Silvia Cei

Effects of non‐surgical periodontal therapy on the glomerular filtration rate of the kidney: an exploratory trial

OBJECTIVE To determine whether non-surgical periodontal treatment (PT) would exert, in subjects with generalized chronic periodontitis (GCP), some beneficial effect on renal function as indicated by surrogate measures of the glomerular filtration rate (GFR). MATERIAL AND METHODS Twenty GCP systemically healthy subjects were treated with PT. Serum samples were collected at baseline and 1 day, 7, 30, 90 and 180 days after treatment. GFR was evaluated using cystatin C, a serum marker and modification of diet in renal disease (MDRD), an equation involving creatinine, urea and albumin. Serum markers of systemic inflammation such as C-reactive protein (CRP), D-dimer, serum amyloid A (SAA) and fibrinogen were also assessed. RESULTS The cystatin C level decreased significantly from baseline to the end of the trial (p<0.01). Conversely, MDRD did not vary. A significant inflammatory reaction was produced by PT in the short term. Greater increases were noted for CRP and SAA within 24 h (p<0.001 versus baseline), while D-dimer (p<0.05) and fibrinogen (p<0.01) showed mild variations. The values of inflammatory markers were normalized after 30 days. CONCLUSIONS GFR, as assessed by cystatin C levels, may be positively affected by PT. Because of the exploratory nature of this trial, further research is needed to investigate this preliminary finding.

Clinical performance of access flap surgery in the treatment of the intrabony defect. A systematic review and meta‐analysis of randomized clinical trials

AIM To systematically review the literature and to determine the clinical performance of conservative surgery (CS) for the treatment of intrabony defects (ID). METHODS RCTs on ID treatment with 12 months of follow-up were identified through electronic databases and hand-searched journals. Primary outcomes were tooth survival, clinical attachment (CAL) gain, probing depth (PD) reduction and gingival recession increase (REC). Weighted means and forest plots were calculated for each outcome variable 12 months after surgery. Long-term stability was explored with RCTs of at least 24 months of follow-up. Subgroup analysis was performed according to the type of flap. RESULTS Twenty-seven trials reporting 647 subjects and 734 defects were identified. Twelve months after CS, tooth survival was 98% (IQ: 96.77-100), CAL gain 1.65 mm (95% CI: 1.37-1.94; p < 0.0001), PD reduction 2.80 mm (CI: 2.43-3.18; p < 0.0001) and REC increase 1.26 mm (CI: 0.94-1.49; p < 0.0001). Longer follow-up showed similar findings. CI of CAL gain were 1.44-3.52 for recently introduced papilla preservation flaps and 1.25-1.89 mm for access flaps. CONCLUSIONS The treatment of intrabony defect with CS is associated with high tooth retention and improvement of periodontal clinical parameters. Clinical performance may vary according to the type of surgical flap used.

Systemic inflammation following non-surgical and surgical periodontal therapy

AIM To describe the kinetics of serum inflammatory markers after a course of treatment comprising surgical and non-surgical treatment of chronic periodontitis (CP). MATERIAL AND METHODS Fourteen CP cases received full-mouth non-surgical treatment and, after 6 months, at least two surgical sessions. Blood samples were collected at various time-points after treatment. Blood markers of systemic inflammation/coagulation including leucocyte counts, C-reactive protein (CRP), serum amyloid-A (SAA) and D-dimers and renal function (cystatin C) were determined using high-sensitivity assays. RESULTS Periodontal treatment resulted in substantial reductions of the number of pockets, gingival bleeding and plaque at 3 and 6 months after non-surgical therapy (p<0.001). Surgical therapy led to an additional reduction of periodontal pockets (p<0.01). Marked increases in the serum levels of CRP and SAA were noted 24 h after non-surgical therapy (p<0.01) and periodontal surgeries (p<0.05). D-dimer levels increased drastically 24 h after non-surgical therapy (p<0.05). The drastic increase of CRP after non-surgical therapy was greater than both the surgical therapy sessions (p<0.05). CONCLUSIONS Patients undergoing periodontal treatment experience perturbations of systemic inflammation of a greater magnitude after non-surgical than surgical periodontal therapy.

Effect of laser micromachining of titanium on viability and responsiveness of osteoblast-like cells.

Objectives:Laser engineering may create hemispherical porosities on titanium surfaces obtaining regular and predetermined rough titanium surfaces. The aim of this study was to assess the viability and the proliferation of primary osteoblast-like cells (OB) to growth factors on titanium surfaces with a different roughness in vitro. Materials and Methods:OB were obtained from volunteers undergoing wisdom tooth removal following a standardized protocol. OB were allowed to attach on 4 different titanium surfaces: sandblasted titanium (SBT) disks, 5-, 10-, and 20-&mgr;m regular laser-engineered micropore titanium disks. A well with no disk was used as control. Cell morphology was evaluated with scanning electron microscopy. Viability was measured with MTT (3[4,5 dimethylthiazol 2yl]2,5 diphenyltetrazolium bromide) assay. Proliferation rate of attached cells was evaluated with Cell Counting Kit-8 48 hours after platelet-released supernatant (PRS) application. Statistical analysiswas performed with analysis of variance test. Results:All surfaces showed OB attachment on scanning electron microscopy. OB appeared more numerous on 20T surfaces. Laser-engineered surfaces showed higher OB viability than SBT (P < 0.01). In terms of proliferation, viability increase was noted for all groups after platelet-released supernatant application. 20T and SBT disks seemed to trigger the higher cellular proliferation (20T vs 10T, P < 0.05). Conclusions:Laser-engineered porous titanium surfaces promote viability and proliferation of OB. In particular, hemispherical porosity of 20 &mgr;m seems to trigger the higher OB response. Further research is needed to confirm these data.

An aromatase polymorphism (g.132810C>T) predicts risk of bisphosphonate-related osteonecrosis of the jaw

BACKGROUND Bisphosphonate (BP)-related osteonecrosis of the jaw (ONJ) is an unpredictable, debilitating adverse effect. Recently, genetic polymorphisms have arisen as promising tools to identify patients with a higher risk of drug-related adverse events. AIM We aimed to examine the association between the aromatase polymorphism g.132810C>T, and the estrogen receptor polymorphisms g.156705T>C and g.156751A>G, and the risk of BP-related ONJ. METHODS Eighty-three subjects were included in the study. A clinical and radiological examination was conducted on oncologic subjects treated with zoledronic acid. Subjects with histologically confirmed ONJ were included in the test group (n = 30) whereas subjects with good oral health were included in control group (n = 53). Aromatase and estrogen receptor polymorphisms from blood samples were analyzed. RESULTS The aromatase g.132810C>T polymorphism displayed an over-representation of the TT genotype in the test group (36.67 vs 16.98%; p < 0.05). There was no significant difference in either estrogen receptor polymorphism genotype frequency between the test and control groups. CONCLUSION Our data suggest a role for the g.132810C>T polymorphism in predicting ONJ risk. These results can pave the way to the personalization of BP therapy, based on individual genotype.

Lack of short‐term adjunctive effect of systemic neridronate in non‐surgical periodontal therapy of advanced generalized chronic periodontitis: an open label‐randomized clinical trial

AIM To determine if the adjunctive use of intra-muscular neridronate (NE) during non-surgical periodontal treatment (PT) provides, in patients with generalized chronic periodontitis (GCP), adjunctive benefits as compared with PT alone 3 months after the completion of a 3-month NE therapy. MATERIAL AND METHODS Sixty GCP healthy patients were randomly assigned to control (CG) or test group (TG). CG patients received PT only. Thirty subjects in TG also received adjunctive NE (12.5 mg in an i.m. injection/week for 3 months). Clinical parameters were evaluated at baseline, at the end of NE treatment (3 months after PT) and 3 months after the completion of NE treatment (6 months after the beginning of PT). RESULTS Groups were balanced at baseline and all clinical parameters showed improvement between baseline and follow-ups. At 6 months improvements from baseline at sites with deep pocket depth (>or=7 mm) were 3.2 mm [95% confidence interval (CI): 2.7-3.9] in CG and 3.0 mm (95% CI: 2.3-3.8) in TG with a non-significant difference of 0.2 mm (95% CI: -1.0-0.5; ANCOVA; p=0.549) between groups. Secondary outcomes did not show significant differences between groups. No major adverse events were reported. CONCLUSIONS The adjunctive use of NE during PT did not result in additional short-term improvements in periodontal conditions of GCP patients when compared with PT.

Unusual asymptomatic giant sialolith of the submandibular gland: a clinical report

This report presents an unusual case of asymptomatic sialolith of the submandibular gland. A 61-year-old man was referred to our department for multiple extractions. An ortopantomographic exam revealed the existence of a large radiopacity in the right premolar mandibular region. The patient was completely asymptomatic and no episodes of pain and swelling had occurred in the previous years. Ultrasonography and clinical examination confirmed the diagnosis of sialolithiasis of the submandibular duct. The calculus was removed trans-orally in local anaesthesia. The sialolith measured 22 mm and it was mainly constituted by phosphate, calcium and smaller amounts of magnesium. The bacteriological exam revealed the presence of Streptococcus Mitis, Streptococcus Salivarius and non-pathogenic Neisserie. Postoperative course was uneventful. Even a sialolith of significant dimensions may not be symptomatic. Nevertheless, the likelihood of future complications may constitute an indication for surgical removal of abnormal asymptomatic sialoliths.

Dental plaque, gingival inflammation and tooth -discolouration with different commercial -formulations of 0.2% chlorhexidine rinse: a double-blind randomised controlled clinical trial.

PURPOSE To investigate the efficacy of various formulations of chlorhexidine 0.2% (CHX) in terms of plaque and gingival bleeding control compared to each other and to saline rinse (CTRL) over a 35-day rinsing period. MATERIALS AND METHODS Seventy subjects were randomly allocated to one of 4 groups rinsing twice daily for 35 days. The different groups used CHX 0.2% rinse with alcohol (CHX1) and without alcohol (CHX2), with an antidiscolouration system (CHX3) or saline rinse (CTRL). Clinical examinations to evaluate full-mouth plaque scores (FMPS) and periodontal parameters were performed at baseline, 7, 21 and 35 days. Tooth discolouration (TD) was measured at each time point using digital photographs and spectrophotometric analysis. RESULTS At 35 days, CTRL showed the highest levels of plaque. The mean changes in FMPS from baseline were 69.8% ± 6.8 for CHX1, 57.5% ± 9.8 for CHX2, 43.7% ± 9.8 for CHX3 and 25.8% ± 7.7 for CTRL. Statistically significant differences were demonstrated between CHX1 and CHX3 (p = 0.02), CHX2 vs CHX3 (p ≤ 0.05) and CHX1/CHX2 vs CHX3 (p < 0.05). In contrast, CHX3 appeared more effective in reducing inflammatory indexes. TD increased over time in 60% to 70% of participants, although lighter staining was found in the CHX3 group. Greater FMPS reduction was observed in participants with staining vs without staining (26.0% ± 12.3, p = 0.04). CONCLUSION Conventional CHX appeared more effective in terms of plaque reduction. Interestingly, the newest formulation showed a higher control of gingival inflammation. Staining was associated with lower plaque levels.

The effects of systemic alendronate with or without intraalveolar collagen sponges on postextractive bone resorption: a single masked randomized clinical trial.

Alendronate is a bisphosphonate frequently used to reduce bone resorption. It has been used for osteoporosis, Pagets disease, and also as adjunctive therapy for periodontal disease. The aim of this study was to evaluate the effect of systemic alendronate with or without endoalveolar collagen sponge on vertical bone resorption after lower wisdom tooth extraction. Forty patients referred for wisdom tooth impaction were selected. Before surgery, patients were randomly assigned to receive one of the following pharmacologic treatments: no medication (group 1), postextractive endoalveolar collagen sponge (group 2), systemic alendronate for 4 months starting the day of surgery (group 3), and group 2 + group 3 (group 4). Standardized orthopantomographic evaluation was obtained during recruitment (T1), immediately after surgery (T2), and 4 months (T3) to evaluate crestal and alveolar socket changes. Results indicate that at T2, crest and socket level did not show significant differences between the four groups. At T3, test sites treated showed less bone resorption compared with controls. In particular, higher vertical bone height levels and a faster intraalveolar healing were achieved in groups 3 and 4. Systemically given alendronate may be used successfully to reduce vertical bone resorption after wisdom tooth extraction.

Acute-phase response following full-mouth versus quadrant non-surgical periodontal treatment: A randomized clinical trial.

AIM A moderate acute-phase response occurs 24-h following full-mouth non-surgical treatment (FM-SRP). The aim of this study was to compare acute-phase (24-h) and medium-term (3 months) inflammation after quadrant scaling (Q-SRP) versus FM-SRP. MATERIAL & METHODS Thirty-eight periodontitis-affected subjects were randomly allocated to FM-SRP or Q-SRP after a baseline visit. Periodontal and anthropometric parameters were collected at baseline and 3 months. Serum samples were drawn at baseline, 1, 7, and 90 days after treatment. High-sensitivity assays of inflammation and endothelial assays were performed. RESULTS FM-SRP produced a greater acute-phase response after 24 h [threefold increase in C-reactive protein (CRP), twofold increase in interleukin (IL-6), and a slight increase in tumour necrosis factor]. No differences in systemic biomarkers were noted between groups at any later follow-ups. Both periodontal treatments produced a comparable improvement in clinical periodontal parameters with no between-group differences. Treatment time was positively associated with the relative 24-h increase in CRP (R = 0.5, p < 0.001) and IL-6 (R = 0.5, p = 0.002), while the number of deeper (>6 mm) pockets predicted only the relative increase in IL-6 (R = 0.4, p < 0.05). CONCLUSIONS FM-SRP triggers a moderate acute-phase response of 24 h duration compared to Q-SRP. Further research is needed to assess the eventual impact of such findings on the risk of vascular events is advocated. (ClinicalTrials.gov NCT01857804).