Effect of Bone Marrow-Derived Mesenchymal Stem Cells and Nanoscaffold on Wound Healing in Irradiated Rats

Background: The effect of bone marrow-derived mesenchymal stem cells (BM-MSCs) and nanoscaffolds were evaluated in enhancing wound healing in irradiated albino rats. Methods: Sixty-four male rats were subjected to 6 grays (Gy) of gamma (γ)-rays. Surgical wounds were created on the rats’ backs and they were randomly assigned to one of four groups (16 each); these were an irradiated control group, which did not receive treatment, an NS group treated with a nanoscaffold, a BM-MSC group injected subcutaneously with 1 million BM-MSCs, and a combination BM-MSC+NS group treated with BM-MSCs and a nanoscaffold. Wound healing was measured clinically and histologically. Results: The greatest reduction of anteroposterior wound dimensions was recorded in the BM-MSC+NS group (-69.79 ±19.27), followed by the NS group (-61.12 ±17.32), then the BM-MSC group (-43.89 ±20.04), and the least decrease was observed in the control group (-16.69 ±12.18) (p = 0.001). Meanwhile, the greatest reduction of lateral wound dimensions was recorded in the NS group (-60.41 ±11.80), followed by the BM-MSC+NS group (-45.23 ±62.82), then the BM-MSC group (-41.07 ±24.78), with the control group demonstrating the least reduction (-16.49 ±20.90) (p = 0.008). Histologically, the combination group demonstrated the best healing results compared to the other groups. Conclusion: Nanoscaffolds and/or BM-MSC transplantation improved wound healing and regeneration in irradiated rats, providing possible therapeutic strategies for delayed wound healing during radiotherapy

Evaluation of Propolis Gel in Two Different Polymeric Systems as an Adjunctive Aid to Non-Surgical Therapy in the Management of Stage III Grade B Periodontitis: A Randomized Clinical Trial

Background: The goal of this study was to clinically evaluate the effect of propolis gel in different polymeric systems as an adjunct to non-surgical therapy in the management of periodontitis patients. Methods: A total of 30 patients with stage III grade B periodontitis were divided into the following three groups: group I patients, who received propolis in a chitosan polymer gel with non-surgical therapy, group II patients, who received propolis in a polyox polymer gel with non-surgical therapy, and group III patients who served as a control treated with non-surgical therapy only. Clinical parameters were assessed at baseline, one month, and three months. Results: At three months, the mean gingival index (GI) of groups I and II was the same (0.6 ±0.52), and there was no change in the mean GI in group III. There was a reduction in the mean probing depth (PD) in group I (4.80 ±0.63) and group II (4.90 ±0.74) at the end of the study. The greatest percent gain in clinical attachment level (CAL) was noted in group II (17.26 ±6.71) followed by group I (5.93 ±9.87), whereas the least percent decrease was noted in group III (3.67 ±7.77). Conclusion: The adjunctive use of propolis in a polyox polymer with non-surgical therapy demonstrated superior clinical results over the use of propolis in a chitosan polymer in periodontitis patients

Platelet-Rich Fibrin Versus Connective Tissue Graft Using Vestibular Incision Subperiosteal Tunnel Access (VISTA) Technique in Multiple Gingival Recessions: Randomized Controlled Trial

Background: One of the most common esthetic concerns in dentistry is gingival recession (GR), and despite the various treatment strategies for root coverage, multiple recessions still present a great challenge, especially Miller Class III/RT2. Thus, this study aimed to compare the effect of platelet-rich fibrin (PRF) versus connective tissue graft (CTG) using vestibular incision subperiosteal tunnel access (VISTA) in patients with Miller class III/RT2 multiple recessions for root coverage. Methods: Twenty-eight patients with multiple Class III/RT2 gingival recessions were randomly allocated to two equal groups – group 1 (VISTA+PRF) and group 2 (VISTA+CTG). Recession depth (RD) and width (RW), probing depth (PD), clinical attachment level (CAL), gingival thickness, keratinized tissue width, and root coverage esthetic score (RES) were measured at 0, 3, and 6 months. Statistical analysis was performed using repeated measures analysis of variance (ANOVA). Bonferroni’s post-hoc test was used for pair-wise comparisons when ANOVA was significant. For non-parametric data, the Mann-Whitney U test was used to compare between the two groups. Results: Within each group, a significant difference from baseline to six months was found. However, between groups, the results for the VISTA+CTG group significantly surpassed the VISTA+PRF group in most clinical outcomes; gingival recession depth (0.5 [0.25-1.75] and 1.33 [0.75-2], respectively), and width (1 [0.38-3.75] and 2.33 [1.33-3], respectively), gingival thickness at three and six months (2.62±0.36 and 2.63±0.36, respectively) and (1.85±0.2 and 1.87±0.18, respectively), and keratinized tissue width (3.98±0.72 and 3.33±0.56, respectively). However, CAL and PD showed a statistically insignificant difference when comparing both groups. Conclusion: The use of CTG is superior to PRF in root coverage of Miller Class III/RT2 when the VISTA technique is used. Connective tissue grafts can be considered the gold standard for root coverage

A Biostimulation Therapy in Periodontics: An Evidence‑Based Review

Low-level laser therapy (LLLT) is a light source treatment that generates light of a single wavelength. Low-level lasers do not cause temperature elevation within tissue, but rather produce their effects through photobiostimulation. Low-level lasers (LLL) do not cut or ablate tissue. Low-level laser therapy devices include gallium-aluminum-arsenide (Ga-Al-As) infrared semiconductors and helium-neon (He-Ne) lasers. The output powers range from 50 to 500 mW with wavelengths in the red and near infrared of the electromagnetic spectrum, from 630 to 980 nm, with pulsed or continuous-wave emission. The application of LLLT has become popular in a variety of clinical applications in periodontics including the promotion of wound healing and the reduction of pain following non-surgical and surgical procedures. There is good evidence that the enhanced cell metabolic functions seen after LLLT are the result of the activation of photo-receptors within the electron transport chain of mitochondria. The articles included in this review were searched from PubMed, TRIP, Google Scholar, and Cochrane databases. The purpose of this review was to critically analyze the effectiveness of LLLT on soft and hard tissue in order for dentists and specialists to have a clear understanding of the clinical applications of LLLT in periodontal disease

Volumetric Soft Tissue Changes After Using Injectable Platelet-Rich Fibrin (I-PRF) Versus Subepithelial Connective Tissue Graft in Interdental Papillae Defects: A Randomized Controlled Clinical Study

Background: Lost interdental papillae in the esthetic region are of great concern from the esthetic and functional point of view. We elicit a clinical study of papillary reconstruction in this article using injectable platelet-rich fibrin (I-PRF) as a nonsurgical procedure and compare its results to those of the subepithelial connective tissue graft (SECTG), being considered the gold standard method used to reconstruct interdental papillae. Methods: Twenty-four patients seeking treatment for black triangles were randomized into two groups: group A patients were treated with the SECTG technique, and group B patients were treated with I-PRF. Four injections were given at each papilla site at baseline, two-, four-, and six-week intervals to ensure optimal esthetics. Pain, clinical, and volumetric assessments were done. Volumetric assessment was completed through intraoral scanning of the papilla site at baseline and after six months, after which the results were obtained by superimposition of both scans. Results: Group A (5.08 ±2.15) had a significantly higher mean pain score value than group B (1.17 ±0.94) (p < 0.001). Group B (0.31 ±0.21) had a higher mean value of volumetric changes at the interdental papillae than group A (0.25 ±0.17), yet the difference was not significant (p = 0.517). Conclusion: Injectable platelet-rich fibrin gave comparable results to SECTG in Nordland Class I defects only, provided that the injection protocol was once every 15 days for a two-month period. Patients treated with I-PRF were more satisfied with the procedure and the results than patients who were treated with SECTG

Clinical and Histologic Evaluation of Using Block Xenograft Combined With Leukocyte-Platelet Rich Fibrin (L-PRF) Versus Intraoral Autogenous Bone Block Graft With L-PRF in Treating Localized Ridge Defects: A Randomized Clinical Trial

Background: Augmentation of vertical bone defects remains the corner stone in periodontal tissue engineering. The amount and quality of alveolar bone available in all dimensions affects the success of dental implants for restoration of edentulous areas. Adequate and healthy bone supports the degree of osseointegration which in turn affects the long-term success of oral implants. The primary aim of the study was to histologically evaluate autogenous block grafts versus synthetic block grafts for the treatment of atrophic vertical and horizontal bony defects (Siebert Class III) in the anterior esthetic zone of the mouth. The secondary aim was to clinically and radiographically evaluate the outcomes of the procedure. Methods: This was a randomized controlled clinical study with a statistically determined sample size of 10 patients per group and a total of 20 patients in both groups. Patients with vertical and horizontal bone loss were enrolled from the Department of Oral Medicine, Periodontology, and Oral Diagnosis of Ain Shams University and Misr International University. Bone augmentation procedures were performed using two techniques: autogenous bone block graft and xenograft bone block graft both with leukocyte-platelet rich fibrin (L-PRF). Results: Both autogenous and xenograft blocks in conjunction with L-PRF had a significant effect on vertical bone augmentation in cases of atrophic ridges in the esthetic region. Conclusion: Both autogenous and xenograft bone blocks in conjunction with L-PRF have a significant effect on vertical bone augmentation in cases of atrophic ridges in the esthetic region

A Novel Approach of Using Free Buccal Pad of Fat Combined With Modified Coronally Advanced Flap in Treating Localized Gingival Recession: A Technical Note

Background: Various surgical techniques have been proposed for the treatment of gingival recession (GR) in the form of either pedicled or free grafts. The free buccal pad of fat is an easy technique for harvesting a free graft for regenerative purposes and is currently gaining popularity and attention in the field of periodontology. The buccal fat pad is a fat tissue that is used as a novel source of mesenchymal cells (MSC). The aim of the current case report was to assess the efficacy of using a free buccal pad of fat in combination with a modified coronally advanced flap procedure (CAF) in treating localized gingival recession. Methods: A healthy 33-year-old male presented with gingival recession type 1 (RT1) affecting his upper right canine and was suffering from continuous sensitivity. Phase I therapy was performed six weeks before surgery. A modified CAF was raised to expose the recipient site and a free buccal fat pad graft (FBFP) was harvested and sutured in place. Results: The color of the tissues was nearly homogeneous two weeks following the surgical procedure. Maximum root coverage was 66.6% achieved at one month. However, a gradual relapse of 25% was noticed through the follow-up at three and six months postoperatively. Conclusion: The use of the FBFP in combination with a modified CAF can be excluded as a successful regenerative method for treating GR. However, further studies and randomized controlled clinical trials are recommended to confirm the effectiveness of this technique for the treatment of GR in the long term

Self-Reported Gum Bleeding in COVID-19 Patients: A Questionnaire-Based Study

Background: Coronavirus disease 2019 (COVID-19) has affected a huge number of people around the world. It has increased worldwide mortality and morbidity and is accompanied by different signs and symptoms. Some researchers have linked oral manifestations as introductory signs for COVID-19, such as vesiculobullous lesions, non-specific stomatitis, and oral ulcers. The oral cavity has been perceived as a potential reservoir for asymptomatic COVID-19 infection, specifically the salivary glands and the oral mucosa. This study builds on a previous case report by the authors on COVID-19 associated gingival bleeding in an attempt to investigate the generalization of this relation. Methods: A cross-sectional survey based on a struc­tured, pre-tested, and validated questionnaire that was adapted and modified by the authors was carried out electronically for a minimal sample size of patients that was calculated for this study beforehand. This study was approved by the Batterjee Medical College ethical committee and data collection followed a structured criteria and a clear work plan based on the established inclusion criteria.  Results: The questionnaire had a high response rate of 315 participants. 63.2% (n=199) reported gum bleeding during virus infection time – 25.6% (n=51) of whom reported that this symptom was present prior to COVID-19 infection. 88.9% (n=177) of participants reported only mild bleeding. Gingival bleeding was more prevalent among females 63.8% (n=127) compared to males 36.2% (n=72) (odds ratio: 0.859 [95% CI, 0.530 to 1.394]). Conclusion: Gingival bleeding may be considered as one of the signs of COVID-19 and is a prevalent symptom as reported by infected patients. However, a larger sample size and investigation of hospitalized moderate and severe cases of the disease would help elucidate the actual association

Clinical and Biochemical Assessment of Lycopene Gel Combined With Nanohydroxyapatite Graft in Treatment of Grade II Furcation Defects: A Randomized Controlled Clinical Study

Background: This study aimed to evaluate the effects of lycopene gel, as a natural antioxidant, mixed with a nanohydroxyapatite graft (NHG) covered by an occlusive resorbable collagen membrane (CM) in the surgical treatment of grade II furcation defects and on the gingival crevicular fluid (GCF) levels of 8-hydroxydeoxyguanosine (8-OHdG), as a marker of oxidative injury. Methods: In this randomized controlled clinical study a total of 24 patients with grade II furcation defects were randomly assigned into three equal groups. Furcation defects in group I were managed with lycopene gel mixed with NHG and CM, group II with NHG and CM, and group III with open flap debridement only. Site-specific changes in clinical parameters including probing depth (PD), vertical clinical attachment level (VCAL), horizontal clinical attachment level (HCAL), radiographic maximum vertical depth (MAX V), and maximum horizontal depth (MAX H) were measured at baseline and six months postoperatively. Gingival crevicular fluid levels of 8-OHdG were analyzed using enzyme-linked immunosorbent assay (ELISA) at baseline, one week, and three months. Results: Surgical management of grade II furcation defects resulted in a significant reduction in PD and 8-OHdG levels and a gain in CAL, MAX V, and MAX H in all groups. The differences between lycopene treated sites compared to NHG and CM alone were not significant at six months but demonstrated significantly superior clinical parameters compared to open flap debridement alone. Conclusion: Lycopene does not confer a benefit when combined with NHG in the surgical treatment of grade II furcation defects

The Prevalence of Gingival Recession in the Egyptian Population

Background: Gingival recession (GR) is a challenging condition especially with the increasing esthetic demand of patients today. Hence, there is a need to assess the prevalence of GR and to investigate possible associations with this condition. Methods: A cross-sectional observational study design was used where a sample of 500 patients, within the age range of 18-60 years, was drawn from the Faculty of Oral and Dental Medicine at Cairo University. The collected data included demographic and periodontal variables, and the significance level was set at P ≤ 0.05. Statistical analysis was performed via IBM® SPSS® Statistics Version 20 for Windows using the Chi-square and Fisher exact test. Results: The overall prevalence of GR was 69.4%. Statistical analysis indicated a significant association between gender and GR (significant male predilection, P ≤ 0.05), and between GR and plaque biofilm due to periodontitis with 90.8% of recession cases having periodontitis. A significant association was also found between the cause and distribution of GR, where mandibular incisors showed the highest prevalence of GR. Conclusion: Gingival recession is a highly prevalent condition among Egyptians, with periodontitis being the fundamental cause. Frenal pull is the most prominent local factor in inducing GR in the Egyptian population. This information can be applied by educating the population and initiating new preventive programs and awareness campaigns