Chen-Ying Wang

Application of antimicrobial photodynamic therapy in periodontal and peri‐implant diseases

Recent advances in technology have led to a constant drive to develop novel approaches for the treatment of periodontal diseases. The need to find more optimal treatment protocols for periodontal disease is a long-term goal for periodontal researchers and clinicians. A novel noninvasive photochemical approach for infection control, namely photodynamic therapy, has been receiving much attention in the treatment of oral diseases (34, 45, 139). Although the original technique was first employed in the treatment of cancer (4), during the last decade an increasing number of studies on photodynamic therapy application have been published in periodontics. They have reported efficient elimination of periodontal pathogens using the photodynamic method, which combines the application of a nontoxic chemical agent (photosensitizer) with low-level light energy (25, 37, 115). Photodynamic therapy has been considered as a promising novel therapeutic approach for eradicating pathogenic bacteria in periodontal and peri-implant diseases. In this review article, an overview on the existing preclinical and clinical evidence on the effects of photodynamic therapy in the treatment of periodontal and periimplant diseases is presented and discussed.

Lasers in minimally invasive periodontal and peri-implant therapy

Laser therapy has the potential to be an effective, minimally invasive procedure in periodontal therapy. The aim of the present review was to survey the relevant literature on the clinical application of lasers as a minimally invasive treatment for periodontitis and peri-implant disease. Currently, there are a large number of published clinical studies and case reports that evaluate the adjunctive use of diode, carbon dioxide, neodymium-doped yttrium aluminium garnet (Nd:YAG), erbium-doped yttrium aluminium garnet (Er:YAG) and erbium, chromium-doped: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) lasers or antimicrobial photodynamic therapy for nonsurgical and minimally invasive surgical treatment of periodontal pockets. These procedures are expected not only to control inflammation but also to provide biostimulation effects with photonic energy. Recent meta-analyses did not show statistically significant differences in pocket reduction and clinical attachment gain compared with mechanical debridement alone, although limited positive effects of adjunctive laser therapy were reported. At present, systematic literature approaches suggest that more evidence-based studies need to be performed to support the integration of various laser therapies into the treatment of periodontal and peri-implant diseases. The disparity between previous statistical analyses and individual successful clinical outcomes of laser applications might reveal the necessity of developing optimal laser-treatment modalities of different wavelengths and better-defined indications for each protocol.

A Novel Urethane Acrylate–based Root Canal Sealer with Improved Degree of Conversion, Cytotoxicity, Bond Strengths, Solubility, and Dimensional Stability

INTRODUCTION We have developed new urethane acrylate-based root canal sealers using polycarbonate (PC) as polyol and 2,2-azobis(2-methyl)butyronitrile (AMBN) as a thermal initiator. The purpose of this study was to compare the properties among a group of seven sealers: (1) polybutyleneadipate (PBA) with 2,2-azobis-isobutyronitrile (AIBN), (2) PBA-AMBN, (3) PC-AIBN, (4) PC-AMBN, (5) AH Plus (Dentsply DeTrey GmbH, Konstanz, Germany), (6) Epiphany (Pentron Clinical Technologies, Wallingford, CT), and (7) EndoREZ (Ultradent Products, Inc, South Jordan, UT). METHODS Attenuated total reflectance-Fourier transforming infrared spectroscopy was used to analyze the degree of conversion. Cytotoxicity was evaluated using MTT assay. In addition, push-out bond strength, solubility, and dimensional stability were investigated. RESULTS Urethane acrylate-based root canal sealers behaved better than Epiphany and EndoREZ for the properties evaluated in this study. The PC-AMBN sealer exhibited the highest degree of conversion even in the apical third, and its cytotoxicity for nonsetting and aged specimens at 24 hours was comparable to AH Plus sealer. In addition, the PC-AMBN sealer with zinc oxide/thermoplastic polyurethane cones had a significantly higher bond strength than AH Plus with gutta percha. Solubility and dimensional changes of the PC-AMBN sealer conformed to the American National Standards Institute/American Dental Association (ANSI/ADA) standard 57. CONCLUSIONS The PC-AMBN sealer has great potential for use in endodontic therapy.

Compositional characteristics and hydration behavior of mineral trioxide aggregates

Mineral trioxide aggregate (MTA) was one of most popular biomaterials for endodontic treatment in the past decade. Its superb biocompatibility, sealing ability and surface for tissue adhesion all make MTA a potential candidate for many dental applications, such as apexification, perforation repair, repair of root resorption, and as a root-end filling material. There are many review articles regarding the physical, chemical and biological properties of MTA. However, there are few reviews discussing the relationship between the composition and hydration behavior of MTA. The aim of this article was to provide a systematic review regarding the compositional characteristics and hydration behavior of MTA.

Light-Emitting Diode Irradiation Promotes Donor Site Wound Healing of the Free Gingival Graft

BACKGROUND This study aims to evaluate the effect of light-emitting diode (LED) light irradiation on the donor wound site of the free gingival graft. METHODS Rat gingival fibroblasts were chosen to assess the cellular activities and in vitro wound healing with 0 to 20 J/cm(2) LED light irradiation. Seventy-two Sprague-Dawley rats received daily 0, 10 (low-dose [LD]), or 20 (high-dose [HD]) J/cm(2) LED light irradiation on the opened palatal wound and were euthanized after 4 to 28 days; the healing pattern was assessed by histology, histochemistry for collagen deposition, and immunohistochemistry for tumor necrosis factor (TNF)-α infiltration. The wound mRNA levels of heme oxygenase-1 (HO-1), TNF-α, the receptor for advanced glycation end products, vascular endothelial growth factor, periostin, Type I collagen, and fibronectin were also evaluated. RESULTS Cellular viability and wound closure were significantly promoted, and cytotoxicity was inhibited significantly using 5 J/cm(2) LED light irradiation in vitro. The wound closure, reepithelialization, and collagen deposition were accelerated, and sequestrum formation and inflammatory cell and TNF-α infiltration were significantly reduced in the LD group. HO-1 and TNF-α were significantly upregulated in the HD group, and most of the repair-associated genes were significantly upregulated in both the LD and HD groups at day 7. Persistent RAGE upregulation was noted in both the LD and HD groups until day 14. CONCLUSION LED light irradiation at 660 nm accelerated palatal wound healing, potentially via reducing reactive oxygen species production, facilitating angiogenesis, and promoting provisional matrix and wound reorganization.

β2-Glycoprotein I-Dependent Anti-Cardiolipin Antibodies Associated With Periodontitis in Patients With Systemic Lupus Erythematosus

BACKGROUND It was reported that patients with systemic lupus erythematosus (SLE) exhibited increased levels of anticardiolipin (anti-CL) antibodies, a class of antiphospholipid antibodies associated with thrombosis. β2-glycoprotein I (β2GPI) has been considered as the actual target antigen for anti-CL antibodies. This study investigates the association of periodontal infection with anti-CL antibodies in patients with SLE. METHODS Fifty-three SLE female patients and 56 healthy female volunteers were recruited in this case-control study. All participants received periodontal examinations. The presence of Porphyromonas gingivalis and Treponema denticola in saliva and plaque samples was detected by polymerase chain reaction. Levels of serum anti-CL and anti-β2GPI antibodies were examined using enzyme-linked immunosorbent assay. RESULTS Patients with SLE exhibited more periodontal attachment loss and increased titers of serum anti-CL and anti-β2GPI antibodies compared with healthy controls. Patients with active SLE who harbored P. gingivalis or P. gingivalis together with T. denticola intraorally exhibited significantly higher anti-CL and anti-β2GPI antibodies than those without these bacteria. Anti-CL and anti-β2GPI antibody levels correlated positively with clinical attachment level. Furthermore, increased anti-β2GPI antibody levels were significantly associated with C-reactive protein and erythrocyte sedimentation rate. CONCLUSIONS Elevated anti-CL and anti-β2GPI antibody levels were associated with periodontopathic bacteria and periodontal breakdown in patients with SLE. Periodontitis might be a modifiable risk factor for SLE.

Tension-compression viscoelastic behaviors of the periodontal ligament.

BACKGROUND/PURPOSE Although exhaustively studied, the mechanism responsible for tooth support and the mechanical properties of the periodontal ligament (PDL) remain a subject of considerable controversy. In the past, various experimental techniques and theoretical analyses have been employed to tackle this intricate problem. The aim of this study was to investigate the viscoelastic behaviors of the PDL using three-dimensional finite element analysis. METHODS Three dentoalveolar complex models were established to simulate the tissue behaviors of the PDL: (1) deviatoric viscoelastic model; (2) volumetric viscoelastic model; and (3) tension-compression volumetric viscoelastic model. These modified models took into consideration the presence of tension and compression along the PDL during both loading and unloading. The inverse parameter identification process was developed to determine the mechanical properties of the PDL from the results of previously reported in vitro and in vivo experiments. RESULTS The results suggest that the tension-compression volumetric viscoelastic model is a good approximation of normal PDL behavior during the loading-unloading process, and the deviatoric viscoelastic model is a good representation of how a damaged PDL behaves under loading conditions. Moreover, fluid appears to be the main creep source in the PDL. CONCLUSION We believe that the biomechanical properties of the PDL established via retrograde calculation in this study can lead to the construction of more accurate extra-oral models and a comprehensive understanding of the biomechanical behavior of the PDL.

Clinical and Radiographic Characteristics of Vertical Root Fractures in Endodontically and Nonendodontically Treated Teeth

Introduction: A vertical root fracture (VRF) is a root fracture extending along the longitudinal axis of roots and is often noted in endodontically treated teeth. However, the clinical and radiographic characteristics of VRFs are not completely known. Methods: A total of 65 teeth with 68 vertical fractured roots in 58 Chinese patients were investigated. The clinical examination records and radiographic images were reviewed in detail. Results: A total of 24 male (41.38%) and 34 female (58.62%) patients aged 25–90 years (average = 57 years) were included; 51 (87.93%) and 7 (12.07%) patients exhibited 1 tooth and 2 teeth with VRFs, respectively, in the dentition. VRFs occurred mainly in the mesial root (20 roots, 57.14%) of the mandibular molars (29 teeth, 44.62%). Clinically, teeth with VRFs usually presented a periodontal probing depth >5 mm (44 teeth, 91.67%, P < .001) with a prosthesis (55 teeth, 84.62%, P < .001) and a relatively intact dentition (42 patients exhibited <4 missing teeth in the dentition, 77.78%, P < .001). Most of the nonendodontically treated VRFs exhibited attrited occlusal surfaces. Radiographic characteristics of the teeth with VRFs were typically associated with prior root canal treatment (56 teeth, 86.15%, P < .001), periodontal bone loss (62 teeth, 95.38%, P < .001), apical bone loss (52 teeth, 80.00%, P < .001), and periodontal ligament widening (61 teeth, 93.85%, P < .001). The mesial roots of the mandibular molars were most susceptible to VRFs in both endodontically and nonendodontically treated teeth. Conclusions: These results elucidated some clinical and radiographic and diagnostic features that facilitate VRF identification.

Epigallocatechin-3-gallate inhibits lysophosphatidic acid-stimulated connective tissue growth factor via JNK and Smad3 suppression in human gingival fibroblasts

BACKGROUND/PURPOSE Connective tissue growth factor (CTGF/CCN2) is involved in the development and progression of fibrotic diseases, including gingival overgrowth (GO). Recent studies indicate that lysophosphatidic acid (LPA) is also significantly involved in wound healing and the development of fibrosis. This study investigated whether epigallocatechin-3-gallate (EGCG) can inhibit LPA-induced CCN2 expression in human gingival fibroblast (GF) and its mechanism. METHODS Western blot analyses were used to study the signaling pathways of LPA-induced CCN2 expression in human GFs and the effects of EGCG on this pathway. RESULTS LPA stimulated CCN2 synthesis in human GFs. This effect can be significantly inhibited bytransforming growth factor-β type I receptor/ALK5, Smad3, and JNK inhibitors but not ERK, P38, and MAPK inhibitors. EGCG completely inhibited LPA-induced CCN2 expression through attenuating the LPA-induced JNK and Smad3 phosphorylation in human GFs. CONCLUSION LPA produced at the surgical wound may contribute to the recurrence of GO by upregulating CCN2 expression in human GFs. This effect was mediated by Smad3 and JNK activation and ALK5 transactivation. EGCG could be a useful agent for reducing the recurrence of GO after surgery through suppression of JNK and Smad3 activations.

Combination of LED light and platelet-derived growth factor to accelerate dentoalveolar osteogenesis

AIM This study aimed to evaluate the adjunctive effect of LED light in platelet-derived growth factor (PDGF)-aided dentoalveolar osteogenesis. MATERIAL AND METHODS Full-thickness osseous wounds were created on rat maxillae and were either unfilled or filled with poly-(D,L-lactide) and poly-(D,L-lactide-co-glycolide) microspheres encapsulating PDGF. Animals received daily 660 ± 25 nm LED light irradiation at 0, 10 (LD), or 20 (HD) J/cm(2) , were killed at days 4-28 (n = 6/group/time) and evaluated by microcomputed tomography (micro-CT), histology, and the expressions of osteopontin and tartrate-resistant acid phosphatase (TRAP). RESULTS Greater osteogenesis was noted in the PDGF-treated defects at day 14. Under the LED light irradiation, osteogenesis was significantly greater in both LD and HD groups of the non-PDGF-treated defects, but only in the LD group of the PDGF-treated defects. No significant differences in osteogenesis among groups were noted at day 28. Greater bone marrow space was noted in the LED light-irradiated specimens, especially in the PDGF-treated defects at both time points. Osteopontin was significantly promoted in the LD group at both time points, and TRAP was significantly promoted in all LED light-irradiated groups at day 28. CONCLUSION LED light could an adjunct to promote early PDGF-aided dentoalveolar osteogenesis by facilitating the osteoblast-osteoclast coupling.