Clinical and Biochemical Assessment of Lycopene Gel Combined With Nanohydroxyapatite Graft in Treatment of Grade II Furcation Defects: A Randomized Controlled Clinical Study

Background: This study aimed to evaluate the effects of lycopene gel, as a natural antioxidant, mixed with a nanohydroxyapatite graft (NHG) covered by an occlusive resorbable collagen membrane (CM) in the surgical treatment of grade II furcation defects and on the gingival crevicular fluid (GCF) levels of 8-hydroxydeoxyguanosine (8-OHdG), as a marker of oxidative injury. Methods: In this randomized controlled clinical study a total of 24 patients with grade II furcation defects were randomly assigned into three equal groups. Furcation defects in group I were managed with lycopene gel mixed with NHG and CM, group II with NHG and CM, and group III with open flap debridement only. Site-specific changes in clinical parameters including probing depth (PD), vertical clinical attachment level (VCAL), horizontal clinical attachment level (HCAL), radiographic maximum vertical depth (MAX V), and maximum horizontal depth (MAX H) were measured at baseline and six months postoperatively. Gingival crevicular fluid levels of 8-OHdG were analyzed using enzyme-linked immunosorbent assay (ELISA) at baseline, one week, and three months. Results: Surgical management of grade II furcation defects resulted in a significant reduction in PD and 8-OHdG levels and a gain in CAL, MAX V, and MAX H in all groups. The differences between lycopene treated sites compared to NHG and CM alone were not significant at six months but demonstrated significantly superior clinical parameters compared to open flap debridement alone. Conclusion: Lycopene does not confer a benefit when combined with NHG in the surgical treatment of grade II furcation defects.

Clinical and Histologic Evaluation of Using Block Xenograft Combined With Leukocyte-Platelet Rich Fibrin (L-PRF) Versus Intraoral Autogenous Bone Block Graft With L-PRF in Treating Localized Ridge Defects: A Randomized Clinical Trial

Background: Augmentation of vertical bone defects remains the corner stone in periodontal tissue engineering. The amount and quality of alveolar bone available in all dimensions affects the success of dental implants for restoration of edentulous areas. Adequate and healthy bone supports the degree of osseointegration which in turn affects the long-term success of oral implants. The primary aim of the study was to histologically evaluate autogenous block grafts versus synthetic block grafts for the treatment of atrophic vertical and horizontal bony defects (Siebert Class III) in the anterior esthetic zone of the mouth. The secondary aim was to clinically and radiographically evaluate the outcomes of the procedure. Methods: This was a randomized controlled clinical study with a statistically determined sample size of 10 patients per group and a total of 20 patients in both groups. Patients with vertical and horizontal bone loss were enrolled from the Department of Oral Medicine, Periodontology, and Oral Diagnosis of Ain Shams University and Misr International University. Bone augmentation procedures were performed using two techniques: autogenous bone block graft and xenograft bone block graft both with leukocyte-platelet rich fibrin (L-PRF). Results: Both autogenous and xenograft blocks in conjunction with L-PRF had a significant effect on vertical bone augmentation in cases of atrophic ridges in the esthetic region. Conclusion: Both autogenous and xenograft bone blocks in conjunction with L-PRF have a significant effect on vertical bone augmentation in cases of atrophic ridges in the esthetic region.

Self-Reported Gum Bleeding in COVID-19 Patients: A Questionnaire-Based Study

Background: Coronavirus disease 2019 (COVID-19) has affected a huge number of people around the world. It has increased worldwide mortality and morbidity and is accompanied by different signs and symptoms. Some researchers have linked oral manifestations as introductory signs for COVID-19, such as vesiculobullous lesions, non-specific stomatitis, and oral ulcers. The oral cavity has been perceived as a potential reservoir for asymptomatic COVID-19 infection, specifically the salivary glands and the oral mucosa. This study builds on a previous case report by the authors on COVID-19 associated gingival bleeding in an attempt to investigate the generalization of this relation. Methods: A cross-sectional survey based on a struc­tured, pre-tested, and validated questionnaire that was adapted and modified by the authors was carried out electronically for a minimal sample size of patients that was calculated for this study beforehand. This study was approved by the Batterjee Medical College ethical committee and data collection followed a structured criteria and a clear work plan based on the established inclusion criteria. Results: The questionnaire had a high response rate of 315 participants. 63.2% (n=199) reported gum bleeding during virus infection time – 25.6% (n=51) of whom reported that this symptom was present prior to COVID-19 infection. 88.9% (n=177) of participants reported only mild bleeding. Gingival bleeding was more prevalent among females 63.8% (n=127) compared to males 36.2% (n=72) (odds ratio: 0.859 [95% CI, 0.530 to 1.394]). Conclusion: Gingival bleeding may be considered as one of the signs of COVID-19 and is a prevalent symptom as reported by infected patients. However, a larger sample size and investigation of hospitalized moderate and severe cases of the disease would help elucidate the actual association.

Influence of Different Decontamination Approaches on Bone Substitute Adhesion to Peri-Implantitis Affected Implant Surfaces: An SEM Proof of Principle Study

Background: During healing, clot blended graft materials may retract away from implant surfaces creating microgaps that compromise re-osseointegration. The present study aimed to evaluate different surface decontamination materials’ effect on adhesion of the graft materials to peri-implantitis affected parts, a factor that can resist clot blended graft retraction improving re-osseointegration. Methods: Eighteen peri-implantitis affected implants diagnosed as hopeless and designated for removal contributed in this prospective, masked trial. Samples were randomly distributed into three groups, each of six implants. Group one (G1) was coated with hydroxyapatite of a micro particle size of 250 to 1000 µm after saline surface decontamination for two minutes. Group two (G2) peri-implantitis affected parts were treated with the graft material following two minutes of chlorhexidine gluconate 0.12% (CHX) surface treatment. Group three (G3) implants were coated with the graft material after citric acid (CA) (pH = 1) surface conditioning for two minutes. Implants in all groups were agitated in phosphate-buffered saline (PBS) by using an automatic tissue processor agitator for three minutes. Implants were prepared for surface scanning evaluation. Results: Scanning electron microscopy (SEM) observation of G1 saline treated control implants were devoid of bone particles adherent to peri-implantitis affected surfaces. The surface area covered by grafted particles in G2 was statistically higher than that of G1 (P<0.01). Group three (CA-treated) showed nearly complete coverage of peri-implantitis affected parts by the graft material covering 88.8% of examined surface areas which was statistically higher than that of G2 (P<0.05). Conclusion: Citric acid implant surface conditioning could improve implant re-osseointegration through enhancement of the graft adhesion to the implant surface. Smear layer barrier effect seemed to be the most important factor that compromised graft adhesion to preri-implantitis affected parts of the implant surfaces.

Is Periodontal Disease a Red Flag for Breast Cancer Among Postmenopausal Female Smokers? An Update of the Last Decade

Periodontal disease is characterized by a chronic inflammation produced in response to a disease-associated, multispecies bacterial community in the subgingival region. In recent years, interest has focused on the potential role of periodontal disease in cancer pathogenesis. In this review, we presented a summary showing a strong association between breast cancer and poor oral health, presence of periodontitis-associated bacteria, tooth loss, and clinical signs of periodontitis. Proinflammatory pathways are activated either by mono- or polymicrobial infections, resulting in an increase in the expression of proinflammatory molecules such as interleukin (IL)-6, IL-8, IL-1β, and tumor necrosis factor (TNF)-α. In addition, it has been shown that several periodontitis-associated species induce the expression of genes related to cell proliferation, cell cycle, apoptosis, transport, and immune and inflammatory responses. Intriguingly, many of these pathways are linked to carcinogenesis. Among them, the activation of Toll-like receptors (TLRs) and antiapoptotic pathways (such as the phosphoinositide-3-kinase-protein kinase B/Akt [PI3K-PKB/Akt], Janus kinase/signal transducers and activators of transcription [JAK/STAT], and mitogen-activated protein kinase [MAPK] pathways), the reduction of proapoptotic protein expression, the increase in cell migration and invasion, and the enhancement in metastasis are addressed. Cigarette smoking is one of the major causes of carcinogenesis. The incidence of breast cancer is increasing worldwide, making it the most common type of cancer among women. The etiology of breast cancer is multifactorial and cigarette smoking is one of the risk factors that has recently been shown to be associated with breast cancer. The relationship between cigarette smoking and breast cancer is due to one of the important components of cigarette smoke, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), which is a representative carcinogen of N-nitrosamines that has gained focus in breast cancer carcinogenesis. The purpose of this review is to investigate the relationship between breast cancer and chronic periodontal disease changes that can occur at the oral level, including alterations of the oral microbiome, and pathological conditions among postmenopausal female smokers. Chronic periodontal disease and tooth loss were highly prevalent in postmenopausal breast cancer survivors. Based on this traditional review, the importance of dentists is clear in proposing to patients with breast cancer appropriate therapies and dedicated prevention sessions.