PURPOSE: The aim of this study was to compare the clinical outcome of open flap debridement (OFD) with a biphasic calcium phosphate (BCP) graft to that of OFD without BCP graft for the treatment of intrabony periodontal defects (IBDs). METHODS: The study included 25 subjects that had at least one intrabony defect of 2- or 3-wall morphology and an intrabony component> or =4 mm as detected radiographically. Subjects were randomly assigned to treatment with (BCP group, n=14) or without BCP (OFD group, n=11). Clinical parameters were recorded at baseline and 6 months after surgery and included the plaque index, gingival index, probing depth (PD), clinical attachment level (CAL), and gingival recession (REC). A stringent plaque control regimen was enforced for all of the patients during the 6-month observation period. RESULTS: In all of the treatment groups, significant PD reductions and CAL gains occurred during the study period (P<0.01). At 6 months, patients in the BCP group exhibited a mean PD reduction of 3.7+/-1.2 mm and a mean CAL gain of 3.0+/-1.1 mm compared to the baseline. Corresponding values for the patients treated with OFD were 2.5+/-0.8 mm and 1.4+/-1.0 mm, respectively. Compared to OFD group, the additional CAL gain was significantly greater in the patients in BCP group (P=0.028). The additional PD reduction was significant for the BCP group (P=0.048). The REC showed a significant increase in both groups, and the amount of recession was significantly smaller in the BCP group than OFD group (P=0.023). In radiographic evaluation, the height of the bone fill in the BCP group was significantly greater than OFD group. CONCLUSIONS: The clinical benefits of BCP found in this study indicate that BCP may be an appropriate alternative to conventional graft materials.
Alveolar Bone Loss ; Bone Transplantation ; Calcium ; Calcium Phosphates ; Chronic Periodontitis ; Debridement ; Gingival Recession ; Humans ; Hydroxyapatites ; Periodontal Index

The aim of this study was to examine the possibility of periodontal ligament regeneration when autotransplantation was used by the periodontal ligament fibroblasts cultured on the acellular dermal matrix in teeth without a periodontal ligament. One minipig was used in this study. The mandibular and maxillary permanent incisors were extracted for the culture of the periodontal ligament cells. The roots of the unextracted teeth were classified into a positive control group, in which the normal periodontal ligament was preserved. The roots of the extracted teeth were divided into the following two groups: The negative control group, in which the periodontal ligament had been removed and the acellular dermal matrix was not applied; and an experimental group, in which the periodontal ligament had been removed and periodontal ligament fibroblast cultured on an acellular dermal matrix was applied. The prepared teeth were transplanted, and completely submerged using physical barrier membranes. The animal was sacrificed 4 weeks after the autotransplant. The transplanted teeth were examined histologically. In this study, the periodontal ligament was normal in the positive control group, and ankylosis was discovered on the denuded root surface in the negative control group. Periodontal ligament-like connective tissue was found adjacent to the denuded root and the new cementum-like layer of hard tissue was formed in the experimental group. These results suggest that the periodontal ligament fibroblasts cultured on the acellular dermal matrix may play a role in regenerating the periodontal ligament-like tissue with new cememtum-like tissue formation.
Acellular Dermis* ; Animals ; Ankylosis ; Autografts* ; Connective Tissue ; Fibroblasts* ; Incisor ; Membranes ; Periodontal Ligament* ; Regeneration ; Swine, Miniature* ; Tooth

PURPOSE: The purpose of this study was to evaluate the clinical efficacy of enhancing deficient interdental papilla with hyaluronic acid gel injection by assessing the radiographic anatomical factors affecting the reconstruction of the interdental papilla. METHODS: Fifty-seven treated sites from 13 patients (6 males and 7 females) were included. Patients had papillary deficiency in the upper anterior area. Prior to treatment, photographic and periapical radiographic standardization devices were designed for each patient. A 30-gauge needle was used with an injection-assistance device to inject a hyaluronic acid gel to the involved papilla. This treatment was repeated up to 5 times every 3 weeks. Patients were followed up for 6 months after the initial gel application. Clinical photographic measurements of the black triangle area (BTA), height (BTH), and width (BTW) and periapical radiographic measurements of the contact point and the bone crest (CP-BC) and the interproximal distance between roots (IDR) were undertaken using computer software. The interdental papilla reconstruction rate (IPRR) was calculated to determine the percentage change of BTA between the initial and final examination and the association between radiographic factors and the reconstruction of the interdental papilla by means of injectable hyaluronic acid gel were evaluated. RESULTS: All sites showed improvement between treatment examinations. Thirty-six sites had complete interdental papilla reconstruction and 21 sites showed improvement ranging from 19% to 96%. The CP-BC correlated with the IPRR. More specifically, when the CP-BC reached 6 mm, virtually complete interdental papilla reconstruction via injectable hyaluronic acid gel was achieved. CONCLUSIONS: These results suggest that the CP-BC is closely related to the efficacy of hyaluronic acid gel injection for interdental papilla reconstruction.
Esthetics, Dental ; Gingiva* ; Humans ; Hyaluronic Acid* ; Male ; Needles ; Treatment Outcome

OBJECTIVES: This study aimed to evaluate the effect of oral health education interval and toothbrushing instruction, the difference between the demonstration-only method and the demonstration with chairside practice toothbrushing instruction method, and the effect of initial patient plaque control ability on the plaque index. METHODS: Patients (n=60) were randomly assigned to receive a 1-week, 2-week, or 3-week interval of oral health education and toothbrushing instruction. Each group was further subdivided into the demonstration-only group and the demonstration with chairside practice group. Patients were categorized as having "good", "fair", or "poor" initial plaque control ability, based on the Turesky modification of the Quigley-Hein plaque index (TQHI). Patients attended five sessions during which they received oral health education and toothbrushing instruction of the modified Bass technique. Plaque evaluation was performed at each visit using the TQHI. RESULTS: The plaque index tended to improve from the first visit to the fifth visit, but there were no significant differences between the 1-week, 2-week, and 3-week education interval. The demonstration with the chairside practice group showed significantly greater improvements in the plaque index, compared to the demonstration-only group. In the good, fair, and poor plaque control ability groups, the plaque index improved gradually from the first to the fifth visit. When plaque control was poor, the improvement in the plaque index increased to a greater degree after oral health education and toothbrushing instruction. CONCLUSIONS: The results of this study may be helpful for suggesting appropriate individualized oral hygiene management methods to improve plaque control ability.
Bass ; Dental Plaque ; Dental Plaque Index ; Education* ; Humans ; Oral Health ; Oral Hygiene ; Toothbrushing

The efficacy of air-polishing on subgingival debridement, as compared to scaling and root planning (SRP), was evaluated clinically and microbiologically. Fifteen patients diagnosed as chronic periodontitis, and having single-root tooth over 5 mm of pocket depth symmetrically in the left and right quadrant, were investigated. Subgingival debridement was performed by SRP and air-polishing. The results were evaluated and compared clinically and microbiologically. Probing pocket depth (PPD), bleeding on probing (BOP), relative attachment level (RAL) and change of gingival crevicular fluid (GCF) were assessed before treatment, and at 14 and 60 days after treatment. Microbial analysis was done pre-treatment, post-treatment, and at 14 and 60 days after treatment. Results of air polishing showed that post treatment, the PPD and BOP decreased, and attachment gain was observed. There was no clinical difference when compared to SRP. The volume of GCF decreased at 14 days, and increased again at 60 days. Compared to SRP, there was a statistical significance of the volume of GCF at 60 days in air-polishing. In the microbial analysis, high-risk bacteria that cause periodontal disease were remarkably reduced. They decreased immediately after treatment, but increased again with the passage of time. Thus, our results show that subgingival debridement by air-polishing was effective for decrease of pocket depth, attachment gain, decrease of GCF and inhibition of pathogens. Further studies are required to compare air-polishing and SRP, considering factors such as degree of pocket depth and calculus existence.
Bacteria ; Calculi ; Chronic Periodontitis ; Debridement ; Gingival Crevicular Fluid ; Hemorrhage ; Humans ; Periodontal Debridement ; Periodontal Diseases ; Root Planing ; Tooth

PURPOSE: The purpose of this animal study was to perform a histological and histomorphometric analysis in order to elucidate the effect of fibroblast growth factor-2 (FGF-2) on injured periodontal ligament (PDL) and cementum after tooth replantation in dogs. METHODS: The roots of 36 mandibular premolars from six mongrel dogs were used in this study. The roots were randomly divided into three groups: (1) a positive control group (n=12), in which the PDL was retained; (2) a negative control group (n=12), in which the PDL and the cementum between the notches were removed; and (3) an experimental group (n=12), in which the PDL and the cementum between the notches were removed and the roots were soaked in an FGF-2 solution (30 microg/0.1 mL). After treating the root surfaces, the extracted roots were replanted into extraction sockets. The animals were sacrificed four and eight weeks after surgery for histologic and histomorphometric evaluation. RESULTS: At four and eight weeks, normal PDLs covered the roots in the positive control group. In the negative control group, most replanted roots showed signs of replacement resorption. In the experimental group, new PDL-like tissue and cementum-like tissue were observed to partially occupy the region between the root surfaces and the newly formed bone. Histomorphometric analysis showed that the mean length of the newly formed cementum-like tissue on the roots treated with FGF-2 was significantly greater than that of the tissue on the roots in the negative control group (four weeks, P=0.008; eight weeks, P=0.042). However, no significant differences were observed between the roots treated with FGF-2 and the negative control roots with respect to newly formed PDL-like tissue. CONCLUSIONS: The results of this study suggest that use of FGF-2 on injured root surfaces promotes cementogenesis after tooth replacement in dogs.
Animals ; Bicuspid ; Cementogenesis ; Dental Cementum* ; Dogs* ; Fibroblast Growth Factor 2 ; Fibroblast Growth Factors* ; Periodontal Ligament* ; Periodontium ; Regeneration ; Tooth ; Tooth Replantation*

PURPOSE: The purpose of this study was to evaluate the effects of 1,25-dihydroxyvitamin D₃ on the proliferation, differentiation, and matrix mineralization of MC3T3-E1 osteoblast-like cells in vitro. METHODS: MC3T3-E1 osteoblastic cells and 1,25-dihydroxyvitamin D₃ were prepared. Cytotoxic effects and osteogenic differentiation were evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, alkaline phosphatase (ALP) activity assay, ALP staining, alizarin red S staining, and reverse transcription-polymerase chain reaction (RT-PCR) for osteogenic differentiation markers such as ALP, collagen type I (Col-I), osteocalcin (OCN), vitamin D receptor (VDR), and glyceraldehyde 3-phosphate dehydrogenase. RESULTS: The MTT assay showed that 1,25-dihydroxyvitamin D₃ did not inhibit cell growth and that the rate of cell proliferation was higher than in the positive control group at all concentrations. ALP activity was also higher than in the positive control group at low concentrations of 1,25-dihydroxyvitamin D₃ (10−10, 10−12, and 10−14 M). RT-PCR showed that the gene expression levels of ALP, Col-I, OCN, and vitamin D receptor (VDR) were higher at a low concentration of 1,25-dihydroxyvitamin D₃ (10−12 M). Alizarin red S staining after treatment with 1,25-dihydroxyvitamin D₃ (10−12 M) showed no significant differences in the overall degree of calcification. In contrast to the positive control group, formation of bone nodules was induced in the early stages of cell differentiation. CONCLUSIONS: We suggest that 1,25-dihydroxyvitamin D₃ positively affects cell differentiation and matrix mineralization. Therefore, it may function as a stimulating factor in osteoblastic bone formation and can be used as an additive in bone regeneration treatment.
Alkaline Phosphatase ; Antigens, Differentiation ; Bone Regeneration ; Calcitriol ; Cell Differentiation ; Cell Proliferation ; Collagen Type I ; Gene Expression ; Glyceraldehyde 3-Phosphate ; In Vitro Techniques ; Miners ; Osteoblasts ; Osteocalcin ; Osteogenesis ; Oxidoreductases ; Receptors, Calcitriol

The purpose of this study was to evaluate the effect of mangosteen extract complex (MEC; Garcinia mangostana L. and propolis extracts) on the inhibition of inflammation and prevention of alveolar bone loss using a ligature-induced periodontitis model. Rat molars were ligatured with silk, and 1 µg/mL of lipopolysaccharide of Porphyromonas gingivalis was injected into the buccal and palatal gingivae of the teeth with or without treatment with the MEC. Changes in the expression levels of prostaglandin E₂ (PGE₂), interleukin-8 (IL-8), inducible nitric oxide synthase (iNOS), matrix metalloproteinase-8 (MMP-8), cyclooxygenase (COX)-1, and COX-2 in gingival tissues were evaluated using enzyme-linked immunosorbent assays. Alveolar bone loss around the ligated molars was examined using micro-computed tomography. The expression levels of PGE₂, IL-8, iNOS, MMP-8, COX-1, and COX-2 in gingival tissues were significantly reduced in the group treated with a mixture of 16 µg of mangosteen extract powder and 544 µg of propolis extract powder (ligation [Lig] + lipopolysaccharide extracted from P. gingivalis KCOM 2804 [L] + MEC 1:34). Additionally, alveolar bone loss was significantly reduced in the Lig + L + MEC 1:34 group compared with that in other groups. These results indicate that the MEC could be useful in preventing and treating periodontitis.
Alveolar Bone Loss ; Animals ; Enzyme-Linked Immunosorbent Assay ; Garcinia mangostana ; Garcinia ; Gingiva ; Inflammation ; Interleukin-8 ; Matrix Metalloproteinase 8 ; Molar ; Nitric Oxide Synthase Type II ; Periodontitis ; Porphyromonas gingivalis ; Propolis ; Prostaglandin-Endoperoxide Synthases ; Rats ; Silk ; Tooth

PURPOSE: The purpose of this study was to evaluate the effects of platelet-rich plasma (PRP) on periodontal healing of replanted root surfaces in dogs histologically and histomorphometrically. METHODS: A total of 36 roots of mandibular incisors and premolars from 6 mongrel dogs were used. The roots were randomly divided into 3 groups: 1) a positive control group (n=12), in which the periodontal ligament (PDL) and cementum were retained and the roots were soaked in saline; 2) a negative control group (n=12), in which the PDL and cementum were removed and the roots were soaked in saline; and 3) an experimental group (n=12), in which the PDL and cementum were removed and the roots were soaked in PRP. After soaking the root surfaces, the extracted roots were replanted into the extraction sockets. The roots were covered using a coronally repositioned flap RESULTS: Histologically, irregular-thickness PDL-like and cementum-like tissues were observed in the 4-week experimental group and the positive control group. PDL-like tissue and cementum-like tissue with a more uniform thickness were observed at 8 weeks. In the negative control group, PDL-like tissue and cementum-like tissue were rarely found, and root resorption and ankylosis were observed. In the cross-sectional histomorphometric analysis, the experimental group demonstrated a higher rate of formation of cementum-like tissue and a lower tooth ankylosis rate than the positive and negative control groups at 4 and 8 weeks. Although there was a significant difference in the tooth ankylosis rate and the formation of cementum-like tissue across the 3 groups (P < 0.05), no statistical significance was observed between any pair of groups (P > 0.017). CONCLUSIONS: Applying PRP to root surfaces during tooth replantation in dogs can reduce tooth ankylosis and increase PDL-like and cementum-like tissue formation.
Animals ; Ankylosis ; Bicuspid ; Clothing ; Dental Cementum ; Dogs ; Incisor ; Periodontal Ligament ; Periodontitis ; Platelet-Rich Plasma ; Root Resorption ; Tooth Ankylosis ; Tooth Replantation ; Tooth

In previous studies, we introduced that mangosteen extract complex (MEC; ethanol extracts of Garcinia mangostana L. peel and propolis) had inhibitory effects on inflammation and alveolar bone loss in silk-ligature applied and Porphyromonas gingivalis lipopolysaccharide (LPS) induced periodontitis model in rats. This study was conducted to evaluate whether MEC had inhibitory effect of alveolar bone loss when a higher inflammatory state was induced by increasing the injection amount of P. gingivalis LPS by 20 times and increasing the treatment dose of MEC by twice the amount or maintaining MEC dose that used in the previous study. The data showed that alveolar bone loss was significantly reduced in the Lig+L+MEC 1:34 group (treated with mixture of 16 µg mangosteen peel extract powder and 544 µg propolis extract powder) and in the Lig+L+MEC 2:68 group (treated with mixture of 32 µg mangosteen peel extract powder and 1,088 µg propolis extract powder) by 24.3% and 28.9%, respectively. This result reveals that the mixture of MEC 1:34 could be useful in improving periodontal tissue health and may be able to be used as a therapeutic adjuvant for periodontitis.