Esra Baltacioglu

Lipid Peroxidation Levels and Total Oxidant/Antioxidant Status in Serum and Saliva From Patients With Chronic and Aggressive Periodontitis. Oxidative Stress Index: A New Biomarker for Periodontal Disease?

BACKGROUND In this study, levels of malondialdehyde (MDA), which is a significant product of lipid peroxidation (LPO), total oxidant status (TOS), total antioxidant capacity (TAOC), and the oxidative stress index (OSI), a novel value as a marker of periodontal disease activity, are investigated in serum and saliva from patients with chronic (CP) and generalized aggressive (GAgP) periodontitis. METHODS A total of 98 patients (33 with CP, 35 patients with GAgP, and 30 periodontally healthy controls) enrolled in the study. After clinical measurements and sample collection, the MDA level, TOS, and TAOC were measured by high-performance liquid chromatography and a novel automatic colorimetric method. The OSI was calculated as [(TOS/TAOC) × 100]. RESULTS Although the salivary MDA levels and serum and salivary TOS and OSI values were significantly higher in the periodontitis groups than in the control group (P <0.05), the serum and salivary TAOC levels were significantly lower, and no significant difference in serum MDA levels was found (P >0.05). Furthermore, oxidative stress parameters were higher in the GAgP group than in the CP group (except the serum and salivary MDA levels and serum TAOC). Significant positive and negative correlations were observed between periodontal parameters and the MDA levels and TOS, TAOC, and OSI values (except serum MDA) (P <0.05). CONCLUSIONS The present findings suggest that an increased TOS and decreased TAOC, rather than LPO, play important roles in the pathology of periodontitis and are closely associated with clinical periodontal status. Furthermore, the OSI may be a useful and practical parameter for evaluating periodontal disease activity.

Total Antioxidant Capacity and Superoxide Dismutase Activity Levels in Serum and Gingival Crevicular Fluid in Pregnant Women With Chronic Periodontitis

Background: There is evidence of reduced antioxidant (AO) defense in periodontitis and pregnancy and adverse interactions between periodontitis and pregnancy. Methods: In this study, serum and gingival crevicular fluid (GCF) total AO capacity (TAOC) and superoxide dismutase (SOD) enzyme concentrations in pregnant patients with chronic periodontitis (CP) were compared to those in non-pregnant patients. Periodontal examinations were performed and GCF/ serum samples were obtained from 33 pregnant patients with CP (PCP), 18 pregnant patients with gingivitis (PG), and 21 periodontally healthy pregnant controls (P-controls), monitored in the first and third trimesters; 27 non-pregnant women with CP; and 25 non-pregnant control women. The concentrations of TAOC (automated measurement method) and SOD (spectrophotometric method) were determined. Results: Periodontal parameters were higher in pregnant patients versus non-pregnant patients and in the CP group compared to controls, whereas TAOC and SOD concentrations were lower (P<0.05). All parameters, except plaque index, increased in pregnant subjects in the third trimester compared to the first trimester, whereas TAOC and SOD levels decreased (P <0.05). Periodontal parameters were highest and TAOC and SOD levels were lowest in the PCP group in the third trimester (P<0.05). Conclusions: Systemic and local GCF AO levels decreased in pregnancy and periodontitis, and AO defense reached the lowest levels in the last phase of pregnancy, whereas periodontal status deteriorated. These results suggest that reduced AO capacity may be associated with adverse periodontitis-Dreanancv interactions, and each situation can be a provocative risk factor for the other.

The Impact of Smoking Status on Antioxidant Enzyme Activity and Malondialdehyde Levels in Chronic Periodontitis

BACKGROUND The aim of this study is to investigate the impact of smoking status on the systemic and local superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) activities and malondialdehyde (MDA) levels in subjects with chronic periodontitis (CP). METHODS Sixty-five CP patients (23 smokers [CP-S], 23 former smokers [CP-FS], and 19 non-smokers [CP-NS]) and 20 periodontally healthy non-smoker controls (PH-NS) were included in the study. After the clinical measurements, serum and gingival tissue samples were collected. SOD, GSH-Px, and CAT activities and MDA levels in hemolysates and gingival tissue samples were spectrophotometrically assayed. RESULTS Blood MDA levels in all the periodontitis groups were higher than in the PH-NS group but only the difference between CP-FS and PH-NS groups was significant (P <0.01). Gingival tissue MDA levels in the periodontitis groups were significantly higher than that in the control group (P <0.01). However, the control group had the highest gingival SOD, GSH-Px, and CAT activities compared with all the periodontitis groups (P <0.01). The CP-S group had the highest gingival MDA levels and SOD, GSH-Px, and CAT activities among the periodontitis groups, whereas the lowest values were observed in the CP-NS group (P <0.01). The blood and gingival MDA levels in the CP-FS group were similar in the CP-NS group, whereas they were lower than in the CP-S group. CONCLUSIONS Systemic and local MDA levels are increased by smoking in addition to the impact of periodontitis. The decreased local SOD, GSH-Px, and CAT activities observed in periodontitis patients may increase with smoking.

Peri-Implant Plastic Surgical Approaches to Increasing Keratinized Mucosa Width: Which to Use and When?

The long-term efficacy of adequate keratinized mucosa (>2 mm) in dental implants is controversial. Peri-implant plastic surgeries are currently used because they increase keratinized mucosa width (KMW), helping to regain peri-implant health and maintaining it over the long-term. We present the clinical findings using free-gingival-graft (FGG) and free-periosteal-graft (FPG) techniques in peri-implant plastic surgery for implant rehabilitation patients. We included 20 patients with implant indications of inadequate KMW (KMW < 2 mm for postimplantation) in the maxilla and mandible. All underwent clinical and radiographic measurements and a treatment protocol was prepared for implant rehabilitation and subsequent peri-implant plastic surgery. A decision as to whether and when FGG or FPG techniques would be used was made. FGG/FPG was performed pre-implantation (before monocortical block-bone augmentation) or postimplantation (before/during/after stage 2 surgery). KMW was ≥ 2 mm after application of FGG/FPG pre- or post-implantation. Moreover, peri-implant tissue health was regained/maintained in all cases from 6 months to 4 years. Peri-implant plastic surgery techniques can prevent hard- and soft-tissue problems after implant rehabilitation and during treatment of developing problems. However, surgical design and timing, and an interdisciplinary perspective determine the success of peri-implant plastic surgery.

Protein carbonyl levels in serum, saliva and gingival crevicular fluid in patients with chronic and aggressive periodontitis

Objective This study aims at evaluating the degree of protein carbonyl (PC) levels in serum, gingival crevicular fluid (GCF) and saliva in patients who suffer from chronic periodontitis (CP) and generalized aggressive periodontitis (GAP). Materials and methods A total of 110 individuals took part in the study. Of this number, 35 were CP patients, 43 GAP patients, and the remaining 32 were healthy controls. Measurements regarding the serum, saliva and GCF PC levels were obtained by high-performance liquid chromatography. Results No statistically significant difference was found in serum PC levels between the groups (P > 0.05). In terms of salivary levels, the CP group demonstrated a significantly higher level (P < 0.05) of PC level compared to the GAP group. However, the difference was not found statistically significant when the comparison was drawn with the control group (p > 0.05). The GCF PC level in the CP group had a significantly higher level of concentration compared to the other groups (P < 0.05), whereas the relevant values in the control group were higher than the values in the GAP group (P < 0.05). GCF PC total values (/30 s) were higher in the CP group than the remaining groups (P < 0.05), whereas the relevant values in the GAP group were higher than the values in the control group (P < 0.05). It could be stated that GCF PC levels were significantly correlated, either positively or negatively, with all clinical periodontal parameters (p < 0.05). Conclusions The results obtained suggest that PC levels of serum and salivary in periodontitis, when compared to periodontal health, do not seem to change considerably. However, in the CP group, a statistically significant increase in PC levels of GCF was observed. This finding suggests the salient role of local protein carbonylation in the periodontal area in CP. That the CP group had a higher level of PC level than the GAP group underscores the higher protein oxidation levels in CP patients.

Peri-implant plastic surgery techniques to hard and soft tissue augmentation in implant rehabilitation

This report presents the clinical results of peri-implant plastic surgical approaches for hard and soft tissues before and during the implant placement in a patient with vertical ridge deformation and a shallow vestibule sulcus, and the subsequently performed prosthetic rehabilitation. The surgical approaches used in this case reduced the crown-height space and crown-to-implant ratio and ensured that the implants were placed in their ideal positions, and peri-implant tissue health was maintained. In conclusion, developments in the peri-implant plastic surgery enable the successful augmentation of hard and soft tissue defects and provide the implant-supported fixed prosthetic rehabilitation.

A combined peri-implant plastic surgery approach for implants in the esthetic zone using a novel technique: A series of 10 cases

OBJECTIVE In this study, 12-month follow-up clinical results of a combined peri-implant plastic surgery approach for hard and soft tissue augmentation in implant rehabilitation in the esthetic zone are presented. METHOD AND MATERIALS Ten individuals who required extraction due to severe periodontal destruction in the maxillary and mandibular area were included in the study. Implant surgery was performed in the same session as the combined peri-implant plastic surgeries, which involved guided bone regeneration and free periosteal grafts. Prosthetic treatment was administered in the sixth month following the surgeries. RESULTS Hard and soft tissue augmentation with sufficient keratinized mucosa width (≥ 2 mm) was achieved with the combined surgical approaches. Pleasing esthetic results were obtained by careful positioning of the implants. CONCLUSIONS In implant rehabilitation, in cases where there are insufficient hard and soft tissues in the esthetic zone, a combined peri-implant plastic surgery approach not only enables the ideal implant position where both function and esthetics are ensured but also provides effective protection of peri-implant tissue health.

Effects of Peri-Implant Plastic Surgery and Hyperbaric Oxygen Therapy on Mandibular Avascular Necrosis After Implant Surgery

A vascular necrosis (AVN) is a disease caused by the temporary or permanent loss of blood supply to the bones. It is also known as osteonecrosis, aseptic (bone) necrosis, or ischemic bone necrosis. To date, many theories have been presented regarding the causative factors of AVN. Hypertension, excessive steroid use, and various genetic factors, as well as vascular pathologies such as vascular compression and vasculitis, that disturb the dynamic interaction between bone and vasculature, are thought to be potential causes of AVN. Avascular necrosis of the jaw (ONJ) is a significant complication involving painful areas of exposed bone and nonhealing in the mouth. Since 2003, bisphosphonates (BPs) have been commonly accepted as the biggest risk factor of ONJ. Bisphosphonates reduce the rate of bone remodeling, which may decrease the removal of micro-damaged regions of bone. Furthermore, even in patients who do not take BPs, AVN of the jaws can occur in bony areas that were exposed after invasive dental procedures, such as tooth extraction and implant surgery. This condition is observed more commonly in the mandible, which is thought to have less blood flow than the maxilla. The AVN-associated complications are not common in systemically healthy individuals and are more often observed after oral surgery or implant placement in patients with certain risks. Unfortunately, an efficient treatment protocol has not been determined for AVN of the jaw. Currently, surgical debridement, coverage of exposed bone with mucosal flaps, and antimicrobial applications are among the possible treatment options. In addition, various studies have reported that hyperbaric oxygen treatment (HBOT), either applied alone or with surgical techniques, is also successful in early-stage AVN. Hyperbaric oxygen treatment involves the intermittent inhalation of 100% oxygen at a pressure less than 1.5 atmosphere absolute. An optimal environment for repair processes is provided by HBOT as the additional oxygen carried to ischemic sites by circulation raises the oxygen tension in the tissues. Hyperbaric oxygen therapy positively affects peri-implant bone healing, which increases the osseointegration of titanium implants. Implant-supported overdenture prostheses are much preferred over conventional complete dentures as a treatment option in patients with total edentulism. In such cases, when there is severe bone resorption, implant placement may be more difficult. When implants are placed, significant complications can occur after surgery, albeit rarely. In this report, we present a case of early-stage AVN in a patient who underwent mandibular implant placement; the area of bony exposure was caused by a labial flap rupture associated with masticatory activity in the surgical area. We also present the clinical results of its treatment with peri-implant plastic surgery and HBOT, followed by prosthetic rehabilitation.

Combined Soft and Hard Tissue Peri-Implant Plastic Surgery Techniques to Enhance Implant Rehabilitation: A Case Report

This case report presents an implant-aided prosthetic treatment in which peri-implant plastic surgery techniques were applied in combination to satisfactorily attain functional aesthetic expectations. Peri-implant plastic surgery enables the successful reconstruction and restoration of the balance between soft and hard tissues and allows the option of implant-aided fixed prosthetic rehabilitation.