Zohaib Akram

Cytokine Profile in Chronic Periodontitis Patients with and without Obesity: A Systematic Review and Meta-Analysis

To investigate the cytokine profile as biomarkers in the gingival crevicular fluid (GCF) of chronic periodontitis (CP) patients with and without obesity, MEDLINE/PubMed, EMBASE, ScienceDirect, and SCOPUS databases were combined with handsearching of articles published from 1977 up to May 2016 using relevant MeSH terms. Meta-analyses were conducted separately for each of the cytokines: resistin, adiponectin, TNF-α, leptin, IL-6, IL-8, and IL-1β. Forest plots were produced reporting standardized mean difference of outcomes and 95% confidence intervals. Eleven studies were included. Three studies showed comparable levels of leptin among obese and nonobese patients with CP. Four studies reported comparable levels of interleukin- (IL-) 6 and resistin whereas five studies reported comparable levels of adiponectin. Two studies reported similar levels of CRP in patients with periodontitis with and without obesity. One study showed higher levels of tumor necrosis factor-alpha in obese patients with CP. One study showed higher levels of IL-1β and IL-8 in obese patients with CP. The level of localized periodontal inflammation may have a greater influence on the GCF proinflammatory biomarker levels as compared to systemic obesity. Whether patients having chronic periodontitis with obesity have elevated proinflammatory GCF biomarkers levels compared to nonobese individuals remains debatable.

Role of lasers as an adjunct to scaling and root planing in patients with type 2 diabetes mellitus: a systematic review

The aim of the study was to assess the efficacy of adjunctive use of laser therapy (LT) alone or antimicrobial photodynamic therapy (aPDT) to improve clinical periodontal and HbA1c levels in patients with both chronic periodontitis (CP) and type 2 diabetes mellitus (T2DM). Electronic search of the MEDLINE, PubMed, EMBASE, Science Direct, and SCOPUS databases were combined with hand searching of articles published from 1975 up to and including March 2016 using relevant MeSH terms. Six studies were selected for this review. In these six studies, laser treatment was applied, after scaling and root planing (SRP), in two ways: Three studies used laser alone and three studies used laser with photosensitizer. All the six included studies reporting clinical periodontal and glycemic parameters showed that LT and aPDT were effective in the treatment of CP in T2DM subjects at follow-up. Two studies showed significantly better periodontal outcomes for LT as an adjunct to SRP as compared to SRP alone, whereas four studies showed comparable periodontal outcomes among adjunctive LT or aPDT with SRP. Two studies showed significant reduction of HbA1c levels in LT and aPDT as compared to SRP, whereas three studies showed comparable percentage levels at follow-up. It remains debatable whether LT or aPDT as adjunct to SRP is more effective as compared to SRP alone in the improvement of clinical periodontal and glycemic control in patients with both CP and T2DM, given that the scientific evidence is weak.

Efficacy of photodynamic therapy versus antibiotics as an adjunct to scaling and root planing in the treatment of periodontitis: A systematic review and meta-analysis

BACKGROUND To determine whether treatment with antimicrobial photodynamic therapy (aPDT) as an adjunct to scaling and root planing (SRP) yield better clinical periodontal outcomes than antibiotics (AB) as adjunct to SRP in periodontitis. METHODS Electronic searches were conducted in databases (MEDLINE, PubMed, EMBASE, SCOPUS, Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials Register databases) up to and including April 2017. RESULTS Five randomized trials were included. All studies used the combined approach aPDT+SRP and AB+SRP in the test and control group respectively. The follow up period ranged from 12 to 48 weeks. All studies used diode lasers. The wavelengths, power density and duration of irradiation used were 670 nanometre, 75 milliwatts per square centimeters and 60s respectively. None of the studies showed additional benefits of aPDT at follow up. Considering the effects of adjunctive aPDT as compared to AB, a high degree of heterogeneity for periodontal probing depth (PPD) (p<0.0001, I2=87.47%) was noticed among both the groups. Meta-analysis showed significant clinical attachment level (CAL) gain (WMD=0.60, 95% CI=0.25 to 0.95, p=0.001), and not PPD reduction (WMD=0.67, 95% CI=-0.36 to 1.71, p=0.204) for aPDT as compared to AB at follow up. CONCLUSION It remains debatable whether aPDT is more effective as compared to adjunctive AB in the treatment of periodontitis, given that the scientific evidence is weak. Precautions must be exercised when interpreting the results of this study due to the small sample size and high heterogeneity among studies.

Effect of nonsurgical periodontal treatment on clinical periodontal variables and salivary resistin levels in obese Asians

This study investigated changes in periodontal outcomes after nonsurgical periodontal treatment (NSPT) and evaluated associations of change in salivary resistin level with periodontal outcomes in obese Malaysians with chronic periodontitis. Sixty-two obese adults with chronic periodontitis were randomly divided into a test group (n = 31), which received NSPT, and a control group (n = 31), which received no treatment. Plaque score (PS), gingival bleeding index (GBI), probing pocket depth (PPD), and clinical attachment loss (CAL) were measured at baseline and at 6 and 12 weeks after NSPT. Salivary resistin levels were evaluated by using an enzyme-linked immunosorbent assay. PS was significantly lower in patients who received NSPT than in the control group at 6 and 12 weeks (P < 0.05). In the NSPT group the percentages of sites with shallow and moderate pockets decreased significantly, but there was no significant change in deep pockets. Resistin levels significantly decreased after NSPT (P < 0.05). Change in salivary resistin level was not significantly associated with periodontal outcomes. In obese Malaysians, NSPT significantly improved PS and GBI, and improved PPD and CAL for shallow and moderately deep pockets but not for deep pockets. Salivary resistin level was not associated with improvement in either periodontal variable.

A systematic review and meta-analysis of pre-clinical studies assessing the effect of nicotine on osseointegration

Nicotine has been associated with vasoconstriction and an impaired cellular healing response. It is therefore likely that nicotine jeopardizes osseointegration. This systematic review and meta-analysis was performed to assess pre-clinical studies on the effect of nicotine on implant osseointegration. Databases were searched up to and including March 2016 for animal/non-human studies using the following Keywords: bone to implant contact; implant; nicotine; osseointegration; bone healing; and new bone formation. In total eight in vivo design studies were included and processed for data extraction. Five studies reported no significant influence of nicotine on healing around implants. Quantitative analysis of the effects of nicotine on the osseointegration of dental implants showed a significant difference in bone-to-implant contact between test and control subjects (Z=-2.49; P=0.014). From the studies included in the present review; it appears that nicotine has an effect on implant osseointegration.

Clinical and radiographic peri‐implant parameters and proinflammatory cytokine levels among cigarette smokers, smokeless tobacco users, and nontobacco users

BACKGROUND It is postulated that clinical and radiographic peri-implant parameters are worse and levels of interleukin (IL)-1β and matrix metalloproteinase (MMP)-9 in the peri-implant sulcular fluid (PISF) are higher in cigarette-smokers (CS) and smokeless-tobacco users (STU) compared with nontobacco user (NTU). PURPOSE The present study aimed to compare clinical and radiographic peri-implant inflammatory parameters and levels of IL-1β and MMP-9 levels among CS, STU, and NTU. MATERIALS AND METHODS Forty-five CS (Group-1), 42 STU (Group-2), and 44 NTU (Group-3) were included. Demographic data was collected using a structured baseline questionnaire. Peri-implant plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were recorded and crestal bone loss (CBL) were assessed using standardized digital radiographs. PISF volume and levels of IL-1β and MMP-9 in PISF were quantified using enzyme-linked immunosorbent assay. Clinical peri-implant parameters and PISF IL-1β and MMP-9 concentrations were analyzed with Kruskal-Wallis test. Bonferroni post hoc adjustment test was used for multiple comparisons. P-value was set at .05. RESULTS Peri-implant PI and PD were significantly worse in group-1 and group-2 patients as compared to group-3 individuals (P < .05). Peri-implant CBL was also significantly higher in group-1 and group-2 compared with group-3 (P < .05). Peri-implant BOP was significantly higher in group-2 and group-3 as compared to group-1 individuals (P < .05). The PISF volume (P < .05) collected and levels of IL-1β and MMP-9 were statistically significantly elevated among individuals in group-1 and group-2 compared with group-3 (P < .01). There was no significant difference in PI, PD, CBL, and PISF levels of IL-1β and MMP-9 among participants in groups 1 and 2. CONCLUSION Clinical and radiographic peri-implant parameters were compromised among CS and STU as compared to NTU. Increased expression of local proinflammatory cytokines may explain greater susceptibility of CS and STU to peri-implant breakdown.

Short-term effects of adjunctive antimicrobial photodynamic therapy in obese patients with chronic periodontitis: A randomized controlled clinical trial

BACKGROUND The aim of the present study was to assess the effect of antimicrobial photodynamic therapy (aPDT) as an adjunct to scaling and root planing (SRP) on clinical periodontal and immunological parameters in obese patients with chronic periodontitis (CP). METHODS Fifty-three obese with CP patients were divided into 2 groups receiving aPDT with SRP and SRP only respectively. Full-mouth plaque index (PI), bleeding on probing (BOP), pocket depth (PD) and clinical attachment level (CAL) were assessed at baseline, 6 and 12 weeks post-therapy. Gingival crevicular fluid (GCF) levels of tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-6 were evaluated using enzyme linked immunosorbent assay at baseline and 12 weeks. RESULTS There was a significant improvement in all periodontal variables in both study groups at 6 weeks and 12 weeks with respect to the baseline visit (p<0.001). Significant reduction in PD of 4-6mm and ≥7mm was observed for aPDT group as compared to SRP group (p<0.01) at both 6 weeks and 12 weeks of follow-up. At 6 weeks, a significant (p<0.001) gain in CAL was observed in both groups, which remained stable at 12 weeks. IL-6 and TNF-α levels decreased significantly (p=0.001) at 12 weeks after therapy in both the groups. Inter-group comparison showed significant difference for TNF-α (p=0.024) and IL-6 (p=0.044) levels for aPDT group at 12 week follow-up. CONCLUSION Within the limits of this clinical trial, adjunctive aPDT showed improvement in clinical and immunological parameters in obese patients with CP. Antimicrobial PDT showed additional benefit in moderate and deep periodontal pockets in obese patients with CP.

Peri-implant conditions and levels of advanced glycation end products among patients with different glycemic control

BACKGROUND A close relationship between poor glycemic control and peri-implant break down has been demonstrated. It is hypothesized that levels of advanced glycation end products (AGEs) in peri-implant sulcular fluid (PISF) are higher with increased glycemic levels in type 2 diabetes mellitus patients. PURPOSE In the present study, we examined the clinical and radiographic peri-implant parameters and levels of AGEs among different glycemic levels in diabetic patients and assessed whether the levels of AGEs correlate with clinical peri-implant parameters. MATERIALS AND METHODS Ninety-three patients who participated in this study were divided into four groups; Group-1: HbA1c 6.1%-8%; Group-2: HbA1c 8.1%-10%; Group-3: HbA1c > 10%; Group-4: non-diabetic individuals with HbA1c < 6%. Peri-implant plaque index (PI), bleeding on probing (BOP), probing depth (PD) and crestal bone loss (CBL) were recorded. Levels of AGEs in PISF were quantified using enzyme-linked immunosorbent assay. Between-group comparison of means was verified with Kruskal-Wallis test and Pearson correlation coefficient for correlations of AGE levels with peri-implant parameters. RESULTS Peri-implant PI, BOP, PD, and CBL were significantly higher in group-1, -2, and -3 as compared to non-diabetic patients (P < .05). These parameters were significantly higher in group-2 and group-3 versus group-1 (P < .01). Mean PI, BOP, PD, and CBL were comparable between group-2 and group-3 patients (P > .05). Mean levels of AGEs in PISF were significantly higher in relation to higher levels of HbA1c levels. Significant positive correlations were found between AGEs and PD (P = .0221) and CBL (P = .0425); and significant negative correlation was found for PI (P = .0376) in patients with HbA1c levels >10%, respectively. CONCLUSIONS Clinical and radiographic peri-implant parameters were poor and levels of AGEs were significantly high in patients with high glycemic levels. These findings suggest that AGEs may be considered as potential marker of inflammation in diabetic individuals with peri-implantitis.

Photodynamic therapy in the treatment of symptomatic oral lichen planus: A systematic review.

The aim of this systematic review was to assess the efficacy of photodynamic therapy (PDT) in the treatment of symptomatic oral lichen planus (OLP).

Assessment of interleukin-1β, interleukin-6, and tumor necrosis factor-Α levels in the peri-implant sulcular fluid among waterpipe (narghile) smokers and never-smokers with peri-implantitis

BACKGROUND It is hypothesized that levels of interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α are significantly higher in the peri-implant sulcular fluid (PISF) of waterpipe-smokers (WS) compared with never-smokers with peri-implantitis. PURPOSE The aim of the present convenience sample case-control study was to compare the levels of IL-6, IL-1β, and TNF-α in the PISF of WS and never-smokers with peri-implantitis. MATERIALS AND METHODS Demographic data was collected using a questionnaire. Peri-implant probing depth (PPD) was measured and crestal bone loss (CBL) was measured on digital bitewing radiographs. PISF samples were collected using paper strips and the collected PISF volume was determined. levels of IL-6, IL-1β, and TNF-α were measured using enzyme linked immunosorbent assay. Study sample-size was estimated and statistical analysis was performed. P values less than .05 were considered statistically significant. RESULTS Sixty-six individuals (33 individuals in group-1 and 33 in group-2) were included. In groups 1 and 2, 41 and 44 implants, respectively were placed. The mean total PPD (P < .001) and peri-implant CBL (P < .001) was statistically significantly higher around implants affected by peri-implantitis in group-1 compared with group-2. The PISF volume (P < .05) collected and levels of IL-1β (P < .01), IL-6 (P < .01), and TNF-α (P < .01) were statistically significantly higher among individuals in group-1 compared with group-2. CONCLUSION WS with peri-implantitis present increased expression of local proinflammatory cytokines in the PISF than never-smokers.