Journal of Dental Medicine

This study is for appointment the dose of systemic 4 groups of patients selected for this study.First group had sealling, root planing and planing and periodontal surgery and no drugs. Second group had sealling, root planing and periodontal surgery with 1 gr per day of tetracycline for two weeks and third group for 3 weeks and fourth group for 4 weeks.The fourth group was.the best clinical improvement. The indexes were PPD, CAL, PI, GI.

Up to now, no complete study was carried out about the prevalence and location of periapical granuloma and radicular cysts from the point of view of clinical symptoms (e.g. pain and swelling fistula) in Iran. The data was collected from the files available in the Department of Pathology, faculty of Dentistry, Tehran University of Medical Sciences. With a consideration on different therapeutic methods. a proper method was selected. Radicular cyst occurred in 59.3 percent of 324 cases while 45.7 percent were granuloma. The most common incidence of these lesions was in the range of 24-25 years old. The most common location of lesions was the maxillary anterior. Sinus tracts occurred in 74 of all cases. 47.3 percent of these patients have been previously received root canal therapy. It is noticeable that 24 percent of all patients were treated endodontically before surgery. Higher incidence of granuloma occurred in small lesions while cysts were more common in large lesions. 232 of all cases showed one of the clinical symptoms, 16% pain, 35.8% swelling and 22.8% fistula. No symptoms were found in 92 cases.

One of the special kinds of periodontal disease is rapidly progressive periodontitis (RPP). This form of periodontitis is an aggressive disease, which results in bone destruction and loss of periodontal attachment 4 to 5 times more than adult periodontitis or slowly progressive periodontitis. The purpose of this study was to investigate the presence of Actinobacilius actinomyct-em comitans (Aa) in RPP patients. A total number of sixty samples was collected from 15 patients with RPP and cultured inanaerobic conditions. Results showed the presence of Aa in 13 patients (86.7%), while 29 samples were Aa positive (48.3%). Two of the RPP patients (13.3%) were Aa negative even after two times bacterial culturing.

Actinomyces species are normal residents of the mouth cavity, gastrointestinal tract and female genital tract. The genus consists of gram-positive bacteria, strictly anaerobic or microaerophilic. The bacteria are opportunists with a low virulence potential that cause actinomycosis only when the normal mucosal barriers are disrupted. The main purpose of this study was the isolation of Actinomyces strains and determining of their role in periodontal diseases. The present study was carried out on 100 patients with periodontal diseases referred to the Periodontic Department of Faculty of Dentistry. The sampling was done in 6 months with isolation of oral Actinomyces from microbial plaque and periodontal pocket. The samples were selected based on the following criteria: periodontal plaque with deep pocket (>3 mm), no antibiotic therapy for a period of at least two weeks, and lack of systemic diseases. One strain of Actinomyces viscosus and two strains of Actinomyces naeslundii were isolated from the patients with gingivitis and periodontitis. Of the 100 patients with gingivitis and periodontitis, aged between 18-57 years old, 46% were males and 54% were females. The peak incidence of the diseases (35%) was in the third age group (31-40) and the lowest incidence (10%) was in the first age group (<20). Forty patients (40%) complained of gingival disease and its bleeding with lower incidence of (42.5%) in female.

This review was focused on investigations in the relationship between human leukocyte antigens and periodontal disease. Several studies have looked for relationship between HLA phenotypes and early onset periodontitis (EOP). There have also been reports on both positive and negative relationship between specific HLA antigens and periodontal disease. Positive relationship has been reported among HLA-A1, A9, A24, A28, A33, B15, B22, B35, B44, C4, DR2, DR4, DR7, DR53, DRB1, DQ3 and DQB1 antigens and different forms of EOP. Several studies have reported negative relationship with HLA-A2, A5, A10, A28, A68, B5, DR2 and DR6. Two antigens that appear to be more related to EOP are HLA-A9 and DR4. Evidence suggests that genes in this area are not genes with major effect for early-onset periodontal diseases. It is possible that genes in the MHC region of chromosome 6 may function as modifying genes that affect clinical expression of periodontal disease. However, additional documents are needed to evaluate the relationship of HLA antigens with periodontal disease. These documents should have adequate controls, which account for racial differences in HLA type and well-defined patient groups whose state of disease is described

Diagnosis and treatment of patients with periodontitis as a manifestation of systemic diseases is of especial concern to the periodontist, especially those associated with genetic disorders, which have poor prognosis. With aggressive progression of periodontal bone and attachment loss, a patient could be a partial or total edentulous early in life.The aim of this article was to report a case of Papillon-Lefevre syndrome (PLS) with generalizedprepubertal periodontitis (GPPP). A ten-year old boy for whom active periodontal treatment and subsequent maintenance recalls was performed for five years since the diagnosis of PLS. Treatment procedures included: precise mechanical instrumentation at several visits, periodontal surgery, adjunctive serial systemic antibiotic therapy, professional irrigation of pockets with 0/2% chlorhexidine solution and periodic maintenance recall visits. In spite of all of these, progressive course of the disease continued until the patient was fifteen and edentulous. Unfortunately association of GPPP with systemic unmanageable condition or diseases has caused refractory periodontitis, which yet has no proven and reliable treatment protocol. Besides, this article has discussed more successful treatment modalities for PLS with GPPP and the genetic aspects of host susceptibility, which is a complicated and challenging field.

Statement of Problem: There is a controversy about the relationship between pulpal and periodontal diseases. The interrelationship between pulp and periodontium could have an important effect on the treatment plan of the tooth.

Purpose: The aim of the present research is to evaluate root canal therapy effects on periodontal healing of teeth with chronic advanced periodontitis.

Materials and Methods: In this randomized controlled clinical trial 32 single rooted teeth which had necrotic pulp or irreversible pulpitis in 7 patients with chronic advanced periodontitis were selected based on specific criteria. Using a split mouth design, teeth were randomly put in two groups of test and control. In the test group root canal therapy ,scaling & root planing were done.In the control group, only scaling & root planing were performed. Clinical parameters including Pocket Depth (PD), Clinical Attachment Level (CAL), mobility, pattern of bone destruction and plaque index (PI) were evaluated in two groups at base line, 1 and 3 months after treatment. Appropriate tests such as paired Wilcoxon and Mann-Whitney were performed.

Results: Statistically significant reductions were found in the test group when comparing baseline and one-month post treatment values for Clinical Attachment level (CAL) but not after 3-months. In the control group the CAL reductions were not statistically significant between baseline and one month post-treatment, but a increase were observed between one month and three months after treatment. There was a statstically significant difference between the test and the control groups. Other parameters didn’t show any significant differences in each group and between two groups.

Conclusion: Since clinical attachment level was the most important parameter we found it can high lighted the role of pathogene with pulpal origin in progression of periodeontal disease and it is concluded that beside periodontal treatment in some advanced periodontal cases pulp therapy maybe an effective procedure for eleminating destructive pathogens of pulp and causing periodontal healing.

Statement of Problem: One of the best ways for treatment of Aggressive Periodontitis (AP) is identification and elimination of etiologic factors specially two microorganisms Actinobacillus actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg) in patients harboring them.

Purpose: This study determines the prevalence of Aa and Pg and its correlation with age, sex and the number of family members as well as probing pocket depth (PPD) in active sites of AP patients, referred to department of periodontics, Faculty of Dentistry, Tehran University of Medical Sciences.

Materials and Methods: In this cross sectional, descriptive study, 54 sites (PPD> 5mm) in 15 patients were considered for culture. Marginal gingiva was dried and sampling performed by paperpoint (#30). The selective medium for Aa, was Trypticase Soy Agar-Bacitracin- Vancomycin (TSBV) and for Pg was Brucella agar.Results were analyzed using Fisher and Chi-Square statistical tests.

Results: Thirteen patients or 38 sites (70.4%) were identified as Aa positive and 3 patients or 10 sites (18.4%) were Pg positive. There was no significant relation between the presence of Aa and sex or age (P=0.086). Pg was more prevalent in men compared with women (P<0.0001) but with regard to age there was no statistical difference between men and women. Aa had a significant positive correlation with PPD (P=0.002), which was not true for Pg. In addition, the number of positive sites showed a significant negative correlation with the number of family members.

Conclusion: Based on the present study, the prevalence of Aa in deep pockets in patients with AP is higher than Pg.

Statement of Problem: Hyperlipidemia is a major risk factor for cardiovascular disease. In recent years some evidence has been presented regarding the association between periodontal and cardiovascular diseases.

Purpose: The aim of this study was the evaluation of association between hyperlipidemia and periodontitis.

Materials and Methods: In this case-control study, levels of plasma lipids in 40 subjects with periodontitis (CPITN score III or IV) were measured and compared with 40 age and sex matched controls. Data were analyzed using t-student test with P<0.05 as the limit of significance.

Results: Total cholesterol (CHL) and triglyceride (TG) were significantly higher in case group compared with control group. (P=0.045 and P=0.016 respectively). HDL and LDL cholesterols were higher in cases but showed no significant differences with controls. The relative frequency of pathologic values of CHL and TG were significantly greater in cases compared with control group (P=0.005 and P=0.001 respectively).

Conclusion: Based on the findings of this study, hyperlipidemia may be associated with periodontitis in medically healthy peoples but whether periodontitis causes an increase in levels of serum lipids or whether hyperlipidemia is a risk factor for both periodontitis and cardiovascular disease need to be further investigated.

Background and Aim: Aggressive periodontitis is one of the periodontal diseases, which affects systemically healthy individuals usually under the age of 30 years old. The disease is characterized by rapid bone destruction which is not in accordance with the quantity of bacterial plaque. The purpose of the present study was to determine the prevalence of aggressive periodontitis among 15-18 years old female students in Tehran high schools.

Materials and Methods: In this cross sectional study, , 2870 students were selected from all educational areas of Tehran during 1382-83 based on systematic clustered random sampling .Probing pocket depth on 6 areas of incisors and first molars were examined in each subject. Students with pocket depth equal to or more than 4 mm on more than one tooth were referred to Shahed Dental School for radiographic examination. For cases in which the distance between the crest of interdental septa and CEJs were equal to or more than 2 mm, full clinical and radiographic examination was performed.

Results: Among the subjects of study, only 4 fulfilled the diagnostic criteria of localized aggressive periodontitis. Nobody was diagnosed with generalized aggressive periodontitis. The prevalence of aggressive periodontitis among 15-18 years old schoolgirls was 0.14%.

Conclusion: The results of the present study were similar to previous studies with the same age groups and diagnostic criteria in other countries. For determination of total prevalence in Tehran, similar studies in schoolboys are recommended.

Background and Aim: Several risk factors directly affect the development of periodontal diseases. Also some systemic diseases act indirectly as predisposing and aggrevating factors. Osteoporosis is one of these factors and one of its main causes is lack of physical activity in postmenopause period. The incidence of osteoporosis is increasing in our country. The goal of this study was to evaluate the periodontal condition of women with osteoporosis and osteopenia referred to bone densitometric division of Loghman hospital in 2003 and compare to control group.

Materials and Methods: In this case control study based on BMD (Bone Mineral Density) measurement of back and thigh using DEXA method, 60 patients referred to bone densitometric division of Loghman hospital, were randomly selected. Cases were divided into three groups, 20 with osteoporosis, 20 with osteopenia and 20 normal cases. Periodontal indices consisting of plaque index (PI), tooth loss (TL), gingival recession (GR), probing pocket depth (PPD) and papilla bleeding index (PBI) were evaluated by clinical and radiographic examination. Data were analyzed by Kruskall Wallis and Dunn tests with p<0.05 as the limit of significance.

Results: PBI, PI and TL were significantly higher in osteoporotic group than osteopenic and normal group. PPD was not different in the three groups. Due to the low prevalence of recession in our study, this parameter was not included in the statistical analysis.

Conclusion: It seems that osteoporosis does not increase the incidence of periodontal diseases because it affects bone quality rather than quantity. In osteoporosis calcium deficiency and increasing age lead to decreased physical activity and ultimately affect the patient's oral hygiene performance. Thus, periodontal manifestations are presented as gingival bleeding and gingivitis.

Background and Aim: Multiple systemic and local factors contribute to the incidence and progression of periodontal diseases. Osteoporosis is defined as changes in trabecular bone structure and probably as a systemic risk factor of periodontitis. Since both diseases are considered as major public health problems and affect numbers of adults the aim of this study was to investigate the relationship between osteoporosis and periodontal disease and the role of oral hygiene in this process.

Materials and Methods: In this historical cohort study, 68 patients were selected from 111 individuals for whom femoral and hip BMD (Bone Mineral Density) with DXA (dual energy X-ray absorptiometry) procedure was performed and PI (Plaque Index) recorded. Cases were divided into four groups of 17 persons each as follow: osteoporotic with good oral hygiene (OH), osteoporotic with poor oral hygiene (OP) normal with good oral hygiene (NH), and normal with poor oral hygiene (NP). Clinical examinations including BOP (bleeding on probing),GR (gingival recession), PPD (probing pocket depth) and TL (tooth loss) was performed for all cases. Data were analyzed by two-way and four-way ANOVA test, with p<0.05 as the level of significance.

Results: Significant relation was observed between GR (P=0.045), and TL (P=0.050) with BMD independent of oral hygiene. Whereas such relation was not true for BOP and PPD (P=0.989).

Conclusion: Our finding showed that osteoporosis can make patients more vulnerable to periodontal diseases by reducing trabecular bone mass and is related to gingival recession as well as tooth loss.

Background and Aim: Elimination of microorganisms and their byproducts from root canal system is one of important aims of root canal therapy. This object is gained by using of many chemomechanical techniques but with noncertain success. A new method is used of nonpathogenic bacteria for growth inhibition of pathogenic bacteria, Antibiosis, in root canal therapy.The aim of this study was in vitro evaluation of antimicrobial effect of probiotics, such as Lactic Acid Bacteria (LAB) on the infected root canal bacteria.

Materials and Methods: Isolated bacteria from infected root canal were grown and then scattered onto the muller Hinton agar plates which contain wells, LAB, extracted from dairy products, were added into these wells, Inhibition effected of LAB was determined. Furthermore the sample taken from the inhibition zone and possible resistant monoclonal bacteria also were identified, then 6 sensitive and 14 resistant samples were selected and E. faecalis species were added to them Then antimicrobial effects of LAB on these samples was reevaluated.

Results: The results showed that 66.7% of the samples were sensitive at least to one type of LAB, and 33% were resistant to all kind of LAB. Meanwhile the outgrowing anaerobic bacteria inside the inhibition zone were from the low frequency oral bacterial flora. Furthermore, adding E. faecalis to the samples caused more sensitivity of them to LAB. Mc-Neamar test recognized the difference significant.

Conclusion: This study showed that the LAB inhibit growth of the pathogenic root canal bacteriae. Furthermore, presence of E. faecalis reinforces the antimicrobial effect of LAB. It seemed that LAB maybe have potential to use in endodontic practice for elimination of root canal infections.

Background and Aim: A major aspect of the adaptive host response in periodontitis is the antibodies. Several risk and susceptibility factors for periodontitis, including smoking, age and composition of the subgingival microflora, have also been suggested to influence antibody production. The present study was conducted to investigate plasma levels of immunoglobulin (Ig) G antibodies in periodontitis patients of Caucasian Iranian heritage referred to dental faculty, Tehran University of Medical Sciences in relation to disease severity and smoking.

Materials and Methods: In this study, 36 patients with severe periodontitis, 39 with moderate periodontitis and 40 controls without periodontal destruction were enrolled. From the total of 80 patients, 21 were diagnosed with aggressive periodontitis and 54 with chronic periodontitis. IgG isotypes were analyzed in plasma samples.

Results: Patients group in comparison with control group had shown higher level of Immuno globolins. There was no significant difference about the IgG1 level in moderate and seven group and also in chronic and aggressive groups (p<0/001). But the level of IgG2 was shown the significant difference in the all study groups. Smoking was significantly reduced the level of IgG1 and IgG2.

Conclusion: The current study shows that non-smoker periodontitis patients have higher levels of IgG2 than smoker periodontitis patients.

Background and Aims: Periodontitis is one of the most common oral diseases with the various incidence rates in different populations. A number of bacteria are considered as the major etiologic agents of periodontitis. The aim of the present study was to determine the prevalence of periodontopathogen bacteria in patients using both PCR and culture techniques.
Materials and Methods: In this study, one-hundred patients (including 62 females and 38 males with an average age of 49±11.5 years) with adult periodontitis referred to periodontics department of School of Dentistry/Tehran University of Medical Sciences were investigated. The samples were taken and sent immediately to the laboratory for culture and molecular evaluation. The PCR was performed using specific primers and the statistical analysis of data was performed using SPSS statistic software and McNemar test.
Results: The results demonstrated that the total detection rate in culture method was 64%. The rate of Aggregatibacter actinomycetemcomitans (Aa) was 28% which was significantly higher than that of Porphyromonas gingivalis (Pg) (6%) and Prevotella intermedia (Pi) (3%). 27% of cases showed mixed bacterial growth. 65% of patients were positive using molecular method. The rate of Aa (30%) was significantly higher than that of Pg (7%) and Pi (5%). The mixed PCR positive rate containing of Aa, Pg and Pi was (23%).
Conclusion: In this study, it was found that most of the bacteria isolated using culture and molecular methods were Aa, Pg and Pi, respectively. Although the detection frequencies of both techniques were similar, the specificity, sensitivity and bacterial detection speed of the PCR technique is obviously higher. Therefore, the use of molecular techniques is strongly recommended. However, both techniques seem to be suitable for microbiological diagnostics.

Background and Aims: Apoptosis or programmed cell death plays an important role in the pathogenesis of many diseases. Previous studies suggest that apoptosis is involved in the pathogenesis of periodontal disease, on the other hand it is also suggested that diabetes mellitus enhances apoptosis of connective tissue cells. Thus, we measured expression of proteins which are relevant to apoptosis in the gingival tissue of diabetic patients with chronic periodontitis in comparison to non diabetic individuals.

Materials and Methods: 25 patients with diabetes and chronic periodontitis and 16 non diabetic controls were included in this study. 4 weeks after scaling and root planning and oral hygiene instructions, periodontal surgery was done and gingival tissues obtained during surgery, were sent to lab to investigate expression of Fas, P53, Bcl-2 and Survivin using real-time PCR technique. Data were analyzed using Mann-Whitney and Chi-squared.

Results: Pro-apoptotic proteins (Fas, P53) were significantly (P<0.05) higher in gingival tissues of diabetics (9.5×10^-6, 2.4×10^-6, respectively) in comparison to non diabetics (9.4×10^-7, 5.6×10^-7), whereas the difference in expression of anti-apoptotic proteins (Bcl-2, Survivin) between 2 groups was not significant (9.7×10^-8, 3.5×10^-7 in comparison to 1.4×10^-7, 3.1×10^-7, respectively)( P =0.91, P =0.29 respectively).

Conclusion: Apoptosis was increased in gingival connective tissue of diabetic patients with chronic periodontitis in comparison to non diabetic ones. Therefore , intervention in expression or function of pro-apoptotic proteins (Fas, P53) could be a new goal in the treatment of periodontal disease of diabetic patients.

  Background and Aims : Antibiotics are commonly used for controlling the growth of porphyromons gingivalis (P.g) which is one of the most important etiologic factors in the periodontal diseases. Different side effects of synthetics and chemical drugs such as increasing the drug resistancy in the human pathogens have led to study on the herbal antibacterial effect. The aim of this study was to evaluate the antibacterial effect of cinnamon on the growth of porphyromons gingivalis in chronic periodontitis patients with deep pockets.

  Materials and Methods: In this experimental study, samples were provided from patients having pockets. After culturing the microorganism and diagnosis of P.g by gram staining and biochemical tests, cinnamon in different concentrations (10, 50, 100, 250, 500, 750 and 1500 mg/ml ) with oil solvent were prepared and placed by disks in the cultures medium. Positive controls were amoxicillin, metronidazole, ciprofloxacin, amikacin and gentamycin . Oil was negative control. Then the plates were incubated for 24 hours in 37 ⁰ C and then non-growth halos by disk diffusion method, MIC (Minimum Inhibitory Concentration) and MBC (Minimum Bactericidal Concentration) were determined. Data were analyzed using One-way ANOVA test.

  Results: The results showed that the cinnamon at the concentration of MIC=750 mg/ml had the inhibitory effects of bacteria and at the concentration of MIC=1500 mg/ml had killing effect. However, this antibacterial effect compared with commonly used antibiotics (amoxicillin, metronidazole), was much weaker (P<0.001).

  Conclusion: Cinnamon showed an antimicrobial effect on porphyromonas gingivalis in chronic periodontitis patients with deep pockets.