Journal of Advanced Periodontology and Implant Dentistry
Volume:16 Issue: 2, Nov 2024

The vehicle in a local drug delivery (LDD) system plays a vital role in delivering the active drug component at the diseased site. Liquid/injectable platelet-rich fibrin (i-PRF), an autologous fibrin matrix, might be used as a vehicle to enmesh drugs and deliver locally at the periodontally diseased sites. This study evaluated the efficacy of the drug (ciprofloxacin [Cip])-loaded i-PRF as a LDD system adjunct to subgingival debridement in subjects with periodontal pockets.

In a parallel design study, 79 periodontally diseased pocket sites were randomized to 3 groups: group 1 (n = 25), scaling and root planing (SRP) + i-PRF + Cip; group 2 (n = 25), SRP + i-PRF; group 3 (n = 25), SRP without any adjunctive intervention. Clinical parameters (probing depth [PD], clinical attachment level [CAL], gingival index [GI], plaque index [PI]) and microbial quantification (relative quantification of levels of Aggregatibacter actinomycetemcomitans) were assessed from baseline to 6th and 12th weeks of follow-up.

All the treatment groups showed significant improvements in the clinical and microbial parameters assessed. Group 1 showed significantly higher PD and GI reduction with CAL gain and decreased in relative levels of A. actinomycetemcomitans in the 12th week, followed by group 2 compared to group 3.

Thus, within the limits of this study, it can be concluded that i-PRF could be considered a potential LDD vehicle for the delivery of ciprofloxacin in periodontal pocket therapy.

Recurrence of gingival pigmentation following depigmentation procedures is common, raising the question of the influence of an underlying cause, if any. Melanin, a nonhemoglobin- derived brown pigment, is the most common endogenous pigment contributing to gingival pigmentation. Hemoglobin derivatives are among the other prime pigments that contribute to gingival color. This exploratory cross-sectional study evaluated the influence of hemoglobin levels on the distribution and severity of gingival melanin pigmentation in periodontitis, gingivitis, and healthy periodontium.

Twenty subjects with periodontitis (group 1), gingivitis (group 2), and healthy periodontium (group 3) were recruited in this observational study, totaling 60 subjects. The hemoglobin levels in g/dL and Hedin Melanin Index (HMI-1977) scores were recorded for all subjects, and relevant statistical tests were applied (P < 0.05).

A negative correlation was observed between the hemoglobin levels and the HMI scores for the whole sample and each group. This correlation was statistically significant for the whole sample and for the gingivitis group in which the correlation was moderate.

The inverse and significant relation between the hemoglobin levels and distribution and severity of melanin pigmentation observed for the whole sample and the gingivitis group requires further research and validation to identify and manage the confounding factors in the treatment of gingival pigmentation.

The interdental papilla plays a crucial role in the esthetic of the smile. Papilla reconstruction surgery is one of the most unpredictable periodontal procedures. This study compared the effect of the non-surgical application of a commercial hyaluronic acid (HA) gel with an autogenous gel named “albumin with platelet-rich fibrin” (Alb-PRF) on interdental papilla reconstruction.

This trial was conducted on 46 incomplete interdental papillae with class I or II defects. The papillae were randomly divided into two experimental groups, and commercial HA or Alb-PRF (prepared from the patient’s peripheral blood) was injected into the papillae twice at a 21-day interval. Three and six months after the intervention, photographs were taken from the black triangles and the black surfaces compared to each other. Patient satisfaction and dental plaque index were also evaluated at the end of the study.

The black triangles’ surfaces significantly decreased over time in both experimental groups (P < 0.001). However, there were no significant differences between the two groups (P = 0.994). The intervention resulted in the patients’ relative satisfaction with the treatment results in both groups. However, the difference between the two groups was not statistically significant (P = 0.965). In addition, no statistically significant differences were observed in plaque index between the two groups (P = 0.566).

HA or Alb-PRF injection into the incomplete interdental papilla may restore the soft tissue to a great extent and lead to patient satisfaction by reducing the area of black triangles that threaten esthetics; however, more studies are needed.

Peri-implant diseases, such as peri-implant mucositis and peri-implantitis, are inflammatory conditions caused by biofilms that can lead to the loss of surrounding soft tissues and bone. The most effective treatment involves non-surgical mechanical debridement to remove plaque, but other treatment modalities have shown limited success. This study investigated the anti-inflammatory and immunomodulatory effects of atorvastatin (ATV) gel as an additional treatment for peri-implant mucositis.

In this double-masked, randomized clinical trial, 49 patients with peri-implant mucositis were randomly divided into two treatment groups: mechanical debridement (MD) + placebo or MD + ATV gel. At baseline, 1 month, and 3 months after the intervention, periodontal parameters, including probing depth (PD), bleeding on probing (BOP), clinical attachment level (CAL), and pain on probing (POP), were measured. Data were analyzed using independent t-test and paired t-test.

Statistically significant improvements in CAL and POP were observed from baseline to each time point throughout the study period (P ≤ 0.001). PD and BOP were statistically significant 1 month and 3 months after the intervention, respectively (P < 0.05).

The clinical parameters associated with peri-implant mucosal inflammation further improved when ATV gel was used with MD.

The importance of peri-implant soft tissues in maintaining tissue health and aesthetics has been recognized. A thickness of at least 2 mm is considered a protective factor against periimplantitis. This study assessed clinical outcomes and complications at implant sites following soft tissue augmentation with either palatal free gingival graft (FGG) or palatal pedicle graft (PPG).

In this randomized controlled clinical trial, 42 patients with inadequate keratinized tissue width (KTW) were randomly assigned to two intervention groups: Group 1 received FGGs, while group 2 underwent PPGs. The KTW, vestibular depth, and surface shrinkage were recorded preoperatively and one and three months after the operation. Patient-reported outcome measurements were recorded at a two-week follow-up.

Thirty-five patients completed the study (FGG group, n = 17; PPG group, n = 18). Group 2 demonstrated a higher increase in KTW and vestibular depth at 1 and 3 months (P < 0.05). The surface shrinkage differences were not statistically significant between the study groups at baseline and three-month follow-up (P > 0.05). The number of analgesics in each group was not significantly different two weeks after the operation; however, the Numeric Pain Rating Scale (NPRS) showed significantly higher pain scores on days 3 to 8 in group 1 patients.

The use of PPG in soft tissue augmentation demonstrated more KTW formation and less postoperative morbidity. There was no difference between the methods used to compare surface shrinkage.

Acellular dermal matrix (ADM) has been introduced as an alternative to autogenous grafts. This study assessed the biological behavior of mesenchymal stem cells (MSCs) on two types of commercial ADM scaffolds.

The present in vitro study investigated the behavior of MSCs cultured on scaffold type I CenoDerm® (Tissue Regeneration Corporation) and type II Acellular Dermis (Iranian Tissue Product Co.) as the test groups and an empty well plate as the control group (n=78). Cell attachment was assessed after 12 hours of incubation using 6,4-diamidino-2-phenylindole (DAPI) staining and methyl thiazole tetrazolium (MTT) assay. Cell proliferation was assessed using the MTT assay at 24- and 84-hour and 7-day intervals. Cell morphology was also assessed under a scanning electron microscope (SEM) at 24 hours. MTT assay and DAPI staining were repeated for five samples in all the three groups. Mann-Whitney, ANOVA, and post hoc Tukey tests were used for statistical analysis.

The DAPI staining and MTT assay showed similar results concerning cell attachment between all the groups at 12 hours (P=0.4). At 24 hours, cell proliferation was significantly higher in scaffold groups (P<0.001). At seven days, the lowest cell proliferation was noted in the scaffold II group, with a significant difference between the groups (P=0.01). At 24 hours, cell expansion was greater in the control group, followed by the scaffold I group.

Both scaffolds were similar in MSC attachment, but scaffold I appeared superior to scaffold II in terms of MSC proliferation and morphology in vitro.

Careful anatomical investigation of canalis sinuosus (CS) is essential to prevent damage to blood vessels and nerves in this area during surgical procedures, such as placing dental implants in the anterior maxillary region. This study investigated the relationship and distance between the CS and its adjacent structures.

A total of 400 cone-beam computed tomography (CBCT) images of Iranian adults aged 20–86 years were included in this retrospective study. Two observers assessed all the images twice with a time interval of one month. The closest tooth to the CS, its position relative to the CS, and distance measurements of the CS from adjacent structures were determined.

CS was found in 10.5% of all images. The mean diameter of the canal was 1.06 ± 0.29 mm, which was not significantly different between the age groups, right and left sides, or genders. The most common location of CS was mid-position relative to the upper lateral incisors. In linear measurements, only the distance from the CS to the buccal cortical plate and perpendicular to the nasopalatine canal exhibited a significant difference between the two sexes, with no significant difference between the right and left sides.

CS location was significantly more palato-lateral in males. There was no significant difference in the prevalence between the two sexes.

The purpose of this study was to review the literature on the efficacy of different surgical regenerative methods for peri-implantitis treatment.

A preliminary search was conducted in seven electronic databases. The studies included in the analysis implemented surgical regenerative treatment in at least one study group. Baseline and follow-up values for bleeding on probing (BoP), pocket depth (PD), plaque index (PI), bone level (BL), and bone gain (BG) were extracted. The standardized mean difference (SMD) was calculated using Cohen’s d or Hedges’ g, and a random-effects-restricted maximum likelihood (REML) method was applied for the meta-analysis.

Fifteen studies were included in the qualitative synthesis. The meta-analysis was performed on six studies comparing regenerative techniques that involved bone grafts with those that did not. The overall effect size for using bone grafts at the one-year follow-up was 0.04 (95% CI: -0.26‒0.35; P = 0.78) for BoP, -0.08 (95% CI: -0.42‒0.27; P = 0.66) for PD, 0.37 (95% CI: 0.08‒0.65; P = 0.01) for PI, -0.44 (95% CI: -0.84 to -0.03; P = 0.03) for BL, and 0.16 (95% CI:-0.68‒1.01; P = 0.70) for BG.

Various materials have been employed for peri-implant defect filling and coverage. A bone substitute did not significantly improve BoP, PD, and BG values, while PI and BL were significantly ameliorated at one-year follow-up. However, recommending a single unified protocol as the most effective for surgical regenerative treatment of peri-implantitis was not feasible.

The present study evaluated the effects of cranberry juice enriched with omega-3 on inflammatory, oxidative stress, and periodontal status in diabetic patients with periodontal disease.

Forty-one patients with diabetes (35‒67 years old) and periodontal disease were assigned to four groups: C: control (n = 12), I1: omega-3 (n = 10, 1 g), I2: cranberry juice (n = 9, 200 mL), and I3: cranberry juice enriched with omega-3 (n = 10, 200 mL, containing 1 g of omega-3) twice daily for 8 weeks. Serum and salivary total antioxidant capacity (TAC), malondialdehyde (MDA), serum uric acid, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), clinical attachment loss (CAL), pocket depth (PD), bleeding on probing (BOP), and plaque index were evaluated in all the subjects before and after the intervention.

Serum and salivary TAC increased, and salivary MDA decreased in the I3 group compared with the control group. Additionally, serum MDA decreased in the I2 and I3 groups while serum TAC increased. Serum hs-CRP, IL-6, and TNF-α decreased in the I3 group compared with the baseline. Furthermore, serum hs-CRP and IL-6 decreased in the I3 group compared with the control group. After the intervention, PD and CAL significantly reduced in all the groups.

The consumption of cranberry juice enriched with omega-3 can be helpful as adjuvant therapy with non-surgical periodontal treatment in decreasing serum levels of IL-6 and hs-CRP, as well as serum and salivary levels of MDA while also increasing serum and salivary levels of TAC.

Dental implant placement in the esthetic zone is associated with challenges for clinicians. The best esthetic outcome of this procedure can be obtained through precise management of hard and soft tissue. Orthodontic forced eruption (OFE) has presented an alternative approach to augment hard and soft tissues, which can be applied rapidly or slowly. OFE of hopeless teeth with its periodontal attachment results in a favorable implant preparation site. Therefore, the present systematic review evaluated the effect of implant site preparation using OFE in hopeless teeth. A complete electronic search was performed in PubMed/MEDLINE, Scopus, and Google Scholar from June 2020 to November 2023. The search was limited to clinical English language studies. Studies were excluded if OFE was performed without implant placement. Finally, 15 studies with a total of 21 teeth, all located in the maxillary anterior region, were included in this study. In eight studies, bone grafting procedures were performed before implant placement. Using OFE could rapidly prepare the implant site by enhancing hard and soft tissues. However, additional interventions like guided bone regeneration should be considered case-dependent.