OBJECTIVE: To investigate the four-year clinical outcome and marginal bone loss around narrow-diameter implants in patients with uncontrolled diabetes mellitus type 2 (T2DM) and normo-glycemic individuals.
METHODS: In 11 T2DM patients with a concentration of glycated hemoglobin (HbA1C) > 6.5% (test group) and 15 normoglycemic patients (HbA1C < 6.0%; control group), one narrow-diameter tissue level implant, placed in the posterior maxilla or mandible, was investigated. The clinical parameters probing depth (PD), bleeding on probing (BOP), attachment loss (CAL), recession, and papilla bleeding index (PBI) were assessed manually after 24 and 48 months of function. The paired digital periapical radiographs were analyzed regarding the change in marginal bone level (MBL) from baseline to 48 months post-op. The technical complications were recorded.
RESULTS: In the T2DM group, 11 patients were available for follow-ups. The overall implant survival rate after 48 months was 100%. The differences in means for the clinical parameters and the MBL between the T2DM and normo-glycemic patients for the observation period were statistically non-significant. No technical complications were recorded.
CONCLUSIONS: The study demonstrated an encouraging clinical outcome with ND implants in patients with uncontrolled T2DM compared to non-diabetics after 48 months\' post loading.
CONCLUSIONS: Patients with HbA1C > 6.5% may benefit from the treatment with narrow-diameter implants by avoiding complex surgical interventions with augmentation procedures. REGISTRATION NUMBER (CLINICALTRIALS.GOV): NCT04630691.

UNASSIGNED: Laser biostimulation therapy (LBT) is suggested to have positive effects on periodontal healing. This study evaluated LBT with nonsurgical periodontal therapy (NSPT) in diabetes mellitus (DM) and systemic health (SH) conditions.
UNASSIGNED: Thirty periodontitis patients (15 with DM and 15 with SH) were included in the study, which had a split-mouth design, by applying LBT in the mouth of the same systemic condition. Thus, 4 study groups were formed, as 1) NSPT - DM: NSPT alone in DM, 2) NSPT + LBT - DM: NSPT + LBT application in DM, 3) NSPT - SH: NSPT alone in SH, and 4) NSPT + LBT - SH: NSPT + LBT application in SH. NSPT was performed on days 15, 30, 37, 44, 51, 58, and 65. LBT was performed 6 times on days 30, 37, 44, 51, 58, and 65 with an Nd:YAG laser. The plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were assessed as the clinical parameters and recorded at baseline and days 30, 37, and 72. Gingival crevicular fluid levels of interleukin 1 beta (IL-1β) and IL-10 were evaluated by ELISA as the biochemical parameters at baseline and on days 30, 37, and 72.
UNASSIGNED: Clinical parameters had improved in all of the groups on day 72 (p < 0.01). PPD and CAL improved more in the DM group with NSPT and LBT group than in the DM group with NSPT without LBT on day 37 (p < 0.05). IL-1β decreased and IL-10 increased in all of the groups on day 72 (p < 0.01). This change was more evident in the DM group with NSPT and LBT than in the DM group with NSPT without LBT on day 7 (p < 0.05).
UNASSIGNED: These results revealed the short-term impacts of LBT on periodontal healing, which return to ineffectiveness with repeated irradiation. Therefore, it may be speculated that LBT via the protocol herein may have a short-term antiinflammatory contribution to NSPT, only in impaired healing conditions such as DM.

OBJECTIVE: This study aimed to explore the effect of nonsurgical periodontal treatment on Galectin-1 and -3 GCF levels in gingivitis and periodontitis stage III compared to periodontally healthy individuals, to determine whether they could serve as diagnostic markers / therapeutic targets for periodontitis and revealing their possible role in periodontal disease.
METHODS: Forty-five systemically healthy participants were included and equally subdivided into three groups: gingivitis, periodontitis (stage III), and a periodontally healthy control group. The clinical parameters were recorded. Galectin-1 and -3 GCF levels were evaluated (before and after non-surgical treatment for periodontitis) using an enzyme linked immune-sorbent assay (ELISA) kit. Receiver operating characteristic (ROC) curve was performed to reveal sensitivity, specificity, predictive value, and diagnostic accuracy of both markers.
RESULTS: The study showed statistical significance between different groups regarding Galectin-3 with higher values in periodontitis and the lowest values in healthy control. Also, Galectin-1 was significantly higher in the periodontitis/gingivitis groups than in the control group. Moreover, non-surgical periodontal treatment in periodontitis patients caused a statistical reduction in clinical parameters and biomarkers. ROC analysis revealed excellent diagnostic ability of both biomarkers in discriminating periodontitis/gingivitis against healthy individuals (100% diagnostic accuracy for Galectin-1 and 93% for Galectin-3, AUC > 0.9) and acceptable diagnostic ability between periodontitis participants against gingivitis (73% diagnostic accuracy for Gal-1 and 80% for Gal-3, AUC > 0.7).
CONCLUSIONS: Both Galectin-1 and Galectin-3 seem to have outstanding diagnostic accuracy for the identification of periodontal disease, an acceptable ability to measure periodontal disease activity and the severity of inflammatory status. Additionally, they could serve as therapeutic targets to monitor treatment efficiency.
BACKGROUND: GOV REGISTRATION NUMBER: (NCT06038812).

BACKGROUND: The purpose of this study was to evaluate the reliability and accuracy in the assignment of the case definitions of peri-implant health and diseases according to the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions.
METHODS: Ten undergraduate students, 10 general dentists, and 10 experts in implant dentistry participated in this study. All examiners were provided with clinical and radiographic documentation of 25 dental implants. Eleven out the 25 cases were also accompanied by baseline readings. Examiners were asked to define all cases using the 2018 classification case definitions. Reliability among examiners was evaluated using the Fleiss kappa statistic. Accuracy was estimated using percentage of complete agreement and quadratic weighted kappa for pairwise comparisons between each rater and a gold standard diagnosis.
RESULTS: The Fleiss kappa was 0.50 (95% CI: 0.48 to 0.51) and the mean quadratic weighted kappa value was 0.544. Complete agreement with the gold standard diagnosis was achieved in 59.8% of the cases. Expertise in implantology affected accuracy positively (p < 0.001) while the absence of baseline readings affected it negatively (p < 0.001).
CONCLUSIONS: Both reliability and accuracy in assigning case definitions to dental implants according to the 2018 classification were mostly moderate. Some difficulties arose in the presence of specific challenging scenarios.

Sjögren\'s syndrome (SS) is a common systemic autoimmune disease that affects oral health, and consequently oral health-related quality of life (OHRQoL) due to the involvement of exocrine glands.
The present study aimed to evaluate the oral health-related quality of life and oral health indicators in patients with SS in comparison with healthy individuals.
In the case and control groups (45 patients and 45 healthy individuals), questions about demographic data, other systemic disorders, medications, the years of infection, xerostomia, as well as inquiries about the quality of life (Oral Health Impact Profile-14 - OHIP-14) were asked. The patients were evaluated clinically, and oral health indicators, including the plaque index (PI), the gingival index (GI), the sulcus bleeding index (SBI), and the number of decayed, missing and filled teeth (DMFT) were assessed on the Ramfjord teeth. Unstimulated saliva samples from both groups were obtained and weighed. The data was analyzed using IBM SPSS Statistics for Windows, v. 24.0. Quantitative variables were compared between the case and control groups with the use of the independent t test or their nonparametric equivalent (the Mann-Whitney test).
The comparison of the quantitative variables between the study groups showed a statistically significant difference in the OHRQoL scores (p = 0.037) and the unstimulated saliva flow rate (p = 0.002) between the case and control groups. Also, there was a statistically significant difference in the DMFT index between patients with primary and secondary SS in the case group (p = 0.048).
The lower OHRQoL of patients with SS requires more attention and follow-up to solve periodontal and dental problems in this group of patients.

OBJECTIVE: Periodontal disease occurs frequently in patients with limited cutaneous systemic sclerosis (lcSSc) while data about underlying pathways contributing to periodontal changes are scarce. The aim of this study was to evaluate periodontal disease and to investigate its association with endothelial dysfunction and clinical changes in patients with lcSSc.
METHODS: In 38 lcSSc patients and 38 controls, periodontal status was evaluated by disease-specific questionnaire, dental examination including bleeding on probing (BOP), pocket depth, and plaque index, and dental panoramic radiograph. Periodontopathogen bacteria were collected subgingivally using paper points and interleukin-1 (IL-1) gene polymorphisms were evaluated using buccal swabs. Endothelial dysfunction was measured by flow-mediated dilatation, pulse-wave velocity and biochemical analysis, including arginine metabolites and endothelial microparticles. Additionally, lcSSc-specific clinical changes and parameters were recorded.
RESULTS: Periodontitis was present in 31 patients with lcSSc (81.6%) and in 27 controls (71.1%) (p = .280). LcSSc patients had a lower teeth number (p = .039) and Eikenella corrodens was to a higher degree detectable in patients with lcSSc (p = .041) while the remaining periodontal parameters revealed no differences between both cohorts. Significant correlations between parameters of arterial stiffness, EUSTAR index, number of teeth and BOP were observed (all p < .05). Detection of Prevotella intermedia was associated with selected IL-1 gene polymorphisms (p = .032) and Porphyromonas gingivalis was associated with severe periodontitis (p = .041).
CONCLUSIONS: Periodontal disease may occur frequently in patients with lcSSc and may be associated with arterial stiffness and with SSc activity.

OBJECTIVE: To assess volumetric tissue changes following combined surgical therapy of peri-implantitis over a follow-up period of 24 months.
METHODS: A total of 20 patients (n = 28 implants) were diagnosed with peri-implantitis and underwent access flap surgery, implantoplasty, and augmentative therapy at intrabony components (ie, combined therapy) using a natural bone mineral and a native collagen membrane. The peri-implant region of interest (ROI) was intraorally scanned pre-operatively (S0), and after 12 (S3) and 24 (S4) months. Digital files were superimposed for the assessment of volumetric changes between the referred time points. The change in thickness was assessed at a standardized ROI, segmented into two equidistant sections (ie, marginal and apical).
RESULTS: Peri-implant tissues exhibited a nonsignificant mean thickness loss of 0.16 (95% CI: -4 to 0.06) and 0.17 mm (95% CI: -0.05 to 0.4) at S3 and S4, respectively. S0-S3 dimensional thickness changes at marginal and apical areas were -0.24 (95% CI: -0.48 to 0.002) and -0.19 mm (95% CI: -0.36 to -0.2), respectively. Dimensional changes from S0 to S4 amounted to -0.22 mm (95% CI: -0.46 to 0.02) and -0.07 mm (95% CI: -0.09 to 0.2), respectively. The thickness changes at marginal and apical ROIs were significant from S0 to S3. Clinical parameters (ie, plaque index, bleeding on probing, and probing depth) significantly improved over the 24-month follow-up period. Linear regression analyses revealed no significant association between baseline bone loss (%), width of keratinized mucosa, and mucosal recession scores and thickness changes.
CONCLUSIONS: Peri-implant tissues revealed minor volumetric changes at 12 and 24 months after combined surgical therapy.

Erectile dysfunction (ED) and chronic periodontal disease (CPD) share mutual risk factors, and the incidence of ED is increasing among young adults. The relation of CPD and ED remains obscure due to inconsistent clinical evidence. This study aimed to further assess the relationship between CPD and ED using the Community Periodontal Index of Treatment Need (CPITN) and the International Index of Erectile Function (IIEF). Totally, 202 adult men were included, with 100 subjects with ED in the case group and 102 subjects without ED undergoing routine dental examinations in the control group. The IIEF questionnaire was used to assess the severity of ED, and CPD was assessed through the Community Periodontal Index (CPI) score. Periodontal assessments were performed by one single calibrated examiner. Logistic regression analysis was performed for the association between CPD and ED. After adjustment for age, smoking status, tooth brushing time, education level, monthly income, tooth brushing frequency, and gum bleeding, higher CPI score was identified to be associated with a greater risk of ED (odds ratio [OR] = 2.755, 95% confidence interval [CI] = [1.400, 5.423], p = .003), suggesting that CPD was positively associated with the odds of ED. CPD was getting more severe with the progress of ED (p < .05). Men with ED could be encouraged to receive routine dental examinations and appropriate preventive dental measures to maintain oral and periodontal health.

Periodontitis (P) is a highly prevalent inflammatory disease of the oral cavity. The objective of the study was to evaluate the stages of pro-inflammatory cytokine IL-1β in initial, moderate and severe periodontitis. One hundred and twenty two patients were included in the study. Periodontitis subjects had at least 20 natural teeth and ≥8 sites with pocket depths of >4 mm and clinical attachment loss (CAL). A questionnaire was used with respect to the socio demographic parameters which included age, gender, ethnicity, education, marital, residence and occupation. To categorize the severity of the disease, teeth were assessed for, Plaque index (PI), Bleeding on probing (BOP), CAL, missing tooth, tooth mobility and bone loss. Unstimulated whole saliva (UWS) was collected and Interleukin-1β (IL-1β) cytokine levels were analyzed using enzyme linked immunosorbent assay with microplate reader at 450 nm. Clinical parameters and salivary cytokine concentrations were assessed using one-way analysis of variance, whereas a correlation of cases with gender and severity of periodontitis was evaluated using chi-square test. Fifty-nine patients were healthy controls and 63 were periodontitis patients Thirty two percent (n = 20) had initial periodontitis, 40% (n = 25) suffered from moderate and 29% (n = 18) had severe periodontitis. Periodontitis subgroups were significantly different with regards to age and gender (p < 0.001). The mean PPD and CAL among the periodontitis patients (PPD, 3.52 ± 1.25 mm; CAL, 4.04 ± 1.64 mm) were significantly compromised (p < 0.05) compared to healthy controls (PPD, 1.52 ± 0.73 mm; CAL, 0.08 ± 0.28 mm). Increased levels of IL-1β were associated with high CAL and PPD findings. UWS IL-1β levels were higher in periodontitis patients compared to healthy individuals. In addition, cases of severe periodontitis showed significantly higher UWS IL-1β levels compared to initial and moderate periodontitis patients. Comparative levels of salivary IL-1β can be potentially used as a diagnostic tool for periodontitis identification and disease progression along with clinical parameters.

OBJECTIVE: To compare the physiological and biochemical markers in healthy and periodontitis subjects, and to relate these markers with the periodontal health condition.
METHODS: The case-control study was conducted at the Dow University of Health Sciences, Karachi, from April 2017 to March 2018, and comprised systematically healthy controls and periodontitis cases. Periodontal probing depth, clinical attachment loss, oral hygiene indices, educational status and body mass index were recorded for all the subjects. Serum levels of biochemical markers, including calcium, phosphate and interleukin-6, were also measured. Data was analysed using SPSS 16.
RESULTS: Of the 150 subjects, 75(50%) each were in the case and control groups. The overall mean age was 31.23±3.7 years (range: 22-42 years). The cases had relatively poor oral hygiene indices and educational status compared to the controls (p<0.05). Serum calcium level was lower, whereas mean body mass index was higher in the cases compared to the controls (p<0.05). No significant difference was found in interleukin-6 and phosphate levels (p>0.05). Clinical attachment loss showed significant correlation (p<0.05).
CONCLUSIONS: Low serum calcium and educational levels, higher body mass index and poor oral hygiene were found to be the risk factors for the progression of periodontitis.