Esra Guzeldemir

Proinflammatory and Anti-Inflammatory Cytokines in Gingival Crevicular Fluid and Serum of Patients With Rheumatoid Arthritis and Patients With Chronic Periodontitis

BACKGROUND The aim of this study is to evaluate proinflammatory and anti-inflammatory cytokine levels in gingival crevicular fluid (GCF) and serum of rheumatoid arthritis (RA) and chronic periodontitis (CP) patients to assess whether cytokine profiles distinguish patients with RA and patients with CP while using healthy patients as background controls. METHODS A total of 49 patients, 17 patients with RA (three males and 14 females; mean age: 47.82 ± 10.74 years), 16 patients with CP (10 males and six females; mean age: 44.00 ± 7.00 years), and 16 controls (eight males and eight females; mean age: 28.06 ± 6.18 years) were enrolled. Patients with RA were under the supervision of rheumatologists; 15 of the patients with RA were being treated with methotrexate-sulfasalazine combined therapy, and two of the patients were being treated with leflunomid therapy. Periodontal parameters (plaque index, gingival index, probing depth, and clinical attachment level) were recorded. Interleukin (IL)-1β, IL-4, IL-10, and tumor necrosis factor-α (TNF-α) were determined in GCF and IL-1β and IL-10 in serum by enzyme-linked immunosorbent assay. RESULTS There were significant differences found among RA, CP, and control groups for all periodontal parameters (P <0.05). The total amount and concentration of GCF IL-1 β, IL-4, IL-10, and TNF-α were similar in RA and CP patients (P >0.05). Although the total amount and concentration of serum IL-10 was not significantly different among the groups (P >0.05), serum IL-1β was significantly lower in the RA group compared to CP patients and controls and was higher in GCF of the RA group compared to the CP group. CONCLUSIONS Although clinical periodontal disease parameters indicated more severe periodontal disease in CP compared to RA patients, immunologic evaluation did not reveal consistent results regarding proinflammatory and anti-inflammatory cytokine levels. This might be a result of the use of non-steroidal anti-inflammatory drugs and rheumatoid agents by patients with RA.

Nitric oxide synthase in gingival tissues of patients with chronic periodontitis and with and without diabetes.

BACKGROUND The purpose of this study was to evaluate the expression of inducible nitric oxide synthase (iNOS) in the gingival tissues of periodontitis patients with and without type 2 diabetes to assess whether NO plays a role in the severity of periodontitis in patients with diabetes. Patients with diabetes and healthy patients were used as controls. METHODS A total of 80 patients were evaluated in four groups (with 20 subjects each): patients with chronic periodontitis and diabetes (12 males and eight females; mean age, 52.1 +/- 6.9 years), patients with chronic periodontitis who were otherwise healthy (12 males and eight females; mean age, 43.1 +/- 8.9 years), periodontally healthy patients with diabetes (12 males and eight females; mean age 50.9 +/- 6.3 years), and systemically and periodontally healthy control subjects (12 males and eight females; mean age 29.8 +/- 9.2 years). Periodontal parameters were recorded. Immunohistochemistry was used to detect inflammation and iNOS expression in gingival tissues. RESULTS Although periodontal parameters were slightly higher in periodontitis compared to diabetic periodontitis, immunohistochemical parameters were higher in diabetic periodontitis compared to periodontitis. All periodontal parameters were higher in patients with periodontitis and with/without diabetes compared to controls and patients with diabetes. All immunohistochemical parameters were higher in patients with diabetes and periodontitis compared to patients with only diabetes or periodontitis, but there was no difference between the latter two groups. There was a correlation between the expression of iNOS and inflammatory cells in controls, patients with diabetes, and patients with periodontitis but not in patients with diabetes and periodontitis. CONCLUSIONS Inflammation and iNOS expression were more prominent in the gingiva of the patients with both diabetes and periodontitis. However, iNOS expression did not seem to have an additional detrimental effect on the course of periodontitis in patients with diabetes compared to those with periodontitis alone.

Long-term clinical evaluation and SEM analysis of the e-PTFE and titanium membranes in guided tissue regeneration.

AIM This study aimed to evaluate clinical outcomes of titanium membrane and compare these findings with clinical outcomes of e-PTFE membrane, and to investigate the effect of bacterial contamination on both membranes with SEM during long-term healing. RESULTS Sixteen titanium and sixteen e-PTFE membranes were surgically placed adjacent to periodontally involved teeth. Seven titanium and 8 e-PTFE membranes were exposed between 4 and 6 weeks. There were no significant difference between groups for plaque and gingival index. Probing depth and clinical attachment level (CAL) were decreased in both groups when compared with baseline; however, these differences were not statistically significant. The CAL gains between the groups were statistically different in 3rd, 6th, 9th, 12th, and 24th months (p < 0.05), and the CAL gain was significantly higher in titanium membrane (p < 0.05). There was significant decrease in bleeding on probing from baseline in both groups (p < 0.05). Surfaces of 15 membranes were studied using SEM. The largest amount of bacteria was found on the external cervical surfaces of 15 exposed specimens. The entire surface showed the presence of slough epithelial cells, leukocytes, red blood cells, yeast, and microbial plaque. Thirteen external mid surfaces of the 15 specimens, external apical surfaces of three e-PTFE and 1 titanium membrane, internal collar surfaces of all specimens, internal mid surfaces of 5 e-PTFE and three titanium membranes and internal apical surface of only one e-PTFE membrane were infected. CONCLUSIONS This study demonstrated that titanium membrane is equivalent to e-PTFE membranes for GTR in the treatment of periodontal defects.

Alport syndrome: significance of gingival biopsy in the initial diagnosis and periodontal evaluation after renal transplantation

Alport Syndrome (AS) is an important hereditary disorder affecting the glomerular basement membrane. Diagnosis of AS is based on the presence of hematuric nephropathy, renal failure, hearing loss, ocular abnormalities and changes in the glomerular basement membrane of the lamina densa. The aims of this case report were to show the changes in the gingival tissues in a patient with AS under therapy with cyclosporin-A after renal transplantation and to discuss the possible role of type IV collagen in gingival basal lamina as an alternative approach for the diagnosis of AS. A 20-year-old male patient with AS underwent periodontal therapy including a series of gingivectomy surgeries. Gingival samples obtained during the second surgery were examined histopathologically and by transmission electron microscopy for further pathological examination. Gingivectomy procedures have been performed every 6 months over the last 4 years. The excessive and fibrous gingival enlargements resulted in migration of the anterior teeth, but no alveolar bone loss occurred. This is the first report to demonstrate the possible changes in the gingival tissues caused by AS. It is suggested that gingival biopsy can be an initial diagnostic tool instead of renal or skin biopsies. Proper dental and periodontal care and regular visits to the dentist could provide limited gingival hyperplasia to patients with AS.

FARKLI İKİ YAPIDA MEMBRAN KULLANILARAK GERÇEKLEŞTİRİLEN YÖNLENDİRİLMİŞ DOKU REJENERASYONU TEKNİĞİNİN 5 YILLIK KLİNİK SONUÇLARININ DEĞERLENDİRİLMESİ

Thirteen subjects were participated (whose ages between 20 and 45) in the study. Guided tissue regeneration (GTR) surgery was performed for 26 interproximal intrabony defects. Two similar defects were selected for each patient. A resorbable membrane manufactured of polylactic and polyglycolic acid (Resolut) and a non resorbable e-PTFE barrier (Gore-tex) were randomly assigned to one defect in each subject. Non-resorbable e-PTFE membrane was removed in 4 6 weeks. Plaque index (PI), gingival index (GI), mobility (MOB), bleeding on probing (BOP), probing pocked depth (PD), clinical attachment level (CAL), position of gingival margin were recorded at baseline, and 3, 6, 9, 12, 24, 36., 48. and 60. months. The clinical healing was similar in both groups. Significant probing depth reduction and gain in clinical attachment levels were observed for each group. No differences were found between two materials. CAL was decreased in long term evaluation. It was concluded that a frequent maintenance protocol is essential for defects that are treated with GTR.