Gokser Cakar

Clinical evaluation of lasers and sodium fluoride gel in the treatment of dentine hypersensitivity.

OBJECTIVE The aim of the present study was to evaluate and compare the efficacy of CO(2) and Er:YAG lasers alone and in combination with topical sodium fluoride (NaF) in the management of dentine hypersensitivity. MATERIALS AND METHODS A group of 50 patients presenting with a total of 420 hypersensitive teeth were randomly allocated into five groups. Group 1 was treated with 2% NaF, groups 2 and 3 were lased by a CO(2) (1 W, continuous wave mode, for 10 sec) or Er:YAG (30 Hz, 60 mJ for 10 sec, without water/air spray) laser, and groups 4 and 5 received NaF plus the CO(2) and the Er:YAG laser, respectively. The scanning speed of the laser was 0.8 mm/sec. The degree of thermal sensitivity was determined with an evaporative stimulus consisting of a 1-sec air blast at a distance of 2 mm from each site tested. Quantification of the degree of discomfort was determined according to a four-point pain scale before treatment and 1 wk, 1 mo, and 6 mo after treatment. RESULTS All treatment forms resulted in significant improvement of discomfort. At 1 wk, 1 mo, and 6 mo, cold air blast scores were significantly reduced compared to baseline scores, except for the NaF group. In the NaF group, there was a statistically significant increase in mean degree of discomfort at 6 mo compared with 1 wk (p +/- 0.01) and 1 mo (p +/- 0.001). Comparison of the other treatment regimens revealed that cold air blast scores were significantly lower for the other four treatments than for NaF gel alone (p +/- 0.001). No superiority was found for desensitization among the CO(2), Er:YAG, CO(2) + NaF, and Er:YAG + NaF groups. CONCLUSIONS We concluded that both the CO(2) and Er:YAG lasers have promising potential for the treatment of dentine hypersensitivity. Lasers in combination with NaF gel appear to show better efficacy compared to either treatment modality alone.

Healing of two and three wall intrabony periodontal defects following treatment with an enamel matrix derivative combined with autogenous bone

BACKGROUND There are still limited data on the outcomes of regenerative periodontal surgery using a combination of an enamel matrix protein derivative (EMD) and autogenous bone (AB). AIM To evaluate the healing of deep intrabony defects treated with either a combination EMD+AB or EMD alone. MATERIALS AND METHODS Forty patients with advanced chronic periodontitis, with one deep intrabony defect, were randomly treated with either EMD+AB (test) or EMD (control). Clinical assessments were performed at baseline and at 1 year after treatment. The primary outcome variable was relative attachment level (RAL). RESULTS Healing was uneventful in all patients. The test sites showed a reduction in the mean probing pocket depth (PPD) of 5.6 +/- 0.9 mm (p<0.001), a gain in the mean RAL of 4.2 +/- 1.1 mm (p<0.001) and a gain in the mean probing bone level (PBL) of 3.9 +/- 1.0 mm (p<0.001). The control group displayed a mean PPD reduction of 4.6 +/- 0.4 mm (p<0.001), a mean RAL gain of 3.4 +/- 0.8 mm (p<0.001) and a mean PBL gain of 2.8 +/- 0.8 mm (p<0.001). RAL gains of > or =4 mm were measured in 90% of the test defects and in 55% of the controls. PBL gains of > or =4 mm were obtained in 85% of the test defects and in 25% of the control ones. The test treatment resulted in statistically higher PPD reductions, RAL gains and PBL gains compared with the control (p<0.01). CONCLUSIONS Within their limits, the present results indicate that: (i) at 1 year after surgery, both therapies resulted in statistically significant clinical improvements compared with baseline and (ii) although the combination of EMD+AB resulted in statistically significant higher soft and hard tissue improvements compared with treatment with EMD, the clinical relevance of this finding is unclear.

Clinical and Biochemical Evaluation of Lozenges Containing Lactobacillus reuteri as an Adjunct to Non-Surgical Periodontal Therapy in Chronic Periodontitis

BACKGROUND This study evaluates the effects on clinical and biochemical parameters of Lactobacillus reuteri-containing probiotic supplementation adjunctive to initial periodontal therapy in patients with chronic periodontitis (CP). METHODS Thirty patients with CP were included and divided into two groups. Every patient had, in each quadrant, ≥2 teeth each with approximal sites with a probing depth (PD) of 5 to 7 mm and gingival index (GI) of ≥2. The test group received scaling and root planing (SRP) and probiotic-containing lozenges. The control group received SRP and placebo lozenges. Plaque index (PI), GI, bleeding on probing (BOP), PD, and attachment gain were measured. Gingival crevicular fluid (GCF) was sampled for the analysis of matrix metalloproteinase (MMP)-8 and tissue inhibitor of metalloproteinase (TIMP)-1 by enzyme-linked immunosorbent assay. All evaluations were performed at baseline and on days 21, 90, 180, and 360. RESULTS Differences in intergroup comparisons of PI, GI, BOP, and PD were found to be significant (P <0.05) in favor of the test group at all time points. Decreased GCF MMP-8 levels and increased TIMP-1 levels were found to be significant up to day 180 (P <0.05). Mean values of attachment gain were significantly higher in the test group compared with the control group on days 90, 180, and 360. CONCLUSIONS Lozenges containing L. reuteri may be a useful supplement in moderately deep pockets of patients with CP. Low MMP-8 and high TIMP-1 levels may indicate the role of the lozenges in reduction of inflammation-associated markers up to day 180.

Clinical evaluation of coronally advanced flap with or without acellular dermal matrix graft on complete defect coverage for the treatment of multiple gingival recessions with thin tissue biotype.

AIM The objective of this study was to compare acellular dermal matrix graft (ADM) combination with coronally advanced flap (CAF) on complete defect coverage, aesthetics and patient satisfaction with CAF alone for multiple recessions with gingival thickness (GT) <0.8 mm. MATERIALS AND METHODS Forty-eight Miller Class I multiple recessions ≥3 mm were divided into test (CAF + ADM) and control (CAF) groups. At baseline and 12 months, recession height (RH), keratinized tissue height (KT), GT, mean and complete defect coverage were evaluated. Patient satisfaction, root coverage aesthetic score (RES) and the correlation between GT and defect coverage were also assessed. RESULTS Baseline RH in CAF + ADM and CAF groups was 3.25 ± 0.34 mm and 3.21 ± 0.26 mm, respectively. Mean and complete defect coverage were 94.84% and 83.33% in test group, 74.99% and 50.00% in control group, respectively. Inter-group differences were found to be statistically significant for RH reduction, attachment gain, KT and GT increase, mean defect coverage and RES in favour of test group (p < 0.05). There was a significant positive correlation between GT and mean defect coverage (p < 0.05). CONCLUSION Coronally advanced flap in association with ADM can be proposed as a valid approach for the treatment of multiple recessions with thin tissue biotype.

Regenerative treatment with platelet‐rich plasma combined with a bovine‐derived xenograft in smokers and non‐smokers: 12‐month clinical and radiographic results

AIM The purpose of this study was to assess the healing response of intrabony defects following regenerative treatment with platelet-rich plasma (PRP) combined with a bovine-derived xenograft (BDX) in smokers and non-smokers. MATERIALS AND METHODS A total of 24 advanced chronic periodontitis patients, 12 smokers and 12 non-smokers, with 113 intrabony defects with an intrabony component of or /=3 mm were included in this study. Defects were surgically treated with PRP/BDX. At baseline and 12 months after surgery, the following parameters were recorded: plaque and sulcus bleeding indices, probing depth (PD), relative attachment level, marginal recession, probing and radiographic bone levels. RESULTS Considering the soft tissue measurements, smokers and non-smokers presented a mean PD reduction of 3.97 +/- 0.76 and 4.63 +/- 0.52 mm, recession of 0.76 +/- 0.44 and 0.50 +/- 0.12 mm and attachment gain of 3.26 +/- 0.42 and 4.06 +/- 0.40 mm, respectively. Evaluation of the hard tissue findings revealed that the mean clinical and radiographic bone gains in smokers and non-smokers were 2.83 +/- 0.47 and 3.63 +/- 0.38 mm, 2.98 +/- 0.38 and 3.67 +/- 0.48 mm, respectively. Inter-group differences for PD reduction (p<0.05), attachment (p<0.001), clinical (p<0.001) and radiographic bone gains (p<0.001) were found to be significant between smokers and non-smokers. CONCLUSIONS Within the limits of this study, the results indicate that treatment outcome following PRP/BDX application in intrabony defects is impaired with smoking.

Treatment of Intrabony Periodontal Defects With Platelet-Rich Plasma Versus Platelet-Poor Plasma Combined With a Bovine-Derived Xenograft: A Controlled Clinical Trial

BACKGROUND The purpose of this study is to assess the healing outcomes of intrabony defects after treatment with platelet-rich plasma (PRP) versus platelet-poor plasma (PPP) combined with bovine-derived xenograft (BDX). METHODS Using a split-mouth design, a total of 79 intrabony defects with an intrabony component of ≥3 mm in 20 patients were treated either with PRP/BDX (group 1) or PPP/BDX (group 2). At baseline and 12 months after surgery, plaque and sulcus bleeding indices, probing depth (PD), relative attachment level, recession, and probing and radiographic bone levels were recorded. RESULTS After 12 months, groups 1 and 2 presented a mean PD reduction of 3.87 ± 0.86 and 3.76 ± 0.80 mm, recession of 1.35 ± 0.68 and 1.58 ± 0.54 mm, attachment gain of 2.51 ± 0.97 and 2.18 ± 0.87 mm, clinical bone gain of 2.18 ± 0.86 and 2.09 ± 0.89 mm, and radiographic bone gain of 2.11 ± 0.87 and 2.19 ± 0.96 mm, respectively. Intergroup differences were found to be insignificant. CONCLUSIONS Within its limits, these results suggest that the outcomes of the treatment after PRP/BDX and PPP/BDX applications in intrabony defects are similar. When the platelet counts are taken into consideration, PPP seems to demonstrate similar clinical efficacy as the PRP.

Platelet-rich plasma in combination with bovine derived xenograft in the treatment of deep intrabony periodontal defects: a report of 20 consecutively treated patients.

There is currently great interest concerning the use of platelet-rich plasma (PRP) in combination with bone grafts for predictably obtaining periodontal regeneration. The aim of the present study was to investigate the effectiveness of PRP and bovine derived xenograft (BDX) combination in the treatment of deep intrabony defects with an emphasis on the evaluation of early wound healing. A total of 85 intrabony defects with an intrabony component of ≥3 mm were selected in 20 advanced chronic periodontitis patients. Defects were surgically treated with PRP/BDX. At baseline and 12 months after surgery, the following parameters were recorded: plaque and sulcus bleeding indices, probing depth (PD), relative attachment level, marginal recession (REC), probing bone and radiographic bone levels. Postoperative healing was evaluated by an early healing index at 1 and 2 weeks after surgery. At 12 months, all clinical and radiographic parameters were improved (p < 0.0001). The mean changes at 12 months were: PD reduction of 4.78 ± 1.20 mm, attachment gain of 4.24 ± 1.03 mm, REC of 0.54 ± 0.34 mm, clinical bone gain of 3.75 ± 0.97 mm, and radiographic bone gain of 3.79 ± 1.02 mm, respectively. Two weeks after surgery, primary closure was maintained in 95% of the defect sites. Treatment with a combination of PRP and BDX leads to a significantly favorable clinical and radiographic improvement in deep intrabony periodontal defects.

Platelet-rich plasma in combination with bovine derived xenograft in the treatment of generalized aggressive periodontitis: A case report with re-entry

Prominence has been given recently to the use of platelet-rich plasma (PRP) in combination with bone graft materials for predictably obtaining periodontal regeneration through bioengineering. The purpose of this report was to present clinical, radiographic and re-entry results of a generalized aggressive periodontitis (GAP) patient with wide intrabony periodontal defects treated with combined PRP and bovine derived xenograft (BDX). A-32 year old GAP patient who received non-surgical therapy and had 12 intrabony defects was treated with PRP and BDX combination. Prior to surgery and at 12 months, probing depth, marginal recession, relative attachment, probing bone and radiographic bone levels were measured. Re-entry was additionally performed at 12 months. Clinical and radiographic measurements together with re-entry results showed marked improvements from baseline with increased stabilization of whole dentition including the hopeless teeth. The surgical technique together with the materials used may be a possible solution for extensive bone loss.

Radiographic and histologic evaluation of platelet-rich plasma and bovine-derived xenograft combination in bilateral sinus augmentation procedure.

There is currently a great interest regarding the use of platelet-rich plasma (PRP) in combination with various bone graft materials in sinus lift procedures. The purpose of this study was to assess and compare the radiographic and histological results of sinus augmentation procedures following treatment with PRP/bovine-derived xenograft (BDX) vs. BDX/collagen membrane. Using a split mouth design, 10 patients, with ≤5 mm of residual alveolar bone in the vertical direction, were treated with PRP/BDX or BDX/collagen membrane. At 8 months after surgery, both graft materials led to a satisfactory increase in vertical dimensions of bone. Bone biopsies were taken from the augmented sites during the implant placement. Histological analysis demonstrated that majority of the trabecula contained orderly layered lamellar bone in the PRP/BDX group, whereas mainly woven bone with a haphazard arrangement of collagen fibers were noticed in the BDX /collagen membrane group. It can be concluded that both combinations resulted with a satisfactory bone height, but more prominent and mature bone formation was observed at sites treated with PRP/BDX.

In Vitro Evaluation of the Effects of Different Treatment Procedures on Dentine Tubules

OBJECTIVE The objective of this preliminary study was to evaluate the occluding effect of topical gaseous ozone application and Er:YAG laser on human dentine tubules by scanning electron microscopic (SEM) analysis. METHODS Twenty-four dentine specimens were divided into three groups. Group I, including specimens treated only with citric acid, served as the control. Group II was treated with Er:YAG (30 Hz 60 mJ, 10 sec), and Group III received only topical gaseous ozone application (10 sec at level 2). Diameters and the number of open dentinal tubules per 100 μm(2) were counted from SEM photomigrophraphs at ×2000 magnification. RESULTS In terms of diameters and numbers of open dentinal tubules per 100 μm(2), both treatment modalities presented significant occlusion. The mean values of the diameters and the number of open dentinal tubules per 100 μm(2) were observed in Group I, Group II, and Group III, in decreasing order. Significant differences were found among the groups in favor of the topical gaseous ozone applied group. CONCLUSIONS The dentine tubules in both treatment groups were occluded, however more marked occlusion were seen in ozone treated group.