Theses supervised by Prof. Dr. Recep Selçuk Yılmaz
10 theses · Yeditepe University
Evaluation of the clinical and immunomodulatory effects of the probiotic lozenges or sub-antimicrobial dose doxycycline as adjuncts to non-surgical periodontal therapy in chronic periodontitis
The effect of probiotics or sub-antimicrobial dose doxycycline (SDD) as an adjunct to scaling and root planing (SRP) on inflammatory parameters in chronic periodontitis (CP) patients needs further investigation because of the controversial data. Therefore, the aim of the present study was to evaluate the clinical and immunomodulatory efficacy of Lactobacillus reuteri (L. reuteri) containing lozenges (Probiotic) or SDD (Doxycycline hyclate) as adjuncts to non-surgical periodontal therapy. A total of 45 patients, with at least 2 teeth having one approximal site with a probing depth (PD) of 5-7 mm and gingival index (GI) of ≥2 in each quadrant, were selected and randomly divided into 3 groups. Group I received SRP + Probiotic lozenges (2x108 cfu/ml), Group II received SRP + SDD (doxycycline hyclate) tablets, whereas Group III received SRP + placebo. Plaque index (PI), GI, PD, bleeding on probing (BoP) and attachment gain were measured and gingival crevicular fluid (GCF) sampling was performed at baseline and day 90. GCF analysis were assessed by enzyme linked immunosorbent assay (ELISA). GCF volume, MMP-8 and TIMP-1 levels were also evaluated at baseline and at day 90. Intra-group comparisons of all parameters were evaluated with paired sample t test while inter-group comparisons of all clinical and biochemical parameters were evaluated with Oneway Anova test. Tukey test was used for the double comparisons of the groups. The statistical significance was set at p <0.05. At the end of the observation period, statistically significant improvements in all evaluated parameters were observed within each group. Inter- group comparisons of mean differences of both clinical and biochemical parameters revealed statistically significance in favour of both SRP + Probiotic and SRP + SDD between days 0-90 at the end of day 90 (p< 0.05). However, no siginificant differences were observed between SRP + Probiotic and SRP + SDD in terms of both clinical and biochemical parameters. (p> 0.05) In conclusion, the results of the present study revealed that the adjunctive usage of L. reuteri containing lozenges and SDD tablets significantly reduced inflammation when compared to SRP + placebo in CP patients.
Kronik periodontitisli hastalarda başlangıç periodontal tedaviye ek olarak farklı parametrelerde kullanılan diyot lazerin klinik ve mikrobiyolojik etkinliğinin değerlendirilmesi
Bu çalışmada kronik periodontitisli (KP) hastalarda başlangıç periodontal tedavi (BPT)?ye yardımcı olarak kullanılan güven aralığı içerisinde iki farklı dezenfeksiyon parametresinde diyot lazer (940 nm) uygulamasının klinik ve mikrobiyolojik etkinliklerinin değerlendirilmesi amaçlandı. Çalışmaya her bir yarım çenesinde sondalama derinliği (SD) ? 5 mm, gingival indeks (Gİ) ? 2 olan en az 3 tek köklü dişe sahip, yaşları 35 ile 60 arasında değişen 16 kadın, 14 erkek toplam 30 KP hastası dahil edildi. Rastgele 3 gruba ayrılan hastalardan 1. gruba diş yüzeyi temizliği ve kök yüzeyi düzleştirmesi (SRP) ve yüksek dezenfeksiyon parametresinde diyot lazer uygulaması (SRP+YPL grubu), (2 W, 20 ms pulse length-20 ms pulse interval, diş başına 30 sn) 2. gruba SRP ile beraber düşük dezenfeksiyon parametresinde diyot lazer uygulaması (SRP+DPL grubu) (1.5 W 20 ms pulse length-20 ms pulse interval diş başına 30 sn) ve 3. gruba sadece SRP uygulaması (SRP grubu) yapıldı. Subgingival plak örnekleri SD ? 5 mm ve Gİ ? 2 olan bölgelerden tedavi öncesi (0. gün) ve tedavi sonrası (90. gün) alındı. Bunu takiben plak indeksi (Pİ), Gİ, sondalamada kanama (SK), SD ve rölatif ataşman seviyesi (RAS) içeren klinik ölçümler yapıldı. Mikrobiyolojik değerlendirme için total canlı bakteri sayımı yapıldı ve zorunlu anaerob bakteri oranları belirlendi. Araştırma süresinin sonunda, tüm ağıza ait klinik parametrelerin hepsinde grup içi değişimlerde istatistiksel olarak anlamlı azalmalar tespit edildi (p<0.05). Klinik parametrelere ait fark ortalamalarının gruplar arası karşılaştırılmasında sadece Pİ değerinde istatistiksel olarak anlamlı farklılık görülmezken (p>0.05), Gİ, SK, SD ve RAS değerlerinde SRP+YPL ve SRP+DPL grupları lehine istatistiksel olarak anlamlı azalmalar tespit edildi (p<0.05). Klinik iyileşmelere paralel olarak, tüm tedavi gruplarında total bakteri sayısında ve zorunlu anaerob bakteri oranında istatistiksel olarak anlamlı azalma tespit edildi (p<0.05). Zorunlu anaerob bakteri oranlarının gruplar arası karşılaştırılmasında ise SRP+YPL ve SRP+DPL grupları lehine istatistiksel olarak anlamlı farklılık tespit edildi (p<0.05). Sonuç olarak Gİ, SK, SD ve ataşman kazancının gruplar arası karşılaştırılmasında, SRP+YPL, SRP+DPL grupları lehine ortaya çıkan klinik üstünlüğün mikrobiyolojik parametrelere de yansıdığı gözlendi. Sonuç olarak, mekanik tedaviye destek olarak kullanılan lazer düşük dozda da olsa anlamlı fark göstermiş, ancak bu çalışma sınırları içerisinde güven aralığında en düşük ve en yüksek doz olarak verilen parametreler arasında bir fark tespit edilmemiştir
Clinical and biochemical evaluation of lactobacillus reuteri containing lozenges as an adjunct to non-surgical periodontal therapy in chronic periodontitis
The effect of probiotics as an adjunct to scaling and root planning (SRP) on inflammatory parameters in chronic periodontitis patients (CP) warrants further investigation because of the controversial data. The aim of this study is to evaluate the clinical and biochemical efficacy of Lactobacillus reuteri containing lozenges as an adjunct to SRP in CP. A total of 40 patients, with at least 2 single-rooted teeth having at least one approximal site with a probing depth (PD) of 5-7 mm and gingival index (GI) of ≥2 in each quadrant were selected and randomly divided into 2 groups. Group-I received SRP+probiotic containing lozenges, whereas Group-II received SRP+placebo twice a day for 3 weeks. Plaque index (PI), GI, bleeding on probing (BoP), PD were measured and gingival crevicular fluid (GCF) sampling was performed at baseline and days 21,90,180 and 360. Intergroup comparisons of PI, GI, PD, BoP and GCF matrix metalloproteinase-8 and tissue inhibitor of metalloproteinase-1 levels revealed significance in favour of Group-I at all time intervals (p<0.05) up to day 180 (p<0.05). At day 360, the significance on the clinical parameters continued to exist (p<0.05), however no difference was observed in terms of biochemical parameters (p>0.05).
Clinical and radiographic comparison of platelet rich fibrin combined with bovine derived xenograft versus bovine derived xenograft alone in the treatment of periodontal intrabony defects
The aim of the present study was to compare the clinical and radiographic effects of platelet rich fibrin (PRF) combined with bovine derived xenograft (BDX) to the use of BDX alone in the treatment of periodontal intrabony defects of advanced chronic periodontitis patients. Twenty advanced chronic periodontitis patients with a mean age of 45.60 ± 10.01 were enrolled in the present study. A total of 92 periodontal intrabony defects with an associated probing depth (PD) of ≥ 5 mm and an intrabony component of ≥ 3 mm were treated with either PRF + BDX or BDX alone. At baseline and 12 months after surgery, plaque and sulcus bleeding indices, PD, marginal soft tissue level, relative attachment level, relative bone level together with radiographic bone level were recorded. Uneventful healing was observed in all cases. At 12 months, both treatment groups revealed significant clinical and radiographic improvements when compared to baseline (p < 0.01). Regarding the deepest site of the defects, following changes in clinical and radiographic parameters were observed at 12 months after surgery for PRF + BDX and BDX groups respectively; a mean PD reduction of 3.35 ± 1.25 (3) mm and 3.0 ± 1.41 (3) mm, attachment gain of 3.02 ± 1.26 (3) mm and 2.15 ± 1.35 (2) mm, gingival recession of 0.33 ± 0.52 (0) mm and 0.79 ± 0.56 (1) mm, clinical bone gain of 2.74 ± 1 (3) mm and 2.10 ± 1.2 (2) mm and radiographic bone gain of 2.63 ± 0.98 (3) mm and 2.24 ± 1.03 (2) mm. Intergroup analysis demonstrated significant attachment gain, gingival recession, clinical bone gain (p < 0.01) and radiographic bone gain (p < 0.05) in favor of the PRF + BDX group. Results obtained in this study revealed that the use of both PRF + BDX combination and BDX alone yields significant improvements in clinical and radiographic parameters compared to baseline and the use of PRF + BDX combination yields better results in regards to attachment gain, clinical and radiographic bone gains.
Miller sınıf I çoklu dişeti çekilmelerinin tedavisinde kuronale kaydırılan flep ve kollajen doku matriksi kombinasyonunun tek başına kuronale kaydırılan flep ile karşılaştırılması
Bu randomize, kontrollü, paralel çalışmada Miller Sınıf I çoklu dişeti çekilmelerinin tedavisinde tek başına kuronale kaydırılan flep (KKF) ve KKF'nin kollajen matriks (KM) ile birlikte kullanımının kök yüzeyini kapatmadaki etkinliğinin araştırılması amaçlandı. Çalışmaya ≥ 3 mm olan Miller Sınıf I çoklu dişeti çekilmesine sahip 20 hasta (12 bayan ve 8 erkek) dahil edildi ve iki gruba ayrılarak KKF+KM ve KKF teknikleri uygulandı. Tedavi öncesi (başlangıç) ve tedavi sonrası (12. ay) sondalama derinliği (SD), dişeti çekilmesi dikey boyutu (DÇDB), dişeti çekilmesi yatay boyutu (DÇYB), klinik ataşman seviyesi (KAS), keratinize dişeti dikey boyutu (KDDB), dişeti kalınlığı (DK), ortalama kök kapanma yüzdesi (OKKY) ve tam kök kapanma yüzdesi (TKKY), kök kapanma estetik skoru (KKES) ve hasta memnuniyeti değerlendirildi. İncelenen parametrelere ait başlangıç değerleri gruplar arasında benzerdir (p>0.05). Başlangıçta KKF+KM ve KKF gruplarında sırasıyla 3.27 ± 0.37 mm ve 3.2 ± 0.26 mm olan DÇDB değerleri; 12. ayda, 1.13±0.52 mm ve 1±0.94 mm'ye azaldı ve bu azalma istatistiksel olarak anlamlı bulundu (p<0.05). Grup içi karşılaştırmada, incelenen tüm parametrelerin başlangıç ve 12. ay değerleri arasında istatistiksel olarak anlamlı farklılık saptandı. Kollajen matriks ve tek başına KKF gruplarındaki OKKY, sırasıyla, %66±13.23 ve %69.99±28.27 bulundu ve iki grup arasında istatistiksel olarak anlamlı bir farklılık saptanmadı (p>0.05). Gruplar arası karşılaştırmada, 12. ayda DK hariç incelenen parametrelerin hiçbirinde istatistiksel olarak anlamlı farklılık gözlenmedi (p>0.05). Kollajen matriks grubunun 12. aydaki DK miktarı, KKF grubundan istatistiksel olarak anlamlı derecede yüksek bulundu (p<0.05). Kollajen matriks ve KKF gruplarında, sırasıyla, toplam 0.33±0.09 mm ve 0.06 ± 0.05 mm'lik DK artışı saptandı. Gruplar arasında, KKES ve hasta memnuniyeti skorları ortalamaları açısından anlamlı bir farklılık bulunmadı (p>0.05). Çoklu dişeti çekilmelerinin tedavisinde her iki tedavi yönteminin de kök kapanması açısından başarılı sonuçlar verdiği saptandı. Kuronale kaydırılan flep ve KM uygulamasının DK'yı arttırdığı belirlendi.
Periodontal kemik içi defektlerin tedavisinde hyaluronik asit ve sığır kaynaklı kemik grefti kombinasyonu ile tek başına sığır kaynaklı kemik grefti uygulamalarının klinik ve radyografik olarak karşılaştırılması
Bu çalışmada, ileri kronik periodontitis teşhisi konmuş hastalarda bulunan periodontal kemik içi defektlerin tedavisinde hyaluronik asit (HA) içeren yeni bir materyal ve sığır kaynaklı kemik grefti (SKKG) kombinasyonu ile tek başına SKKG uygulamalarının klinik ve radyografik olarak karşılaştırılması amaçlandı. Çalışmaya, sondalama derinliği (SD) ≥5 mm ve kemik içi defekt derinliği ≥3 mm olan 20 kronik periodontitis hastasına ait 3+2+1, 3+2, 3+1, 3, 2+1 ve 2 duvarlı toplam 109 kemik içi defekt dahil edildi. Defektlerden 54 tanesi HA+SKKG kombinasyonu (1. grup) ile tedavi edilirken, 55 tanesi sadece SKKG (2. grup) ile tedavi edildi. Operasyondan önce ve 12 ay sonra, plak ve dişeti oluğu kanama indeksleri, rölatif dişeti kenarı seviyesi, SD, rölatif ataşman ve kemik seviyeleri ile radyografik kemik seviyesi ölçümleri yapıldı. Operasyondan sonraki 12. ayda, her iki grupta da incelenen tüm klinik ve radyografik parametrelerde başlangıca göre istatistiksel olarak anlamlı bir iyileşme saptandı (p<0.05). Defektin en derin noktası gözönüne alındığında, 1. ve 2. gruplarda sırasıyla, 3.38±1.29 mm ve 2.99±0.75 mm SD azalması, 2.56±1.26 mm ve 2.33±0.57 mm ataşman kazancı, 0.79±0.88 mm ve 0.66±0.56 mm dişeti çekilmesi, 2.39±1.45 mm ve 2.09±0.65 mm klinik ve 2.28±1.34 mm ve 1.93±0.95 mm radyografik kemik kazancı saptandı. Gruplar arasında incelenen tüm klinik ve radyografik parametreler yönünden anlamlı fark tespit edilmedi (p>0.05). Bu çalışmadan elde edilen bulgular, hem HA+SKKG kombinasyonunun hem de tek başına SKKG uygulamasının ileri kronik periodontitisli hastalarda bulunan periodontal kemik içi defektlerde, 12. ayda anlamlı klinik ve radyografik iyileşme sağladığını, ancak gruplar arasında anlamlı bir farkın bulunmadığını göstermektedir. Anahtar kelimeler: Hyaluronik Asit, Sığır Kaynaklı Kemik Grefti, Kemik İçi Defekt, Kronik Periodontitis
Clinical evaluation of coronally advanced flap with or without platelet rich fibrin for the treatment of multiple gingival recessions
The objective of this controlled study was to assess the clinical effectiveness of platelet rich fibrin (PRF) in combination with coronally advanced flap on root coverage, aesthetics and patient satisfaction compared to coronally advanced flap (CAF) alone for the treatment of multiple Miller Class I gingival recession defects. A total of 20 patients (10 females and 10 males) with 49 Miller Class I multiple recessions ≥3 mm were included and divided into CAF + PRF and CAF groups. At baseline and 6 months after the surgery, plaque and gingival indices, bleeding on probing, probing depth, clinical attachment level, recession height (RH), keratinized tissue height, gingival thickness (GT), and mean and complete defect coverage were evaluated. Patient satisfaction and root coverage aesthetic scores were also assessed. Baseline RH in CAF+PRF and CAF groups was 3,20 ± 0,26 mm and 3,36 ± 0,34 mm, respectively. Intragroup comparisons revealed statistically significant differences at 6 months for all parameters (p<0.05). Gingival thickness increased from 0,78 ± 0,06 mm to 1,31 ± 0,07 mm in CAF + PRF group, and from 0,73 ± 0,07 mm to 0,8 ± 0,08 mm in CAF group. Mean root coverage was 79,02% (RH reduction: 2,5±0,53 mm) in CAF + PRF group, and 74,63% (RH reduction: 2,51±0,33 mm) in CAF group. Complete root coverage was achieved 36% of the teeth (9 out of 25 sites) for the CAF + PRF group, while it occurred 33.3% of the teeth (8 out of 24 sites) for the CAF group. Intergroup differences were found to be significant only for GT gain (p<0.05). Both techniques were successful in the treatment of multiple Miller Class I gingival recession defects. Tissue thickness significantly increased with the use of PRF graft in CAF + PRF group.
Treatment of multiple gingival recessions with two different approaches
The objective of this controlled study was to evaluate the clinical effectiveness of tunnel technique (TUN) in combination with acellular dermal matrix graft (ADM) on defect coverage, aesthetics and patient satisfaction compared to coronally positioned flap (CAF) plus ADM for the treatment of Miller Class I multiple gingival recessions. A total of 20 patients (13 females and 7 males) with 58 Miller Class I multiple recessions ≥3 mm were included and divided into TUN+ADM and CAF+ADM groups. At baseline and 12 months after the surgery, plaque index, gingival index, bleeding on probing, probing depth (PD), clinical attachment level, recession height (RH), keratinized tissue height (KT), gingival thickness (GT), and mean and complete defect coverage were evaluated. Patient satisfaction and root coverage aesthetic scores (RES) were also assessed. Baseline RH in TUN+ADM and CAF+ADM groups was 3.23 ± 0.28 mm and 3.30 ± 0.35 mm, respectively. Intragroup comparisons revealed statistically significant differences at 12 months for all parameters, except PD (p<0.05). Gingival thickness increased from 0.82 ± 0.06 mm to 1.40 ± 0.07 mm in TUN+ADM group, and from 0.76 ± 0.06 mm to 1.38 ± 0.09 mm in CAF+ADM group. Mean defect coverage was 75.72% (RH reduction: 2.45 ± 0.20 mm) in TUN + ADM group, and 93.81% (RH reduction: 3.10 ± 0.57 mm) in CAF + ADM group. Complete defect coverage was achieved 37.36% of the teeth (12 out of 31 sites) for the TUN+ADM group, while it occurred 85% of the teeth (23 out of 27 sites) for the CAF+ADM group. Intergroup differences were found to be significant for RH reduction, KT increase, MRC, CRC, and RES (p<0.05). Both techniques were effective in root coverage of multiple recession defects, however better aesthetic results and clinical improvements were achieved with CAF and ADM combination.
Clinical and microbiological effects of probiotic lozenges in the treatment of chronic periodontitis: A 1-year follow-up study
The objective of this study was to evaluate the effect of Lactobacillus reuteri (L. reuteri) containing lozenges as an adjunct to initial periodontal therapy in chronic periodontitis (CP) patients and to detect L. reuteri colonization in periodontal pockets. A total of 40 patients, with at least 2 teeth having one approximal site with a probing depth (PD) of 5-7 mm and gingival index (GI) of ≥2 in each quadrant, were selected and randomly divided into 2 groups. Group I received scaling and root planing (SRP) + L. reuteri containing lozenges, whereas Group II received SRP + Placebo. Plaque index (PI) and (GI), bleeding on probing (BoP), PD and relative attachment level (RAL) were measured. Microbiological sampling was performed at baseline and days, 21, 90, 180 and 360 and was analyzed by culture method including total viable count (TVC) and proportions of obligate anaerobes. Repeated measure analysis of variance was used for intra-group comparison of the clinical parameters and proportions of obligate anaerobes whereas the Friedman test was used for the TVC values at different time point measurements. The Bonferroni corrected Paired sample t was used to evaluate intra-group comparisons of the clinical parameters and proportions of obligate anaerobes in pairs. The Bonferroni corrected Wilcoxon signed ranks test was used to evaluate the intra-group comparisons of the TVC values in pairs. The Student t or Mann-Whitney U tests were used to evaluate the inter-group comparisons of the mean differences according to their distribution. Intergroup comparisons of PI, GI, BoP and PD revealed significance in favor of Group I at all time intervals (p<0.05). Intergroup comparisons of total viable cell count and proportions of obligate anaerobes revealed significance in favor of Group I at all time intervals, except day 360 (p<0.05). In conclusion, within the limits of this study it can be stated that L. reuteri containing lozenges might be an adjunctive useful agent for retarding recolonization and the improvement of periodontal health. Further studies are warranted to clarify the administration dose of the lozenges.