Publications by authors named "Lazaros Tsalikis"

23 Publications

  • Page 1 of 1

Effects of orthodontic forces on bone turnover biomarkers in peri-miniscrew crevicular fluid: A systematic review.

Int Orthod 2020 Sep 22;18(3):403-411. Epub 2020 Apr 22.

Aristotle University of Thessaloniki, Department of Preventive Dentistry, Periodontology and Implant Biology, Thessaloniki, Greece.

Objective: Peri-miniscrew crevicular fluid (PMCF) analysis of biomarkers representing bone formation or resorption could provide a non-invasive way to monitor bone turnover around miniscrews and the response to force loading. Our objective was to systematically investigate the relevant available evidence.

Materials And Methods: Search without restrictions in eight databases and hand searching until March 2020 took place. We searched for prospective human studies measuring the levels of markers of bone formation and resorption in PMCF under the effect of orthodontic forces. Following study retrieval and selection, relevant data was extracted and the risk of bias was assessed following the Cochrane Collaboration guidelines.

Results: Four studies, two randomized and two non-randomized, were finally identified, following miniscrews for a period up to 90 days. Loading of miniscrews led to a transient increase in C-telopeptide of type I collagen amounts. Temporary increases were also observed for the enzymes: alkaline phosphatase and aspartate aminotransferase. Under the effect of orthodontic loading the total amount of Receptor Activator of Nuclear Factor-κB Ligand (RANKL) in the PMCF consistently increased compared to the unloaded group, at all sampling points. These changes led to a stable decrease in the osteoprotegerin (OPG)/RANKL ratio under force application throughout the study period, as OPG in this group, together with OPG and RANKL in the unloaded group, remained mostly unchanged. No differences were detected for the total OPG quantity between the two loading groups. The levels of bone specific alkaline phosphatase and chondroitin sulfate did not change significantly during observation. All studies presented some issues of concern regarding the risk of bias.

Conclusion: Biomarkers of bone turnover in PMCF showed variable responses following orthodontic loading. Overall, the findings were suggestive of adaptive bone alterations to physiologic force stimuli.
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http://dx.doi.org/10.1016/j.ortho.2020.03.005DOI Listing
September 2020

Review of the association between periodontitis and chronic obstructive pulmonary disease in smokers.

Monaldi Arch Chest Dis 2019 Mar 20;89(1). Epub 2019 Mar 20.

Aristotle University of Thessaloniki, School of Dentistry.

Both periodontitis and chronic obstructive pulmonary disease (COPD) are among the most common diseases associated with smoking. These conditions frequently present alongside comorbidities including diabetes, coronary heart disease, duodenal ulcer, deep vein thrombosis, pulmonary embolism, osteoporosis and muscle atrophy. Chronic inflammation contributes to the pathology of both periodontitis and COPD, and in patients suffering from both conditions treatment of periodontitis may lead to relief from COPD symptoms as well. Smoking contributes to the underlying pathophysiology by causing local inflammation, increasing the production of proinflammatory cytokines and most importantly, by locally increasing the activity of proteolytic enzymes which degrade the extracellular matrix in both periodontal and lung interstitial tissue. The increase in protease activity and extracellular matrix degradation may explain why periodontitis and COPD comorbidity is so common, a finding which also indicates that therapeutic interventions targeting protease activity and the inflammatory response may be beneficial for both conditions.
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http://dx.doi.org/10.4081/monaldi.2019.1018DOI Listing
March 2019

PRGF as adjunct to DBB in maxillary sinus floor augmentation: histological results of a pilot split-mouth study.

Int J Implant Dent 2019 Apr 1;5(1):14. Epub 2019 Apr 1.

Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden.

Background: Various technologies of autologous blood concentrates are currently evaluated for their potential to enhance bone formation.

Aim: To report on the histological outcome of maxillary sinus floor augmentation (MSFA) with deproteinized bovine bone (DBB) in combination with chair-side prepared autologous platelet-rich growth factor (PRGF), in comparison to that with DBB alone.

Materials And Methods: Six partially edentulous patients with ≤ 3-mm residual bone height bilaterally in the posterior maxilla were subjected to MSFA with the lateral window technique, using DBB in combination with PRGF (PRGF System1 Vitoria, Spain) on one side or DBB alone on the contralateral side. Cylindrical biopsies from the augmented sinuses were collected during implant installation, ca. 6 months post-MSFA, and subjected to non-decalcified histological and histomorphometric evaluation.

Results: The collected biopsies varied in length (range 3.5-9.9 mm); consequently, the portion of the biopsy representing augmented tissues also varied (range 2.3-14.6 mm). New bone formation with a trabecular appearance and numerous DBB particles in contact with the new bone or with loose connective tissue were observed. No differences in the relative volumes of bone formation were found in sinuses augmented with DBB + PRGF or DBB alone 6 months after MSFA (35.6 ± 8.26 mm and 37.8 ± 3.15 mm, respectively).

Conclusion And Clinical Implications: In conclusion, based on these preliminary results, PRGF as adjunct to DBB for MSFA, except from improved handling during the operation, does not appear to enhance nor interfere with bone formation inside the human sinus 6 months after MSFA, compared with the use of DBB alone.
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http://dx.doi.org/10.1186/s40729-019-0166-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441666PMC
April 2019

Treatment duration and gingival inflammation in Angle's Class I malocclusion patients treated with the conventional straight-wire method and the Damon technique: a single-centre, randomised clinical trial.

J Orthod 2017 06 1;44(2):75-81. Epub 2017 May 1.

a Department of Orthodontics, Faculty of Dentistry , School of Health Sciences, Aristotle University of Thessaloniki , Thessaloniki , Greece.

Objective: To compare the duration of orthodontic treatment and Gingival Index (GI) scores in Class I malocclusion patients treated with a conventional straight-wire method (CG) or the Damon technique (DT).

Design: Two-arm, parallel, randomised clinical trial Setting: A postgraduate orthodontic clinic Participants: Patients with a balanced facial profile, a full permanent dentition and Angle's Class I malocclusion with moderate crowding.

Methods: The primary outcome was the duration of orthodontic treatment in months. GI scores throughout treatment were secondary outcomes and the PAR index was also assessed. Randomisation was accomplished using a table of random numbers and the allocation was concealed in sequentially numbered and opened, opaque, sealed envelopes. Blinding was applicable for PAR assessment only. Comparison of data between groups was performed with appropriate tests for independent samples.

Results: Twenty-two patients were randomly allocated to treatment in a 1:1 ratio to either CG or DT group. Age at the start of treatment, initial PAR index and GI scores were similar between groups. All patients completed the study, but the total duration of orthodontic treatment was almost half of the initial assumption. No statistically significant differences were observed in treatment duration (CG: Mean ([Formula: see text]) = 14.5 months, Standard Deviation (SD) = ±3.03; DT: [Formula: see text] months, SD = ±2.93; 95% Confidence Interval: -0.40 to 4.90; P = 0.093; t-test). The two groups did not differ statistically regarding the GI scores during the observational period. No serious harms were observed other than gingival inflammation associated with oral biofilm accumulation.

Conclusions: The present study did not reveal statistically significant differences between the compared, conventional straight-wire method and Damon technique-treated, Angle's Class I malocclusion groups regarding total treatment duration and GI scores.
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http://dx.doi.org/10.1080/14653125.2017.1316902DOI Listing
June 2017

Influence of Body Mass Index and Other Periodontitis-associated Risk Factors and Risk Indicators on Periodontal Treatment Needs: A Cross-sectional Study.

Oral Health Prev Dent 2017;15(2):191-197

Purpose: To record periodontal treatment needs in a randomised sample and evaluate the association between body mass index (BMI) and periodontal treatment needs, as well as the association between diabetes, smoking, BMI and periodontal treatment needs.

Materials And Methods: The study sample comprised 633 patients aged 18 to 85 years visiting an outpatient clinic. Body mass index (BMI) and periodontal status were recorded. Demographic data including gender, year of birth, smoking habits and medical history were collected from each patient.

Results: 216 subjects (36%) were overweight, while 188 subjects (31.3%) were obese. CPITN (Community Periodontal Index of Treatment Needs) scores of 2 and 3 (minimal to moderate periodontal treatment needs) were widespread among this population (68.2%). Using model-based clustering, the total sample of 600 subjects was divided into four clusters of 202, 241, 111 and 46 subjects.

Conclusion: The periodontal treatment needs of the sample were generally minimal to moderate, with only a weak association between the BMI and treatment needs. However, diabetics, smokers and older subjects classified as overweight or obese needed moderate to complex periodontal treatments.
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http://dx.doi.org/10.3290/j.ohpd.a37933DOI Listing
November 2017

Pre-restorative crown lengthening surgery outcomes: a systematic review.

J Clin Periodontol 2016 12 25;43(12):1094-1108. Epub 2016 Oct 25.

Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH, USA.

Background: Pre-restorative crown lengthening surgery (CLS) is a common periodontal procedure, for which systematic reviews are lacking. This systematic review aimed to assess outcomes of CLS performed for restorative reasons.

Methods: Databases (MEDLINE, Scopus, OpenGrey) were searched up to January 2016 for clinical/animal trials on CLS for restorative reasons with ≥6-month follow-up. Primary outcomes investigated were: free gingival margin position, probing depth, clinical attachment level, and plaque/inflammation indices.

Results: Four non-randomized and one randomized controlled clinical trial and one controlled animal trial were included. Heterogeneity and high risk of bias were identified. CLS resulted in increased crown length (6-month average: 1.4-3.3 mm). Between immediate postsurgery and follow-up, gingival margin may rebound, largely during the first three postoperative months. Technical (flap positioning, osseous resection, root preparation) and anatomical (periodontal biotype) factors influence outcomes. The literature lacks studies on tooth mobility, crown-root ratio, patient- and referring dentist-reported outcomes, surgical technique comparisons, and restorative treatment timing.

Conclusions: Within the available data limitations, it is concluded that CLS results in increased crown length and possible gingival margin rebound. Technical aspects (primarily) and anatomical factors (secondarily) influence outcomes. Future research is needed to fill significant voids in our knowledge on several procedural aspects.
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http://dx.doi.org/10.1111/jcpe.12617DOI Listing
December 2016

Erratum to: Classification of periodontal biotypes with the use of CBCT. A cross-sectional study.

Clin Oral Investig 2016 Nov;20(8):2073

Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Agiou Dimitriou 195, 541 24, Thessaloniki, Greece.

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http://dx.doi.org/10.1007/s00784-016-1889-xDOI Listing
November 2016

Classification of periodontal biotypes with the use of CBCT. A cross-sectional study.

Clin Oral Investig 2016 Nov 22;20(8):2061-2071. Epub 2015 Dec 22.

Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Agiou Dimitriou 195, 541 24, Thessaloniki, Greece.

Objectives: The aim of this study is to investigate the relationship between periodontal morphometric parameters and to develop a biotype classification based on the variables examined with the use of cone-beam computed tomography (CBCT).

Materials And Methods: Forty-two periodontally healthy subjects that underwent a CBCT examination as part of a different diagnostic procedure participated in the study. Measurements were performed on sectional images and included gingival thickness and labial bone plate thickness midbuccally, crown width to crown length ratio, bone crest to the CEJ distance and bone crest to the gingival margin distance midbuccally, and at the approximal aspects of 186 maxillary anterior teeth.

Results: Gingival thickness at the level of CEJ was positively correlated with labial bone plate thickness and crown form. Crown form was not correlated with labial bone plate thickness. Cluster analysis supported the existence of four periodontal biotypes, "thin," "thick," "average," and "mixed." Labial bone plate thickness was thinner than 1 mm at 70 % of the measured sites.

Conclusions: Only 50 % of the teeth belonged to thin or thick biotype. The other 50 % of the teeth belonged to the average cluster or presented mixed characteristics. Assessment of labial bone plate thickness based on periodontal biotype should be made with caution.

Clinical Relevance: Taking into consideration the characteristics of periodontal biotypes enables the clinician to avoid complications in periodontology, prosthetic dentistry, implant dentistry in the esthetic zone, and orthodontics.
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http://dx.doi.org/10.1007/s00784-015-1694-yDOI Listing
November 2016

A Two-Domain Self-Report Measure of Periodontal Disease Has Good Accuracy for Periodontitis Screening in Dental School Outpatients.

J Periodontol 2016 Oct 1;87(10):1165-73. Epub 2016 Jul 1.

Division of Periodontology, Department of Developmental and Surgical Sciences, University of Minnesota, Minneapolis, MN.

Background: The assessment of periodontitis and treatment needs is primarily based on clinical and radiographic examinations. Albeit effective in predicting treatment needs, these examinations are costly, time-consuming, and impractical for assessing population-level needs. The purpose of the present study is to evaluate a two-domain self-report questionnaire for rapid periodontitis screening.

Methods: Six hundred white adult individuals, dentate or partially dentate and seeking dental therapy at a university clinic, underwent oral examination utilizing the full-mouth Community Periodontal Index of Treatment Needs (CPITN). To assess predictive value of self-reported periodontal measures (SRPMs) for periodontitis screening, four questions were formulated. Two questions aimed to assess "dentist-diagnosed periodontal disease" and two inquired about "self-assessed periodontitis." Multiple logistic regression models were used to construct receiver-operating characteristic curves, and predictor selection was performed via a forward stepwise selection process.

Results: Five hundred thirty-five volunteers with a mean age of 50.1 years elected to respond to SRPMs via telephone interview. After oral examination, 17.8% of participants were assessed as having CPITN = 4, representing compromised periodontal status. Sensitivity and specificity for correctly classifying compromised periodontal status ranged from 5.3% to 72.6%, and 87.8% to 99.5% for individual SRPMs. Sensitivity and specificity were increased when combining a measure of self-assessed periodontal disease and a measure of dentist-diagnosed disease as predictors. Addition of age and sex maximized sensitivity/specificity at 82.1%/82.2%. Diabetic status, smoking, and body mass index did not enhance the prediction.

Conclusions: A two-domain self-report measure combining two self-report items with age and sex has good sensitivity and specificity for periodontitis screening in a white, university-based population. The proposed self-report measure can be valuable for periodontitis screening in resource-limited settings where gold standard clinical examination may not be pragmatic. Further validation studies are required to assess whether findings from this study are context-specific.
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http://dx.doi.org/10.1902/jop.2016.160043DOI Listing
October 2016

Prevalence of β-lactam (bla TEM) and Metronidazole (nim) Resistance Genes in the Oral Cavity of Greek Subjects.

Open Dent J 2016 28;10:89-98. Epub 2016 Mar 28.

Department of Preventive Dentistry, Periodontology and Implant Biology, Dental School, Aristotle University of Thessaloniki, Greece.

Objectives: The aim of this study is to investigate the prevalence of bla TEM and nim genes that encode resistance to β-lactams and nitroimidazoles, respectively, in the oral cavity of systemically healthy Greek subjects.

Materials And Methodology: After screening 720 potentially eligible subjects, 154 subjects were recruited for the study, including 50 periodontally healthy patients, 52 cases of gingivitis and 52 cases of chronic periodontitis. The clinical parameters were assessed with an automated probe. Various samples were collected from the tongue, first molars and pockets >6mm, and analysed by polymerase chain reaction-amplification of the bla TEM and nim genes, using primers and conditions previously described in the literature.

Results: There was a high rate of detection of bla TEM in plaque and tongue samples alike in all periodontal conditions (37% of plaque and 60% of tongue samples, and 71% of participants). The bla TEM gene was detected more frequently in the tongue samples of the periodontally healthy (56%) and chronic periodontitis (62%) groups compared to the plaque samples from the same groups (36% and 29%, respectively; z-test with Bonferroni corrections-tests, P<0.05). The nim gene was not detected in any of the 343 samples analysed.

Conclusion: The oral cavity of Greek subjects often harbours bla TEM but not nim genes, and therefore the antimicrobial activity of β-lactams might be compromised.
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http://dx.doi.org/10.2174/1874210601610010089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820533PMC
April 2016

Periodontal treatment needs and systemic diseases in an older population in Greece.

J Clin Exp Dent 2016 Feb 1;8(1):e32-7. Epub 2016 Feb 1.

DDS, Dr med dent, Associate Professor, Department of Preventive Dentistry, Periodontology and Implant biology, School of Dentistry, Aristotle University of Thessaloniki, Greece.

Background: To evaluate the relationship between systemic diseases, body mass index and periodontal treatment needs in an older population in Greece.

Material And Methods: A total of 262 older people were clinically examined about their periodontal status and medical histories were recorded using a health history questionnaire. Additionally, weight and height measurements as well as demographic data were obtained from the participants in the study.

Results: Older people exhibited mean age of 63.98 years, weight of 78.76 kg and height of 1.64 m. The mean CPITN score was 2.84. 31.7% of the study population were smokers and 53.8% females. No statistically significant difference was observed in seniors between periodontal treatment needs and systemic diseases. Females exhibited statistically significant more often osteoporosis, thyroid disorders (p<0.001) and hypercholesterolemia (p=0.014) than males. High CPTIN scores were not associated with higher levels of BMI.

Conclusions: Within the limitation of this study, older adults' periodontal treatment needs are not associated significantly with a great number of systemic diseases and body mass index.

Key Words: Seniors, periodontitis, systemic diseases, body mass index (BMI), smoking, Greece.
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http://dx.doi.org/10.4317/jced.52763DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4739365PMC
February 2016

Prevalence of Staphylococcus aureus and methicillin resistant Staphylococcus aureus (MRSA) in the oral cavity.

Arch Oral Biol 2015 Sep 20;60(9):1410-5. Epub 2015 Jun 20.

Department of Preventive Dentistry, Periodontology and Implant Biology, Dental School, Aristotle University of Thessaloniki, Greece.

Objective: To assess the prevalence of Staphylococcus aureus and methicillin resistant Staphylococcus aureus (MRSA) in plaque and tongue samples from systemically healthy subjects with periodontal health, gingivitis or chronic periodontitis.

Methods: After screening 720 potentially eligible subjects, 154 systemically healthy participants were ultimately enrolled in the current study. Subgingival samples were taken from the first molars and the tongue and analyzed for the presence of S. aureus and MRSA by polymerase chain reaction (PCR), using primers and conditions previously described in the literature. In addition, samples were taken from deep periodontal pockets of chronic periodontitis patients. Statistical analysis was performed by applying non-parametric tests (Kruskal-Wallis for clinical parameters, and z-test with Bonferroni corrections for distributions of assessed parameters). All comparisons were set at the 0.05 significance level.

Results: S. aureus was detected in 18% of all participants and in 10% of the samples tested. No significant differences were found in its distribution among the three investigated groups (z-test for proportions with Bonferroni corrections, p>0.05). The mecA gene was not present in any of the S. aureus found.

Conclusions: S. aureus can be found in the oral environment regardless of the periodontal conditions and therefore should be considered as a member of the transient flora not participating in periodontal pathology. Subgingival sites and tongue surfaces seem to be an unusual habitat of MRSA.
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http://dx.doi.org/10.1016/j.archoralbio.2015.06.009DOI Listing
September 2015

Prevalence of antibiotic resistance genes in subjects with successful and failing dental implants. A pilot study.

Open Dent J 2014 6;8:257-63. Epub 2015 Jan 6.

Department of Preventive Dentistry, Periodontology and Implant Biology, Dental School, Aristotle University of Thes-saloniki, Thessaloniki, Greece.

Objectives: To investigate the prevalence of the bacterial genes encoding resistance to beta-lactams, tetracyclines and metronidazole respectively, in subjects with successful and failing dental implants and to assess the presence of Staphylococcus aureus and the mecA gene encoding for Methicillin Resistant Staphylococcus aureus (MRSA) in the same samples.

Materials And Methodology: The subject sample included 20 participants with clinically healthy osseointegrated implants and 20 participants with implants exhibiting peri-implantitis. Clinical parameters were assessed with an automated probe, samples were collected from the peri-implant sulcus or pocket and analyzed with Polymerase Chain Reaction for bla TEM , tetM, tetQ and nim genes, S. aureus and MRSA using primers and conditions previously described in the literature.

Results: Findings have shown high frequencies of detection for both groups for the tetracycline resistance genes tetM (>30%), tetQ (>65%) with no statistical differences between them (z-test with Bonferroni corrections, p<0.05). The bla TEM gene, which encodes resistance to beta-lactams, was detected in <15% of the samples. The nim gene, which encodes resistance to metronidazole, S.aureus and the mecA gene encoding for MRSA were not detected in any of the analyzed samples.

Conclusions: Healthy peri-implant sulci and peri-implantitis cases often harbor bacterial genes encoding for resistance to the tetracyclines and less often for beta-lactams. Thus, the antimicrobial activity of the tetracyclines and to a lower extent to beta-lactams, might be compromised for treatment of peri-implantitis. Since no metronidazole resistance genes were detected in the present study, its clinical use is supported by the current findings. S.aureus may not participate in peri-implant pathology.
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http://dx.doi.org/10.2174/1874210601408010257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311380PMC
February 2015

Effects of doxycycline on clinical, microbiological and immunological parameters in well-controlled diabetes type-2 patients with periodontal disease: a randomized, controlled clinical trial.

J Clin Periodontol 2014 Oct 3;41(10):972-80. Epub 2014 Sep 3.

Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Aim: To evaluate the clinical, microbiological and immunological effects of systemic doxycycline as an adjunct to scaling and root planing (SRP) in chronic periodontitis patients with well-controlled type 2 diabetes.

Materials And Methods: Sixty-six patients compliant to oral hygiene (Hygiene Index <20%) allocated to either a test (systemic doxycycline for 21 days) or a control (placebo) group participated in the present randomized controlled trial (RCT). Clinical assessments were recorded at baseline, 3 and 6 months after therapy and included clinical attachment level (CAL), set as the primary outcome of the study, probing pocket depth (PPD), recession (RE) and bleeding on probing (BOP). At the same time points, counts of 15 subgingival species were evaluated by "checkerboard" DNA-DNA hybridization, gingival crevicular fluid samples were analysed for matrix metalloproteinase-8 (MMP-8) by ELISA and HbA1c levels were determined. Comparisons between and within groups were performed by non-parametric tests (Mann-Whitney, Wilcoxon signed-ranks and z-test for proportions with Bonferroni corrections) at the 0.05 level.

Results: No major differences were noticed in clinical and microbiological parameters of periodontal disease or levels of MMP-8 between the two groups.

Conclusions: Adjunctive systemic doxycycline does not seem to significantly enhance the effects of SRP in well-controlled diabetes type 2 patients.
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http://dx.doi.org/10.1111/jcpe.12287DOI Listing
October 2014

Immunological and microbiological findings after the application of two periodontal surgical techniques: a randomized, controlled clinical trial.

J Clin Periodontol 2013 Nov 22;40(11):1036-42. Epub 2013 Aug 22.

Department of Preventive Dentistry, Periodontology and Implant Biology, Dental School, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Aim: To examine microbiological and immunological alterations following two periodontal surgical techniques, over a 6-month period.

Materials And Methods: A total of 30 chronic periodontitis patients participated in the present randomized controlled clinical trial and were randomized in two groups. Modified Widman flap (MWF) was applied in the control group and apically positioned flap (APF), without intervention to the bone, in the experimental group. Gingival crevicular fluid samples and subgingival plaque samples from the operated sites were collected at baseline, 6th, 12th and 24th post-operative week.

Results: No major differences were noticed in immunological and microbiological profile of patients receiving either modified MWF or APF, for a period of 6 months.

Conclusions: The choice of the periodontal surgical procedure does not seem to affect the immunological and the microbiological profile of patients with chronic periodontitis.
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http://dx.doi.org/10.1111/jcpe.12149DOI Listing
November 2013

Crestal bone resorption after the application of two periodontal surgical techniques: a randomized, controlled clinical trial.

J Clin Periodontol 2012 Oct 30;39(10):971-8. Epub 2012 Jul 30.

Department of Preventive Dentistry, Periodontology and Implant Biology, Dental School, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Aim: To radiographically assess, by means of digital subtraction radiography, crestal bone loss following two periodontal surgical techniques, over a period of 6 months.

Material And Methods: A total of 30 chronic periodontitis patients participated in this randomized controlled clinical trial and were separated into two groups. Modified Widman flap was applied in the control group and apically positioned flap, without intervention to the bone, in the experimental group. Clinical measurements (plaque index, gingival bleeding index, probing pocket depth and clinical attachment level) were recorded at baseline, 6 weeks, 3 and 6 months after surgery. Digital radiographs were taken at baseline, 1, 3, 6 weeks, 3 and 6 months after surgical treatment and subtracted digitally in pairs.

Results: Both groups showed statistically significant improvement of clinical parameters. Statistically significant differences between the two groups were observed only in probing pocket depth (PPD) at 6 weeks interval, where the test group showed more reduction (smallest statistically significant differences observed, SSSDO = 0.64). Both groups showed the same rate of crestal bone resorption.

Conclusions: Bone resorption of the alveolar crest is a phenomenon that is observed as a consequence of periodontal surgical treatment without significant differences between the two techniques. Furthermore, both surgical techniques lead to satisfactory clinical results, indicating that bone removal during periodontal surgical treatment is not always necessary.
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http://dx.doi.org/10.1111/j.1600-051X.2012.01928.xDOI Listing
October 2012

Clinical, radiographic, microbiological, and immunological outcomes of flapped vs. flapless dental implants: a prospective randomized controlled clinical trial.

Clin Oral Implants Res 2013 Sep 18;24(9):969-76. Epub 2012 Jun 18.

Department of Preventive Dentistry, Periodontology & Implant Biology, School of Dentistry, Aristotle University, Thessaloniki, Greece.

Objectives: The objective of this study was to compare the placement of flapped vs. flapless dental implants utilizing clinical, radiographic, microbiological, and immunological parameters.

Material And Methods: A total of 20 patients received 30 dental implants following a one-stage protocol. The patients were randomly assigned into two study groups: control group with 15 flapped implants and test group with 15 flapless implants. Follow-up examinations were carried out after 1, 2, 6, and 12 weeks. Clinical recordings, sulcular fluid sampling, microbiological analysis, and digital subtraction radiography were utilized to compare the two surgical approaches.

Results: Peri-implant sulcus depth was significantly greater in flapped implants at both 6 and 12 postsurgical weeks (P < 0.001). Flapped implants showed crestal bone loss (0.29 ± 0.06 mm), whereas no bone resorption was detected around flapless implants. Matrix metalloproteinase-8 values were higher to a statistically significant level in the control group at 1 (P = 0.003) and 6 weeks (P = 0.007) after placement. In the test group, the presence of Porphyromonas gingivalis was significantly higher at the 2nd postoperative week (P = 0.005), whereas the counts of Tannerella forsythia were significantly elevated at the 1st (P = 0.005), 2nd (P = 0.001), and 12th (P = 0.002) postoperative weeks, possibly indicating an earlier formation and maturation of the peri-implant sulcus. Patients reported more pain after flapped implant placement.

Conclusions: Flapless implant placement yielded improved clinical, radiographic, and immunological outcomes compared with flapped implantation. In addition, patients seem to better withstand flapless implant placement.
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http://dx.doi.org/10.1111/j.1600-0501.2012.02503.xDOI Listing
September 2013

The effect of age on the gingival crevicular fluid composition during experimental gingivitis. A pilot study.

Authors:
Lazaros Tsalikis

Open Dent J 2010 Mar 1;4:13-26. Epub 2010 Mar 1.

Department of Preventive Dentistry, Periodontology and Implant Biology, Dental School Aristotle, University of Thessaloniki, Greece.

Background: Cytokines have been proposed as potentially useful diagnostic or prognostic markers of periodontal inflammation related alterations during the experimental gingivitis model. The role of ageing in periodontal disease needs further elucidation; therefore investigations of its influence on host response are needed.

Objective: To study the effect of age on interleukins IL -6, IL-8 and TNF-a levels in gingival crevicular fluid (GCF) and their correlations to clinical parameters during experimental gingivitis.

Materials And Methods: Five young subjects (20-22 years old) and five old subjects (61-65 years old), all periodontal healthy, participated in this clinical trial. A professional plaque control programme was undertaken to establish healthy gingival conditions at baseline. Plaque index (PI), gingival index (GI) were recorded at 60 sites at baseline, after 21 days of no oral hygiene and one week later after professional cleaning and reestablishment of oral hygiene procedures. A total of 180 samples were analyzed with ELISA for levels of IL -6, IL-8 and TNF-a in gingival crevicular fluid. The examination included the mesiobuccal sites of the Ramfjord teeth. Comparisons between and within groups were performed by non-parametric tests (Mann- Withney) and correlations were sought for with Wilcoxon test. Significance was set at p=0.05.

Results: Results showed significant diferences between the two groups with regard to the plaque and bleeding scores and GCF volume, all of which proved to be more pronounced in old group. With respect to laboratory data, mean cytokine concentrations were in general lower in young group. TNF-a had a steady increase for the adults, which was found to be statistically significant between Days 0 and 21, IL-8 showed a statistically significant decrease at Day 28 in the young group and finally IL-6 showed a fluctuation, which was totally adverse for the two groups at each time point.

Conclusion: Within the limitations of the present study, age cannot be identified as a factor that strongly affects the cytokine expression and fluctuations even in a well-controlled environment of inflammation, such as experimental gingivitis.
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http://dx.doi.org/10.2174/1874210601004010013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874215PMC
March 2010

The influence of sex steroid hormones on gingiva of women.

Open Dent J 2009 Jun 5;3:114-9. Epub 2009 Jun 5.

Department of Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Greece.

Steroid sex hormones have a significant effect on different organ systems. As far as gingiva are concerned, they can influence the cellular proliferation, differentiation and growth of keratinocytes and fibroblasts. Estrogen is mainly responsible for alterations in blood vessels and progesterone stimulates the production of inflammatory mediators. In addition, some micro-organisms found in the human mouth synthesize enzymes needed for steroid synthesis and catabolism. In women, during puberty, ovulation and pregnancy, there is an increase in the production of sex steroid hormones which results in increased gingival inflammation, characterized by gingival enlargement, increased gingival bleeding and crevicular fluid flow and microbial changes.
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http://dx.doi.org/10.2174/1874210600903010114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2758498PMC
June 2009

The effect of osteoporosis on periodontal status, alveolar bone and orthodontic tooth movement. A literature review.

J Int Acad Periodontol 2007 Jul;9(3):77-84

Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, Greece.

Osteoporosis, an age-related condition, is defined as a systemic skeletal disease characterized by low bone mass and micro-architectural deterioration with a consequent increase in bone fragility and susceptibility to fracture. It is considered the most common bone metabolic disease and it constitutes a major public health problem. Several studies indicate that osteoporosis may be related to decreased oral bone density and alveolar bone loss. In osteoporotic patients, uncoupling of bone resorption and bone formation has taken place. Both bone resorption and bone formation are accelerated, and excessive bone resorption usually leads to loss of attachment. Osteoporosis could also affect the rate of tooth movement through the involvement of alveolar bone. In healthy individuals, bone is constantly being remodeled in the coupled sequence of bone resorption and formation. When a force is applied to a tooth, alveolar bone formation and resorption occur predominantly on the tension and pressure sides of the root, respectively, and the tooth moves with increased alveolar bone remodeling. Experimental studies suggest that systemic-osteoporotic hormone imbalance increases bone turnover and accelerates tooth movement while under orthodontic treatment. Based on these observations it can be concluded that deviations in bone turnover and consequent periodontal problems influence the response to orthodontic forces, and this should be taken into consideration when planning orthodontic treatment in adult patients with metabolic bone disease, especially postmenopausal females or those on chronic medication affecting bone metabolism.
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July 2007

Orthodontic and periodontal considerations in managing teeth exhibiting significant delay in eruption.

World J Orthod 2004 ;5(3):224-9

Department of Orthodontics, Dental School, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Aim: Significant delay in tooth eruption may be observed in many orthodontic patients. This delay may lead to complications, such as devitalization, ankylosis, external root resorption, injury to the adjacent teeth, and mucogingival problems. These complications may result in prolonged treatment time, esthetic deformities, damage to the periodontal tissues, and tooth loss. This report investigates the special considerations needed in treating such cases.

Methods: Combined orthodontic and surgical treatment can be used in managing teeth exhibiting significant delay in eruption.

Results: A high rate of success can be achieved in terms of esthetics, occlusion, and periodontal health.

Conclusion: Nontraumatic surgery, adequate control of gingival inflammation, and use of minimal orthodontic forces may ensure a higher percentage of success and prevention of problems associated with teeth exhibiting significant delay in eruption.
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January 2005

Association of gingival crevicular fluid and serum intracytoplasmic enzyme levels in periodontally healthy homozygous (major) beta-thalassemia patients.

J Clin Periodontol 2004 May;31(5):356-63

Department of Preventive Dentistry, Periodontology and Implant Biology, Dental School, Aristotle University of Thessaloniki, Greece.

Objective: To assess tissue necrosis in beta-thalassemia major patients, as in other areas of medicine, lactate dehydrogenase (LDH), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) have been widely used. These markers of tissue degradation have also been studied in the gingival crevicular fluid (GCF) in relation to periodontal disease status. The purpose of this study was to investigate whether periodontal diagnostic tests based on these markers of tissue degradation are influenced from the enzymes' levels in serum and, therefore, could be used in the assessment of the patient's periodontal status.

Material And Methods: Forty-four periodontally healthy, homozygous beta-thalassemia patients were enrolled in the study. GCF and serum samples were obtained and the levels of AST, ALT and LDH were determined; the measurements took place in an automated analyzer (Hitachi 777) using the kits of Roche Company.

Results: Lack of correlations between serum and GCF enzyme levels was demonstrated. Serum LDH and serum AST, serum AST and serum ALT are significantly positively correlated. Concerning the GCF, AST and ALT were proved to be significantly positively correlated.

Conclusions: Elevated values of LDH, ALT and AST in serum do not constitute a confounding factor in GCF measurements of the respective enzymes.
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http://dx.doi.org/10.1111/j.1600-051X.2004.00485.xDOI Listing
May 2004

Effects of orthodontic treatment on gingival crevicular fluid flow rate and composition: clinical implications and applications.

Int J Adult Orthodon Orthognath Surg 2002 ;17(3):191-205

Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, Greece.

The gingival crevicular fluid (GCF) flow rate and composition vary according to the condition of the periodontal tissues. The levels of some of its constituents have been shown to correlate with the actual clinical measurements of periodontal disease progression and reflect changes occurring deep in the periodontium. During the course of orthodontic treatment, the forces exerted produce a distortion of the periodontal ligament extracellular matrix, resulting in alterations in cellular shape and cytoskeletal configuration. Such events lead to the synthesis and presence in the deeper periodontal tissues of extracellular matrix components, tissue-degrading enzymes, acids, and inflammatory mediators; induce cellular proliferation and differentiation; and promote wound healing and tissue remodeling. These changes may modify both the GCF flow rate and its components. Consequently, analysis of GCF samples may provide a better understanding of the biochemical processes associated with tooth movement and may help the clinician make therapeutic choices based on qualitative and quantitative information.
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March 2003