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

Evaluation of Salivary Leptin Levels in Healthy Subjects and Patients with Advanced Periodontitis

Objectives: Leptin is a hormone-like protein produced by the adipose tissue. It plays an important role in protection of host against inflammation and infection. Some studies have reported changes in leptin levels in the gingival crevicular fluid (GCF), saliva and blood serum of patients with periodontal disease compared to healthy individuals. The aim of the present study was to compare the salivary leptin levels in patients with advanced periodontitis and healthy individuals. Materials and Methods: In this case-control study, the salivary samples of healthy individuals and patients with advanced periodontitis with clinical attachment loss >5mm were obtained using a standardized method and the leptin levels were measured in the salivary samples by means of ELISA. The effects of the periodontal status and sex on the salivary leptin levels of both groups were statistically analyzed by two-way ANOVA. Results: The means ± standard deviation (SD) of salivary leptin levels in healthy subjects and patients with advanced periodontitis were 34.27±6.88 and 17.87±5.89 pg/mL, respectively. Statistical analysis showed that the effect of sex on the salivary leptin levels was not significant (P=0.91), while the effect of advanced periodontitis on the salivary leptin levels was significant compared to healthy individuals (P<0.0001). Conclusions: In patients with advanced periodontitis, the salivary leptin levels were significantly lower compared to healthy individuals. Thus, assessment of salivary leptin can be done as a non-invasive and simple method to determine the susceptibility of patients to advanced periodontitis

Effect of Postoperative Amoxicillin on Early Bacterial Colonization of Peri-Implant Sulcus: A Randomized Controlled Clinical Trial

Objectives: With side effects of antibiotics taken into consideration, the necessity of antibiotic therapy after simple implant placement procedures is still a subject of debate and the existing literature on this topic is widely controversial. The aim of this study was to assess the effect of postoperative amoxicillin therapy on early colonization of peri-implant sulcus after implant placement. Materials and Methods: In this randomized controlled clinical trial, 20 patients requiring simple implant placement were randomly allocated to test or control groups and received postoperative amoxicillin or placebo, respectively. Microbiological samples were collected on day 0 and day 7. Mann Whitney and Wilcoxon signed rank tests were utilized to evaluate changes in colony count of identified bacterial species between the test and control groups, and between day 0 and day 7. Results: The decrease in the number of sensitive facultative species and the increase in the number of resistant anaerobes in amoxicillin group were statistically significant as compared to the placebo group (P=0.025 and P=0.005, respectively). The increase in the number of sensitive anaerobes in the placebo group as compared to amoxicillin group, and the decrease in the number of facultative Gram-positive cocci as compared to the placebo group were statistically significant (P=0.011 and P=0.035, respectively). Conclusions: Postoperative administration of amoxicillin resulted in an increase in the number of resistant anaerobes and a decrease in the number of sensitive facultative bacteria and facultative Gram-positive cocci, as compared to the placebo, but with no sign/symptom of infection in any group.