Alcohol and Periodontal Disease: A Narrative Review.

The scientific literature dealing with alcohol and alcoholic beverages revealed that these drinks possess an adverse impact on periodontal tissues. Additionally, other principal risk factors include tobacco, smoking, poor oral hygiene, etc. It has been observed that among chronic alcoholics, there are further issues, such as mental, social, and physical effects, that promote alcoholism. These people may have weak immunity for defense against pathogenic organisms and bacteria. Thus, chances of gingival bleeding, swollen gums, bad breath, and increased bone loss are there. Different alcoholic beverages in the market cause less salivation; these beverages contain sugars that promote acid production in the oral cavity by pathogens that demineralize the enamel and damage gum and teeth. This chronic alcohol consumption can progress into different types of oral disorders, including cancer, halitosis, and caries, and is also associated with tobacco and smoking. Chronic alcohol consumption can cause alteration of the oral microbiome and increase oral pathogens, which lead to periodontal disease and an environment of inflammation created in the body due to malnutrition, diminished immunity, altered liver condition, brain damage, and gut microbiota alteration. Heavily colored alcoholic beverages produce staining on teeth and, due to less saliva, may cause other toxic effects on the periodontium. Over-dependency on alcohol leads to necrotizing lesions such as necrotizing gingivitis, necrotizing periodontitis, and necrotizing stomatitis. These pathological impairments instigate severe damage to oral structures. Therefore, proper counseling by the attending dental surgeon and related health professionals is urgently required for the patient on the basis that the individual case needs to go away from the regular heavy consumption of alcohol.

Biphasic Calcium Phosphate Versus Demineralized Freeze-Dried Bone Allograft in the Treatment of Periodontal Disease: A Clinical and Radiographical Evaluation.

 Aim The study aimed to clinically and radiographically evaluate the effect of biphasic calcium phosphate (BCP) versus demineralized freeze-dried bone allograft (DFDBA) in treating periodontal disease. Method The study consisted of 44 patients. The sites were randomly assigned to receive one of two treatment modalities (BCP at site 1 and demineralized freeze-dried bone at site 2) by a computerized method. All the clinical data were measured with the help of a University of North Carolina-15 (UNC-15) probe at the baseline, three months, and six months postoperatively. Radiovisiographs were taken using a Rinn XCP® (Dentsply/Rinn Corp, Elgin, IL) system and an oral grid using the paralleling technique. A manual calculation of the defect area was undertaken at the end of six months and was compared with the other groups. Result The linear bone growth recorded for site 1 at the end of six months was 3.8 ± 1.14 mm, and site 2 was 4.6 ± 1.07 mm. The intergroup comparison showed more remarkable linear bone growth in site 2, which was statistically insignificant, with a mean difference of 0.8 ± 1.23 mm and a p-value of 0.07. Conclusion Improvements were observed on all the documented parameters. However, the sites treated with DFDBA showed better periodontal regeneration.

Identifying Gingival Pigmentation Patterns and Skin Color and Its Co-relation With Serum Ferritin Levels in Thalassemic Patients.

BACKGROUND: Patients with ß-thalassemia major (ß-TM), a genetic issue due to hemoglobin (Hb) synthesis disorder, require life-long erythrocyte transfusion. The purpose of this study is to evaluate and compare gingival pigmentation and skin color with serum ferritin levels of patients with ß-TM, using the Dummett's oral pigmentation index (DOPI) and Fitzpatrick skin scale, respectively. METHODS: A total of 100 patients were monitored at a thalassemia care center. Each patient's gingival pigmentation and skin color were matched with DOPI and the skin scale under natural light. Serum ferritin levels, the interval of blood transfusions, and iron chelation medications were studied. A gingival pigmentation score and skin color type were compared with the serum ferritin. RESULTS: A significant correlation was found between age, serum ferritin, pigmentation score, and skin color, which means as serum ferritin level increases, gingival pigmentation score increases, and skin color darkens. CONCLUSION: This study evaluated the correlation between gingival pigmentation and skin color with serum ferritin levels and established gingival pigmentation as a sign of iron deposition in ß-TM patients. This is the simplest and least invasive method for evaluating serum ferritin level parameters in ß-TM patients.

Clinical and radiographic evaluation of demineralized freeze-dried bone allograft with concentrated growth factor versus concentrated growth factor alone in the treatment of intrabony defects.

BACKGROUND: Periodontal disease is one of the major causes of alveolar bone loss. There are various ways of regenerating the lost bone, i.e. guided tissue regeneration, bone grafts, and growth factors. In this purview, it becomes immensely important for a clinician to decide the best modality of treatment. In this study, we compared the effect of demineralized freeze-dried bone allograft (DFDBA) in combination with concentrated growth factors (CGF) verses CGF alone. METHODS: This double-blind, split-mouth study was conducted on ten patients with two comparable bilateral intrabony defects. Each pair of defects was randomly treated by DFDBA + CGF or CGF alone. Clinical parameters such as plaque index (PI), modified gingival index (MGI), pocket probing depth (PPD), and relative attachment level (RAL) were recorded at baseline, three months, and six months. In addition, radiograph with grids was also taken at baseline and six months. The paired t-test was used to compare the pre- and post-treatment values and the unpaired t-test was used to compare the test and control group. RESULTS: The PI score decreased significantly from baseline to six months. Similarly, the mean MGI score decreased significantly from baseline to six months. The intragroup comparison showed that there was a significant reduction in PPD in both the test and control group. However, the intergroup comparison showed that the reduced pocket depth was not significant. The intragroup radiographic comparison showed that there was the significant formation of bone in both the test and control group but inter-group showed that the formation of bone among both the group were non-significant. CONCLUSION: Radiographic and clinical outcomes of this study concluded that post six months, both groups demonstrated significant improvement in clinical and radiographic parameters. However, the addition of DFDBA to CGFs did not give any additional benefits.

A randomized comparative study of platelet-rich fibrin along with hydroxyapatite graft for the treatment of 3-walled defects in chronic periodontitis.

Background: Platelet Rich Fibrin (PRF) is a concentrate of leucocyte and platelets that contains various polypeptide growth factors. It has immense potential for use as a periodontal regenerative material in periodontal defects. Porous hydroxyapatite (HA) has long been used as bone grafting material. Recently it has been reported that when PRF is used in combination with HA, itgives a synergistic effect and results in a better periodontal regeneration. The present study aims to explore the clinical and radiographic effectiveness of autologous PRF versus PRF+HA in the regenerative treatment of intrabony defects (IBD) in patients with chronic periodontitis. Methods: Sixty patients with IBDs were divided into test and control groups. The test group patients were treated with autologous PRF, whereas the control group patients were treated with PRF+HA. Clinical parameters were recorded at baseline, three months, six months and nine months' time interval. Radiographic measurements were recorded at baseline and nine months. Results: A reduction in PI, MGI, PPD, RAL, and IBD was observed in both the groups at nine months. Mean IBD reduction in the control group was 3.70 ± 1.16 mm, whereas, the mean reduction in the test group was 4.80 ± 1.03 mm, showing a significant reduction in IBDs. Similarly, the percentage of bone fill in the test group was 65% ± 3.67%, whereas bone fill in controls was 56.7% ± 3.56%, showing a significant bone fill in the study group. Conclusion: Treatment of IBDs with PRF+HA showed a significant improvement in all the clinical and radiographic parameters. When HA was added to PRF, it increased the regenerative effect in the treatment of 3 wall IBDs.

Treating Public Health Dilemma of Gingival Recession by the Dehydrated Amnion Allograft: A 5-Year Longitudinal Study.

Aim: This study aimed to evaluate the efficacy of dehydrated amnion allograft with coronally positioned flap procedure in paired Miller's class I recession defects. Methods: A total of 51 subjects were included in the study with bilateral Miller's class I gingival recession defects. In the test group, patients were treated with an amniotic membrane (AM) with a coronally positioned flap, while in the control group, patients were treated with coronally positioned flap alone. Clinical parameters such as recession depth, recession width (RW), probing depth (PD), relative attachment level (RAL), width of keratinized gingiva (WKG), and thickness of keratinized gingiva (TKG) were recorded at baseline and after 5 years of follow-up. Result: The mean baseline recession was 2.95 ± 0.89 in the test group and 2.70 ± 0.85 in the control group, and both were statically non-significant. At the end of 6 months, all the parameters, when compared with the baseline, showed a significant improvement. Intergroup comparison showed the non-significant difference in all settings except the TKG. Conclusion: AM proved to help improve the TKG. This increase in thickness helps in the long-term maintenance of the gingival margin in Miller's class I recession defect.

A clinical and radiographical comparison of buccolingual crestal bone changes after immediate and delayed implant placement.

AIM: The study aims to clinically and radiographically compare the bucco-lingual crestal bone changes after immediate and delayed placement of implants. METHODS: Two groups that consisted of fifty implants were considered for this study. In group A the implants were placed immediately post extraction, whereas, in group B implants placement were delayed by four to six weeks. All the implants were submerged within the alveoli confines. Bone grafts were only placed if the jumping distance was more than 1.5 mm. Barrier membrane was not placed in any of the cases. Bucco-lingual width was measured at the time of implant placement and during abutment placement after four to six weeks. Primary flap closure was ensured in all the cases. RESULTS: Thirty-one implants were placed in the mandible and nineteen were placed in the maxilla. All the implants achieved osseointegration. Immediate implant group showed a mean width of 8.80 mm (SD2.280) at the time of implant placement whereas, 7.60 mm (SD 1.871) after six months. Delayed implant group showed a mean width of 8.40 mm (SD1.673) at the time of implant placement, and 7.40 mm (SD 1.658) after six months. Intragroup showed statistically significant data (P<0.05). When the intergroup comparison of group 1 and group 2 was made at implant placement day and abutment placement day, it was found to be statistically non-significant. CONCLUSION: This study suggests that circumferential defect heals on itself without any guided bone regeneration in both the groups. The data suggests that the healing in both the group were equally good. The equally good results suggest placing the implant immediately post extraction. This saves the cost, time and most importantly the need for an extra surgery.

Comparative Evaluation of Treatment of Localized Gingival Recessions with Coronally Advanced Flap Using Microsurgical and Conventional Techniques.

BACKGROUND: Coverage of gingival recession is a very precision-oriented procedure. Employment of operating microscope has proved to be a boon in various surgical procedures and therefore can have positive benefits on the outcome of a procedure. AIM: The aim of this study is to find out whether the use of an operating microscope in the surgical treatment of Millers Class I and Class II gingival recession defects could improve the outcome in terms of root coverage and final tissue appearance compared to those done by the conventional technique. MATERIALS AND METHODS: This clinical study was carried out on ten patients with the presence of bilateral isolated gingival recession classified as Miller's Class I or Class II recession defect. The split-mouth design was used where coronally advanced flap with the placement of platelet-rich fibrin was done in defects in test (microsurgical) and control (conventional) groups. Various clinical parameters were recorded at baseline and then postoperatively at 3-months and 6-month intervals. RESULTS: The visual analog scale scores showed a statistically significant difference between scores while all other parameters had no statistically significant difference in intergroup comparison after 3 and 6 months. CONCLUSION: While microscope permitted less traumatic and minimally invasive procedure, both groups showed convincing improvement in clinical parameters.