Selçuk Yilmaz

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.

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.

Evaluation of the Clinical and Antimicrobial Effects of the Er:YAG Laser or Topical Gaseous Ozone as Adjuncts to Initial Periodontal Therapy

OBJECTIVE The aim of this study was to evaluate the clinical and microbiological results of treatment with the Er:YAG laser and topical gaseous ozone application as adjuncts to initial periodontal therapy in chronic periodontitis (CP) patients. BACKGROUND DATA Although many studies have evaluated the effectiveness of the Er:YAG laser as an adjunct to initial periodontal therapy, few studies have focused on the use of gaseous ozone as an adjunct. MATERIALS AND METHODS Thirty patients with CP were randomly divided into three parallel groups, each composed of 10 individuals with at least four teeth having at least one approximal site with a probing depth (PD) of ≥5 mm and a sulcus bleeding index (SBI) ≥2 in each quadrant. Groups of patients received: (1) Scaling and root planing (SRP)+Er:YAG laser; (2) SRP+topical gaseous ozone; or (3) SRP alone. The microbiological and clinical parameters were monitored at day 0 and day 90. RESULTS At the end of the observation period, statistically significant improvements in clinical parameters were observed within each group. Parallel to the clinical changes, all treatments reduced the number of total bacteria and the proportion of obligately anaerobic microorganisms. Although intergroup comparisons of microbiological parameters showed no significant differences, clinical findings, including attachment gain and PD reduction, were found to be statistically significant in favor of the SRP+Er:YAG laser group. CONCLUSIONS Although statistically nonsignificant, the fact that the obligate anaerobic change was mostly observed in the SRP+Er:YAG laser group, and a similar decrease was noted in the SRP+topical gaseous ozone group, shows that ozone has an antimicrobial effect equivalent to that of the Er:YAG laser.

Er:YAG Laser Versus Systemic Metronidazole as an Adjunct to Nonsurgical Periodontal Therapy: A Clinical and Microbiological Study

OBJECTIVE The objective of this randomized clinical trial was to describe the clinical and microbiological results obtained by treatment with Er:YAG laser and systemic metronidazole used as adjuncts to mechanical subgingival debridement in chronic periodontitis. METHODS Twenty-seven chronic periodontitis (CP) patients were randomly divided into three parallel groups each comprising nine individuals with at least four teeth having at least one approximal site with a probing depth (PD) of ≥5 mm and gingival index (GI) of ≥2 in each quadrant. Groups of patients received: (1) Scaling and root planing (SRP)+ Er:YAG laser (10 hz, 30 mJ/pulse, 1 min per pocket, apico-coronal direction in parallel paths with 30 degree angle tips, under water irrigation), (2) SRP+ systemic metronidazole, or (3) SRP alone. In all treatment groups, SRP was performed at 1 week intervals in two sessions. The microbiological and clinical effects of the treatments were evaluated after 90 days. RESULTS At the end of the experimental period, statistically significant improvements in plaque index, GI, PD and attachment level, as well as reductions in the number of total bacteria and proportions of obligately anaerobic microorganisms were observed within each group. Although intergroup comparisons revealed no significant microbiological differences, clinical parameters as attachment gain and PD reduction were found significantly higher in Group 1 compared with the other groups. CONCLUSIONS Within its limits, this study demonstrated the possibility of better resolution of infection with combined SRP+Er:YAG laser treatment. However, microbiological results failed to demonstrate significant advantages of this combination in comparison with SRP alone or SRP+systemic metronidazole.

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.

Dental implant survival and success rate after sinus augmentation with deproteinized bovine bone mineral and platelet-rich plasma at one and five years: a prospective-controlled study

ABSTRACT The aim of this comparative study was to evaluate, at one and five years, the implant success rate in the resorbed maxilla after sinus augmentation with platelet-rich plasma (PRP)/deproteinized bovine bone mineral (DBBM) versus DBBM/collagen membrane (CM). Using a split-mouth design, 10 patients with ≤5 mm of residual alveolar bone were treated with PRP/DBBM or DBBM/CM. After eight months, a total of 22 and 21 implants (Osseospeed™, Astra Tech AB, Sweden) were inserted in the PRP/DBBM and DBBM/CM sites, respectively. The implant success and survival rates, modified plaque and bleeding indices, probing depth and changes in bone level were all evaluated one year later, and again five years later. Only one implant was lost before the prosthetic rehabilitation of the PRP/DBBM group. There were no statistically significant differences in the evaluated parameters for the 1- and 5-year follow-up in the two groups (p > 0.05). After five years of loading, no further implants were lost, giving it an overall success rate of 83%. The clinical study showed that a high implant success and survival rate can be achieved at one year and maintained for up to five years, after a sinus-lift procedure utilizing both combinations.

Platelet Rich Plasma in Reconstructive Periodontal Therapy

1.1 Regenerative periodontal therapy The goal of periodontal therapy is to improve periodontal health and thereby to satisfy the patient’s esthetic and functional needs or demands. To achieve this goal, most periodontal treatments aim to reduce probing depths and maintain or improve attachment levels and these parameters are used as surrogates of improved tooth retention. Conventional periodontal therapy includes non-surgical treatment as well as a variety of surgical approaches. In such treatments, histologic analysis revealed that periodontal healing occurs with repair rather than regeneration (Listgarten & Rosenberg, 1979). In repair, long junctional epithelium exists between the treated root surface and alveolar bone (Caton & Greenstein, 1993). However, over the last three decades, the major goal of periodontal therapy has been shifted from repair to reconstruction of periodontal tissues thereby reversing the damage to the periodontium caused by the disease process. “True periodontal regeneration” is the reformation of a functionally oriented periodontal ligament with collagen fibers inserting in both regrown alveolar bone and reformed cementum over a previously diseased root surface. The first evolutionary stage of periodontal regeneration focused on using a variety of bone graft materials. A number of techniques and autogenic, allogenic, xenogenic and alloplastic bone graft materials have been used for regeneration purpose (Brunswold & Mellonig, 1993). Although significant clinical improvements in terms of probing depth reduction, attachment and bone gains were obtained, the results of the histological studies reported that new attachment achieved by bone grafts was usually a result of the formation of long junctional epithelium with slight or no new connective tissue attachment and negligible new cementum formation. Since these techniques have had limited success, more effective regenerative approaches have been suggested that utilize tissue-engineering techniques. The concept of tissue engineering in periodontics began with guided tissue regeneration (GTR), a mechanical approach utilizing nonresorbable or bioabsorbable membranes to regenerate periodontal defects. GTR is a technique in which the placement of an occlusive membrane guides progenitor cells, residing in the periodontal ligament to repopulate the osseous defects in order to form new tooth supporting tissues (Nyman et al., 1982). The evidence, in fact, demonstrated that treatment of twoand threewall intrabony defects with GTR has yielded successful clinical results in numerous studies and could promote