Ülkü Noyan

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.

Er:YAG Lasers Versus Ultrasonic and Hand Instruments in Periodontal Therapy: Clinical Parameters, Intracrevicular Micro-organism and Leukocyte Counts

OBJECTIVE The aim of this study was to compare the clinical parameters and crevicular cell population, particularly leukocyte counts, changes after initial periodontal therapy with different instruments by a chairside laboratory technique, in severe periodontitis patients. BACKGROUND DATA Although scaling and root planing (SRP) with hand curettes or ultrasonic scalers may alter the subgingival microbial composition and improve clinical parameters, it is known that this effect decreases as the pocket depth (PD) increases. MATERIAL AND METHODS Thirty systemically healthy subjects with severe chronic periodontitis were randomly assigned to three groups (n=10), and were treated either with hand curettes, ultrasonic scalers, or Er:YAG laser alone. Clinical measurements were made before and 90 days after treatment. A total of four subgingival plaque samples were collected from pockets with a PD 4-6 and ≥7 mm and were analyzed with a phase-contrast microscopy for microorganism proportions and leukocyte counts at baseline and 7 and 90 days after treatment. RESULTS From day 0 to day 90, clinical parameters were significantly improved in all groups (p<0.01), but there were no significant differences among groups. Laboratory assessments revealed significant differences in all groups between baseline, day 7, and day 90. However, considering changes from day 7 to day 90, hand curettes were the most successful for maintaining the levels of micro-organisms and leukocytes. CONCLUSIONS Although Er:YAG lasers are promising in treating periodontitis, the results of this study favor finishing SRP with hand curettes. Moreover, as there is a similar tendency between micro-organism and leukocyte count changes, leukocyte counts may be used as chairside marker to evaluate the efficacy of SRP.

Determination of storage time of saliva samples obtained from patients with and without chronic periodontitis for the comparison of some biochemical and cytological parameters.

Salivary glutathione (GSH), malondialdehyde (MDA), protein, sialic acid (SA) levels, cytological parameters, and tissue factor activities (TFa) were investigated when fresh and after 3, 7, 11, 15, 21, and 30 days (d) of storage at −20°C both in the control and the periodontitis group. Moreover, the control and the periodontits groups were compared and continuity of the significances detected between the two groups were evaluated.

Plasma Tissue Factor Levels and Salivary Tissue Factor Activities of Periodontitis Patients with and without Cardiovascular Disease

The association between periodontal and cardiovascular disease has received considerable attention. Studies have demonstrated a higher incidence of atherosclerotic complications in patients with periodontal disease. Tissue factor (TF) has been known as a key initiator of the coagulation cascade, and the TF pathway is the primary physiological mechanism of initiation of blood coagulation. Recently, it has been shown that the circulating pool of TF in blood is associated with increased blood thrombogenicity in patients with coronary artery disease (CAD). Various tissues and saliva have been known to have TF activity. Consequently, the aim of this study was to investigate plasma TF levels and TF activity of saliva in periodontitis patients with and without diagnosed CAD. Twenty-six patients with a diagnosis of CAD and 26 systemically healthy patients were examined in the dental clinic, and the Community Periodontal Index Treatment Needs (CPITN) scores were recorded. Plasma TF levels were determined using commercially available ELISA kit. Salivary TF activities were determined according to Quick’s one-stage method. Plasma TF levels were significantly increased in patients with CAD when compared with the control group. There was no difference in salivary TF activities between the 2 groups, but there was a strong and negative correlation between salivary TF activities and CPITN indexes in both groups. In order to determine the possible role of TF activity as a salivary marker in CAD and periodontitis and to fully understand the negative correlation between salivary TF activities and CPITN, TF activity of gingival crevicular fluid that may also affect saliva can be evaluated.

Levels of C-Reactive Protein and Protein C in Periodontitis Patients with and without Cardiovascular Disease

Since periodontitis is a chronic and inflammatory disease, a number of hypotheses have proposed that it has an etiological or modulating role in cardiovascular disease (CVD). This study aimed to ascertain the changes in the plasma levels of C-reactive protein (CRP) and protein C (PC), a natural anticoagulant also having an anti-inflammatory effect, in patients who have mild-to-severe periodontitis with or without CVD. The test group consisted of 26 patients with CVD and chronic periodontitis and the control group consisted of 26 patients with chronic periodontitis and no systemic disease. In both groups Community Periodontal Index of Treatment Needs scores were recorded and blood samples were collected. CRP levels were significantly high and PC activity was significantly low in the test group compared to the control group (p < 0.001). There was a negative correlation between tooth loss and PC and between CRP and PC. How PC is affected by the inflammatory events and its association with CRP is an active area of investigation.

Serum and saliva sialic acid in periodontitis patients with and without cardiovascular disease.

Serum total sialic acid (sTSA) has recently been shown to be a cardiovascular risk factor. However, there is little information about the role of sTSA and TSA in saliva in periodontitis, a chronic and inflammatory disease known to be a risk factor for cardiovascular disease (CVD). We aimed to investigate the changes in sTSA and TSA levels in saliva in patients having both periodontitis and CVD versus periodontitis patients without diagnosed CVD. The study group consisted of 26 patients with proven periodontitis and 26 controls with no diagnosed systemic disease but periodontitis. sTSA and saliva TSA levels were determined by the thiobarbituric acid method, and C-reactive protein (CRP) was evaluated by the nephelometric method. The severity of periodontitis has been determined by the community periodontal index of treatment needs (CPITN). TSA in blood and saliva and CRP levels in blood were significantly increased in CVD patients compared with the control group. CPITN ranged from 2 to 4 in both groups. Significant and positive correlations were found between sTSA and saliva SA levels in patients and controls and between tooth loss and TSA both in blood and saliva. Therefore, TSA in saliva may be a useful marker similar to sTSA in CVD patients.

Adjunctive Systemic Use of Beta-Glucan in the Nonsurgical Treatment of Chronic Periodontitis

Periodontal lesions in chronic periodontitis are associated with a subgingival microbiota predominated by gram-negative anaerobic rods, spirochetes and other motile microorganisms (Tanner et al., 1979). Chronic periodontitis is a complex process itself involving periodontal microorganisms, immune system and host factors. One reason for the augmented colonization of these periodontopathogens is believed to be related with a weak specific T helper 1-mediated immunity (Bartova et al., 2000; Breivik & Thrane, 2001; Wassenar et al., 1998) and, the immune response in patients with periodontal lesions may be inclined towards a strong T helper 2-mediated immunity. Immune functions can be enhanced by activating macrophages and establishing Th1 dominance (Inoue et al., 2002; Lee et al., 2002). The use of certain immunomodulating agents may stimulate immune response and activate macrophages and neutrophils. Beta-glucan (┚-glucan), a polysaccharide extracted from cell walls of Saccharomyces cerevisiae, has been found to have immunomodulatory effects in animals and humans (Babineau et al., 1994; Bleicher & Mackin, 1995; Chan et al., 2009; Engstad, 1994; Engstad et al., 2002). It increases resistance to bacterial infections and cancer cells while stimulating wound healing (Brown & Gordon, 2001; Chan et al., 2009; Yun et al., 2003). Numerous studies have shown that ┚-glucan is a stimulator activating phagocytosis, respiratory burst, and the production of cytokines and chemokines in macrophages (Kankkunen et al., 2010; Sherwood et al., 1987, Williams & Di Luzio, 1980). Recently, the possibility of subcutaneous injections of ┚-glucan being able to modulate allergic sensitisation has been demonstrated in children (Sarinho et al., 2009). The authors proposed a new therapeutic strategy in allergic diseases as ┚-glucan possesses a beneficial action in restoring T helper 2 function (Sarinho et al., 2009). Furthermore, besides its antibacterial effects, antiviral and antifungal properties of ┚-glucan have been put forward (Bedirli et al., 2003; Di Luzio et al., 1980; Jung et al., 2004; Kenyon, 1983; Kernodle et al., 1998; Leblanc et al., 2006; Nicoletti et al., 1992; Tzianabos, 2000). The protective effect of ┚-glucan has been established to Staphylococcus aureus (Di Luzio & Williams, 1978), Escherichia coli, Listeria monocytogenes, Mycobacterium leprae, Candida albicans (Williams et al., 1978), Pneumocytis carinii, Leishmania donovani and Influenza virus (Jung et al., 2004).

Efficacy of adjunctive photodynamic therapy in the treatment of generalized aggressive periodontitis: A randomized controlled clinical trial: PHOTODYNAMIC THERAPY IN AGGRESSIVE PERIODONTITIS

Generalized aggressive periodontitis (GAgP) is a distinct type of periodontal disease characterized by rapid loss of attachment and alveolar bone occurring in young individuals. Photodynamic therapy (PDT) was introduced in periodontology as an adjunctive approach to non‐surgical periodontal treatment (NPT) in periodontitis patients. In this trial, the aim was to evaluate the clinical and microbiological effects of adjunctive PDT to NPT in patients with GAgP.

Is there a relationship between hyperlipidemia and periodontitis

Assist. Prof. Ömer Birkan Ağralı Marmara University, Faculty of Dentistry Department of Periodontology Başıbüyük Mahallesi, Başıbüyük Yolu 9/3, 34854, İstanbul Tel: +90505 906 00 38 E-Mail: omer.agrali@marmara.edu.tr SUMMARY Aim: The aim of present study is to investigate any relationship between hyperlipidemia and periodontal disease. Materials and Methods: In this cross sectional study, a total of 160 individuals were divided into two groups based on their metabolic status: hyperlipidemic group (n= 97) and normolipidemic group (n= 63). Plaque index, gingival index, bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL) and CPITN scores were measured. Triglyceride (TG), total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C) and high density lipoprotein-cholesterol (HDL-C) levels had been determined during previously routine systemic examinations. Daily brushing habits, interdental cleaning, dietary habits, alcohol consumption and physical activity were also recorded. Results: The mean BOP (%), PD, CAL, CPITN scores of the hyperlipidemic group were higher than the normolipidemic group (P< 0.05). TG showed positive association with TC, LDL-C, CAL, and negative association with HDL-C, CPITN (P< 0.05). Positive correlations were detected between TC and TG, LDL-C, HDL-C, BOP, PD, CAL, BMI (P< 0.05). LDL-C was positively correlated with PD, CAL (P< 0.05). Positive correlations were detected among all periodontal parameters as expected. Conclusion: Our findings suggest that patients with hyperlipidemia manifested higher values of periodontal parameters compared to normalipidemic individuals and are more prone to periodontal disease.