival biopsies of patients with periodontal disease

Hyaluronic acid (HA) is the most abundant glycosaminoglycan of high molecular weight in the extracellular matrix of soft periodontal tissues. Our group recently demonstrated an HA-induced reduction in lymphoplasmocyte inflammatory infiltrate in periodontal disease. The objective of this study was to determine the effect of an HA gel of high molecular weight on cell proliferation, inflammation, and different periodontal lesion parameters. A double-blind clinical trial was conducted on the effect of an HA gel on cell proliferation in gingival biopsies from 28 patients with periodontal disease. A split-mouth design was used, randomly applying the gel to one quadrant and a placebo to the contralateral one. A gingival biopsy was taken for histopathological and immunohistochemical study, in order to determine the expression of cell proliferation antigen Ki-67 and to evaluate the inflammatory infiltrate. HA gel treatment induced a significant reduction in the proliferation index of the gingival epithelium, with 276 (range 234-317) Ki-67-positive cells per mm2 in treated samples versus 514 (range 158-876) per mm2 in controls (Mann-Whitney U test, p<0.003). In 13 patients, the number of Ki-67-positive fibroblastic cells was reduced by the treatment, whereas in 6 patients no differences were found (global difference, p=0.12). In 10 patients, Ki-67-positive cells were decreased in chronic inflammatory infiltrate present in the lamina propria, whereas in 6 patients no differences were found (global difference, p=0.054). We conclude that high molecular-weight HA gel reduces cell proliferation in epithelial cells such as fibroblasts and lymphocytes, abates the inflammatory process, and improves the periodontal lesion in patients with chronic periodontitis.     

牙周夹板联合正畸治疗对牙周炎所致前牙扇形移位患者咀嚼功能和龈沟液PGE2、sICAM-1、PAK5的影响

目的:探讨牙周夹板联合正畸治疗对牙周炎所致前牙扇形移位患者咀嚼功能和龈沟液中前列素E2(PGE2)、可溶性细胞间黏附分子-1(s ICAM-1)、p2l活化激酶5(PAK5)的影响。方法:采用随机数字表法,将我院2018年2月~2020年2月间接收的93例牙周炎所致前牙扇形移位患者分为对照组(46例,牙周基础治疗、牙周夹板治疗)和研究组(47例,牙周基础治疗、牙周夹板治疗联合正畸治疗),观察两组疗效,对比两组治疗前后的牙周情况,咀嚼功能、美观度,龈沟液PGE2、s ICAM-1、PAK5水平。结果:研究组的临床总有效率高于对照组(P<0.05)。研究组治疗后牙周菌斑指数(PLI)、探诊深度(PD)、牙龈指数(GI)、附着丧失(AL)、龈沟出血指数(SBI)低于对照组(P<0.05)。研究组治疗后探诊出血率、前牙咬合低于对照组,咀嚼功能评分高于对照组(P<0.05)。研究组治疗后牙周袋深度、前牙覆盖度、牙槽骨高度低于对照组(P<0.05)。研究组治疗后龈沟液PGE2、s ICAM-1、PAK5水平低于对照组(P<0.05)。结论:牙周夹板联合正畸治疗可有效恢复牙周炎所致前牙扇形移位患者牙周功能和咀嚼功能,且美观效果好,还可减轻对龈沟液PGE2、s ICAM-1、PAK5水平的影响。     

The evaluation of chorionic membrane in guided tissue regeneration for periodontal pocket therapy: a clinical and radiographic study

Periodontal regenerative therapy is aimed at reconstruction and to restore the architecture and function of lost or injured tissues. Melcher (J Periodontol 47(5):256–260, 1976) introduced the concept of guided tissue regeneration (GTR) for osseous reconstructive surgery. The aim of the present innovative clinical and radiographic study was to evaluate the effect of chorionic membrane (CM) in GTR in periodontal pocket therapy. Ten patients with moderate to severe periodontitis were selected in the single blind randomized controlled clinical trial. Patients were treated with periodontal pocket therapy along with CM in study sites and the control sites were treated with periodontal pocket therapy alone. The clinical parameters were recorded at baseline and 12 months. The radiographic parameters were recorded at baseline, 6 and 12 months. Clinical parameters included gingival index (GI), plaque index (PI), pocket probing depth (PPD) and relative attachment level (RAL). Digital images were analysed for bone gain (BG) and density. Data were evaluated using t test. Statistical significant differences were found in both sites at 12 months for GI, PI, PPD and RAL. Highly significant reduction was seen in GI 0.40 ± 0.08 (p = 0.0001), PI (0.41 ± 0.18), PPD 2.50 ± 0.53 mm (p = 0.0431) and increased BG 0.86 ± 0.18 (p < 0.0001) were observed in study sites. This shows that CM when used with pocket therapy can have influence on clinical parameters. Radiographic findings from this study demonstrated significant BG and density in sites treated with CM as compared to control sites.     

Gingival and Periodontal Parameters in a Population of Healthy Adults, 22–90 Years of Age1

There are little data concerning the periodontal status of aging individuals free of systemic disease and medication utilization. In the present study 55 healthy male and female, non-medicated adults between the ages of 22 and 90 were evaluated by comparing gingival and periodontal parameters. The results indicate greater proportions of sites with dental plaque, calculus, gingival bleeding and recession, and attachment loss in the oldest age group. The progression of these changes from young to middle to old age was not uniform. Attachment loss showed the most significant age-related changes. Results from this small, cross-sectional study of healthy individuals are generally comparable to findings reported from the NIDR 1985 National Survey of Oral Health in U.S. Adults.     

Lycopene solid lipid microparticles with enhanced effect on gingival crevicular fluid protein carbonyl as a biomarker of oxidative stress in patients with chronic periodontitis

Abstract

Lycopene (LP), a naturally occurring carotenoid in red-coloured fruits, especially tomatoes, has a pivotal role in counteracting the deleterious effect of oxidative stress on periodontal tissues. The aim of this study is to prepare solid lipid microparticles (SLMs) encapsulating LP and to assess their biochemical and clinical effects in the management of chronic periodontitis. Optimization of SLMs was performed by assessing particle size and LP entrapment efficiency. Clinical study included 16 chronic periodontitis patients allocated into two groups, Group I was managed by scaling and root planing (SRP) and local delivery of LP loaded SLMs, while Group II was managed by SRP only. Protein carbonyl (PC) levels as a biomarker of oxidative stress and drug concentration in gingival crevicular fluid (GCF) were assessed at different time intervals. Results revealed that optimum formula of SLMs had a particle size of 77.28 µm and entrapped 98.03% of LP. SLMs recorded 30 d of drug release with no burst effect. Patients treated with LP SLMs showed significantly lower levels of PC after SRP compared to those treated with SRP only, in addition to improvement in the measured clinical parameters. In conclusion, locally delivered LP SLMs along with SRP could have a protective effect over periodontal tissues and it has the ability to decrease oxidative damage of proteins in diseased periodontium.     

抗菌肽JH-3治疗沙门氏菌感染的效果评价

【目的】沙门氏菌(Salmonella)是重要的人畜共患传染病原菌,其感染是引起世界性胃肠疾病的主要因素,全球每年大概有2 100万伤寒病例,给世界公共卫生带来严重威胁。目前抗生素滥用问题严峻,急需寻找一种抗生素的替代品。抗菌肽JH-3是本实验室分离并人工改造后具有广谱杀菌活性的小肽,以沙门氏菌标准菌株CVCC541为研究对象,在小鼠模型上评价抗菌肽JH-3治疗沙门氏菌感染的效果。【方法】在CVCC541感染BALB/c小鼠前3 d连续腹腔注射抗菌肽JH-3或环丙沙星(B3d,共计40 mg/kg)和感染后3 d连续注射JH-3或环丙沙星(P3d,共计40 mg/kg)进行治疗。【结果】发现环丙沙星预防组效果最佳,抗菌肽JH-3的预防组(B3d)效果较好,可显著保护小鼠免受致死剂量CVCC541的攻击,小鼠存活率高达100%,临床症状评分、血液和脏器荷菌数降低,小肠段病理变化减轻,效果与环丙沙星治疗组相当;而感染3 d后JH-3治疗效果较差,临床症状评分、脏器荷菌量以及小肠病理变化均显著高于3 d前预防组,但3 d后治疗组小鼠存活率为70%,仍明显高于单独感染组。【结论】系统评价了抗菌肽JH-3不同给药时间对沙门氏菌感染的治疗效果,预防性给药方式的抗菌作用最佳,与环丙沙星治疗效果相当,为新型抗菌药物的研究提供参考。     

Development and Evaluation of Biodegradable Chitosan Films of Metronidazole and Levofloxacin for the Management of Periodontitis

Metronidazole (MZ) and levofloxacin (LF) are widely employed for treatment of periodontitis, but high oral dose and resistance development after long-term oral administration limit their use. The aim of this study was to alleviate shortcomings in the treatment of periodontitis by fabrication of intrapocket, biodegradable films of chitosan (CS) loaded with MZ and LF meant for inserting into periodontal pockets to treat infections. The films were developed by solvent casting technique using propylene glycol as plasticizer and glutaraldehyde as crosslinking agent. Their physical characteristics, such as drug content, surface pH, swelling index, and folding endurance, exhibited results within limit. Further, FTIR and DSC studies revealed stability of films and compatibility between drugs and excipients. SEM images of films showed the presence of free drug particles on the surface causing burst effect. In vitro release in McIlvaine buffer pH 6.6 was of sustained nature assisted by the burst effect. CS and crosslinking agent concentrations negatively affected drug release and positively affected T₉₀ (time for releasing 90% of the drug) due to altered matrix density. In contrast, the plasticizer concentration increases membrane permeability and hence increased drug release, lowering T₉₀. Crosslinked films demonstrated sustained release up to 7 days. The antibacterial efficacy of films was tested on Staphylococcus aureus and Escherichia coli, indicating good antibacterial activity. Clinical trials on patients proved the therapeutic efficacy of the films by a significant (p?<?0.05) decrease in the clinical markers of periodontitis, i.e. gingival index, plaque index and pocket depth. Conclusively, the films of MZ and LF were successful tools for the management of periodontitis.     

牙周骨再生过程中BMP-1表达变化的临床意义

目的:观察在牙周骨再生过程中骨形态发生蛋白-1(BMP-1)的表达的变化情况及临床意义。方法:以我院收治的牙周骨缺损患者196例作为研究对象,采用常规的基础牙周治疗(龈上洁治彻底,龈下刮治,整平根面)处理后,通过引导组织再生术(GTR)技术对骨缺损进行修复的同时,植入Bio-oss人工骨材料和Bio-gide胶原膜。在治疗前和治疗后,分别测定患者血清BMP-1水平,分析BMP-1表达水平与牙周骨缺损修复的关系。结果:与治疗前相比,患者治疗后的牙周骨缺损均有所修复,所有患者在术后所有时间点的PPD和骨密度值与治疗前相比均显著改善(P0.05)。治疗6个月后,牙周骨密度出现小幅度下降,但显著高于治疗前,差异具有统计学意义(P0.05)。与治疗前相比,所有患者治疗后1 d、2 d、5 d、10 d、1个月、3个月、6个月血清BMP-1的水平均显著升高,差异具有统计学意义(P0.05),且治疗后BMP-1水平的变化与PPD呈显著负相关(P0.05),但与骨密度的相关性不显著(P0.05)。结论:血清BMP-1在牙周骨修复过程存在动态变化与患者牙周骨术后恢复相关。     

云南白药与丁香油牙周塞治剂辅助治疗牙周炎的临床效果比较

目的:为探讨和比较云南白药牙周塞治剂与丁香油牙周塞治剂辅助牙周手术治疗的临床效果差异,进而为复杂慢性牙周炎的临床治疗提供借鉴和参考依据。方法:选择2012年8月至2014年8月期间我院临床收治的慢性牙周炎患者88例为研究对象,根据患者临床治疗方法的不同将患者分成了研究组和对照组,各44例,分别给予云南白药牙周塞治剂与丁香油牙周塞治剂辅助术后治疗,对两组患者治疗后菌斑指数、牙龈指数、出血指数和松动度等指标进行观察和比较。结果:研究组患者的止血有效率显著高于对照组,且差异有统计学意义;研究组患者的愈合有效率显著高于对照组,且差异有统计学意义;研究组患者的菌斑指数、牙龈指数、出血指数和松动度均明显优于对照组,且组间比较差异有统计学意义。结论:在临床针对手术牙周炎患者实施治疗的实践过程中,采用云南白药牙周塞治剂的临床比较优势明显,可以显著提升患者术后疗效,很好的包含牙龈,有效的控制牙龈出血,是临床实践过程中的理想选择。     

龈沟液中骨硬化蛋白对慢性牙周炎患者疗效评价的临床价值

目的:探讨龈沟液中骨硬化蛋白对慢性牙周炎疗效评价的临床价值。方法:选择2013年1月-2017年12月我院收治的81例慢性牙周炎患者作为观察组及同期79例牙周健康者为对照组,观察组患者给予基础治疗。观察和比较对照组和观察组治疗前及治疗后1个月、2个月的牙周临床指标、龈沟液中的骨硬化蛋白水平,并分析牙周临床指标与龈沟液骨硬化蛋白水平的相关性。结果:治疗前,观察组的菌斑指数、出血指数、牙周探诊深度、附着丧失水平及龈沟液中骨硬化蛋白水平明显高于对照组;治疗后1个月、2个月,观察组以上指标均明显低于治疗前,且治疗后2个月,观察组以上指标明显低于治疗后1个月,但附着丧失水平仍高于对照组(P均0.05),而两组的菌斑指数、出血指数、牙周探诊深度对比差异无统计学意义(P0.05)。龈沟液中骨硬化蛋白水平与菌斑指数、出血指数、牙周探诊深度、附着丧失水平呈高度正相关(r1=0.876,P10.001;r2=0.842,P10.00;r3=0.913,P10.001;r4=0.903,P10.001)。结论:慢性牙周炎患者龈沟液中骨硬化蛋白水平明显上调,并与与菌斑指数、出血指数、牙周探诊深度、附着丧失水平呈高度正相关,可作为慢性牙周炎疗效评价的参考指标。     

水激光与超声洁治对中度慢性牙周炎的疗效对比

目的:探讨水激光与超声洁治对中度慢性牙周炎的疗效。方法:选取81例中度慢性牙周炎患者,年龄27-62岁,随机分为两组:激光组(41例)采用水激光治疗,超声组(40例)采用超声洁治法治疗。通过患者治疗后1个月,3个月的菌斑指数(plaque index,PLI),牙龈指数(gingival index,GI),牙周袋深度(probing depth,PD),牙周附着水平(clinical attachment level,CAL),治疗过程中的VAS评分等观察指标,对水激光与超声洁治进行疗效对比。结果:与基线各项牙周指数相比,激光组和超声组治疗后1个月,3个月的各项牙周指数均明显降低(P0.05)。与超声组相比,激光组治疗后1个月的GI值明显低于超声组,治疗后1个月和3个月的PD值和CAL值均低于超声组(P0.05)。治疗前,两组VAS评分相比,差异没有统计学意义(P0.05),治疗后,激光组的VAS评分明显低于超声组(P0.05)。结论:水激光治疗中度慢性牙周炎,治疗过程痛觉感受轻微,能轻易清除引起炎症的牙石及菌斑,促进牙周组织愈合。     

Enhancing gingival biotype through chorion membrane with innovative step in periodontal pocket therapy

A thick gingival biotype is a requisite for good periodontal health. It has important role in resisting trauma and subsequent gingival recession. The gingival thickness is a significant predictor of clinical outcome of periodontal surgeries. Various surgical procedures are used to increase the gingival thickness. The present study incorporated the innovative step of placement of chorion membrane to objectively evaluate the increase in thickness of gingival biotype during periodontal pocket therapy. The patients in age group between 25 and 45 years with chronic periodontitis, indicated for flap surgery were selected for the study. The sites with pocket depth of 6–8 mm in the mandibular anterior teeth were divided into test and control sites. Periodontal flap surgery was carried at both the sites and chorion membrane was placed at the test sites. The gingival thickness measurement was assessed using a markings marked on injection needle, these markings were read using digital vernier caliper, pre and post operatively. The baseline values of gingival thickness at test site (1.04 ± 0.19 at mid buccal region, 1.24 ± 0.20 at mid papillary) and control site (0.94 ± 0.11 at mid buccal region, 1.14 ± 0.11 at mid papillary region) showed no statistically significant difference. At test sites, 6 weeks post treatment (1.36 ± 0.16 at mid buccal region and 1.48 ± 0.17 at mid papillary region) as compared to control sites (1.06 ± 0.11 at mid buccal region, 1.24 ± 0.11 at mid papillary) showed statistically significant increase in gingival thickness (p ≤ 0.05*). The innovative step of placement of chorion membrane during periodontal pocket therapy facilitated increase in the gingival thickness in the areas with thin gingival biotype.     

Gingival and dermal fibroblasts produce interleukin-1 beta converting enzyme and interleukin-1 beta but not interleukin-18 even after stimulation with lipopolysaccharide

Epithelial cells play a critical role in periodontal disease through the secretion of pro-inflammatory cytokines such as interleukin-1 beta (IL-1 beta) and interleukin-18 (IL-18). However, the role played by fibroblasts is still unclear. The rationale of this study was to throw light on the role of gingival fibroblasts in periodontal disease. We thus investigated the expression of IL-1 beta, IL-18, and ICE mRNA and the secretion of the corresponding proteins by human normal gingival fibroblasts before and after stimulation with lipopolysaccharide (LPS) from Porphyromonas gingivalis and Escherichia coli. IL-1 beta, IL-18, and ICE mRNA expression was evaluated by RT-PCR. Proteins were analyzed by Western blot and ELISA. We demonstrated that gingival fibroblasts expressed ICE mRNA. Basal expression of ICE was modulated following cell stimulation with lipopolysaccharide (5 mug/ml). However, gingival fibroblasts expressed low levels of IL-1 beta mRNA. The expression was potentiated by LPS. The expression of IL-1 beta mRNA was followed by the secretion of IL-1 beta but not IL-18 protein. Our study suggests that fibroblasts may be involved in the defense against infections via an IL-1 beta-mediated but not an IL-18-mediated mechanism.     

Wound-dressing materials with antibacterial activity from electrospun polyurethane-dextran nanofiber mats containing ciprofloxacin HCl

Dextran is a versatile biomacromolecule for preparing electrospun nanofibrous membranes by blending with either water-soluble bioactive agents or hydrophobic biodegradable polymers for biomedical applications. In this study, an antibacterial electrospun scaffold was prepared by electrospinning of a solution composed of dextran, polyurethane (PU) and ciprofloxacin HCl (CipHCl) drug. The obtained nanofiber mats have good morphology. The mats were characterized by various analytical techniques. The interaction parameters between fibroblasts and the PU-dextran and PU-dextran-drug scaffolds such as viability, proliferation, and attachment were investigated. The results indicated that the cells interacted favorably with the scaffolds especially the drug-containing one. Moreover, the composite mat showed good bactericidal activity against both of Gram-positive and Gram-negative bacteria. Overall, our results conclude that the introduced scaffold might be an ideal biomaterial for wound dressing applications.     

Interleukin 1beta-secreting cells in inflamed gingival tissue of adult periodontitis patients.

Interleukin 1beta (IL-1beta) is a cytokine with a wide range of biological activities. It is produced by various cell types including macrophages, fibroblasts, and neutrophils. The inflammatory responses mediated by IL-1beta play an important role in periodontal tissue destruction. The purposes of this study were: (1) to determine the location of IL-1beta in inflamed human gingival tissues by the immunofluorescence method; and (2) to correlate this location to the concomitant presence of macrophage or neutrophils by immunohistochemistry. Five patients with moderate to advanced adult periodontitis receiving periodontal phase I therapy were included in this study. One month after phase I therapy, 15 sites with a probing pocket depth >/=5 mm and gingivitis index >/=1 were arranged for modified Widman flap operation. Another three sites with a probing pocket depth 相似文献   

Non‐surgical treatment of gingival overgrowth induced by nifedipine: a case report on an elderly patient

doi:10.1111/j.1741‐2358.2009.00273.x
Non‐surgical treatment of gingival overgrowth induced by nifedipine: a case report on an elderly patient Drug‐induced gingival overgrowth (DIGO) is a significant problem for periodontologists and this side effect is frequently associated with three particular drugs: phenytoin, cyclosporin A and nifedipine. A case report of gingival overgrowth induced by nifedipine in an elderly patient treated with non‐surgical periodontal therapy is described. A 75‐year‐old male with generalised gingival overgrowth reported the problem of oral malodour and significant gingival bleeding. The medical history revealed a controlled hypertensive state and Cerebral Vascular Accident (CVA) 3 years prior to consultation. The diagnosis was gingival overgrowth associated with nifedipine, no other risk factors being identified. The patient had been taking nifedipine for 18 months, but after the consultation with the patient’s doctor, nifedipine was suspended, as the hypertension was controlled. Treatment consisted of meticulous oral hygiene instruction, scaling, root surface instrumentation and prophylaxis. Six months after the first intervention, clinical parameters revealed a significant improvement with a considerable reduction in gingival overgrowth, demonstrating the effect of non‐surgical periodontal therapy in severe cases of gingival overgrowth. Non‐surgical treatment of DIGO is a far less invasive technique than surgical approaches and has demonstrated an impressively positive treatment response. It should therefore be considered as a first treatment option for DIGO.