Comparing Laser-Assisted and Conventional Excision in the Management of Oral Soft Lesions: A Prospective Clinical Study.

Introduction: Oral soft lesions represent a diverse array of pathological conditions that necessitate precise and effective treatment. Laser-assisted excision has gained prominence due to its purported benefits in terms of reduced procedural time, decreased bleeding, and improved aesthetic outcomes. However, conventional excision remains a common practice. Materials and Methods: A total of 100 patients with clinically diagnosed oral soft lesions were enrolled in this prospective study. The patients were randomly divided into two groups: the laser-assisted excision group and the conventional excision group. Demographics, lesion characteristics, and medical histories were recorded for each patient. Procedural parameters such as operative time and intraoperative bleeding were meticulously documented. Results: The laser-assisted excision group exhibited a statistically significant reduction in procedural duration compared to the conventional excision group (P < 0.05), with mean operative times of 15.2 and 20.8 min, respectively. Intraoperative bleeding was significantly reduced in the laser-assisted group (P < 0.01), with an average blood loss of 15.7 ml, while the conventional excision group reported an average blood loss of 28.6 ml. Postoperative complications analysis demonstrated that the laser-assisted group had a lower incidence of wound infections (P < 0.05) compared to the conventional excision group (5% vs. 15%). Additionally, the laser-assisted group exhibited significantly reduced scarring (P < 0.01) as reported by both patients and clinicians. Patient satisfaction scores were consistently higher in the laser-assisted excision group, with 85% of patients reporting contentment with the procedure, in contrast to 65% in the conventional excision group. Conclusion: In light of the results obtained from this study, laser-assisted excision emerges as a favorable approach for the management of oral soft lesions.

Antibacterial Efficacy of Dual-dye and Dual Laser Photodynamic Therapy on Oral Biofilms of Enterococcus faecalis, Streptococcus mutans, and Prevotella intermedia: An In Vitro Study.

Aim: To assess and compare the antibacterial efficacy of methylene blue (MB) and red laser (660 nm) antimicrobial photodynamic therapy (aPDT), indocyanine green (ICG) and infrared laser (810 nm) aPDT, and dual-dye (MB and ICG) and dual light (red and infrared) aPDT on oral biofilms of Enterococcus faecalis (E. faecalis), Prevotella intermedia (P. intermedia), and Streptococcus mutans (S. mutans). Materials and methods: Biofilms of E. faecalis, S. mutans, and P. intermedia were grown at 36°C and 5% CO2 for 7 days in a 96-well plate in a brain heart infusion (BHI) growth medium. Before aPDT, a total of 27 inoculums were collected from culture wells and grown on culture plates to assess baseline colony forming units (CFU). The microbial wells were treated with MBaPDT (group I), ICGaPDT (group II), and MBICGaPDT (group III). Post-aPDT, inoculums were collected from wells to be cultured to assess CFU. One-way analysis of variance (ANOVA) and student paired t-tests were used for statistical analysis. The significance level was fixed at p ≤ 0.05. Results: Methylene blue antimicrobial photodynamic therapy (MBaPDT) caused a significant reduction in E. faecalis counts compared to other groups (f = 11.15, p = 0.01). aPDT on S. mutans resulted in a significant (p = 0.04) reduction of bacterial counts in the ICGaPDT group. aPDT on P. intermedia resulted in a significant reduction in bacterial counts (p ≤ 0.05) in MBaPDT and ICGaPDT groups. Conclusion: Dual-dye and dual light aPDT showed an antibacterial effect against E. faecalis. It was ineffective against S. mutans and P. intermedia. Clinical significance: Dual-dye aPDT may effectively reduce E. faecalis counts in infected root canals and improve the outcomes of root canal treatment. How to cite this article: Yavagal C, Yavagal PC, Marwah N, et al. Antibacterial Efficacy of Dual-dye and Dual Laser Photodynamic Therapy on Oral Biofilms of Enterococcus faecalis, Streptococcus mutans, and Prevotella intermedia: An In Vitro Study. Int J Clin Pediatr Dent 2023;16(S-2):S128-S132.

Comparative Evaluation of Conventional Therapy With and Without Use of Diode Laser (DL) in the Treatment of Chronic Generalized Periodontitis: A Clinico-Microbiological Study.

INTRODUCTION: Chronic periodontitis is caused by a persistent and expanding interaction between a subgingival pathogenic microbial biofilm and the host immune system. The host's reaction to local factors directly influences the inflammation and bone loss that result from these interactions. Depending on variables like the severity of soft tissue damage and bone loss, treatment options can range from nonsurgical to surgical. Nonsurgical treatments are frequently used as the first-line therapy for inflammatory periodontal disease. In fact, careful scaling and root planing (SRP), a nonsurgical treatment, has been extensively studied and shown to be a highly predictable and effective therapy. According to recent research, using a diode laser (DL) in addition to standard SRP may reduce bacterial count and reinfection significantly. Laser therapy could be helpful in treating periodontal disease because of its antibacterial and detoxifying effects. The goal of this study is to investigate whether using a DL in addition to conventional flap surgery enhances patient outcomes for those with chronic generalized periodontitis. MATERIALS AND METHODS: The 12 participants in this split-mouth trial with chronic generalized periodontitis were the main subject of the study. All of them had probing pocket depths (PPDs) of at least 5 mm after the initial phase of treatment. Each patient in the control group (Group A) and test group (Group B) received a conventional flap after being randomly assigned to one of the groups. Group B underwent a conventional flap with a 980 nm DL, whereas those in Group A did not receive any DL therapy. Periodontal pockets in both groups were evaluated at baseline, 45 days, and 90 days after a sub-gingival plaque test. Quantitative real-time polymerase chain reactions were used to examine the presence of red complex organisms in the plaque sample. RESULTS: From baseline to 45 days and then to 90 days, clinical attachment loss (CAL), plaque index (PI), and gingival index (GI) all significantly decreased. However, results from 45 days to 90 days were statistically non-significant, with the exception of the GI, where Group B results were significantly different from Group A results from 45 days to 90 days. On the other hand, when a DL was combined with conventional flap surgery in the test group, the quantity of red complex bacteria was significantly decreased. CONCLUSION: When DL was used in conjunction with conventional flap surgery, the results showed that CAL, PI, and GI were all significantly reduced while the quantity of red complex bacteria was also significantly decreased.

Comparative Evaluation of the Crestal Bone Level Around Pre- and Post-loaded Immediate Endoosseous Implants Using Cone-Beam Computed Tomography: A Clinico-Radiographic Study.

Introduction  Dental implants replace missing teeth. Dental implants are surgically placed tooth root replacements that secure prosthetic teeth and bridges. Branemark's original dental implant technique included a mesiobuccal flap and a two-stage approach, needing 6-8 months of recovery following extraction, sterile conditions, machined titanium implants, 3-6 months without stress for osseointegration, and a detachable temporary prosthesis. The restoration would usually be ready a year following the implant surgery. Implant treatment seeks the best function, aesthetics, and complication risk. Implant therapy with low patient morbidity and fast extraction-to-restoration times is a secondary target. Instantaneous implant insertion has made implant dentistry more convenient for patients and clinicians. This study measures bone height before, after, and one month after implant placement using cone-beam computed tomography (CBCT). Materials and Methods Participants were selected from oral evaluation candidates. This investigation included 11 people missing front maxillary or mandibular teeth or root components. Diagnostic castings determined the interarch connection before surgery. Alginate maxillary and mandibular arch imprints were cast in Type III dental stone for diagnosis. CBCT scans were taken pre-operatively, post-implant, and post-prosthesis. After the tooth was removed, the empty socket was cleaned up with curettes. An intraoral periapical radiograph and manual probing were done to determine the implant's size. The implant was removed for examination after three months, and healing abutments and gingival formers were placed. Finally, fins were placed. The CBCT images also captured the bone height around the implants. The soft tissue parameters were recorded and evaluated at baseline and one-month following prosthetic loading as plaque index (PI). Radiographic evaluation was done at baseline and one-month following functional loading using CBCT. After one month following functional loading, crestal bone levels were measured again with the help of CBCT using Image J software (National Institutes of Health, Bethesda, Maryland, US). Results The sample population had an average age of 42.81 years, with a standard deviation of 13.44 years. Using a paired t-test, we found that the mean PI dropped significantly from pre-loading levels to one-month post-loading levels, with a p-value of less than 0.001. The mean crestal bone level (mesial) evaluated by CBCT at baseline and one-month post-loading was 2.52 ± 1.97 mm and 1.17 ± 1.31 mm, respectively. The mean difference between mean crestal bone loss (distal) at baseline and one-month post-loading was 0.94 ± 1.89 mm, which was not statistically significant. The mean difference between mean crestal bone loss (buccal) at baseline and one-month post-loading was 1.82 ± 1.60 mm, which was statistically significant. The mean difference between mean crestal bone loss (lingual) at baseline and one-month post-loading was 1.91 ± 1.53 which was statistically significant. Conclusion CBCT provides all the diagnostic data needed for implant placement; hence, it is recommended.

Clinical Evaluation of Coronally Advanced Flap With or Without Advance-Platelet Rich Fibrin Membrane in the Treatment of Miller's Class-II Localized Gingival Recession: A Clinical Study.

INTRODUCTION:  Periodontal treatment focuses on maintaining a patient's natural teeth and gums. The gingival margin recedes to a point apical to the tooth in 20%-100% of people. Coronally advanced flap (CAF) is one of several effective treatments for this condition. This surgery covers the tooth root with gingiva. The predictability of this surgery depends on the blood supply, donor tissue, and surgical skills. Platelet concentrates, which include platelet-rich fibrin (PRF), majority of the time is used for various regenerative therapies. Since no bovine thrombin or anticoagulant is needed, its manufacturing is simpler, cheaper, and less biochemically modified than PRP. Platelet-rich fibrin (PRF) is a fibrin matrix that progressively releases platelet cells and cytokines. AIM: The present study aimed to evaluate the efficacy of CAF with and without A-PRF in the treatment of Miller's class-II localized gingival recession. MATERIALS AND METHODS: Twenty patients were chosen who had Miller's class-II localized gingival recession. A random number generator was used to place patients into either the "test" or "control" group. Treatment for both Groups A and B included a coronally advanced flap, but only Group A additionally got autologous platelet-rich fibrin (A-PRF). After receiving a detailed explanation of the treatment process, the patient signed an informed consent form. Complete medical and dental histories were taken to see whether there were any absolute or relative contraindications. RESULTS:  Following treatment with either method in the current study, gingival thickness improved considerably. The percentage of root coverage did not change considerably between the two groups. The clinical result might likely have been different if other factors, such as platelet concentration and PRF consistency, had been examined in the current investigation. Furthermore, there was no histological examination of the healing process. As a result, we are unsure of the extent to which PRF affects how effectively connective tissue attaches. CONCLUSION: The additional use of A-PRF membrane did not provide additional benefits in terms of root coverage outcomes compared with CAF alone. The use of A-PRF membranes significantly reduced the recession depth.

Efficacy of Laser Photoacoustic Streaming in Paediatric Root Canal Disinfection - An Ex-Vivo Study.

BACKGROUND: Various techniques have been employed to enhance the root canal disinfection rate using sodium hypochlorite (NaOCl) as an irrigant. Photon initiated photo-acoustic streaming using lasers is a newer method of endodontic disinfection. AIM: The aim of this study is to evaluate and compare the efficacy of photo-initiated photoacoustic streaming and conventional irrigation technique using 2.5% NaOCl for root canal disinfection in primary teeth. SETTING AND DESIGN: Laboratory setting and ex-vivo design. MATERIALS AND METHODS: Twenty extracted primary teeth were selected in which Enterococcus faecalis incubation was done in the root canals and bacterial counts were obtained before the intervention. The teeth were randomly allocated into two groups. Group I samples were irrigated with conventional syringe method using 2.5% NaOCl and Group II samples were irrigated using photon-initiated photo-acoustic streaming method with erbium-doped yttrium aluminum garnet laser (wavelength - 2940 nm). Postintervention samples were obtained, and bacterial colony count was done. Wilcoxon Signed- Ranks Test and Mann-Whitney test were applied to test the intragroup and intergroup differences in the bacterial counts. RESULTS: Postintervention results showed no bacterial growth in the canals irrigated using Laser (P = 0.004) whereas, fewer bacterial colonies were observed in NaOCl group (P = 0.005). There was statistically significantly higher reduction in E. faecalis counts in Laser Activated irrigation (LAI) group compared to NaOCl group (P < 0.05). CONCLUSION: Total elimination of E. faecalis counts was obtained by the use of laser activated NaOCl irrigation in the infected root canals, hence, it can be considered as an effective method for pediatric endodontic disinfection.

Evaluation of the Efficacy of Guava Extract as an Antimicrobial Agent on Periodontal Pathogens.

AIM: The present study was undertaken to assess the inhibitory effect of guava extracts on Porphyromonas gingivalis and Aggregatibacteractinomycetemcomitans, to assess the time-kill curve of P. gingivalis and A. actinomycetemcomitans, and to determine the antiproteolytic activity of guava on P. gingivalis. MATERIALS AND METHODS: Kanamycin blood agar was used to isolate P. gingivalis and A. actinomycetemcomitans. Ethanolic guava extract (EGE) and aqueous guava extract (AGE) were prepared and the inhibitory effects of these extracts for two periodontal pathogens were tested by minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) procedures. Antibacterial activity of guava extracts was determined by well diffusion method. Antiproteolytic activity of guava on protease of P. gingivalis was determined by gelatin liquefaction test. RESULTS: The MIC determined for AGE and EGE was at 75 µL/mL concentration for P. gingivalis, whereas EGE exhibited the activity at 75 µL/mL on P. gingivalis. The MIC determined for AGE was at 50 µL/mL for A. actinomycetemcomitans, whereas MIC determined for EGE was at 3.12 µL/mL for A. actinomycetemcomitans. Porphyromonas gingivalis was susceptible to EGE compared with AGE. Aggregatibacter actinomycetemcomitans was more susceptible to guava extracts compared with P. gingivalis. CONCLUSION: Guava extract may be a potential therapeutic agent for periodontitis as it shows significant activity against both P. gingivalis and A. actinomycetemcomitans. CLINICAL SIGNIFICANCE: Guava leaves extract can be used as economical and suitable adjuvant to synthetic drugs and can be a potential therapeutic agent for periodontitis.

mRNA expression of IFN-λs in the gingival tissue of patients with chronic or aggressive periodontitis: A polymerase chain reaction study.

BACKGROUND: Several studies have proven the existence of herpesviruses in periodontal pockets of patients with chronic or aggressive periodontitis. Recently discovered interferon lambda (IFN-λ) has antiviral properties and is induced by herpesviruses. The present study was a quantitative analysis of messenger RNA (mRNA) expression of IFN-λs (IFN-λ1, IFN-λ2, IFN-λ3) in the gingival tissues of patients with chronic or aggressive periodontitis. METHODS: A total of 90 participants (50 men and 40 women; age range 19-50 years, mean age 31.50 ± 7.8) were categorized into three groups: healthy participants, patients with chronic periodontitis, and patients with aggressive periodontitis. mRNA expression of IFN-λs in gingival tissues was estimated using reverse transcriptase polymerase chain reaction and was correlated with clinical parameters such as gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL). RESULTS: mRNA of IFN-λ1, IFN-λ2, and IFN-λ3 was expressed in gingival tissues of healthy participants and in patients with chronic or aggressive periodontitis. The highest level of IFN-λ1 was observed in patients with aggressive periodontitis (3.049 ± 9.793), whereas IFN-λ2 (4.322 ± 11.310) and IFN-λ3 (11.932 ± 27.479) were highest in patients with chronic periodontitis. The difference in mRNA expression of IFN-λ1 (P = 0.008) and IFN-λ3 (P = 0.043) among three groups was statistically significant CONCLUSION: Increased quantity of IFN-λs in patients with chronic and patients with aggressive periodontitis suggests a role in periodontitis. Variation in the expression of IFN-λ1 and IFN-λ3 in patients with periodontitis needs to be further evaluated. The mRNA expression of antiviral IFN-λs in gingival tissues might enhance our understanding related to viral pathogenesis of periodontal diseases.

Assessment of Root Resorption and Root Shape by Periapical and Panoramic Radiographs: A Comparative Study.

INTRODUCTION: One of the common findings encountered by the clinician at the end of orthodontic treatment is the apical root resorption. Root resorption occurs to various degrees. A severe form of root resorption is characterized by shortening of root for more than 4 mm or more than one-third of the total tooth length. A low incidence rate of resorption is observed based on radiographic findings for the diagnosis of root resorption, panoramic radiography, and periapical radiography. Hence, we evaluated the accuracy of panoramic radiographic films for assessing the root resorption in comparison with the periapical films. MATERIALS AND METHODS: This study included the assessment of all the cases in which pre- and post-treatment radiographs were available for analysis of the assessment of the amount of root resorption. Complete records of 80 patients were analyzed. Examination of a total of 900 teeth was done. Mean age of the patients in this study was 21 years ranging from 11 to 38 years. The majority of the patients in the present study were females. All the treatments were carried out by registered experienced orthodontists having minimum experience of more than 10 years. All the cases were divided into two study groups. Group I comprised panoramic radiographic findings, while group II consisted of periapical radiographic findings. For the measurement of crown portion, root portion, and the complete root length, magnification loops of over 100 powers with parallax correction with inbuilt grids were used. Assessment of the tooth length and the crown length was done by the same observers. All the results were analyzed by Statistical Package for the Social Sciences software version 6.0. RESULTS: Maximum amount of root resorption was observed in case of maxillary central incisors and canines among group I and II cases respectively. However, nonsignificant difference was obtained while comparing the mean root resorption in relation to maxillary incisors and canines among the two study groups. While comparing the overall value of root resorption among the two study groups, a significant difference was obtained. The maximum value of tooth length in both the groups was observed in cases of maxillary canines. Significant differences were observed while comparing the tooth length of various teeth among the two study groups. Among the deviated forms of root shape, dilacera-tion was the most common form of root shape detected in both the study groups. CONCLUSION: Periapical radiographs are more efficient in the assessment of the shape and resorption of the root. CLINICAL SIGNIFICANCE: Thorough evaluation of periapical radiographs is necessary for detection of even minute levels of root resorption.

Molariform mesiodens in primary dentition.

Mesiodens is a midline supernumerary tooth commonly seen in the maxillary arch, and incidence of molariform mesiodens in the maxillary midline is rare in permanent dentition and extremely uncommon in primary dentition. A midline supernumerary tooth in the primary dentition can cause ectopic or delayed eruption of permanent central incisors which will further alter occlusion and may compromise esthetics and formation of dentigerous cysts. This paper reports a rare case of the presence of a molariform mesiodens in the primary dentition. On clinical and radiographic examination, flaring of the primary central incisors was seen, with a molariform mesiodens consisting of multiple lobes or tubercles on the occlusal surface with the well-formed root. The treatment plan consisted of the extraction of the supernumerary tooth and regular observation of permanent central incisors for proper eruption and alignment.

Interleukin-6 promoter polymorphism (-174 G/C) in Indian patients with chronic periodontitis.

Recent studies have focused on genetic polymorphism of the interleukin-6 (IL-6) gene, which has led to a better understanding of the intricate interactions between host response, microorganisms, and genetics. Genotype prevalence appears to vary by the race and ethnicity of the population studied. We used a polymerase chain reaction technique to determine the prevalence of single nucleotide polymorphism in IL-6 at position -174 G>C in a population of 30 South Indians. Blood samples were collected from 15 chronic periodontitis patients and 15 healthy controls. The results showed that the G/G genotype was significantly more frequent in the chronic periodontitis group and that the C/C genotype was significantly more frequent in the control group (P = 0.0069 for both). The G allele was more frequent in chronic periodontitis patients (76.67%), whereas the C allele was more frequent in the control group (73.33%). Among chronic periodontitis patients, the odds ratio for having the G allele, as compared with the controls, was 9.04. In this population, the presence of the G/G genotype of IL-6 (-174) might increase susceptibility to chronic periodontitis, whereas the C/C genotype may have a protective effect.

Herpesviruses in chronic and aggressive periodontitis patients in an Indian population.

Many recent studies have assessed the prevalence and role of herpesviruses in the etiopathogenesis of periodontal diseases, which has led to the realization of intricate interactions between viruses and bacteria within periodontal pockets. It has also been shown that the occurrence of herpesviruses may vary depending upon the age of the patient and the race of the population studied. Thus, the present study aimed at detecting herpes simplex virus type 1 and 2 (HSV 1 and 2), Epstein-Barr virus (EBV) and human cytomegalovirus (HCMV) in periodontal pockets of Indian patients with chronic and aggressive periodontitis. Subgingival plaque samples (n = 33) were collected from 19 randomly chosen chronic periodontitis and 14 aggressive periodontitis patients. Herpesviruses were detected using multiplex polymerase chain reaction technique. Chronic periodontitis patients revealed presence of HSV-1 in 19 (100%) samples, HSV-2 in 3 (15.7%), EBV in 15 (78.9%) and HCMV in 5 (26.31%) samples. Samples from aggressive periodontitis patients showed the presence of HSV-1 in 8 (57.14%), EBV in 4 (28.57%) and HCMV in 1 (7.14%), whereas HSV-2 was not detected in any specimen. In this population, herpesviruses were found more frequently in chronic periodontitis than in aggressive periodontitis patients and their prevalence may vary according to the age and race of the patient.