Hsein-Kun Lu

Periodontitis and chronic kidney disease are both chronic inflammatory diseases and share some common risk factors. This 3-month pilot study aimed to clarify whether non-surgical periodontal therapy is beneficial in clinical, biochemical, and microbiological conditions in patients with periodontitis and kidney failure. Kidney failure patients with moderate to severe periodontitis were recruited from two hospitals. Treatment group received non-surgical periodontal therapy, and control group received oral hygiene instruction only. Outcome assessments were conducted 1 and 3 months after treatment. Non-parametric tests were used to analyze the patient-level data. Periodontal site-level assessments were analyzed by Student t-test and paired t-test. Statistical significance was set at p-value < 0.05. A total of 11 subjects completed the study. There was no significant difference between groups in all-cause mortality, cardiovascular events, infection events, systemic parameters, and serum biomarkers. Comparing to control group, clinical periodontal parameters, gingival crevicular fluid interleukin-1β (IL-1β) level and periodontal pathogens showed significant improvement in the treatment group. Non-surgical periodontal treatment did not change systemic outcomes in kidney failure patients, but changed the local micro-environment.

Dihydropyridine-induced gingival overgrowth (DIGO) is a side effect observed in patients treated for hypertension. The disease is aggravated by inflammation. Nifedipine (Nif), a dihydropyridine, causes gingival overgrowth by increasing the expression of the androgen receptor (AR). Furthermore, the proinflammatory cytokine interleukin 1β (IL-1β) induces collagen α1(I) expression through the AR in DIGO fibroblasts. These observations prompted us to investigate whether and how nuclear factor kappa B (NF-κB) affects AR expression in DIGO. Therefore, gingival fibroblasts obtained from the tissues of patients with DIGO and healthy subjects were stimulated with IL-1β, Nif, or both. mRNA and protein expression was detected with real-time polymerase chain reaction and Western blotting. High correlation coefficients were observed for the mRNA expression of the AR, connective tissue growth factor, and collagen α1(I) induced by both drugs. Western blot analysis showed that IL-1β and Nif increased and activated NF-κB more in DIGO cells than in healthy cells. An electrophoretic mobility shift assay demonstrated that the promoter and 5′-untranslated regions (5′-UTRs) of the AR gene contains 3 binding sites for the NF-κB p65 subunit. A chromatin immunoprecipitation assay revealed that the NF-κB p65 subunit was associated with AR 5′-UTRs in gingival fibroblasts. A site-directed mutagenesis study indicated that a mutation of NF-κB binding sites reduced Nif- and IL-1β-induced AR promoter activities. Collectively, these data indicate that NF-κB is an essential transcriptional regulator of AR gene expression and thus plays a crucial role in collagen overproduction in DIGO fibroblasts.

Aim: In this review, we assessed clinical outcomes of autotransplanted teeth with complete root formation and the effects of various influencing factors.Materials and Methods: Pubmed, Scopus, Google scholar and a hand search were used to identify prospective and retrospective cohort studies and case series till February 2013. Using multilevel Poisson regression, the annual failure rate (FR), 1‐year and 5‐year survival rates (SRs), infection‐related root resorption rate (RR), ankylosis rate (AR), the influences of systemic antibiotics (SAs), endodontic and splinting modalities and donor tooth morphology were analysed. Failure was defined as a transplant being lost during follow‐up.Results: Twenty‐six studies were included. The estimated FR, RR, AR, 1‐ and 5‐year SRs were 2.0%, 2.1%, 1.2%, 98.0% and 90.5%, respectively. The estimated FR was higher in the absence of SA, suture splinting, wire splinting ≤14 days and posterior donors. The estimated RR was higher in the absence of SA, endodontic treatment within post‐operative 14 days and anterior/premolar donors. The estimated AR was higher with wire splinting and premolar donors.Conclusions: Tooth autotransplantation with complete root formation is a favourable treatment with rare FR, RR and AR. However, SAs, endodontic and splinting modalities and tooth morphology seemed to influence the outcomes.

Objective: Repigmentation variably occurs with different treatment methods in patients with gingival pigmentation. A systemic review was conducted of various treatment modalities for eliminating melanin pigmentation of the gingiva, comprising bur abrasion, scalpel surgery, cryosurgery, electrosurgery, gingival grafts, and laser techniques, to compare the recurrence rates (Rrs) of these treatment procedures.Material and Methods: Electronic databases, including PubMed, Web of Science, Google, and Medline were comprehensively searched, and manual searches were conducted for studies published from January 1951 to June 2013. After applying inclusion and exclusion criteria, the final list of articles was reviewed in depth to achieve the objectives of this review. A Poisson regression was used to analyze the outcome of depigmentation using the various treatment methods.Results: The systematic review was based on case reports mainly. In total, 61 eligible publications met the defined criteria. The various therapeutic procedures showed variable clinical results with a wide range of Rrs. A random‐effects Poisson regression showed that cryosurgery (Rr = 0.32%), electrosurgery (Rr = 0.74%), and laser depigmentation (Rr = 1.16%) yielded superior result, whereas bur abrasion yielded the highest Rr (8.89%).Conclusions: Within the limit of the sampling level, the present evidence‐based results show that cryosurgery exhibits the optimal predictability for depigmentation of the gingiva among all procedures examined, followed by electrosurgery and laser techniques.Clinical Significance: It is possible to treat melanin pigmentation of the gingiva with various methods and prevent repigmentation. Among those treatment modalities, cryosurgery, electrosurgery, and laser surgery appear to be the best choices for treating gingival pigmentation.

For ethical reasons it is becoming increasingly more difficult to obtain, from clinical studies, histological data on infrabony defects treated with guided tissue regeneration (GTR) techniques. The aim of this systematic review was to find the value of extrapolating animal data on treatment of periodontal infrabony lesions, using GTR only or GTR + bone grafts, to human clinical results. Searches of the PubMed and Cochrane databases were combined with hand searching of articles published from 1 January 1969 to 1 August 2012. The search included any type of barrier membrane, with or without grafted materials, used to treat periodontal infrabony lesions. All studies with histological or re-entry methodology outcome parameters that evaluated bone-filling and/or new-cementum-formation ratios from a defect depth were collected. When comparing animal and human outcomes, a meta-analysis was used to evaluate the bone-filling ratio, but only a descriptive analysis of the histological studies was performed. In total, 22 studies were selected for the meta-analysis. In the GTR + bone graft groups the weighted-average bone-filling ratios were 52% (95% CI: 18-85%) in animals and 57% (95% CI: 30-83%) in humans, which were not statistically significantly different (p = 0.825). Similar results were found in the GTR-only groups, in which the weighted-average bone-filling ratios were 54% (95% CI: 37-72%) in animals and 59% (95% CI: 42-77%) in humans (p = 0.703). New-cementum formation of GTR only and GTR + bone grafts showed comparable ratio outcomes, and both were superior to the control group in animals only (p = 0.042). Although quality assessments differed between animal and human studies, our analysis indicated that animal models and human results showed similar bone-filling ratios in infrabony defects treated with GTR only or with GTR + bone grafting.