Periodontal and microbiological evaluation in cleft lip/palate patients undergoing orthodontic treatment: A cross-sectional study.

BACKGROUND: The present cross-sectional study was undertaken to evaluate the periodontal and microbiological parameters in patients with surgically repaired unilateral cleft lip and palate (UCLP) undergoing orthodontic correction in comparison to patients without any cleft or orthodontic treatment. METHODS: A total of 120 patients, out of initial 148 patients, between the age group 6 and 18 years were enrolled and divided into four groups with 30 patients each: non-cleft patients without orthodontic treatment in Group 1, non-cleft patients undergoing fixed orthodontic treatment in Group 2, patients with UCLP without any orthodontic treatment in Group 3, and patients with UCLP undergoing fixed orthodontic treatment in Group 4. Periodontal parameters including plaque index (PI), gingival index (GI), gingival bleeding index (GBI), community periodontal index of treatment needs (CPITN) index, pocket probing depth (PD), and tooth mobility were measured in all the groups. The subgingival plaque samples of all the patients were subjected to microbial evaluation using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF-MS) for clinical diagnosis. RESULTS: The periodontal parameters were significantly raised in Group 4, followed by Group 3 and Group 2 in comparison to Group 1 (p < 0.01), thereby suggesting poor periodontal health in patients with UCLP undergoing orthodontic treatment. Statistically significant differences (p < 0.01) in counts of micro-organisms among the groups were observed for P. gingivalis, P. intermedia, Veillonella, and Capnocytophaga, with the highest proportions in Group 4, indicating a deteriorating oral health in these patients. CONCLUSION: Poor periodontal and microbial health in patients with UCLP undergoing orthodontic treatment indicates a need for reinforcement of oral hygiene practices among these patients.

Microbial community diversity of an integrated constructed wetland used for treatment of sewage.

The microbial community diversity in Constructed Wetland System (CWS) plays a key role in the removal of pollutants from waste water. An integrated functional CWS developed at Neela Hauz Biodiversity Park, Delhi was selected to assess the diversity in composition and structure of microbial community diversity of sludge and sediment of CWS, based on metagenomic approach using 16S rRNA genes. The sediment showed higher diversity than sludge and both formed distinct clusters. The taxonomic structure of the microbial community of CWS is represented by 6,731 OTUs distributed among 2 kingdoms, 103 phyla, 227 classes, 337 orders, 320 families, 295 identified genera, and 84 identified species. The relative abundance of top 5 dominant phyla of sludge and sediment varied from 3.77% (Acidobacteria) to 35.33% (Proteobacteria) and 4.07% (Firmicutes) to 28.20% (Proteobacteria), respectively. The range of variation in relative abundance of top 5 dominant genera of sludge and sediment was 2.58% (Hyphomicrobium) to 6.61% (Planctomyces) and 2.47% (Clostridium) to 4.22% (Syntrophobacter), respectively. The rich microbial diversity of CWS makes it perform better in pollutants removal (59.91-95.76%) than other CWs. Based on the abundance values of taxa, the taxa are grouped under four frequency distribution classes-abundant (>20), common (10-19), rare (5-9), and very rare (1-4). The unique structure of microbial communities of integrated CWS is that the number of abundant taxa decreases in descending order of taxonomic hierarchy, while the number of rare and very rare taxa increases. For example, the number of abundant phyla was 14 and 21 in sludge and sediment, respectively and both communities have only 3 abundant genera each. This is in contrast to 4 and 17 very rare phyla in sludge and sediment, respectively and both the communities have 114 and 91 very rare genera, respectively. The outcomes of the study is that the integrated CWS has much higher microbial community diversity than the diversity reported for other CWs, and the rich diversity can be used for optimizing the performance efficiency of CWS in the removal of pollutants from waste water. Such structural diversity might be an adaptation to heterogeneous environment of CWS.

Effect of Laparoscopic Sleeve Gastrectomy on Quality of Life.

PURPOSE: The clinical benefits of bariatric surgery are well-established, but the impact of bariatric surgery on psychosocial outcomes such as health-related quality of life (HRQL) is less clear. The aim of this study is to assess the Quality of life (QOL) as a whole and in separate domains in post-bariatric surgery patients. METHODOLOGY: A single unit cross-sectional analysis of a prospective study is done on QOL in 51 patients undergoing laparoscopic sleeve gastrectomy at tertiary hospital. QOL was assessed by WHOQOL-BREF (World Health Organisation Quality of Life questionnaire -Brief version) questionnaire and Global Quality of Life Scale in each patient. Scores were calculated on a 0-100 scale and results compared. RESULTS: The median scores given by patients before surgery were 14, 21, 42, 40 and 12.5 for each of the parameters physical, psychological, social, environmental and overall well-being respectively. The median scores for after surgery were 86, 87, 91, 88 and 87.5 respectively. The difference was significant (p value 0.001). Global QOL after surgery, calculated year wise, showed QOL scores of 90, 100, 95 and 80 in patients with 1 year, 2 years, 3 years and 4 years of follow-up without any significant difference (p value 0.502). CONCLUSION: Through this study, we emphasize the need for the selection of a standardised scale by international organisations to compare the different studies. By proving the significant differences in the QOL of patients who underwent LSG [laparoscopic sleeve gastrectomy], we suggest to consider the Quality of Life as one of the criteria to consider a patient for bariatric surgery.

ISP good clinical practice recommendations for gum care.

Oral health is vital for the general well-being, overall body health and the quality of life throughout our lifetime. Most of the oral diseases and conditions are largely related to the maintenance of oral hygiene, lacking that people suffer from diverse oral diseases at different times in their life. With greater life expectancy, the individuals have teeth involved with periodontal diseases that would not only require professional care but also home gum care for them to last a lifetime. Indian Society of Periodontology (ISP) has recognized the need for systematic documents to update everyday clinical practice of general dental practitioners and have provided evidence-based consensus documents, namely good clinical practice recommendations from time to time to raise the oral health-related awareness and standards of oral healthcare delivery across the country. The current set of clinical practice recommendations focused to "Gum Care for All", is aimed at emphasizing and enhancing the awareness regarding oral health promotion, maintenance, and disease prevention. Twenty-five subject matter experts from across the nation, prepared these recommendations after a thorough literature review and group discussions. The document has been prepared in three distinct sections, namely pretherapeutic, therapeutic, and post therapeutic, to provide guidance during the respective phases of patient management and may serve as a quick and concise reference to the readers. The guidelines shall provide the distinct definitions, signs and symptoms, treatment required; recall visit specifications for plausible clinical case situations, home care advice regarding maintenance of oral hygiene including information on brushing technique, care and change of brush, use of interdental aids, and mouthwashes, etc. The document should advocate and guide the combined efforts of general dentists, and the population at large toward an empowered, evidence based, integrated, and comprehensive oral health care, which shall enhance the healthful functioning and longevity of the dentition and general health of the individual.

A novel injectable platelet-rich fibrin reinforced papilla reconstruction technique.

Formation of black triangles due to the loss of interdental papilla is one of the utmost perplexing esthetic problems of the periodontium. Many surgical and nonsurgical treatment options have been researched upon to obtain complete papillary fill, but minimally invasive procedures have always been the choice of treatment both for the operator as well as the patient. This article describes the use of injectable platelet-rich fibrin (i-PRF) as a novel nonsurgical technique for the reconstruction of deficient interdental papilla. This is probably the first article that describes the use of i-PRF for the nonsurgical treatment of black triangles. Six sites with the presence of deficient interdental papilla in four patients were selected for this case series. After completion and reevaluation of scaling and root planing, autologous i-PRF was injected at the base of the interdental papilla using the insulin syringe. Photographs obtained before the treatment and at 1, 3, and 6 months after the intervention were assessed by Image J software along with clinical measurements. The use of novel nonsurgical injectable PRF technique allows clinician to successfully treat deficient interdental papilla.

Evaluation of the correlation between interleukin 1ß levels in peri-implant crevicular fluid as an adjunctive diagnostic marker with clinical and radiographic parameters for assessing the peri-implant health status.

Background: Interleukin-1ß (IL-1ß) is one of the most important cytokines that seems to have an important role in the inflammatory process in gingival and peri-implant tissues. As peri-implant crevicular fluid (PICF) provides with a more swift and objective measure of the disease activity, the present study was conducted to evaluate IL-1ß level in PICF as a biochemical marker and to investigate its correlation with clinical parameters and radiological parameters. Materials and Methods: After evaluating all the patients following inclusion and exclusion criteria, 60 patients were selected for the study. After 3-4 months of implants placement, the implants were exposed following standard surgical procedure. PICF sample from implant site was taken 3 days after suture removal with gingival former still in place followed by measurement of clinical and radiological parameters. Results: There was significant increase in IL-1ß levels in both the follow-ups from baseline with variable and minimal change in the clinical parameters and radiological parameters as well, which shows that IL-1ß levels change significantly even when there is a minimal gingival inflammation. Conclusion: Therefore, IL-1ß level in PICF can be used as an adjunctive diagnostic marker to clinical and radiographic parameters for assessing the peri-implant health status.

44-year journey of palatal connective tissue graft harvest: A narrative review.

Connective tissue graft (CTG) is considered the gold standard for soft-tissue correction and augmentation surgeries, but involves a secondary donor area and its associated complications. The techniques to harvest CTG have undergone a large number of modifications over a period of 44 years since the time it was introduced by Edel in 1974 to increase the width of keratinized gingiva. This review compiles all the techniques of graft harvest from the palate and their modifications which have been introduced in the last 44 years till date. This review is based on systematic reviews, comparative human studies, and case reports describing any new technique of graft harvest. Publications till April 2018 were selected and further reviewed. In addition, specific related journals and books were searched upon. In order to minimize the pain, bleeding, and morbidity associated with donor site, several researchers proposed harvesting of the connective tissue by means of different techniques, each precisely different from others in terms of design, incisions, and procedure of harvest. Although the latest techniques are minimally invasive with reduced incision lines, less compromised blood supply, accelerated healing, and no sloughing of the overlying flap, they are technique sensitive which requires higher expertise to execute.

Application of platelet-rich fibrin membrane and collagen dressing as palatal bandage for wound healing: A randomized clinical control trial.

BACKGROUND: The palatal donor site of the free gingival graft (FGG) significantly influences the pain and discomfort experienced by the patient, and there is a potential for postoperative bleeding. The aim of this study was to compare the wound healing parameters with the use of a commercially available collagen dressing (CollaCote®) and platelet-rich fibrin (PRF) membrane as palatal bandage. MATERIALS AND METHODS: Twenty patients requiring FGG either for reduced/inadequate gingiva or gingival recession in the maxillary or mandibular anterior region were divided into two groups. In the first experimental group (10 patients), CollaCote® membrane was placed over the palatal wounds; conversely, the second experimental group patients were treated with a PRF membrane as palatal bandage. Clinical parameters recorded includes depth, immediate, and delayed bleeding, size of wound, pain, and tests for epithelialization which included hydrogen peroxide test and toluidine blue test at various time intervals. RESULTS: Intragroup comparisons showed significant improvement in wound healing parameters in both the groups. No statistically significant difference was found on intergroup comparison with respect to depth, hemorrhage, pain, epithelialization, and size, though the PRF group healed slightly better initially. CONCLUSION: Both CollaCote® and PRF palatal bandages significantly accelerate palatal wound healing and reduce the patient's pain and discomfort. PRF was easier to handle and suture and is also autogenous and economical as compared to CollaCote®.

Comparative Evaluation of Coronally Advanced Flap Using Amniotic Membrane and Platelet-rich Fibrin Membrane in Gingival Recession: An 18-Month Clinical Study.

BACKGROUND: An amnion membrane is a placenta-derived tissue that consists of numerous growth factors, proteins, and stem cell reserves which help in accelerated wound healing and regeneration. Platelet-rich fibrin (PRF) also releases growth factors after activation from the platelets and gets trapped within fibrin matrix which has been shown to stimulate the mitogenic response in the periosteum for bone repair and regeneration during normal wound healing. This preliminary, controlled, randomized clinical trial with an 18-month follow-up was aimed to evaluate the effectiveness of coronally advanced flap (CAF) with either PRF membrane or bioresorbable amniotic membrane (AM) in treatment of localized gingival recession defects. MATERIALS AND METHODS: Sixteen healthy adult patients presenting with Miller Class I recession defects were treated surgically with CAF along with AM (Group I) or PRF (Group II) for coverage of the recession defects. For all patients, plaque index, gingival index, bleeding on probing, clinical attachment level, depth of recession, width of recession, width of attached gingiva, and gingival thickness were evaluated at 6 months and 18 months postoperatively. Statistical analysis was done using paired t-test, repeated measure analysis of variance test, Bonferroni test for intragroup comparison and unpaired t-test for intergroup comparison. RESULTS: The results showed statistically nonsignificant (P < 0.01) difference in all clinical parameters at the 6- and 18-month follow-ups in both groups. Gingival recession in both PRF and amnion group when evaluated individually, significantly reduced from baseline to 6 months (P = 0.000) and from baseline to 18 months (P = 0.000). However, the mean value from 6 months to 18 months was statistically nonsignificant. CONCLUSION: The present study demonstrated that both CAF + PRF and CAF + AM are equally effective in providing clinically significant outcomes with respect to root coverage with AM showing the better percentage of root coverage as compared to PRF.

Multidisciplinary prognostic transition of a molar tooth for long-term survival.

Patients with periodontitis may have one or few teeth with hopeless prognosis, which would have to be extracted before initiation of orthodontic therapy. Periodontal therapy aims to prolong the lifespan of dentition, as preserving natural dentition is always the best treatment option. The decision to retain a tooth is always based on the probability of long-term success of one or more treatment modality. A 17-year-old female patient seeking fixed orthodontic treatment presented with the left mandibular first molar tooth (36) having hopeless periodontal prognosis with advanced primary periodontal and secondary endodontic lesion, grade III mobility, and grade II furcation involvement. Root canal treatment followed by periodontal surgery using a combination of bone graft (allograft) and platelet-rich fibrin membrane resulted in a clinical and radiographic indication of periodontal healing. The tooth (36) was even used for orthodontic anchorage 3-month postsurgically and was maintained for 2 years. Appropriate diagnosis and meticulous multidisciplinary treatment approach can lead to the restoration of health and function of the teeth with severe loss of attachment and bone loss and can even be used for orthodontic anchorage.

Effect of supragingival oral irrigation as an adjunct to toothbrushing on plaque accumulation in chronic generalized gingivitis patients.

AIM: The aim of this study was to evaluate the efficacy of supragingival oral irrigation either with water or different concentrations of chlorhexidine (CHX) digluconate as an adjunct to toothbrushing on plaque accumulation in chronic generalized gingivitis patients. MATERIALS AND METHODS: Fifty patients were randomly allocated into five groups. Group 1: toothbrushing alone, Group 2: toothbrushing with mouthwash, Group 3: toothbrushing with water irrigation, Group 4: toothbrushing with 0.0075% CHX digluconate (36 mg) supragingival irrigation, and Group 5: toothbrushing with 0.02% CHX digluconate (96 mg) supragingival irrigation. The collected data were subjected to statistical analysis. STATISTICAL ANALYSIS: Descriptive data were obtained for all outcome variables and reported as mean ± standard deviation. The Student's t-test, Chi-square test, and one-way analysis of variance (ANOVA) were applied for the statistical evaluation of means and comparisons of proportions, and post hoc Bonferroni test was used for multiple comparisons after the application of the ANOVA test for comparison within the groups. RESULTS: When intergroup difference of the mean differences was compared for individuals using toothbrushing along with 0.0075% CHX digluconate irrigation and those using toothbrushing along with 0.02% CHX digluconate irrigation from BL-14, BL-28, and between 14 and 28 days, it was found to be statistically nonsignificant. CONCLUSIONS: In our study, the CHX digluconate concentration for mouthwash and oral irrigation in addition with toothbrushing was found to be same, i.e., <50 mg for improving the gingival health by reducing gingival inflammation.

Clinical and Histologic Evaluation of Platelet-Rich Fibrin Accelerated Epithelization of Gingival Wound.

The foremost indication for gingival depigmentation is patient demand for improved aesthetics. In most cases after the removal of pigmented layer, the area is covered with periodontal packs. These dressings have no curative properties. They only minimise the likelihood of surface trauma during mastication. However, platelet-rich fibrin (PRF) accelerates wound healing by effective neovascularisation and promoting fast cicatricial tissue remodelling. In the present split mouth study, PRF membrane was applied in the first quadrant and non-eugenol dressing (Coe-Pack) in the second quadrant after depigmentation. Clinical evaluation of epithelization with toluidine blue revealed that PRF treated sites stained substantially less indicating better wound healing as compared to Coe-Pack sites, which appeared more erythematous after 5 days. The histologic evaluation also revealed greater inflammatory cell infiltrate on Coe-Pack sites as compared to PRF. Thus, PRF membrane as a periodontal dressing is a successful approach to protect the raw wound area of the depigmented site to reduce healing time and patient discomfort.

Comparative evaluation of probing depth and clinical attachment level using a manual probe and Florida probe.

BACKGROUND: To compare and evaluate the intra- and inter-examiner efficacy and reproducibility of the first-generation manual (Williams) probe and the third-generation Florida probe in terms of measuring pocket probing depth (PD) and clinical attachment level (CAL). MATERIALS AND METHODS: Forty subjects/4000 sites were included in this comparative, cross-sectional study. Group- and site-wise categorizations were done. Based on gingival index, PD, and CAL, patients were divided into four groups, i.e., periodontally healthy, gingivitis, mild to moderate periodontitis, and severe periodontitis. Further, based on these parameters, a total of 4000 sites, with 1000 sites in each category randomly selected from these 40 patients, were taken. Full mouth PD and CAL measurements were recorded with two probes, by Examiner 1 and on Ramfjord teeth by Examiner 2. RESULTS: Full mouth and Ramfjord teeth group- and site-wise PD obtained with the manual probe by both the examiners were statistically significantly deeper than that obtained with the Florida probe. The full mouth and Ramfjord teeth mean CAL measurement by Florida probe was higher as compared to manual probe in mild to moderate periodontitis group and sites, whereas in severe periodontitis group and sites, manual probe recorded higher CAL as compared to Florida probe. CONCLUSION: Mean PD and CAL measurements were deeper with the manual probe as compared to the Florida probe in all the groups and sites, except for the mild-moderate periodontitis group and sites where the CAL measurements with the manual probe were less than the Florida probe. Manual probe was more reproducible and showed less interexaminer variability as compared to the Florida probe.

Comparison of the clinical applicability of Miller's classification system to Kumar and Masamatti's classification system of gingival recession.

BACKGROUND: The aims of the present study were to (i) Find the percentage of recession cases that could be classified by application of Miller's and/or Kumar and Masamatti's classification of gingival recession, and (ii) compare the percentage of clinical applicability of Miller's criteria and Kumar and Masamatti's criteria to the total recessions present. MATERIALS AND METHODS: A total of 104 patients (1089 recession cases) were included in the study wherein they were classified using both Miller's and Kumar and Masamatti's classification systems of gingival recession. Percentage comparison of the application of both classification systems was done. RESULTS: Data analysis showed that though all the cases of the recession were classified by Kumar and Masamatti's classification, only 34.61% cases were classified by Miller's classification. 19.10% cases were completely (having only labial/buccal recession) classified. In 15.51% (out of 34.61%) cases, only buccal recession was classified according to Miller's criteria and included in this category, although these cases had both buccal and lingual/palatal recessions. Furthermore, 29.75% cases of recession with interdental loss and marginal tissue loss coronal to mucogingival junction (MGJ) remained uncategorized by Miller's classification; categorization of palatal/lingual recession was possible with Kumar and Masamatti's classification. CONCLUSION: The elaborative evaluation of both buccal and palatal/lingual recession by the Kumar and Masamatti's classification system can be used to overcome the limitations of Miller's classification system, especially the cases with interdental loss and having marginal tissue loss coronal to MGJ.

A comparative evaluation of freeze dried bone allograft and decalcified freeze dried bone allograft in the treatment of intrabony defects: A clinical and radiographic study.

BACKGROUND: Ideal graft material for regenerative procedures is autogenous bone graft but the major disadvantage with this graft is the need for a secondary surgical site to procure donor material and the frequent lack of intraoral donor site to obtain sufficient quantities of autogenous bone for multiple or deep osseous defects. Hence, to overcome these disadvantages, bone allografts were developed as an alternative source of graft material. MATERIALS AND METHODS: In 10 patients with chronic periodontitis, 20 bilateral infrabony defects were treated with freeze dried bone allograft (FDBA-Group A) and decalcified freeze dried bone allograft (DFDBA-Group B). Clinical and radiographic parameters were assessed preoperatively and at 3 months and 6 months postoperatively. Data thus obtained was subjected to statistical analysis. RESULTS: Significant improvement in the reduction in probing depth and relative attachment level (RAL) from the baseline to 3 months to baseline to 6 months in group A and group B, which was statistically significant but no statistically significant reduction was seen between 3 months and 6 months. On inter-group comparison, no significant differences were observed at all-time points. In adjunct to the probing depth and RAL, the radiographic area of the defect showed a similar trend in intra-group comparison and no significant difference was seen on inter-group comparison at all-time points. CONCLUSIONS: Within the limitations of the current study, it can be concluded that DFDBA did not show any improvement in the clinical and radiographic parameters in the treatment of the intrabony defects as compared to FDBA.

A prospective study to assess the levels of interleukin-6 following administration of diclofenac, ketorolac and tramadol after surgical removal of lower third molars.

INTRODUCTION: The surgical removal of impacted third molars involves, trauma to soft and bony tissue and can result in considerable pain, swelling, and trismus. The greater the amount of tissue injury the greater is the amount of inflammation in the perisurgical region. Interleukin-6 (IL-6) is both a pro inflammatory and anti-inflammatory cytokine. It is secreted by T cells and macrophages to stimulate the immune response. IL-6 is also an early marker of tissue damage. In addition to NSAIDs, corticosteroids, opioids also have immunomodulatory effects. AIM: To evaluate the changes in serum IL-6 levels following surgical removal of third molars under local anaesthesia after administration of two NSAIDs diclofenac and ketorolac and opioid tramadol post operatively. METHODS: Patients undergoing surgical removal of impacted mandibular third molar teeth were randomly assigned to three groups. Each group received one of the three analgesics viz diclofenac 50 mg, ketorolac 10 mg and tramadol 50 mg. The mean levels of IL-6 was then estimated by ELISA. RESULTS: The results of our study showed that all three drugs i.e. diclofenac, ketorolac and tramadol have properties which can downregulate the production of IL-6 in response to surgical trauma. CONCLUSION: It is of clinical significance that the suppression of IL-6 values occurs in tramadol group closely following the diclofenac group. Even though the drug ketorolac suppresses the IL-6 levels similar to diclofenac initially but after 7 days tramadol and ketorolac showed similarities in suppression of IL-6 expression which is less compared to diclofenac group.

Assessment of the width of attached gingiva using different methods in various age groups: A clinical study.

BACKGROUND: The width of attached gingiva varies from tooth to tooth and also among individuals with mixed opinions regarding an "adequate" or "sufficient" dimension of the gingiva. Although the need for a so-called adequate amount of keratinized tissue for maintenance of periodontal health is questionable, the mucogingival junction serves as an important clinical landmark in periodontal evaluation. There are various methods of locating the mucogingival junction namely the functional method and the visual method with and without histochemical staining, which aid in the measurement of the width of attached gingiva. MATERIALS AND METHODS: This study was carried out to assess the full mouth mid-buccal width of attached gingiva in individuals of four different age groups. This study also evaluated the difference in visual and histochemical methods in identification of the mucogingival junction to calculate the width of attached gingiva. RESULTS: It was seen that the width of attached gingiva increases with age, and there was no significant difference in the width of attached gingiva by both the methods. CONCLUSION: Width of attached gingival varies in different areas of the mouth and also increases with age with no significant difference in the method of its assessment.

Comparison of nanocrystalline hydroxyapatite and synthetic resorbable hydroxyapatite graft in the treatment of intrabony defects: A clinical and radiographic study.

BACKGROUND: The aim of this study is to compare, clinically and radiographically, the effectiveness of nanocrystalline hydroxyapatite (NHA) and synthetic resorbable hydroxyapatite (HA) in the treatment of intrabony defects. MATERIALS AND METHODS: Ten subjects with bilateral defects, with probing depth (PD) 6-9 mm and radiographic evidence of an intraosseous component ≥4 mm participated in the present study. Subjects were allocated randomly to treatment with NHA (test group) or HA (control group). At baseline, 3 and 6 months after surgery, the following clinical parameters were recorded: Plaque index, gingival index, PD, relative attachment level (RAL), and radiographic reduction in intrabony defect. RESULTS: At 6 months following therapy, the test group showed a reduction in mean PD from 6.4 ± 0.843 to 3.3 ± 0.8232 mm and a change in mean RAL from 12.9 ± 1.197 to 10.1 ± 0.7378 mm, whereas in the control group the mean PD decreased from 7.65 ± 1.8566 to 3.9 ± 1.1005 mm, and mean RAL decreased from 13.9 ± 0.9944 to 10.7 ± 0.6749 mm. On comparison of the mean difference in probing depth between the two groups after the unpaired t-test was applied at baseline, 3 months and 6 months, scores were found to be statistically non-significant (P > 0.01). CONCLUSION: The results of the present study indicate that both NHA and conventional HA led to the improvement of clinical and radiographic parameters over the course of the study. However, the test group did not show any significant improvement over the control group.

Comparison of two different depigmentation techniques for treatment of hyperpigmented gingiva.

INTRODUCTION: Demand for cosmetic therapy of gingival melanin pigmentation is common. Re-pigmentation after gingival depigmentation is an important point. The aim of this study is to evaluate the effect of surgical scraping and electrosurgery on postoperative pain, healing and recurrence of pigmentation. MATERIALS AND METHODS: Fifteen patients with esthetic concern related to black gums were selected and treated by surgical scraping with respect to right quadrant and electrosurgery with respect to left quadrant. Patients were recalled post-operatively to evaluate healing and recurrence of pigmentation. Each patient was asked to complete the Visual Analogue Scale (VAS) index cards 2 and 24 hours postoperatively. RESULTS: In the initial post-operative period, VAS index cards showed that the discomfort and pain level associated with electrosurgery was significantly higher than conventional scalpel surgery (P < 0.05). Clinically delayed healing was observed in the electrosurgically treated site. Electrosurgery showed better results as compared to epithelial excision for recurrence of pigments. At the end of 15 months, 7 sites in the scalpel excision group showed recurrence, whereas only 4 site showed recurrence in the electrosurgically treated group. CONCLUSION: The methods used here produced desired results and above all, the patients were satisfied with the outcome. Increased pain level and clinically delayed healing was associated with electrosurgery as compared to scalpel surgery, whereas repigmentation occurred more frequently in scalpel-treated sites.