In vitro evaluation of remineralizing agents on dentinal tubule occlusion: A scanning electron microscopic study.

Context: Over the years, numerous treatment modalities have been researched for the management of dentinal hypersensitivity. A recent remineralizing agent containing a phase of amorphous calcium phosphate combined with fluoride has shown the ability to rapidly convert into biomimetic hydroxyapatite. This potential can be utilized in occluding the dentinal tubules for the treatment of hypersensitivity. Aims: The present study aims to compare the effectiveness of biomimetic hydroxyapatite-based tooth mousse and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) tooth mousse as desensitizing agents on dentinal tubule occlusion. Materials and Methods: The in vitro study design involved 30 prepared dentin specimens that were divided into three groups: Group A: negative control, Group B: CPP-ACP tooth mousse (GC tooth mousse™), and Group C: fluoride-doped amorphous calcium phosphate (F-ACP) tooth mousse (Curasept Biosmalto Denti Sensibili Tooth Mousse). The specimens were observed under a scanning electron microscope (SEM) and an attached energy-dispersive X-ray (EDX) spectroscopy apparatus after 1 week. Statistical Analysis: The data were analyzed using Kruskal-Wallis test and post hoc Mann-Whitney test for intragroup and intergroup analysis, respectively. Results: The SEM analysis of the F-ACP group showed statistically greater percentage of tubule occlusion (40.21%) compared to the CPP-ACP group (38.15%). EDX analysis of both F-ACP and CPP-ACP groups revealed calcium, phosphorus, carbon, oxygen, and silica with an additional fluoride element in the F-ACP group. Conclusions: In the present study, both remineralizing agents were able to occlude the dentinal tubules. Among the two, the F-ACP tooth mousse showed greater tubule occlusion, and therefore, appears promising as an upcoming remineralizing agent in the management of dentinal hypersensitivity.

Management of Aberrant Frenal Attachments in Adults by Scalpel Method and 980 nm Diode Laser.

Treatment modalities like electrosurgery and lasers have emerged as effective painless alternatives to scalpel methods for a frenectomy. The present case series involves ten patients, diagnosed with abnormal frenal attachments. Frenectomy was performed by 980 nm diode laser and scalpel methods. Scalpel frenectomy was performed as described by Archer and Kruger. Laser-assisted frenectomy was performed by a hemostat-guided incision using a 980 nm diode laser tip in a paintbrush motion. It was observed that Visual Analogue Scale (VAS) pain scores in patients who underwent scalpel frenectomy were comparatively higher than the laser-treated patients. In contrast, wound healing scores were higher in the scalpel group, suggesting early wound healing in the scalpel-treated patients.

Comparison of color accuracy and picture quality of digital SLR, point and shoot and mobile cameras used for dental intraoral photography - A pilot study.

The present study aimed to compare the picture quality and color accuracy of three cameras, namely, Point and shoot, DSLR and mobile cameras, and determine the most suitable camera for dental photography (intra-orally and for casts). A computer program, namely, NRM (No-Reference matrix BRISQUE), was used to evaluate the quality of the photos taken by three cameras. Further, color accuracy was determined by computation of total color difference (ΔE) by identifying the L∗a∗b∗ values. The ANOVA (Kruskal-Wallis) analysis was done to assess the difference in the quality of cast photos, and it showed a statistically significant difference (p < 0.05) between the cameras. The post hoc analysis showed the NRM value of Point and shoot (18.93 ± 2.04) better than the Mobile phone (20.59 ± 2.65). However, no statistically significant difference was obtained while assessing the picture quality of the intraoral photographs using One-Way ANOVA (Fisher's) (P = 0.05). Evaluation of total color difference (ΔE) showed fewer differences between the DSLR and the Point and shoot than the mobile camera. There was no statistically significant difference in ΔE value in the participant photographs. The L in the LAB values of both the cast and the participant photograph showed a similar result, with the mobile phone showing a lighter value than the other two cameras. The B value in the participant photos showed a significant difference between the mobile and the Point and shoot cameras. The quality of Point and shoot, DSLR, and mobile cameras were equally good for taking pictures of any external surface, but the mobile camera offered more brightness and appeared more yellow. On the other hand, the quality was similar for intraoral images with mobile and Point and shoot cameras, although color accuracy was better with Point and shoot and DSLR cameras.

Type 1 diabetes and periodontal disease: a literature review.

Objective: This narrative review examines the literature on type 1 diabetes mellitus (T1DM) and periodontitis pathogenesis, seeking to determine the effectiveness of periodontal therapy in improving glycemic control in individuals with T1DM. Methods: A detailed search of the literature was conducted in the following electronic databases: PubMed, Google Scholar, Scopus, and Cochrane Library. Inclusion criteria were systematic reviews with meta-analyses published between 2015 and 2020, and human peer-reviewed clinical trials addressing the effectiveness of periodontal treatment on glycemic control in individuals with T1DM published between 1995 and 2020. Results: The search retrieved 3 systematic reviews and 9 original research papers that included 10 clinical studies. Discussion: Three systematic reviews on T1DM and periodontal disease suggested that individuals with T1DM have more features of periodontitis than healthy subjects, although long-term data are scarce. Nine of the ten clinical studies showed no impact on glycemic control in individuals with T1DM, while 1 study reported improvement. Conclusion: The selected literature lacked data on long term assessment and adequate randomization with controls. The data perused did not provide sufficient evidence to determine the effectiveness of periodontal therapy in improving glycemic control in type 1 diabetes or to suggest that T1DM is a risk factor for periodontal disease.

Objectif: La présente revue narrative examine la documentation sur le diabète sucré de type 1 (DST1) et la pathogénie de la parodontite et cherche à déterminer l'efficacité de la thérapie parodontale dans l'amélioration de la régulation glycémique chez les individus atteints du DST1. Méthodologie: Une recherche détaillée de la documentation a été effectuée dans les banques données électroniques suivantes : PubMed, Google Scholar, Scopus et la Bibliothèque Cochrane. Les critères d'inclusion étaient les revues systématiques avec méta-analyses publiées entre 2015 et 2020, et les essais cliniques chez les humains, évalués par des pairs traitant l'efficacité du traitement parodontal sur la régulation glycémique chez les individus atteints de DST1, publiées entre 1995 et 2020. Résultats: La recherche a repéré 3 revues systématiques et 9 documents de recherche originaux qui comprenaient 10 études cliniques. Discussion: Trois revues systématiques sur le DST1 et la maladie parodontale ont suggéré que les individus atteints du DST1 ont plus de caractéristiques de parodontite que les sujets en santé, bien qu'il y ait peu de données à long terme. Neuf des dix études cliniques n'ont montré aucun effet sur la régulation glycémique chez les individus atteints de DST1, alors qu'une étude a déclaré de l'amélioration. Conclusion: La documentation sélectionnée avait insuffisamment de données sur l'évaluation à long terme ainsi qu'une randomisation insuffisante avec témoins. Les données examinées n'ont pas fourni assez de preuves pour déterminer l'efficacité de la thérapie parodontale dans l'amélioration de la régulation glycémique du diabète de type 1 ou pour suggérer que le DST1 est un facteur de risque de la maladie parodontale.

Management of excessive gingival display with mucosal coronally positioned flap.

OBJECTIVE: Current methods of managing excessive gingival display, an aesthetic concern, with gingivectomy, orthodontic intrusion, restorative dentistry and even botulinum toxin, have often been unsatisfactory. This study evaluates the efficacy of mucosal coronally positioned flap (MCPF) for reduction of gingival display. MATERIAL AND METHODS: Eight healthy patients, above 18 years, with either short or hyperactive upper lip, gingival display ≥4 mm during smiling or vertical maxillary excess, were recruited into the study. The smile line, upper lip length, upper lip vermillion length, distance between the lips and amount of gingival display along with clinical indices were assessed. The patients then underwent MCPF procedure and were re-evaluated for healing of the surgical site after 15 days and at 3 months. Patients also provided their perceptions of outcome of treatment, through a questionnaire. Paired t test and Repeated measures ANOVA were used for data analysis. RESULTS: Significant improvement in the gingival display was noted 3 months after the procedure, while no concomitant changes were observed in other parameters like upper lip length, vermillion length and distance between the lips post operatively. CONCLUSION: The results of the study suggest that the MCPF procedure provides satisfactory results in terms of reduction of gingival display. Simplicity of the surgical procedure makes it an attractive option for patients without any gross skeletal abnormalities.

Comparison of Oncostatin M in Patients with Chronic Periodontitis with and without Diabetes

Abstract Objective: To compare the Oncostatin M (OSM) concentrations in tissues of patients with chronic periodontitis with and without diabetes. Material and Methods: Sixty-four subjects visiting the dental outpatient department were categorized as "healthy" (Group 1), "periodontitis" (Group 2), and "diabetes with periodontitis" (Group 3) groups. The clinical oral examination included assessment of plaque, gingivitis, probing depth, clinical attachment level. Blood glucose was assessed for group 3 patients. OSM concentration in the tissues was assessed using ELISA in all groups. Results: The mean OSM was 0.02 ± 0.04 pg/mg in the healthy group, 0.12 ± 0.09 pg/mg in the chronic periodontitis group and 0.13 ± 0.10 pg/mg in the diabetes-periodontitis group. A significantly higher mean OSM was seen in Group 2 and Group 3 than Group 1. The amount of OSM positively correlated with probing depth and clinical attachment level. Conclusion: Periodontal disease causes a rise in Oncostatin M, independent of the diabetic status. Expression of OSM in the gingival tissues can serve as an inflammatory marker.

Simvastatin in polymer bioscaffold for bone regeneration. An in vitro and in vivo analysis.

OBJECTIVE: The study aimed to fabricate and test the biocompatibility of a polylactic-co-glycolic acid (PLGA) based guided tissue regeneration membrane impregnated with 'simvastatin' to promote sustained drug delivery near osseous defects and evaluate the regenerative potential of the membrane histologically. MATERIALS AND METHODS: We tested the mechanical properties and cytotoxicity of an indigenously fabricated PLGA membrane incorporated with simvastatin (1 mg/cm2). An animal study evaluated the regenerative potential of the membrane. Twenty-four adult Wistar rats, approximately 175 g in weight, were used in this study. The rats were divided randomly into four groups based on the postoperative healing periods into ten days, 1, 3, and 6 months. Within each time group, six rats were divided into three subgroups: Subgroup A - sham surgery controls; Subgroup B - PLGA without Simvastatin; Subgroup C - PLGA with simvastatin tests. The radiographic examination intervals were ten days, 1 and 3 months, while the histological assessment was around 1, 3, and 6 months. RESULTS: Simvastatin content was distributed uniformly in all the prepared membranes and was equivalent to 1 mg/cm2. 100 mg PLGA membrane with simvastatin demonstrated uniform drug release over time, excellent mechanical properties, and biocompatibility. The rat models in Subgroup C had better bone tissue formation radiographically and histologically. CONCLUSION: The study suggested that 'PLGA with Simvastatin' has the requisite properties to serve as a third-generation barrier membrane with the potential for local drug delivery.

Diode laser-assisted management of intraoral soft tissue overgrowth: a case series.

The conventional method of managing intraoral soft tissue overgrowth involves surgical excision using a scalpel under local anesthesia. These procedures are often associated with excessive bleeding that leads to complications. Now, minimally invasive methods such as laser excision are available for the management of intraoral soft tissue lesions. The objective of the present case series is to describe the use of a 980-nm diode laser to treat 4 cases of soft tissue enlargement of the oral cavity. Two women and 2 men with an age range of 21-73 years presented with chief complaints of intraoral swelling. The overgrowth was located on the tongue in 2 patients and in the gingival region in 2 patients. In all 4 patients, the overgrown tissues were excised with a 980-nm gallium-arsenide diode laser at a power of 1.0-4.0 W in continuous-wave contact mode. Excised tissues were sent for histopathologic examination to confirm the clinical diagnosis. Each lesion was excised with adequate hemostasis in 15-20 minutes. At the recall examination after 10 days, patients did not report any postoperative complications. There was no sign of recurrence in any patient at the 3-month follow-up. Based on the histopathologic reports, 2 lesions were diagnosed as pyogenic granuloma, 1 as capillary hemangioma (a form of pyogenic granuloma), and 1 as peripheral ossifying fibroma. The results of this limited case series suggest that a 980-nm diode laser may be an advantageous surgical modality for treating benign proliferative lesions of the oral mucosa with negligible postoperative adverse sequelae.

VISTA technique in combination with chorionic allograft for gingival recession coverage: a case series.

The vestibular incision subperiosteal tunnel access (VISTA) technique, a minimally invasive procedure, achieves multitooth recession coverage with only a single access incision. Use of fetal membranes such as the amnion and chorion has become increasingly popular in the field of dentistry due to their lack of immunogenicity and added advantage of growth factors. The present case series aimed to provide information regarding the potential advantage of placing a chorionic membrane in combination with the VISTA technique to achieve recession coverage. Eight healthy adult patients presenting with 24 Miller Class I multitooth gingival recession defects were surgically treated with the VISTA technique and a chorionic membrane. The clinical parameters measured at baseline and 1, 3, and 6 months postoperatively were probing depth, clinical attachment level, width of keratinized gingiva, thickness of attached gingiva, and height of gingival recession. A repeated-measures analysis of variance with a post hoc Bonferroni test was carried out to compare the baseline values with the 1-, 3-, and 6-month postoperative values. The mean (SD) height of gingival recession was significantly reduced from 2.04 (0.67) mm at baseline to 0.71 (0.71) mm at 6 months (P < 0.001). In addition, there were statistically significant gains in the clinical attachment level, width of keratinized gingiva, and thickness of attached gingiva from baseline to 6 months postoperatively (P < 0.001). The probing depth remained the same at all measurement times. The VISTA technique provided good results in terms of recession coverage. Although there was an improvement in the gingival biotype, the placement of a chorionic membrane did not provide any advantage in terms of percentage of root coverage.

The association between diabetic retinopathy and periodontal disease.

PURPOSE: The purpose of the study was to study the association between diabetic retinopathy (DR) and periodontal disease (PD) in a South Indian cohort. METHODS: This was a cross-sectional, observational, interdisciplinary hospital-based study wherein patients with diabetes mellitus visiting the ophthalmology department of a university teaching hospital in coastal Karnataka, south India, during the study period, were screened independently for retinopathy by an ophthalmologist and PD by a periodontal surgeon. All the patients were above 18 years of age and did not have juvenile or gestational diabetes. A total of 213 patients consented to participate in the study. The data were analyzed for association using the Chi-square test. RESULTS: There was a statistically significant association between the presence of DR and PD (P = 0.02). The increasing severity of DR was associated with an increase in the components of PD including plaque index (P < 0.001) and gingival index (P < 0.001). CONCLUSION: There is a significant association between DR and PD. The awareness of this association can aid in the screening of potentially sight-threatening retinopathy in diabetics presenting to the dental clinic with PD.

Influence of polycystic ovary syndrome on the periodontal health of Indian women visiting a secondary health care centre.

OBJECTIVES: Periodontal disease and polycystic ovary syndrome (PCOS) share risk factors like obesity, insulin resistance, and dyslipidemia, along with evidence of chronic inflammation in the two conditions. Evaluating the influence of PCOS on periodontal health would, therefore, identify a possible association. MATERIALS AND METHODS: Sixty women, divided into equal groups of PCOS and healthy patients, were clinically examined for periodontal parameters like probing depth (PD), plaque index (PI), modified gingival index (mGI), and bleeding on probing (BOP). Fasting blood sugar (FBS), insulin (FI), triglycerides (TG), and free testosterone along with serum and gingival crevicular fluid (GCF) levels of malondialdehyde (MDA) and myeloperoxidase (MPO) were the biochemical parameters evaluated. RESULTS: Women with PCOS had statistically significant differences in mGI, PI, testosterone, FBS, and TG when compared with healthy women (p < 0.05). MDA levels in serum and GCF between women with PCOS and controls were also significantly different. BOP and mGI showed a moderate positive correlation (r = 0.45 and 0.44) with serum levels of MDA. Relatively greater gingival inflammation was observed in patients with PCOS compared to healthy controls, independent of the risk factors present. CONCLUSION: PCOS seemed to have an impact on gingival inflammation, in addition to the effect of dental plaque and other local factors in the oral cavity, in PCOS patients when compared with healthy individuals. CLINICAL RELEVANCE: Women diagnosed with PCOS may have probabaility of co-existing gingival inflammation. Therefore, emphasis on medical treatment for PCOS and periodic screening for periodontal disease may be warranted.

Assessment of Pyrexia and Associated Sickness Behavior in Patients with Chronic Periodontitis.

BACKGROUND AND OBJECTIVES: The purpose of this study was to assess pyrexia and sickness behavior such as anxiety, depression, lethargy, and weight loss in subjects with chronic periodontitis, and evaluate inflammatory mediators such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in the patients with fever. METHODS: This was a cross-sectional study that consisted of 150 chronic periodontitis and 150 healthy subjects. Sublingual and subgingival temperatures were assessed using a digital temperature probe. Associated sickness behavior was assessed for all the subjects. Pathological tests, i.e., ESR and CRP were done for subjects with fever. RESULTS: Evaluating the presence of fever with the severity of periodontal disease, 66.7% of the subjects with fever were in the group diagnosed with severe periodontitis, 20.4% had with moderate periodontitis, and 5.3% were in the healthy group. Subjects diagnosed with periodontitis comprised 66.2% of the subjects with higher (i.e., > 36.3°C) subgingival temperatures and healthy subjects made up the remaining 33.8% (p < 0.001). A correlation between the sublingual and subgingival temperature with the Pearson ρ correlation coefficient of 0.227 (p < 0.001) was observed. A statistically significant mean value of 37.05 ± 11.24 of ESR and 1.59 ± 1.11 mg/L of CRP was reported amongst the subjects with fever (p < 0.001). The association of sickness behavior with the severity of periodontitis was found to be significant: depression 40.006, anxiety 50.857, reported weight loss 76.463, and lethargy 141.581 (p < 0.001). DISCUSSION AND CONCLUSION: The study demonstrated that there is a significant increase in the sublingual temperature amongst patients with severe chronic periodontitis. The subgingival temperature has a positive correlation with the sublingual temperature. There was a linear trend of an association of sickness behavior with the severity of chronic periodontitis. A significant increase in the circulating inflammatory mediators, CRP and ESR, were noticed in subjects with elevated body temperature.

Use of a mandibular torus for autogenous grafting: a case report.

Conventional treatment for the management of 2- to 3-walled intrabony defects is the use of allograft or alloplasts. Autogenous grafts are the gold standard because of their osteogenic potential. Mandibular tori are an ideal site for harvesting bone because their excision causes no structural, esthetic, or functional compromise to the patient. This case report describes the use of an autogenous graft obtained from a mandibular torus. The graft was utilized, in particulate form, to fill an intrabony defect at the mandibular right central incisor. The mandibular torus provided sufficient graft material and eliminated the need for a second surgical site. A follow-up at 1 year revealed reduction in clinical attachment loss and complete resolution of tooth mobility.

Localized In Situ Nanoemulgel Drug Delivery System of Quercetin for Periodontitis: Development and Computational Simulations.

This study was aimed at formulating a bioabsorbable, controlled-release, nanoemulgel of Quercetin, a potent antimicrobial and anti-inflammatory agent for the treatment of periodontitis that could improve its solubility and bioavailability. Screening of components was carried out based on the solubility studies. Nanoemulsion containing cinnamon oil as the oil phase, tween 80 and Carbitol® as the surfactant-cosurfactant mixture (Smix) and water as the aqueous phase containing 125 µg/200 µL of Quercetin was prepared by using spontaneous emulsification method. Nanoemulgel was prepared using 23% w/v poloxamer 407 as gel base. Comprehensive evaluation of the formulated nanoemulgel was carried out, and the optimized formulation was studied for drug release using Franz vertical diffusion cells. The formulated nanoemulgelexhibited a remarkable release of 92.4% of Quercetin at the end of 6 h, as compared to that of pure Quercetin-loaded gel (<3% release). The viscosity of the prepared nanoemulgel was found to be 30,647 ± 0.32 cPs at 37 °C. Also, molecular dynamics (MD) simulation was utilized to understand the gelation process and role of each component in the formulation. The present study revealed that the developed nanoemulgel of Quercetin could be a potential delivery system for clinical testing in periodontitis.