Antimicrobial Photodynamic Therapy as an Adjunctive Modality in the Treatment of Chronic Periodontitis

INTRODUCTION: Due to penetration of pathogenic bacteria into the periodontal tissues in moderate to severe periodontitis, the mechanical methods are not sufficient in these cases. Therefore, administration of local/systemic antibiotic is recommended following mechanical root debridement. However, side effects of antibiotics such as microbial resistance and patient allergy led to development of alternative methods. One of the suggested methods is the antimicrobial photodynamic therapy (aPDT). aPDT is a local non invasive treatment modality without the side effects caused by antibiotics. The aim of this study was to collect the clinical articles related to the application of aPDT in the treatment of chronic periodontitis.METHODS: In order to find related clinical articles, a search of PubMed, Google Scholar and Science Direct until 2012 was performed.RESULTS: A total of 11 articles were found. In 7 of the 11 articles, the assessment of aPDT led to a significant improvement in the clinical attachment and probing depth. In 4 studies, there was no difference between the scaling & root planing (SRP) and adjunctive application of aPDT. aPDT in most cases resulted in less gingival bleeding compare to SRP alone. Furthermore, its application in multiple doses was more effective in comparison to a single dose treatment.CONCLUSION: It appears that aPDT is effective as an adjunctive therapy compared to conventional non_surgical treatment alone, and is recommended in multiple doses in order to achieve more appropriate results

Periosteal Releasing Incision With Diode Laser in Guided Bone Regeneration Procedure: A Case Series

Introduction: Periosteal releasing incision (PRI) is nearly always essential to advance the flap sufficiently for a tension-free flap closure in bone augmentation procedures. However, hematoma, swelling, and pain are recognized as the main consequences of PRI with scalpel. The aim of this case series was to investigate the effectiveness of laser-assisted PRI in guided bone regeneration (GBR) procedure. In addition, postoperative hematoma, swelling, and pain and implant success were assessed.Methods: Seventeen patients needed GBR were included in this study. Diode laser (940 nm, 2 W, pulse interval: 1 ms, pulse length: 1 ms, contact mode, 400-μm fiber tip) was used in a contact mode to cut the periosteum to create a tension-free flap. Facial hematoma, swelling, pain, and the number of consumed nonsteroidal anti-inflammatory drugs (NSAIDs) were measured for the six postoperative days. Six months after implant loading, implant success was evaluated.Results: Minimal bleeding was encountered during the procedure. A tension-free primary closure of the flap was achieved in all cases. The clinical healing of the surgical area was uneventful. None of the patients experienced hematoma, ecchymosis, or intense swelling after surgery. The mean value of maximum pain (visual analogue scale – VAS) was 20.59 ± 12.10 mm (mild pain). Patients did not need to use NSAID after four postoperative days. All implants were successful and functional and none of them failed after 6 months of implant loading.Conclusion: This study revealed the effectiveness of laser-assisted PRI in GBR procedure. This technique was accompanied with minimal sequelae at the first postoperative week. All implants were successful and no complication was noted during the course of this study

Photodynamic Inactivation of Porphyromonas gingivalis utilizing Radachlorin and Toluidine Blue O as Photosensitizers: An In Vitro Study

Introduction: Porphyromonas gingivalis is one of the major pathogens in the development and progression of periodontal disease. Antimicrobial photodynamic therapy (aPDT) is a new approach which is sorted in non-invasive phototherapy for bacterial elimination. This in vitro study was conducted to compare photodynamic inactivation using Radachlorin and Toluidine blue O (TBO) as photosensitizers on P. gingivalis.Methods: Bacterial suspensions (200 μL) of P. gingivalis were exposed to either TBO with concentration of 0.1 mg/mL associated with portable light-emitting diode (LED) device (peak wavelength: 630 nm, output intensity: 2.000 mW/cm2, tip diameter: 6.2 mm) or 0.1% Radachlorin® and laser irradiation (InGaAlP, Peak wavelength: 662±0.1% nm, output power: 2.5 W, energy density: 6 J/cm2, fiber diameter: 2 mm). Those in control groups were subjected to laser irradiation or LED alone, Radachlorin® or TBO alone, and one group received neither photosensitizer nor light irradiation. Then counting of colony forming units (CFU) was performed to determine the bactericidal effects in each subgroup.Results: LED-based aPDT reduced the colony count of P. gingivalis more than that of TBO (P < 0.001) or LED group (P = 0.957). Also, laser-based aPDT had a great reduction in colony count of P. gingivalis in comparison with Radachlorin® (P < 0.001) or laser irradiation alone (P = 0.28). In addition, the colony count reduction of laser-based aPDT was significantly more than LED-based aPDT (P < 0.05).Conclusion: Considering the results of this study, the viability of P. gingivalis was more affected by the combination of laser and Radachlorin® 0.1% in comparison with LED and TBO 0.1

Medical Students’ Satisfaction with a Web-based Training Module of Clinical Reasoning

Background: There is a paucity of literature regarding the medical students’ perspectives on web-based training of clinical reasoning. Objectives: This study aimed to describe the implementation of a web-based training course of clinical reasoning for medical students and to evaluate their satisfaction with the program. Methods: This cross-sectional study was conducted at the Tehran University of Medical Sciences in 2018. Fifty internal medicine interns were consecutively enrolled. The study consisted of two phases. The first phase focused on the development of a web-based training module of clinical reasoning. The second focused on evaluating the trainee’s satisfaction with the virtual course. The educational content of the program was prepared by an expert panel and incorporated in a web-based educational tool designed for virtual training purposes. The students’ satisfaction with the virtual course was assessed using a questionnaire. Each item of the questionnaire was scored from 0 (0) to 1.5 (100). The content validity of the questionnaire determined by an expert panel, and its reliability was measured. Results: The mean score of each item of the questionnaire ranged from 77.3 to 85.3 which showed that the participants agreed with the items of the questionnaire. Also, Cronbach’s alpha coefficient was excellent in nine items of the questionnaire, good in four items, and acceptable in three items. The intraclass correlation coefficient was also estimated as 0.98. Conclusions: The participants were satisfied with the web-based training tool for clinical reasoning, used in the present study. The developed questionnaire also showed good validity and reliability for the assessment of trainees’ satisfaction with the web-based training module of clinical reasoning. Keywords: Logic, Distance Education, Assessment, Medical Studen

Evaluation of health related quality of life in irritable bowel syndrome patients

Background: Quality of life (QOL) is an important measure in the management of Irritable Bowel Syndrome (IBS). Controversy exists in the findings of studies evaluating QOL in IBS subtypes, and little is known about this issue in Iranian patients. Determination of the factors affecting QOL in IBS patients may influence treatment outcomes. The aims of this study are to: 1) compare QOL between subtypes in a sample of Iranian IBS patients, 2) determine the factors associated with QOL in IBS. Methods: This cross sectional study included two hundred and fifty IBS patients with the mean age ( ± standard deviation) of 31.62 ( ± 11.93) years that were referred to outpatient gastroenterology clinic. IBS patients were diagnosed based on Rome-3 criteria by a gastroenterologist, and then they were categorized into three subtypes according to the predominant type of bowel habit. The “QOL specific for IBS”, “Stait-trait anxiety inventory”, and “Beck depression inventory-2 ” questioners were used to evaluate QOL, anxiety, and depression symptoms, respectively. Results: The mean QOL scores in IBS mixed subtype (71.7 ± 25.57), constipation predominant subtype (80.28 ± 25.57), and diarrhea predominant subtype (76.43 ± 19.13) were not different. (P value: 0.05) In multivariate linear regression analysis, anxiety symptom scores were inversely correlated with QOL scores. [Standardized beta:-0.43, (95 % confidence interval:-0.70,-0.39), P value: < 0.01] Conclusion: It seems reasonable to manage anxiety symptoms properly in IBS patients since this might increase their QOL

A Psychometric Re-Examination of the Science Teaching Efficacy and Beliefs Instrument (STEBI) in a Canadian Context

A teacher’s self-efficacy has been found to be one of the most important factors contributing to a successful teaching–learning outcome for both the teacher and the students. Numerous studies have shown that there is a relationship between students’ self-efficacy, students’ academic achievement, teacher burnout and a teacher’s sense of self-efficacy. In this study, the psychometric properties of the Science Teaching Efficacy and Beliefs Instrument (STEBI) by Riggs and Enochs (1990) were re-examined in a Canadian context utilizing data of 1630 teachers from the Pan-Canadian Assessment Program (PCAP) in 2013. Exploratory factor analysis (EFA) and its associated methods were used to investigate the factorial structure of the STEBI, and Cronbach’s alpha was calculated as a measure of reliability. The results showed adequacy of a two-factor solution and similar overall patterns of factor loadings across orthogonal and oblique rotations. In terms of reliability analysis, both factors had reliability coefficients lower than the original scale. The implications of these findings and the future directions for research are discussed

Photobiomodulation Therapy for the Management of Patients With Inferior Alveolar Neurosensory Disturbance Associated With Oral Surgical Procedures: An Interventional Case Series Study: Photobiomodulation THERAPY for Inferior Alveolar Neurosensory Disturbance

Introduction:: Inferior alveolar nerve (IAN) injury is a serious complication during intraoral surgeries. We aimed to evaluate the outcome of photobiomodulation (PBM) therapy in patients with IAN injury associated with third molar or implant procedures. Methods: Eight patients with alteration of sensory function of the IAN after third molar or implant surgeries were enrolled in this case series study. The patients received 10 sessions of PBM therapy (810 nm diode laser, 200 mW, 10 J/cm2 per point, three times a week). Pinprick (PP) and visual analog scale (VAS) neurosensory tests were recorded at each treatment session and 14 days after the last treatment.  Results: The median percentage change of outcomes from first to last visit was as follows: VAS score: +125.00% (range: 50.00 to 166.67); PP score: +350% (range: 150 to 800). The duration of paresthesia was inversely correlated with changes of VAS and PP scores. No significant association was found between the gender or age of patients and changes in VAS and PP scores. Conclusion: Considering the limitations of this study, PBM with the parameters used in this study presented positive effects on neurosensory recovery in patients suffering from IAN injury associated with routine intraoral procedures. Patients with a shorter duration of paresthesia tended to respond more favorably to PBM therapy

Effectiveness of plaque control on improving gingival manifestation of oral Lichen planus: A review of literature

Background and Aims: Lichen planus is a chronic inflammatory mucocutaneous disease with unknown etiology. One of the most common manifestations of patients with oral lichen planus is gingival involvement in the form of generalized erythematous areas. The aim of this study was to review the articles evaluating the role of plaque control on the gingival manifestations of oral lichen planus. Materials and Methods: Motor searches of Ovid Medline and EM base databases, PubMed, Google Scholar, and Science Direct were searched for article published between January 1990 and December 2017 using of relevant key words. After reviewing the abstracts of articles, 20 full articles were selected and among them, 7 relevant articles were reviewed in this study. Conclusion: From the literature, it was concluded that effective plaque control is the main part of lesions treatment and improvement of symptoms and gingival manifestations of oral Lichen planus

Application of an Acellular Dermal Matrix Allograft (CenoDerm) for Treatment of Multiple Gingival Recession Defects: A Case Report with One-year Follow-up

Several techniques and materials have been introduced for the treatment of gingival recession defects. This article reports the case of a 43-year old female patient with chief complaint of esthetic problem, presenting multiple gingival recession defects in anterior maxilla. CenoDerm combined with coronally positioned flap was used for management of six teeth with gingival recession. Complete root coverage was achieved in 66.6% of treated sites in one-year follow-up and the patient was satisfied with the esthetic result. The mean root coverage was 86.0% ± 22.3. The mean recession depth reduction and clinical attachment gain were 1.8 ± 0.8 mm and 2.5 ± 0.6 mm, respectively. According to th