Mehmet Sağlam

Comparison of Er,Cr:YSGG laser and hand instrumentation on the attachment of periodontal ligament fibroblasts to periodontally diseased root surfaces: an in vitro study.

BACKGROUND This study investigates the effects of erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser irradiation and hand instrumentation on the attachment of periodontal ligament (PDL) fibroblasts to periodontally involved root surfaces. METHODS Twenty-four single-rooted periodontally involved human teeth (test groups), and six healthy premolar teeth extracted for orthodontic reasons (control group) were included in this study. A total of 45 root slices were obtained from all selected teeth and assigned to the following five groups: 1) untreated healthy group (+control); 2) untreated periodontally diseased group (-control); 3) hand instrumentation group (scaled Gracey); 4) laser I, Er,Cr:YSGG laser irradiation setting-I (short pulse); and 5) laser II, Er,Cr:YSGG laser irradiation setting-II (long pulse). All of the root slices were autoclaved in phosphate buffered saline and slices were placed onto cell culture inserts. PDL fibroblasts were placed at the density of 80,000 cells on the root plate (5 x 6 mm) and incubated for 48 hours and transferred to 24-well plates. The attachment PDL fibroblasts on the root plates were observed using confocal microscopy (at 12 hours and on days 3 and 7) and scanning electron microscopy (at 12 hours and day 3). 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl-tetrazolium bromide assay was performed on day 5 for PDL fibroblast survival. RESULTS 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl-tetrazolium bromide assay shows that whereas laser-treated specimens showed a significantly higher cell density, the Gracey-treated group showed a lower cell density compared to the positive control group (P <0.05). Based on confocal microscopy, apparent reduction was observed in the attachment of PDL cells to the periodontally diseased root surfaces. In the laser and Gracey groups, cells looked well-oriented to the root surfaces. Laser-treated groups provided suitable environment for cell adhesion and growth. Laser I treatment was more favorable for the attachment of PDL compared to scaled Gracey, laser II, and even healthy root surfaces. CONCLUSION The results of the study indicate that short-pulse laser setup (laser I) looks more promising regarding the attachment, spreading, and orientation of PDL cells.

Efficacy of Collagen Membrane Seeded With Autologous Gingival Fibroblasts in Gingival Recession Treatment: A Randomized, Controlled Pilot Study

BACKGROUND Gingival recession (GR) is one of the most common esthetic concerns associated with periodontal tissues. Recently, tissue engineering technology has been developed and applied in periodontology for the treatment of GR. The aim of this study is to compare the clinical efficacy of collagen membrane with or without autologous gingival fibroblasts under a coronally advanced flap for root coverage. METHODS In this split-mouth, controlled clinical study, 22 sites are selected from 11 patients with Miller Class I recessions affecting canines or premolars in the maxillary arch. One tooth in each patient was randomized to receive either a collagen membrane (CM) (control group) or a collagen membrane seeded with autologous gingival fibroblasts (CM+GF) (test group) under a coronally advanced flap. Thickness of the gingiva, GR, and percentage of root coverage (PRC) were recorded by a calibrated examiner at baseline and 3, 6, and 12 months postoperatively. Furthermore, GR and PRC were evaluated using photogrammetric analysis at baseline and 3, 6, and 12 months. RESULTS Both treatments resulted in a significant gain in root coverage compared with baseline. A statistically significant increase was detected in PRC in the test group compared with the control group. No significant difference was noted between the test and control sites regarding the thickness of the gingiva. CONCLUSIONS The results indicated that CM+GF prepared by tissue engineering technology can be considered an alternative method for the treatment of Miller Class I recession defects.

The Effectiveness of Crataegus orientalis M Bieber. (Hawthorn) Extract Administration in Preventing Alveolar Bone Loss in Rats with Experimental Periodontitis

The purpose of this animal study was to evaluate the effects of hawthorn (Crataeus orientalis M Bieber.) extract on serum oxidative status and alveolar bone loss in experimental periodontitis. Twenty-seven Wistar rats were assigned to one of the following groups: non- ligated+placebo (saline) (NL, n = 9), ligature only+placebo (saline) (LO, n = 9), and ligature and treated with hawthorn extract in saline (H, n = 9) (100 mg/kg orogastrically, once a day for 11 days). Periodontitis was induced by submerging a 4/0 silk ligature in the sulcus of the mandibular right first molars of rats, and the animals were sacrificed after 11 days. Micro-CT examinations were performed for linear and volumetric parameter assessment of alveolar bone. Periodontal tissues were histopathologically examined to assess the differences among the study groups. Levels of serum total antioxidant status (TAS)/total oxidant status (TOS), and oxidative stress index (OSI) were also analyzed. Alveolar bone loss was significantly reduced by hawthorn administration compared to LO group (p<0.05). The number of inflammatory cells and osteoclasts in the LO group was significantly higher than that of the NL and H groups (p< 0.05). The number of osteoblasts in the LO and H groups was significantly higher than that of the NL group (p<0.05). TOS and OSI levels were significantly reduced in H group compared to LO group (P <0.05) and TAS levels were similar in H and NL group (p< 0.05). Hawthorn extract showed inhibitory effect on periodontal inflammation and alveolar bone loss by regulating TAS, TOS and OSI levels in periodontal disease in rats when administered systemically.

Interleukin-33 could play an important role in the pathogenesis of periodontitis

BACKGROUND AND OBJECTIVE Interleukin-33 (IL-33) controls T-helper type 2 (Th2) cytokines and the development of mast cells. This study aimed to investigate the expression of IL-33 and its association with RANKL and osteoprotegerin (OPG) in periodontal health and experimental periodontitis. MATERIAL AND METHODS Eighteen Wistar rats were assigned to two study groups of nine animals each: ligature only (LO) and nonligated (NL). Silk sutures were placed subgingivally, surrounding the right lower first molars. The animals were killed on day 11 after ligature placement, and the alveolar bone loss at the first molars was determined histometrically. Periodontal tissues were examined histopathologically to evaluate the differences between the groups. The expression of IL-33, RANKL and OPG was detected immunohistochemically. RESULTS The LO group showed significantly greater alveolar bone loss compared with the NL group (p < 0.05). The numbers of osteoclasts, osteoblasts and inflammatory cells were significantly higher in the LO group compared with the NL group (p < 0.05). Osteoblastic activity was significantly lower in the LO group than in the NL group (p < 0.05). There was significantly higher expression of IL-33 and RANKL and a greater number of OPG-positive cells in the LO group (p < 0.05). IL-33 expression showed a positive correlation with RANKL expression and with the number of mast cells (p < 0.05). CONCLUSION The experimental periodontitis group exhibited increased expression of IL-33 and RANKL compared with the healthy group. Additionally, there was a positive correlation between these expressions. According to these results, IL-33 could be associated with the pathogenesis of periodontal disease.

Level of Interleukin-35 in Gingival Crevicular Fluid, Saliva, and Plasma in Periodontal Disease and Health

BACKGROUND A novel member of the interleukin (IL)-12 family, IL-35 is an important inhibitory cytokine released by regulatory T cells. The aim of this study is to evaluate gingival crevicular fluid (GCF), saliva, and plasma levels of IL-35 in periodontal disease and health. METHODS Samples of GCF, whole saliva, and plasma were obtained from systemically healthy, non-smoking individuals with gingivitis (n = 20) or chronic periodontitis (CP) (n = 20) and periodontally healthy individuals (n = 20). Full-mouth clinical periodontal measurements, including probing depth (PD), bleeding on probing, gingival index, and plaque index (PI), were also recorded. Enzyme-linked immunosorbent assay was used to determine IL-35 levels in the samples. Data were tested statistically by analysis of variance and Pearson rank correlation test. RESULTS All clinical parameters were significantly higher in the CP group than the healthy and gingivitis groups (P <0.001). The GCF total amount of IL-35 was significantly higher in the CP group than the other groups (P = 0.04), whereas the GCF concentration of IL-35 was significantly higher in the healthy group than the other groups (P = 0.002). There were significant differences among the study groups in terms of salivary IL-35 level (P <0.001), with the highest level observed in the healthy group and the lowest in the CP group. There was no statistical difference between groups in plasma levels of IL-35 (P >0.05). There was a positive correlation between GCF total amount of IL-35 and PD (r = 0.338, P = 0.03) and PI (r = 0.374, P = 0.005) parameters. CONCLUSIONS IL-35 could have an important role in suppressing periodontal inflammation and maintaining periodontal health. Additional studies are required to evaluate its role in periodontal diseases.

Boric acid inhibits alveolar bone loss in rats by affecting RANKL and osteoprotegerin expression

BACKGROUND AND OBJECTIVE The goal of the present study was to evaluate the effects of systemic boric acid on the levels of expression of RANKL and osteoprotegerin (OPG) and on histopathologic and histometric changes in a rat periodontitis model. MATERIAL AND METHODS Twenty-four Wistar rats were divided into three groups of eight animals each: nonligated (NL); ligature only (LO); and ligature plus treatment with boric acid (BA) (3 mg/kg per day for 11 d). A 4/0 silk suture was placed in a subgingival position around the mandibular right first molars; after 11 d the rats were killed, and alveolar bone loss in the first molars was histometrically determined. Periodontal tissues were examined histopathologically to assess the differences among the study groups. RANKL and OPG were detected immunohistochemically. RESULTS Alveolar bone loss was significantly higher in the LO group than in the BA and NL groups (p < 0.05). The number of inflammatory infiltrate and osteoclasts in the LO group was significantly higher than that in the NL and BA groups (p < 0.05). The numbers of osteoblasts in LO and BA groups were significantly higher compared with NL group (p < 0.05). There were significantly more RANKL-positive cells in the LO group than in the BA and NL groups (p < 0.05). There was a higher number of OPG-positive cells in the BA group than in the LO and NL groups (p < 0.05). CONCLUSION The present study shows that systemic administration of boric acid may reduce alveolar bone loss by affecting the RANKL/OPG balance in periodontal disease in rats.

Gingival Crevicular Fluid and Salivary Periostin Levels in Non-Smoker Subjects With Chronic and Aggressive Periodontitis : Periostin Levels in Chronic and Aggressive Periodontitis.

Periostin, an extracellular matrix protein functioning as an important structural mediator and adhesion molecule, has been shown to be an important regulator of connective tissue integrity. This study aimed to evaluate the levels of periostin in chronic periodontitis (CP) and aggressive periodontitis (AgP) compared to non-periodontitis (NP). Individuals were submitted to gingival crevicular fluid (GCF) and saliva sampling. Periodontal examination consisted of plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL) measurements. Assays for periostin were performed by an enzyme-linked immunosorbent assay. Periodontitis patients presented more severe clinical indices compared to the NP group (p < 0.001). The mean GCF level of periostin was lowest in the AgP group as compared to the other groups and was lower in the CP group as compared to the NP group (p < 0.001). Increased levels of periostin were observed in the saliva of patients with AgP as compared to the CP and NP groups (p < 0.05). There was a negative relationship between GCF periostin levels and clinical parameters (p < 0.01), whereas a positive correlation was observed between salivary periostin levels and full-mouth GI and CAL scores (p < 0.01). To our knowledge, this is the first report investigating periostin levels in GCF and saliva in aggressive periodontitis. The results suggest that subjects with CP and AgP exhibit a different periostin profile. Periostin in GCF may have a protective role against periodontal disease. Furthermore, salivary periostin concentrations may have a promising diagnostic potential for the aggressive forms of periodontal disease.

Biological response of commercially available different tricalcium silicate‐based cements and pozzolan cement

This study evaluated four root repair materials for cytotoxicity and cell attachment in vitro. Cell viability was determined at 24 hr, 3 days and 7 days by using a 2,3‐bis‐(2‐methoxy‐4‐nitro‐5‐sulfophenyl)‐2H‐tetrazolium‐5‐carboxanilide (XTT) assay with material extracts. Cell adhesion was examined with a scanning electron microscope on the surface of materials at 24 and 48 hr. Angelus MTA displayed the lowest cell viabilities at all‐day incubations. Endocem had high biocompatibility on the first day. After culturing for 3 days and 7 days, the cell viabilities of Biodentine, Endocem and MM‐MTA had similar results, and their cell viability was significantly higher than that of Angelus. No definite relation was found between the incubation time and the relative cell viability in any group. In scanning electron micrographs, the cells were attached to the material surface for all materials, although the cells in the Biodentine group were attached better than the other groups on the second day. Cell viability and cell attachment was lower in the Angelus group. Endocem, Biodentine and MM‐MTA were similar in biocompatibility and cytotoxicity.

Treatment of localized gingival recessions with free gingival graft

Mucogingival therapy is a general term describing nonsurgical and surgical treatment procedures for the correction of defects in morphology, position, and/or amount of soft tissue and underlying bony support around teeth and dental implants. The free gingival graft is a reliable mucogingival surgical procedure for increasing the zone of attached gingiva at the buccal or lingual aspect of a single tooth, or groups of teeth, or for covering areas of gingival recession. In this review; using free gingival grafts for treating localized gingival recessions have been outlined in the light of current knowledge.

Effects of high power-pulsed Nd:YAG laser irradiation on the release of transforming growth factor-beta (TGF-β) and vascular endothelial growth factor (VEGF) from human gingival fibroblasts

ABSTRACT The purpose of this study was to investigate the effect of different high-power energy settings of a neodymium:yttrium-aluminum-garnet (Nd:YAG) laser (1064 nm) on cell viability of human gingival fibroblasts (GFs) and release of transforming growth factor-beta (TGF-β) and vascular endothelial growth factor (VEGF) on these cells. GFs were isolated from human gingival connective tissues during the crown lengthening procedure. GFs were irradiated with different laser parameters as follows: group 1: 1 W (100 mJ, 10 Hz) 10 seconds; group 2: 1.5 W (150 mJ, 10 Hz) 10 seconds; group 3: 2 W (200 mJ, 10 Hz) 10 seconds; group 4: 1 W (100 mJ, 10 Hz) 20 seconds; group 5: 1.5 W (150 mJ, 10 Hz) 20 seconds; and group 6: 2 W (200 mJ, 10 Hz) 20 seconds. Cell viability/cell proliferation was analyzed with XTT (tetrazolium salt, cell proliferation kit) staining. The release levels of TGF-β and VEGF were analyzed by the enzyme-linked immunosorbent assay. No significant differences were observed in the different laser irradiation groups compared to the control group in terms of cell viability (p > 0.05). The release of TGF-β was not affected by different laser irradiation settings (p > 0.05). Only group 6 promoted significantly higher VEGF release from GFs in 24 hours compared to the control group (p ˂ 0.05). These findings suggest that high-power Nd:YAG laser is probably safe but has a very limited effect for wound healing.