Effect of propolis extract on clinical parameters and salivary level of matrix metalloproteinase 8 in periodontitis patients: A randomized controlled clinical trial

Background: Periodontitis is bacterial induced inflammation of the tooth-supporting structures. Local antibacterial agents are used as an adjunctive therapy in the treatment of Periodontitis. The aim of this study was to compare the efficacy of subgingivally delivered propolis extract (a resin produced by the honey bees) with chlorhexidine (CHX) mouthwash on clinical parameters and salivary levels of matrix metalloproteinase 8 (MMP-8) in periodontitis patients. Methods: 28 periodontitis patients in stage II or III and grade B were divided in two groups. In control group, patients prescribed 0.2 % CHX mouthwash twice a day for two weeks. In the 20% propolis hydro-alcoholic group, subgingival irrigation was performed twice a week for two weeks. Clinical parameters were measured at baseline and after 2 months. Saliva samples were collected from propolis and control group at baseline and 2 months later to assess MMP-8 levels using the enzyme-linked immunosorbent assay. Additionally, Saliva from 12 periodontally healthy subjects was used to determine the normal levels of MMP-8. Data were analyzed using SPSS, P<0.05 was considered as the level of significance. Results: In the healthy group, the mean salivary levels of MMP-8 were significantly lower than that in control and propolis groups at baseline (P<0.001). The results indicated that there was a significant improvement in clinical parameters (p<0.001) in the propolis group compared to control group, while MMP-8 levels decreased significantly in both groups (P<0.001). Conclusions: Propolis is recommended as an adjunct therapy for periodontitis patients. Clinical trials registration code: IRCT2016122030475N3.

Periodontal status associated with dual habits of smoking and smokeless tobacco use: A cross-sectional study in young adults

Background: Tobacco smoking is an established risk factor for periodontitis. However, few studies have evaluated the periodontal status of smokeless tobacco (SLT) users, while that of individuals with dual habit has largely been unexplored. The current study aimed to find if the periodontal status in individuals with dual habits of smoking and SLT use is different from those with any single habit. Methods: Four groups (A: exclusive smokers, B: exclusive tobacco chewers, C: individuals with dual habits, and D: non-users of tobacco), each comprising 75 males in the age group of 20-35 years, were selected. Along with the history of tobacco use, a modified oral hygiene index (OHI), gingival index (GI), probing depth (PD), and the number of teeth with gingival recession (GR) were recorded. The data were assessed using the Chi-square test, one-way ANOVA, and logistic regression. Results: Group C had the highest mean OHI scores, with 94.66% of participants having poor oral hygiene (OHI>3.0). The prevalence of severe gingivitis (GI>2.0) was significantly lower among exclusive smokers (group A) and those with dual habits (group C) when compared to the other two groups. As much as 60% of group C participants were found to have average PD in the range of 4-6 mm, while deeper average PD (>6 mm) was most common among smokers. The highest risk of having a tooth with GR was also associated with the dual habit (OR = 4.33, 95% CI = 3.24 - 5.76) when compared with the non-users. Conclusion: While both forms of tobacco were associated with poor periodontal status, the additive effect of smoking and SLT use was evident in almost all parameters, more so with poor oral hygiene and the prevalence of gingival recession. These findings emphasize that individuals with dual habits have an additional risk for periodontal destruction.

Comparative assessment of bone mineral density levels in type 2 diabetic subjects with or without chronic periodontitis: A cross-sectional study

Background. This cross-sectional study investigated the bone mineral density (BMD) in type 2 diabetes mellitus (T2DM) subjects with or without chronic periodontitis (CP). Methods. A total of 120 subjects aged 35‒55, divided equally into four groups: i) T2DM with CP, ii) T2DM without CP, iii) CP alone, and iv) healthy patients, were included in this study. Clinical parameters like plaque index (PI), gingival index (GI), and probing pocket depth (PPD) were recorded. All the participants were evaluated for blood sugar levels using glycated hemoglobin (HbA1c) and BMD by Hologic dual-energy x-ray absorptiometry (DEXA) scan. The association of BMD with clinical periodontal parameters and HbA1c in all groups was investigated using linear correlation analysis (r). Results. The mean value of BMD (0.9020±0.0952 g/cm2) was lower in subjects with both T2DM and CP compared to T2DM and CP alone. BMD was weakly correlated with all the clinical periodontal parameters; a positive correlation was observed between BMD and GI in the T2DM and CP group (r=0.405, P=0.026) and the CP group (r=0.324, P=0.081). A weak positive correlation was observed in BMD and HbA1c in the T2DM group (r=0.261, P=0.13), T2DM and CP group (r=0.007, P=0.970), with a negative correlation to HbA1c in the CP group (r= -0.134, P=0.479). Conclusions: Diabetes mellitus impacts clinical periodontal status and bone mass, and the effect is accentuated when chronic periodontitis is present. Based on the present study, BMD is associated with T2DM and CP, but a weak correlation was observed between BMD and HbA1c and clinical periodontal parameters.

Gingival recession and attachment loss: Cross-sectional and retrospective data of 10 years

Background. Gingival recession is a manifestation of the presence of periodontitis and the expression of its characteristics for a long time in the patient’s oral cavity. Loss of attachment and its association with gingival recession affect the prosthetic value of the tooth as they significantly change the center of axial rotation of the tooth. The present study aimed to determine the correlation between gingival recession and attachment loss. Methods. Data on gingival recession and loss of attachment were collected in two groups of patients. In the first group (n=34), cross-sectional data were collected; in the second group (n=64), previously collected data over 10 years were evaluated. Results. Gingival recession was the most prevalent in the age group of 20-30 age group in 56% of the patients. The same values held for the retrograde data. An attachment loss of 4-6 mm was reported in 26% of the patients in the 31-50 age group in the cross-sectional data group, and 7 mm of gingival recession was reported in 3% of the patients in the 31-50 age group. Conclusions. The high prevalence of periodontitis at a young age indicates a poor prognosis of this disease at older ages. Gingival recession associated with attachment loss for patients with chronic periodontitis has higher values at the 31-50 age group, where systemic conditions are gradually developing in the human body.

Antibacterial agent-releasing scaffolds in dental tissue engineering

It seems quite challenging in tissue engineering to synthesize a base material with a range of essential activities, including biocompatibility, nontoxicity, and antimicrobial activities. Various types of materials are synthesized to solve the problem. This study aimed to provide the latest relevant information for practitioners about antibacterial scaffolds in dental tissue engineering. The PubMed search engine was used to review the relevant studies with a combination of the following terms as search queries: tissue engineering, scaffolds, antimicrobial, dentistry, dental stem cells, and oral diseases. It is noteworthy to state that only the terms related to tissue engineering in dentistry were considered. The antimicrobial scaffolds support the local tissue regeneration and prevent adverse inflammatory reactions; however, not all scaffolds have such positive characteristics. To resolve this potential defect, different antimicrobial agents are used during the synthesis process. Innovative methods in guided tissue engineering are actively working towards new ways to control oral and periodontal diseases.

Crack growth pattern analysis of monolithic glass ceramic on a titanium abutment for single crown implant restorations using smooth particle hydrodynamics algorithm

Background. Glass ceramic materials have multiple applications in various prosthetic fields. Despite the many advantages of these materials, they still have limitations such as fragility and surface machining and ease of repairing. Crack propagation has been a typical concern in fullceramic crowns, for which many successful numerical simulations have been carried out using the extended finite element method (XFEM). However, XFEM cannot correctly predict a primary crack growth direction under dynamic loading on the implant crown. Methods. In this work, the dental implant crown and abutment were modeled in CATIA V5R19 software using a CT-scan technique based on the human first molar. The crown was approximated with 39514 spherical particles to reach a reasonable convergence in the results. In the present work, glass ceramic was considered the crown material on a titanium abutment. The simulation was performed for an impactor with an initial velocity of 25 m/s in the implant-abutment axis direction. We took advantage of smooth particle hydrodynamics (SPH) such that the burden of defining a primary crack growth direction was suppressed. Results. The simulation results demonstrated that the micro-crack onset due to the impact wave in the ceramic crown first began from the crown incisal edge and then extended to the margin due to increased stress concentration near the contact region. At 23.36 µs, the crack growth was observed in two different directions based on the crown geometry, and at the end of the simulation, some micro-cracks were also initiated from the crown margin. Moreover, the results showed that the SPH algorithm could be considered an alternative robust tool to predict crack propagation in brittle materials, particularly for the implant crown under dynamic loading. Conclusion. The main achievement of the present study was that the SPH algorithm is a helpful tool to predict the crack growth pattern in brittle materials, especially for ceramic crowns under dynamic loading. The predicted crack direction showed that the initial crack was divided into two branches after its impact, leading to the crown fracture. The micro-crack initiated from the crown incisal edge and then extended to the crown margin due to the stress concentration near the contact area.

Different techniques in transalveolar maxillary sinus elevation: A literature review

Dental implant treatment in the posterior maxilla encounters bone quality and quantity problems. Sinus elevation is a predictable technique to overcome height deficiency in this area. Transalveolar sinus elevation is a technique that is less invasive and less time-consuming, first introduced for ridges with at least 5 mm of bone height. Many modifications and innovative equipment have been introduced for this technique. This review aimed to explain the modifications of this technique with their indications and benefits. An exhaustive search in PubMed Central and Scopus electronic databases was performed until December 2020. Articles were selected that introduced new techniques for the transalveolar maxillary sinus approach that had clinical cases with full texts available in the English language. Finally, twenty-six articles were included. The data were categorized and discussed in five groups, including expansion-based techniques, drill-based techniques, hydraulic pressure techniques, piezoelectric surgery, and balloon techniques. The operator’s choice for transalveolar approach techniques for sinus floor elevation can be based on the clinician’s skill, bone volume, and access to equipment. If possible, a technique with simultaneous implant placement should be preferred.