Correlation of periodontal inflamed surface area with glycated hemoglobin,interleukin-6 and lipoprotein(a)in type 2 diabetes with retinopathy

BACKGROUND The two-way relationship between periodontitis and type 2 diabetes mellitus(T2DM)is well established.Prolonged hyperglycemia contributes to increased periodontal destruction and severe periodontitis,accentuating diabetic complications.An inflammatory link exists between diabetic retinopathy(DR)and periodontitis,but the studies regarding this association and the role of lipoprotein(a)[Lp(a)]and interleukin-6(IL-6)in these conditions are scarce in the literature.AIM To determine the correlation of periodontal inflamed surface area(PISA)with glycated Hb(HbA1c),serum IL-6 and Lp(a)in T2DM subjects with retinopathy.METHODS This cross-sectional study comprised 40 T2DM subjects with DR and 40 T2DM subjects without DR.All subjects were assessed for periodontal parameters[bleeding on probing(BOP),probing pocket depth,clinical attachment loss(CAL),oral hygiene index-simplified,plaque index(PI)and PISA],and systemic parameters[HbA1c,fasting plasma glucose and postprandial plasma glucose,fasting lipid profile,serum IL-6 and serum Lp(a)].RESULTS The proportion of periodontitis in T2DM with and without DR was 47.5%and 27.5%respectively.Severity of periodontitis,CAL,PISA,IL-6 and Lp(a)were higher in T2DM with DR group compared to T2DM without DR group.Significant difference was observed in the mean percentage of sites with BOP between T2DM with DR(69%)and T2DM without DR(41%),but there was no significant difference in PI(P>0.05).HbA1c was positively correlated with CAL(r=0.351,P=0.001),and PISA(r=0.393,P≤0.001)in study subjects.A positive correlation was found between PISA and IL-6(r=0.651,P<0.0001);PISA and Lp(a)(r=0.59,P<0.001);CAL and IL-6(r=0.527,P<0.0001)and CAL and Lp(a)(r=0.631,P<0.001)among study subjects.CONCLUSION Despite both groups having poor glycemic control and comparable plaque scores,the periodontal parameters were higher in DR as compared to T2DM without DR.Since a bidirectional link exists between periodontitis and DM,the presence of DR may have contributed to the severity of periodontal destruction and periodontitis may have influenced the progression of DR.

Classification and detection of dental images using meta-learning

Meta-learning of dental X-rays is a machine learning technique that can be used to train models to perform new tasks quickly and with minimal input.Instead of just memorizing a task,this is accomplished through teaching a model how to learn.Algorithms for meta-learning are typically trained on a collection of training problems,each of which has a limited number of labelled instances.Multiple Xray classification tasks,including the detection of pneumonia,coronavirus disease 2019,and other disorders,have demonstrated the effectiveness of meta-learning.Meta-learning has the benefit of allowing models to be trained on dental X-ray datasets that are too few for more conventional machine learning methods.Due to the high cost and lengthy collection process associated with dental imaging datasets,this is significant for dental X-ray classification jobs.The ability to train models that are more resistant to fresh input is another benefit of meta-learning.

Effects of interleukin-10 treated macrophages on bone marrow mesenchymal stem cells via signal transducer and activator of transcription 3 pathway

BACKGROUND Alveolar bone defects caused by inflammation are an urgent issue in oral implant surgery that must be solved.Regulating the various phenotypes of macrophages to enhance the inflammatory environment can significantly affect the progression of diseases and tissue engineering repair process.AIM To assess the influence of interleukin-10(IL-10)on the osteogenic differentiation of bone marrow mesenchymal stem cells(BMSCs)following their interaction with macrophages in an inflammatory environment.METHODS IL-10 modulates the differentiation of peritoneal macrophages in Wistar rats in an inflammatory environment.In this study,we investigated its impact on the proliferation,migration,and osteogenesis of BMSCs.The expression levels of signal transducer and activator of transcription 3(STAT3)and its activated form,phos-phorylated-STAT3,were examined in IL-10-stimulated macrophages.Subsequently,a specific STAT3 signaling inhibitor was used to impede STAT3 signal activation to further investigate the role of STAT3 signaling.RESULTS IL-10-stimulated macrophages underwent polarization to the M2 type through substitution,and these M2 macrophages actively facilitated the osteogenic differentiation of BMSCs.Mechanistically,STAT3 signaling plays a crucial role in the process by which IL-10 influences macrophages.Specifically,IL-10 stimulated the activation of the STAT3 signaling pathway and reduced the macrophage inflammatory response,as evidenced by its diminished impact on the osteogenic differentiation of BMSCs.CONCLUSION Stimulating macrophages with IL-10 proved effective in improving the inflammatory environment and promoting the osteogenic differentiation of BMSCs.The IL-10/STAT3 signaling pathway has emerged as a key regulator in the macrophage-mediated control of BMSCs’osteogenic differentiation.

Evolution,current status and advances in application of platelet concentrate in periodontics and implantology

Platelet concentrates(PC) [platelet-rich plasma(PRP) and platelet-rich fibrin(PRF)] are frequently used for surgical procedures in medical and dental fields,particularly in oral and maxillofacial surgery,plastic surgery and sports medicine.The objective of all these technologies is to extract all the elements from a blood sample that could be used to improve healing and promote tissue regeneration.Although leukocyte rich and leukocyte poor PRP's have their own place in literature,the importance of non-platelet components in a platelet concentrate remains a mystery.PC have come a long way since its first appearance in 1954 to the T-PRF,A-PRF and i-PRF introduced recently.These PC find varied applications successfully in periodontics and implant dentistry as well.However,the technique of preparation,standing time,transfer process,temperature of centrifuge,vibration,etc.,are the various factors for the mixed results reported in the literature.Until the introduction of a proper classification of terminologies,the PC were known by different names in different countries and by different commercial companies which also created a lot of confusion.This review intends to clarify all these confusion by briefing the exact evolution of PC,their preparation techniques,recent advances and their various clinical and technical aspects and applications.

Porphyromonas gingivalis bacteremia increases the permeability of the blood-brain barrier via the Mfsd2a/Caveolin-1 mediated transcytosis pathway

Bacteremia induced by periodontal infection is an important factor for periodontitis to threaten general health. P. gingivalis DNA/virulence factors have been found in the brain tissues from patients with Alzheimer’s disease(AD). The blood-brain barrier(BBB) is essential for keeping toxic substances from entering brain tissues. However, the effect of P. gingivalis bacteremia on BBB permeability and its underlying mechanism remains unclear. In the present study, rats were injected by tail vein with P. gingivalis three times a week for eight weeks to induce bacteremia. An in vitro BBB model infected with P. gingivalis was also established. We found that the infiltration of Evans blue dye and Albumin protein deposition in the rat brain tissues were increased in the rat brain tissues with P. gingivalis bacteremia and P. gingivalis could pass through the in vitro BBB model. Caveolae were detected after P. gingivalis infection in BMECs both in vivo and in vitro. Caveolin-1(Cav-1) expression was enhanced after P. gingivalis infection.Downregulation of Cav-1 rescued P. gingivalis-enhanced BMECs permeability. We further found P. gingivalis-gingipain could be colocalized with Cav-1 and the strong hydrogen bonding between Cav-1 and arg-specific-gingipain(RgpA) were detected.Moreover, P. gingivalis significantly inhibited the major facilitator superfamily domain containing 2a(Mfsd2a) expression. Mfsd2a overexpression reversed P. gingivalis-increased BMECs permeability and Cav-1 expression. These results revealed that Mfsd2a/Cav-1 mediated transcytosis is a key pathway governing BBB BMECs permeability induced by P. gingivalis, which may contribute to P. gingivalis/virulence factors entrance and the subsequent neurological impairments.

High incidence of periodontitis in patients with ascitic decompensated cirrhosis

BACKGROUND Periodontitis has been associated with various liver diseases.However,the relevance of periodontitis in the progression of decompensated cirrhosis remains inconclusive.In particular,it is unclear whether the common periodontitis pathogens,Porphyromonas gingivalis(P.gingivalis)and Actinobacillus actinomycetemcomitans(A.actinomycetemcomitans),can be detected not only in the oral mucosa but also in ascites and stool.AIM To investigate the significance of periodontitis,P.gingivalis,and A.actinomycetemcomitans in cirrhosis patients with ascitic decompensation.METHODS This prospective study was conducted at the University Hospital Hamburg Eppendorf,a tertiary center in Northern Germany.A cohort of 27 patients with ascitic decompensated liver cirrhosis underwent dental examinations to assess the association between periodontitis and various clinical parameters of cirrhosis,as well as patient outcomes.PCR was used to test gingival samples,ascites,and stool for the presence of P.gingivalis and A.actinomycetemcomitans.Gingival samples were collected by probing the deepest gum pocket of a sextant and wiping them on a cotton swab.RESULTS Periodontitis was diagnosed in 22 out of 27(82%)ascite patients,which is significantly more common than in a control cohort of 100 unselected patients(59%,P=0.04).P.gingivalis was detected in the gingiva of six patients,and one of them also had P.gingivalis in their stool.However,P.gingivalis was not found in the ascites of any patient.Five out of six patients with P.gingivalis had periodontitis(83%).A.actinomycetemcomitans was not detected in any sample.Patients without periodontitis had a significantly higher mortality rate compared to those with periodontitis,and survival(Kaplan-Meier analysis)was longer in patients with periodontitis(P=0.02).Transplantfree survival was also more common in patients with periodontitis compared to those without(63%vs 0%,P=0.02).CONCLUSION Decompensated cirrhotic patients frequently suffer from periodontitis.However,there was no evidence of the translocation of P.gingivalis or A.actinomycetemcomitans into ascites.The survival of cirrhotic patients with periodontitis was not reduced.

Expert consensus on odontogenic maxillary sinusitis multi-disciplinary treatment

Odontogenic maxillary sinusitis (OMS) is a subtype of maxillary sinusitis (MS). It is actually inflammation of the maxillary sinus that secondary to adjacent infectious maxillary dental lesion. Due to the lack of unique clinical features, OMS is difficult to distinguish from other types of rhinosinusitis. Besides, the characteristic infectious pathogeny of OMS makes it is resistant to conventional therapies of rhinosinusitis. Its current diagnosis and treatment are thus facing great difficulties. The multi-disciplinary cooperation between otolaryngologists and dentists is absolutely urgent to settle these questions and to acquire standardized diagnostic and treatment regimen for OMS. However, this disease has actually received little attention and has been underrepresented by relatively low publication volume and quality. Based on systematically reviewed literature and practical experiences of expert members, our consensus focuses on characteristics, symptoms, classification and diagnosis of OMS, and further put forward multidisciplinary treatment decisions for OMS, as well as the common treatment complications and relative managements. This consensus aims to increase attention to OMS, and optimize the clinical diagnosis and decision-making of OMS, which finally provides evidence-based options for OMS clinical management.

Single-cell transcriptomics reveals cell atlas and identifies cycling tumor cells responsible for recurrence in ameloblastoma

Ameloblastoma is a benign tumor characterized by locally invasive phenotypes,leading to facial bone destruction and a high recurrence rate.However,the mechanisms governing tumor initiation and recurrence are poorly understood.Here,we uncovered cellular landscapes and mechanisms that underlie tumor recurrence in ameloblastoma at single-cell resolution.Our results revealed that ameloblastoma exhibits five tumor subpopulations varying with respect to immune response(IR),bone remodeling(BR),tooth development(TD),epithelial development(ED),and cell cycle(CC)signatures.Of note,we found that CC ameloblastoma cells were endowed with stemness and contributed to tumor recurrence,which was dominated by the EZH2-mediated program.Targeting EZH2 effectively eliminated CC ameloblastoma cells and inhibited tumor growth in ameloblastoma patient-derived organoids.These data described the tumor subpopulation and clarified the identity,function,and regulatory mechanism of CC ameloblastoma cells,providing a potential therapeutic target for ameloblastoma.

Role of dental plaque,saliva and periodontal disease in Helicobacter pylori infection

Helicobacter pylori (H. pylori) infection is one of the most common bacterial infections in humans. Although H. pylori may be detected in the stomach of approximately half of the world&#x02019;s population, the mechanisms of transmission of the microorganism from individual to individual are not yet clear. Transmission of H. pylori could occur through iatrogenic, fecal-oral, and oral-oral routes, and through food and water. The microorganism may be transmitted orally and has been detected in dental plaque and saliva. However, the role of the oral cavity in the transmission and recurrence of H. pylori infection has been the subject of debate. A large number of studies investigating the role of oral hygiene and periodontal disease in H. pylori infection have varied significantly in terms of their methodology and sample population, resulting in a wide variation in the reported results. Nevertheless, recent studies have not only shown that the microorganism can be detected fairly consistently from the oral cavity but also demonstrated that the chances of recurrence of H. pylori infection is more likely among patients who harbor the organism in the oral cavity. Furthermore, initial results from clinical trials have shown that H. pylori-positive dyspeptic patients may benefit from periodontal therapy. This paper attempts to review the current body of evidence regarding the role of dental plaque, saliva, and periodontal disease in H. pylori infection.

Bone morphogenetic protein-2 gene controls tooth root development in coordination with formation of the periodontium

Formation of the periodontium begins following onset of tooth-root formation in a coordinated manner after birth. Dental follicle progenitor cells are thought to form the cementum, alveolar bone and Sharpey＇s fibers of the periodontal ligament （PDL）. However, little is known about the regulatory morphogens that control differentiation and function of these progenitor cells, as well as the progenitor cells involved in crown and root formation. We investigated the role of bone morphogenetic protein-2 （Bmp2） in these processes by the conditional removal of the Bmp2 gene using the Sp7-Cre-EGFP mouse model. Sp7-Cre-EGFP first becomes active at E18 in the first molar, with robust Cre activity at postnatal day 0 （PO）, followed by Cre activity in the second molar, which occurs after P0. There is robust Cre activity in the periodontium and third molars by 2 weeks of age. When the Bmp2gene is removed from Sp7＋ （Osterix＋） cells, major defects are noted in root, cellular cementum and periodontium formation. First, there are major cell autonomous defects in root-odontoblast terminal differentiation. Second, there are major alterations in formation of the PDLs and cellular cementum, correlated with decreased nuclear factor IC （Nfic）, periostin and α-SMA＋ cells. Third, there is a failure to produce vascular endothelial growth factor A （VEGF-A） in the periodontium and the pulp leading to decreased formation of the microvascular and associated candidate stem cells in the Bmp2-cKOsp7-cre＇EGFe. Fourth, ameloblast function and enamel formation are indirectly altered in the Bmp2-cKOsp7-cre＇EGFe. These data demonstrate that the Bmp2 gene has complex roles in postnatal tooth development and periodontium formation.

Expression of RUNX2 and MDM21 in rats with periodontitis under chronic intermittent hypoxia

Objective: To discuss the expression of RUNX2 and MDM21 in rats with periodontitis under the chronic intermittent hypoxia. Methods: A total of 32 SD healthy rats were randomly divided into four groups, with 8 rats in each group. The molecular biological techniques of immunohistochemistry, RT-PCR and Western blotting were employed to detect the effect of different hypoxia time(0, 6, 12, 24 and 48 h) and different concentrations of hypoxia(0.000, 0.001, 0.010, 0.060 and 0.100 ppm) on the expression of RUNX2 and MDM21 in rats of four groups. Results: The expression of RUNX2 and MDM21 in each group was significantly higher than the one at other concentrations when the concentration was 0.010 ppm, with the statistical difference(P<0.05). The expression of RUNX2 and MDM21 was that normoxic control group > periodontitis group> chronic intermittent hypoxia group > compound group under the action with the concentration of 0.010 ppm for 12 h, but there was no significant difference for the comparison among groups(P>0.05). Conclusions: The condition of chronic intermittent hypoxia can reduce the expression of RUNX2 and MDM21 in rats with periodontitis and aggravate the damage of periodontal bone.

The dimension and morphology of alveolar bone at maxillaryanterior teeth in periodontitis: a retrospective analysis usingCBCT

The morphology of the alveolar bone at the maxillary anterior teeth in periodontitis patients was evaluated by cone-beam computed tomography(CBCT) to investigate the distribution of alveolar defects and provide guidance for clinical practice. Ninety periodontitis patients and 30 periodontally healthy individuals were selected to determine the morphology of the alveolar bone at the maxillary anterior teeth according to the degree of bone loss, tooth type, sex and age. The differences in the dimensions between periodontitis patients and healthy individuals were compared, and the distribution of alveolar bone defects was analyzed.A classification system was established regarding the sagittal positions and angulations of the teeth. The buccal residual bone was thicker and the lingual bone was thinner in the periodontitis patients than in the periodontally healthy individuals, and there were differences between the different tooth types, sexes and age subgroups. The buccal undercut was close to the alveolar ridge, while fenestration was reduced and the apical bone height was higher in periodontitis patients than in periodontally healthy individuals.The apical bone height increased with the aggravation of bone loss and age. The proportions of different sagittal positions changed with the aggravation of bone loss. Moreover, the teeth moved more buccally regarding the positions of the maxillary anterior teeth.The morphology of the alveolar bone at the maxillary anterior teeth differed between periodontitis patients and healthy individuals,and the differences were related to the degree of bone loss, tooth type, sex and age.

Gingival enlargements: Differential diagnosis and review of literature

Gingival enlargement is one of the frequent features of gingival diseases. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. They can be categorized based on their etiopathogenesis, location, size, extent, etc. Based on the existing knowledge and clinical experience, a differential diagnosis can be formulated. Subsequently, after detailed investigation, clinician makes a final diagnosis or diagnosis of exclusion. A perfect diagnosis is critically important, since the management of these lesions and prevention of their recurrence is completely dependent on it. Furthermore, in some cases where gingival enlargement could be the primary sign of potentially lethal systemic diseases, a correct diagnosis of these enlargements could prove life saving for the patient or at least initiate early treatment and improve the quality of life. The purpose of this review article is to highlight significant findings of different types of gingival enlargement which would help clinician to differentiate between them. A detailed decision tree is also designed for the practitioners, which will help them arrive at a diagnosis in a systematic manner. There still could be some lesions which may present in an unusual manner and make the diagnosis challenging. By knowing the existence of common and rare presentations of gingival enlargement, one can keep a broad view when formulating a differential diagnosis of localized(isolated, discrete, regional) or generalized gingival enlargement.

Evaluation of anatomical considerations in the posterior maxillae for sinus augmentation

The edentulous posterior maxilla is considered a clinical challenge during dental implant treatment for many dental practitioners. This is because its insufficient bone quality, deficient alveolar ridge, spiny ridges, undercuts, and sinus pneumatization are often encountered after tooth loss. To overcome these problems, several approaches have been developed and are currently used, including sinus augmentation and bone augmentation. Today, two main procedures of sinus floor elevation for dental implant placement are in use: a two-stage technique using the lateral window approach, and a onestage technique using a lateral or a crestal approach. In this study, we deal with the anatomic relations ofthe structures of the maxillary sinus during sinus augmentation. These anatomical findings can help in complications and potential injuries of the maxillary sinus procedures. It can be suggested that pre-operative evaluation is helpful for diagnosis and treatment planning and minimizing complication during the surgery.

Juxtacrine interaction of macrophages and bone marrow stromal cells induce interleukin-6 signals and promote cell migration

The bone marrow contains a heterogeneous milieu of cells, including macrophages, which are key cellular mediators for resolving infection and inflammation. Macrophages are most well known for their ability to phagocytose foreign bodies or apoptotic cells to maintain homeostasis; however, little is known about their function in the bone microenvironment. In the current study, we investigated the in vitro interaction of murine macrophages and bone marrow stromal cells （BMSCs）, with focus on the juxtacrine induction of IL-6 signaling and the resultant effect on BMSC migration and growth. The juxtacrine interaction of primary mouse macrophages and BMSCs activated IL-6 signaling in the co-cultures, which subsequently enhanced BMSC migration and increased BMSC numbers. BMSCs and macrophages harvested from IL-6 knockout mice revealed that IL-6 signaling was essential for enhancement of BMSC migration and increased BMSC numbers via juxtacrine interactions. BMSCs were the main contributor of IL-6 signaling~ and hence activation of the IL-6/ gp130/STAT3 pathway. Meanwhile, macrophage derived IL-6 remained important for the overall production of IL-6 protein in the co-cultures. Taken together, these findings show the function of macmphages as co-inducers of migration and growth of BMSCs, which could directly influence bone formation and turnover.

Periodontitis combined with smoking increases risk of the ulcerative colitis: A national cohort study

BACKGROUND Periodontitis is a chronic inflammation of periodontal tissues.The effect of periodontitis on the development of inflammatory bowel disease(IBD)remains unclear.AIM To assessed the risk of IBD among patients with periodontitis,and the risk factors for IBD related to periodontitis.METHODS A nationwide population-based cohort study was performed using claims data from the Korean National Healthcare Insurance Service.In total,9950548 individuals aged≥20 years who underwent national health screening in 2009 were included.Newly diagnosed IBD[Crohn’s disease(CD),ulcerative colitis(UC)]using the International Classification of Disease 10th revision and rare intractable disease codes,was compared between the periodontitis and nonperiodontitis groups until 2017.RESULTS A total of 1092825 individuals(11.0%)had periodontitis.Periodontitis was significantly associated with older age,male gender,higher body mass index,quitting smoking,not drinking alcohol,and regular exercise.The mean age was 51.4±12.9 years in the periodontitis group and 46.6±14.2 years in the nonperiodontitis group(P<0.01),respectively.The mean body mass index was 23.9±3.1 and 23.7±3.2 in the periodontitis and non-periodontitis groups,respectively(P<0.01).Men were 604307(55.3%)and 4844383(54.7%)in the periodontitis and non-periodontitis groups,respectively.The mean follow-up duration was 7.26 years.Individuals with periodontitis had a significantly higher risk of UC than those without periodontitis[adjusted hazard ratio:1.091;95%confidence interval(CI):1.008-1.182],but not CD(adjusted hazard ratio:0.879;95%confidence interval:0.731-1.057).The risks for UC were significant in the subgroups of age≥65 years,male gender,alcohol drinker,current smoker,and reduced physical activity.Current smokers aged≥65 years with periodontitis were at a 1.9-fold increased risk of UC than non-smokers aged≥65 years without periodontitis.CONCLUSION Periodontitis was significantly associated with the risk of developing UC,but not CD,particularly in current smokers aged≥65 years.

Effect of acid etching on marginal adaptation of mineral trioxide aggregate to apical dentin:microcomputed tomography and scanning electron microscopy analysis

The present investigation assessed the effect of acid etching on marginal adaptation of white- and gray-colored mineral trioxide aggregate （MTA） to apical dentin using microcomputed tomography （micro-CT） and scanning electron microscopy （SEM）. Sixty-four extracted single-rooted human maxillary teeth were used. Following root-end resection and apical preparation, the teeth were equally divided into four groups according to the following root end filling materials： （i） white-colored MTA （WMTA）, （ii） etched WMTA （EWMTA）, （iii） gray-colored MTA （GMTA） and （iv） etched GMTA （EGMTA）. After 48 h, the interface between root-end filling materials and the dentinal walls was assessed using micro-CT and SEM. Data were statistically analyzed using the KruskaI-Wallis and Dunn tests. Micro-CT analysis revealed gap volumes between the apical cavity dentin walls and EGMTA, GMTA, EWMTA and WMTA of （0.007 1±0.004） mm3, （0.053±0.002） mm3, （0.003 6±0.001） mm3 and （0.005 9±0.002） mm3 respectively. SEM analysis revealed gap sizes for EGMTA, WMTA, EWMTA and GMTA to be （492.3±13.8） μm, （594.5±17.12）μm, （543.1±15.33） μm and （910.7±26.2）μm respectively. A significant difference in gap size between root end preparations filled with GMTA and EGMTA was found （P〈O.05）. No significance difference in gap size between WMTA and EWMTA were found in either SEM or micro-CT analysis. In conclusion, pre-etching of apical dentin can provide a better seal for GMTA but not for WMTA.

Correlation of periodontal inflamed surface area with glycemic status in controlled and uncontrolled type 2 diabetes mellitus

BACKGROUND The bidirectional link between periodontitis and diabetes mellitus(DM)has been established.Periodontitis causes systemic inflammatory burden through inflammatory mediators.The currently utilized tools[clinical attachment loss(CAL)and probing pocket depth(PPD)]are linear measurements,that do not exactly quantify the inflammatory burden of periodontitis.Periodontal inflamed surface area(PISA)quantifies the surface area of bleeding pocket epithelium and estimates the inflammatory burden.Studies relating to the periodontal status of diabetic patients with and without microvascular complications are scarce.This study assessed the proportion of periodontitis and correlation of PISA with glycemic status in controlled,uncontrolled type 2 DM(T2DM)with and without microvascular complications.AIM To assess the proportion of periodontitis and correlation of PISA with glycemic status in controlled,and uncontrolled T2DM with and without microvascular complications.METHODS This study comprised 180 T2DM patients.Based on glycated hemoglobin(HbA1c)levels,they were grouped into:(1)Controlled T2DMgroup:(HbA1c≤7%);(2)Uncontrolled T2DM group:(HbA1c>7%)without microvascular complications;and(3)Uncontrolled T2DM group:(HbA1c>7%)with microvascular complications.Each group comprised 60 patients.All patients were assessed for periodontal parameters(Bleeding on Probing,PPD,CAL,Oral hygiene index simplified and PISA),and systemic parameters(HbA1c,fasting plasma glucose and post prandial plasma glucose).RESULTS The proportion of periodontitis among controlled T2DM group,uncontrolled T2DM group without microvascular complications,uncontrolled T2DM group with micro-vascular complications was 75%,93.4%and 96.6%respectively.Extent and severity of periodontitis were high in the uncontrolled T2DM group.A significant positive correlation was found between PISA and HbA1c among all patients(r=0.393,P<0.001).The dose–response relationship between PISA and HbA1c was observed.An increase of PISA with 168 mm^(2) was associated with a 1.0%increase of HbA1c.CONCLUSION High proportion and severity of periodontitis,and increased inflamed surface area in uncontrolled T2DM may have contributed to the poor glycemic control and microvascular complications.

Periodontal-orthodontic interdisciplinary management of a“periodontally hopeless”maxillary central incisor with severe mobility:A case report and review of literature

BACKGROUND Treating periodontally hopeless teeth with advanced bone resorption and severe tooth mobility is a great challenge for both orthodontists and periodontists.Biofilm-induced periodontal inflammation and occlusal trauma-related inflammation may synergistically aggravate tooth mobility.This case report illustrates that even periodontally hopeless teeth can be saved and have long-term stability with comprehensive periodontal treatment to control periodontal inflammation and promote periodontal bone regeneration and intricate orthodontic mechanical control to correct cross bite and occlusal trauma.CASE SUMMARY A 27-year-old female patient whose chief complaint was severe tooth mobility and discomfort of the maxillary incisor was diagnosed with severe aggressive periodontitis by clinical and radiographic examinations.To reduce tooth mobility and establish stable occlusion,we combined orthodontic treatment with periodontal therapy to preserve the tooth.Orthodontic treatment was performed after basic periodontal therapy and periodontal surgery.The loosened upper right central incisor was successfully retained,and the periodontal tissue remained stable during follow-up.CONCLUSION Teeth with severe mobility and bone loss can be saved through interdisciplinary treatment when periodontal inflammation is strictly controlled.

Non-surgical management of dens invaginatus type IIIB in maxillary lateral incisor with three root canals and 6-year follow-up:A case report and review of literature

BACKGROUND The presence of dens invaginatus(DI)complicates treatment of any tooth,from diagnosis to access cavity and biomechanical preparation and obturation.Reports of successful non-surgical management of DI type IIIB in maxillary lateral incisor are rare.Here,we report such a case,with three root canals and a long follow-up.CASE SUMMARY A 13-year-old female patient presented with mild pain in the maxillary right lateral incisor(#7)for 10-15 d.On examination,the tooth was slightly rotated,with slight tenderness on percussion and grade I mobility but with no caries,pockets or restorations and non-vital pulp(via vitality tests).Radiographic examination revealed unusual configuration of the tooth’s root canals,with an enamel-lined invagination extending to the apex,suggesting the possibility of DI Oehler’s type IIIB and a periapical radiolucency.Widening the access cavity lingually revealed one distinct buccal orifice and two distinct palatal orifices;under higher magnification of a dental operating microscope(DOM),the mesio palatal and disto-palatal orifices were observed as connected by a C-shaped groove.The root canals were prepared with hand K-files following a step-back technique,and obturated using a combination technique of lateral condensation and vertical compaction.At the 6-year follow-up,the patient was asymptomatic,and the periapical radiography displayed significant healing around the apical end of the root.CONCLUSION Proper knowledge of unusual root canal anatomy is required in treating DI.Conventional methods of root canal treatment can successfully resolve such complex cases,facilitated by DOM and cone-beam computed tomography.