Comparative evaluation of pinhole surgical technique with and without A-PRF in the treatment of multiple adjacent recession defects: A clinico radiographic study.

BACKGROUND: To evaluate and compare efficacy of pinhole surgical technique (PST) alone and with advanced platelet rich fibrin (A-PRF) in the management of bilateral multiple adjacent gingival recession defects (MAGRD). METHODS: One hundred and sixty five MAGRD were randomly assigned to control group (treated with PST) and test group (PST with A-PRF). Clinical parameters of gingival recession depth (GRD), gingival recession width (GRW), width of keratinised gingiva (WKG), complete root coverage (CRC) and gingival thickness (GT) on ST-CBCT was measured at 2, 4 and 6 mm apically from the gingival margin. Also, root coverage aesthetic score and patient satisfaction ratings were recorded at baseline, 6 and 12 months postoperatively. RESULTS: Substantial reduction in GRD (Test: 1.29 ± 0.69 mm and Control 0.98 ± 0.30 mm) (p < 0.001) and GRW (Test: 2.03 ± 0.90 mm and control 1.73 ± 0.99 mm) (p < 0.05) with associated gain in WKG and GT was observed (p < 0.001). Mean GT values were increased in both the groups at 2, 4 and 6 mm from the crest. Comparison of Test and Control groups yielded significant reductions in GRD (-0.17 ± 0.56 mm) and WKG (0.73 ± 1.07 mm) favoring the Test group (p < 0.05). Similar increase in GT was observed with better results in Test than control group. (p < 0.001). CONCLUSION: Both groups exhibited sound clinical outcomes with test group offering better resolution of MAGRD in comparison to control group. Also, it enhances clinical and therapeutic end results in terms of attaining reduction in GRD and GRW along with greater gain in KTW and GT. CLINICAL SIGNIFICANCE: PST as a minimally invasive approach has numerous benefits, some of which include the absence of scarring and improved aesthetics linked to faster wound healing. The addition of A-PRF enhances the intended therapy outcomes, which is beneficial for both patients and professionals in the field of periodontics.

Evaluation and correlation of extraoral and intraoral attributes on smile esthetics.

AIM: The harmonious existence of the extraoral and intraoral attributes are critical and capable of enhancing smile esthetics. Therefore, the present study was planned as a gender-based evaluation and correlation of interpupillary width (IPW) and intercommisural width (ICOW) with the combined width of the maxillary central incisors and anterior teeth and gingival thickness (GT) in periodontally healthy patients. MATERIALS AND METHODS: A total of 120 patients within an age range of 20 to 40 years were divided equally into two groups based on gender. The extraoral parameters were recorded on digitized photographs, the intraoral parameters on a stone cast with dental floss and a digital caliper, and the GT clinically. RESULTS: The mean values of IPW and GT in males and females were 63.95 ± 4.40 mm and 60.55 ± 2.43 mm, and 2.14 ± 0.37 mm and 1.07 ± 0.21 mm, respectively. Similarly, the mean combined width of the maxillary central incisors and anterior teeth in males and females differed significantly, being 18.69 ± 1.16 mm and 17.86 ± 1.09 mm, and 55.70 ± 3.14 mm and 51.46 ± 2.18 mm, respectively. CONCLUSIONS: Although the correlations between the parameters in the present study were found to be weak and positive, they can be accepted as preliminary findings that may require further exploration. The gender variability of the extraoral and intraoral parameters such as IPW, GT, combined width of the maxillary anterior teeth (CMA), and combined width of the maxillary central incisors (CMI) provide valuable guidelines that can be implemented in restorative procedures in the maxillary anterior sextant.

Comparative evaluation of semaphorin-4D, peptidylarginine deiminase-2, and matrix metalloproteinase-8 levels of gingival crevicular fluid in periodontally healthy and Stage III periodontitis smoker and non-smoker patients before and after non-surgical periodontal therapy.

BACKGROUND: This study was designed to assess the influence of non-surgical periodontal therapy (NSPT) on gingival crevicular fluid (GCF) levels of semaphorin-4D (SEMA-4D), peptidylarginine deiminase-2 (PAD-2), and matrix metalloproteinase-8 (MMP-8) levels in periodontally healthy, Stage III periodontitis non-smoker and smoker patients. METHODS: Sixty patients were equally divided into three groups, Group I: Periodontally healthy, Group II: Non-smokers with Stage III periodontitis, and Group III: Smokers with Stage III periodontitis. The patients underwent NSPT with clinical and biochemical parameters examined at baseline and 3 months post therapy. GCF was collected for levels of SEMA-4D, PAD-2, and MMP-8 through enzyme-linked immunosorbent assay (ELISA). RESULTS: Greater values of PPD (8.06 ± 0.19 mm), CAL (8.94 ± 0.19 mm), PI (2.58 ± 0.19) while lower PBI (1.39 ± 0.19%) and GI (1.72 ± 0.19) scores were seen in Group III as compared to Group II, which reduced significantly from baseline to 3 months in both the groups after NSPT. Minimum values of SEMA-4D, PAD-2, and MMP-8 levels in GCF were seen for Group I, which increased incrementally to Group II and III. Also, among Group II and III the SEMA-4D, PAD-2, and MMP-8 levels in GCF reduced from baseline to 3 months indicating a favorable response within the tissues. CONCLUSION: Greater levels in GCF of Levels of SEMA-4D, PAD-2, and MMP-8 in Group II and III, which reduced significantly post NSPT, implied that these biomarkers play a pivotal role in the inflammatory process and can be utilized for early diagnosis.

Clinicoradiographic comparative evaluation of 1% melatonin gel plus platelet-rich fibrin over platelet-rich fibrin alone in treatment of Grade II furcation defects: A randomized controlled double-blind clinical trial.

BACKGROUND: The present study aims to evaluate and compare the effects of 1% melatonin gel plus platelet-rich fibrin (PRF) and PRF alone in treatment of furcation defects, clinically and radiographically using cone-beam computed tomography. METHODS: This split-mouth clinical trial included 23 patients with 46 bilateral Grade II furcation defects in first or second maxillary or mandibular molars. Control group was treated with PRF alone while the test group was treated with 1% melatonin gel and PRF. Clinical attachment level (CAL) and horizontal probing depth (HPD) were primary outcome parameters while secondary outcome parameters were pocket probing depth (PPD) and defect volume (DV) assessed at 3 and 6 months postoperatively. RESULTS: Significantly greater mean reduction of PPD, HPD, and CAL gain was observed in test group (2.23 ± 0.41, 2.36 ± 0.68, and 2.97 ± 0.62 mm, respectively) in comparison with control group (2.83 ± 0.78, 2.85 ± 0.67, and 3.21 ± 0.86 mm, respectively) at 6 months. A significant reduction in the mean DV was exhibited radiographically in test group (1.06 ± 0.5 mm3 ) as compared with control group (3.94 ± 1.32 mm3 ) at the end of 6 months. Both the groups showed improvements in assessed parameters. CONCLUSIONS: In Grade II furcation defects the combination therapy of 1% melatonin + PRF shows a statistically significant degree of bone fill within the periodontal tissues and also better results in terms of decrease in PPD, HPD, and a greater CAL gain.

Gender-based evaluation of interproximal dimensions.

OBJECTIVE: The present study was formulated as a gender-based evaluation of the vertical apicocoronal (VAC), horizontal mesiodistal (HMD), and horizontal faciopalatal (HFP) dimensions of the interproximal area and their influence on the presence of interdental papillae and gingival thickness (GT) in maxillary anterior teeth. MATERIALS AND METHODS: A total of 120 patients in an age range of 20 to 40 years, divided equally into two groups based on gender, were evaluated for interproximal VAC, HMD, and HFP dimensions through radiovisiographic (RVG) images. Additionally, the existence of interdental papillae and GT were assessed clinically in the maxillary anterior sextant. RESULTS: The overall mean VAC dimensions in between the central incisors were greater in females than in males, with maximum mean values of 5.91 ± 0.33 mm and 5.03 ± 0.23 mm, respectively. The mean values for HMD and HFP showed a reverse trend, being greater in males than in females, with the differences being statistically significant. Similarly, the mean GT was greater in males than in females (P < 0.0001). It was also shown that as the VAC dimension increased, the existence of complete papillae in the interproximal areas reduced. CONCLUSIONS: The gender variability of intraoral characteristics such as VAC and GT dimensions and their influence on the existence of interdental papillae provide valuable guidelines that can be implemented in procedures in the maxillary anterior sextant. The associations between HMD and HFP dimensions and interdental papillae were not clearly evident, and further exploration in participants of different age groups would be useful and informative.

Efficacy of platelet rich fibrin with and without metformin in the treatment of periodontal osseous defects: a systematic review and meta-analysis.

OBJECTIVE: The systematic review and meta-analysis aimed to evaluate the efficacy of Metformin (MF) with Platelet Rich Fibrin (PRF) over PRF alone in the treatment of periodontal osseous defects. MATERIALS AND METHODS: An extensive electronic search for articles published up to September 2021 was conducted on 'Embase', 'PubMed' and other library databases accompanied with manual searching. Randomized controlled trials (RCTs), comparing MF plus PRF Vs PRF alone in periodontal osseous defects were identified in which periodontal pocket depth (PPD), Clinical attachment level (CAL) and Intrabony defect depth (IBD Depth) were the outcome measures. RESULTS: Four studies compared MF plus PRF vs .PRF alone in periodontal osseous defects. Meta-analysis was carried out for PPD reduction, CAL gain and IBD Depth changes. A standardized mean difference (SMD) of 1.86 for PPD reduction, 1.95 for CAL gain and 1.31 for IBD Depth reduction in all the studies was observed and the findings were statistically significant favouring test group. CONCLUSION: The systematic review indicates supplemental benefits of combination therapy of MF + PRF over monotherapy in resolving periodontal osseous defects. In our quest to achieve maximum regeneration in periodontal osseous defects, combination therapies such as MF + PRF have reported to be better treatment choices over other modalities.

Association of gingival exhibit with lip dimensions, intercommissural width, and gingival and interdental smile lines - a gender-based evaluation.

OBJECTIVE: The present study aimed to evaluate the gender-based association of gingival exhibit with lip dimensions, intercommissural width (ICW), interdental smile line (ISL), and gingival smile line (GSL) in periodontally healthy patients. MATERIALS AND METHODS: 120 patients aged between 20 and 40 years were divided equally into two groups based on gender. The parameters of lip length (LL) at rest and on smiling, ICW, and the intraoral parameters of gingival exhibit in ISL and GSL were measured on digitized photographs in the maxillary anterior teeth. RESULTS: The LL positions at rest and on smiling differed significantly: 23.50 ± 3.31 mm and 19.89 ± 1.91 mm, and 16.53 ± 2.94 mm and 13.91 ± 1.93 mm for males and females, respectively. The gingival exhibit of the interdental papillae in ISL was 3.01 ± 1.85 mm for males and 4.26 ± 1.85 mm for females, while the midfacial exhibit in GSL was 0.62 ± 1.01 mm for males and 1.24 ± 1.44 mm for females; both the differences were statistically significant. CONCLUSION: The gender variability in LL, the interdental papillae exhibit in ISL, and the midfacial exhibit in GSL can provide constructive guidelines that can be implemented in the esthetic zone.

Comparative evaluation of 1% melatonin gel in the treatment of intrabony defect: A randomized controlled clinical trial.

BACKGROUND: The present study aims to evaluate and compare the efficacy of locally delivered 1% melatonin gel as an adjunct to non-surgical periodontal therapy (NSPT) in treatment of intrabony defect in Stage III periodontitis, clinically, and radiographically using cone-beam computed tomography (CBCT). METHODS: This split-mouth clinical trial randomly allotted 44 bilateral intrabony defect (in 22 patients) into two groups where Group I was treated with NSPT with locally delivered placebo gel while Group II was treated with NSPT with 1% melatonin gel. The intrabony defect fill measured from cemento-enamel junction (CEJ)-base of the defect (BD), and the difference in the measurement values of CEJ-BD from baseline to 6 months denoting the bone fill and bone volume evaluated at 6 months using CBCT were the primary outcome measures. Secondary outcome measures were change in probing depth (PD), clinical attachment level (CAL), plaque index, and modified sulcus bleeding index recorded at baseline, 3 months, and 6 months. RESULTS: Both the study groups showed improvements in assessed parameters, however, a significant gain in intrabony defect fill was observed in Group II (1.46 ± 0.58) as compared with Group I (0.50 ± 0.38) and change in bone volume for Group I was 21.4645 ± 8.8980 mm3 and for Group II was 51.8418 ± 30.2329 mm3 with P < 0.0001.The mean reduction in PD and gain in CAL was 3.90 ± 0.78 and 2.94 ± 0.80 in Group II and in Group I it was 3.23 ± 0.90 and 1.96 ± 0.80 (P < 0.0001). CONCLUSION: The use of 1% melatonin gel as an adjunct to NSPT is more beneficial in achieving better clinical and radiographic outcome at 6 months which indicates that adjunct use of melatonin gel to NSPT as a local drug delivery is preferred when compared with NSPT and placebo gel alone.

Peri-implant Tissue Health in Bone-Level Implants with Repeated Abutment Replacements Versus Tissue- Level Implants with a Definitive Abutment: A Randomized Controlled Trial.

The present randomized controlled study was undertaken to evaluate and compare peri-implant hard and soft tissue changes between implants restored with multiple disconnections and reconnections of the abutment (control group) vs implants restored with a definitive abutment (test group). Twenty edentulous sites from 13 systemically healthy participants were selected for the study. The recorded clinical parameters were bleeding on probing (BOP) and peri-implant pocket depth (PIPD). The measured radiographic parameter was peri-implant marginal bone loss (PMBL). Two parameters were measured both clinically and by CBCT: distance from the cementoenamel junction to the alveolar crest and alveolar ridge width. At the time of surgery, sites were randomly assigned to either the control or test group. At 6 months, (1) BOP was absent in both groups, (2) PIPD increased in both groups and was significantly greater in the control group, and (3) the mean PMBL was significantly higher in the control group than the test group. Thus, it can be concluded that the use of implants with a definitive abutment could be more beneficial in achieving better maintenance of marginal peri-implant tissue health.

Evaluation of stress, serum, and salivary ghrelin and cortisol levels in smokers and non-smokers with Stage III periodontitis: A cross-sectional study.

BACKGROUND: The present study aimed to investigate the serum and salivary ghrelin and cortisol levels in smokers and non-smokers with Stage III Periodontitis. METHODS: The present study comprised of a total of 90 systemically healthy patients categorized in three groups: Group I- Periodontally healthy patients; Group II-Non-smokers with Stage III Periodontitis and Group III-Smokers with Stage III periodontitis. Clinical parameters of Probing pocket depth (PPD), Clinical attachment levels (CAL), Plaque Index (PI), Gingival Index (GI) and Papillary Bleeding Index (PBI) were recorded and biochemical parameters of serum and salivary ghrelin and cortisol levels were analyzed via Enzyme Linked Immunosorbent Assay (ELISA). Stress levels were assessed using Zung's self-rating depression scale. RESULTS: Serum and salivary ghrelin values were found to be higher in Group II (620.25 ± 260.86 pg/mL, 892.40 ± 271.65 pg/mL respectively) as compared to Group III. Similarly, salivary as well as serum cortisol levels were higher in Group III (20.78 ± 9.23 pg/mL, 399.37 ±189.21 pg/mL respectively) as compared to Group II (16.36 ± 8.88 pg/mL, 320.68 ± 107.01 pg/mL respectively). In Group III, a direct correlation was observed between stress, serum and salivary cortisol levels while an inverse correlation was found between stress, serum and salivary ghrelin levels. Group III showed a greater number of depressed patients followed by Group II and I. CONCLUSION: As per the results smokers with Stage III Periodontitis exhibit an elevated stress and cortisol levels, lower serum and salivary ghrelin levels as compared to the non-smokers.

Clinico-radiographic comparative evaluation of 1% metformin gel plus platelet-rich fibrin over platelet-rich fibrin alone in the treatment of Grade II furcation defects: A randomized controlled double-blind clinical trial.

BACKGROUND: The present study was aimed to evaluate and compare the effects of 1% MF plus PRF over PRF alone in treatment of Grade II furcation defects, clinically and radiographically by using cone-beam computed tomography. METHODS: This split-mouth clinical trial randomly allotted 21 patients with 42 bilateral Grade II furcation defects into two groups. Group I was treated with PRF alone while Group II with 1% MF gel and PRF. The primary outcome parameters were clinical attachment level (CAL) and horizontal probing depth (HPD) while the secondary outcome parameters were probing depth (PD) and defect volume (DV). The clinical parameters were evaluated at 3, 6, and 12 months and the radiographic parameters at 12 months. RESULTS: Both the study groups yielded improvements in assessed parameters; however, significantly greater mean reduction of PD, HPD, and CAL gain was observed in Group II (3.90 ± 0.78 mm, 2.94 ± 0.80 mm, and 3.42 ± 0.93 mm) in comparison with Group I (3.23 ± 0.90 mm, 1.96 ± 0.80 mm, and 2.67 ± 0.88 mm) at 12 months, respectively. A significant reduction of DV was exhibited radiographically in Group II (12.61 ± 4.01 mm3 ) as compared with Group I (9.14 ± 4.31 mm3 ) at the end of 12 months. CONCLUSIONS: Better clinical and radiographic findings in terms of reduction in PD, HPD, CAL gain, and significant reduction in DV in Group II patients indicated that the combination therapy of 1% MF + PRF promotes regenerative ability within the periodontal tissues in Grade II furcation defects to a greater extent.

Peri-implant soft tissue stability through vestibular extension procedure: a retrospective study.

OBJECTIVES: The present retrospective study assessed the width of keratinized mucosa (WKM) and vestibular depth (VD) adjacent to dental implants subsequent to vestibular extension procedure in patients exhibiting inadequate WKM. A correlation between these two parameters with peri-implant soft tissue stability and the incidence of peri-implant soft tissue dehiscence (PSTD) was also examined. METHOD AND MATERIALS: The study included 36 patients (age range 30 to 50 years) with implant restoration. The patients with an inadequate WKM and VD underwent vestibular extension procedure in areas of implant placement. The Modified Plaque Index, Gingival Index, Sulcus Bleeding Index, WKM, VD, and the peri-implant probing depth were measured and compared at baseline, 3 months, and after 1 and 2 years post vestibular extension procedure. RESULTS: A significant enhancement was observed in VD dimensions for both men and women from baseline (1.73 ± 1.10 mm and 1.57 ± 0.98 mm, respectively) to 2 years posttherapy (6.93 ± 0.88 mm and 7.95 ± 1.12 mm, respectively). Similarly, there was an increase in WKM of 4.14 ± 0.24 mm in men and 4.84 ± 0.14 mm in women. However, a weak and insignificant negative correlation was observed between WKM, VD, and PSTD after 2 years. CONCLUSION: The results of the present study indicate that the vestibular extension procedures around dental implants enable the clinician to achieve greater WKM and VD posttherapy, which is maintainable for a considerable time. The peri-implant soft tissue stability achieved thereafter ensures proper oral hygiene at the site and also negatively correlates with the PSTD.

Peri-implant tissue stability in premolar and molar sites: a retrospective clinical and radiographic analysis.

OBJECTIVES: The retrospective study was undertaken to assess the peri-implant tissue stability in premolar and molar sites clinically and radiographically for implants 7 years after loading. METHOD AND MATERIALS: 408 implants placed in 275 patients from 2012 to 2020 and following a regular recall protocol were assessed for Modified Plaque Index (MPI), Sulcus Bleeding Index (SBI), pocket probing depth (PPD), and the peri-implant soft tissue dehiscence (PSTD) clinically and mesial bone loss (MBL) and distal bone loss (DBL) radiographically. RESULTS: Significant differences were found in MPI, SBI, and PPD amongst both men and women in the premolar and molar regions. The mean MBL and DBL were substantially greater in women than in men and marginally more in the maxilla than in the mandible. Maximum mean bone loss on either aspect of the premolar and molar implants was 2.80 ± 1.54 mm and 2.97 ± 0.96 mm for women. Implant success of 96.82% at 7 years was achieved and the patient satisfaction levels of 94.55% and 95.50% in the mandibular and maxillary arches, respectively, implied that patients were satisfied with the treatment. CONCLUSION: Women exhibited greater marginal bone loss on the mesial and distal aspects than men, with premolar implant sites demonstrating greater propensity for marginal bone loss than molar implant sites.

Bone replacement grafts with guided tissue regeneration in treatment of grade II furcation defects: a systematic review and meta-analysis.

AIM: The present systematic review appended with meta-analysis aimed to evaluate the efficacy of bone replacement graft (BRG) with guided tissue regeneration (GTR) over BRG or open flap debridement (OFD) alone in the treatment of grade II furcation defects. MATERIALS AND METHODS: An electronic literature search of PubMed, Cochrane Library and Google Scholar databases accompanied with manual searching was done. Randomized controlled trials (RCTs) up to October 2019, comparing BRG+GTR with BRG or OFD in grade II furcation defects, were identified. Clinical attachment level (CAL) gain, changes in gingival marginal level (GML), vertical defect fill (VDF), horizontal defect fill (HDF) and reduction in defect volume were the outcome parameters. RESULTS: Of a total of 12, 9 studies compared BRG+GTR vs BRG while 3 compared BRG+GTR vs OFD. Meta-analysis was carried out for CAL gain, VDF, HDF and GML changes. In the BRG+GTR vs BRG comparison group, out of 9 studies, 6 RCTs showed standardized mean difference (SMD) of 0.513 for VDF, 9 RCTs showed SMD of 0.83 for HDF and 2 RCTs showed SMD of 0.651 for CAL gain, whereas only 2 studies in the same group reported reduction in defect volume. Three studies of the BRG+GTR vs OFD group exhibited significant VDF and CAL gain with SMD of 2.002 and 1.161 respectively. However, no significant change was recorded for GML in both groups. CONCLUSION: The present systematic review indicates supplemental benefits of combination therapy of BRG+GTR over monotherapy in resolving grade II furcation defects. CLINICAL RELEVANCE: In our quest to achieve maximum regeneration in grade II furcation defects, combination therapies such as BRG+GTR have been accepted as treatment choices over other modalities. Clinical situations warranting near-complete regeneration of the tissues in such defects are better suited for combination therapies.

Association of the nasolabial angle and lip length with the gingival and interdental smile line-A gender based evaluation.

OBJECTIVE: Proportionate existence of the lip framework and gingival scaffold have a critical role in smile esthetics. So, the present study was conducted to assess and correlate the nasolabial angle (NLA) and lip length (LL) with gingival smile line (GSL) and interdental smile line (ISL). MATERIALS AND METHODS: One hundred and twenty periodontally healthy patients with an age group 20 to 40 years were equally divided based on gender into two groups. The parameters of NLA, LL, GSL, ISL, amount of midfacial gingiva, and interdental papilla display were recorded in the maxillary anterior sextant. RESULTS: The mean values of NLA and LL at rest and on smiling were found to be higher in males. Majority of study population exhibited Low GSL (LGSL) and High ISL (HISL). On correlation of LL with GSL, the difference in the mean values between males and females for LGSL were highly significant, for HGSL and Cupid's bow the values were significant. The mean values of midfacial gingiva and interdental papilla visible in females was greater than males. CONCLUSION: The NLA and LL influence the quantum of gingival exhibit in maxillary anterior teeth with a definitive sexual dimorphism and this can be considered a valuable reference point in smile designing procedures. CLINICAL SIGNIFICANCE: The quantum of gingival exhibit on smiling is an important feature in periodontal, implant, restorative, and smile designing procedures in patients possessing HGSL and HISL category of GSL and ISL. It is indicated that the lip length is correlated with the amount of gingival tissue display both in midfacial as well as interdental region and which needs to be considered by the clinician.

Influence of facial index, facial profile, lip size, and angulations of teeth on gingival characteristics of anterior teeth: A gender-based evaluation.

OBJECTIVE: A prime component in an esthetic and pleasing appearance of face is the proportionate presence of different compositions of the face. The present study aimed to evaluate the association between facial index, facial form, lip size, and angulation of anterior teeth with periodontal phenotype in males and females. MATERIALS AND METHODS: This cross-sectional study included 100 consecutive periodontally healthy orthodontic patients equally divided based on gender in two groups. The facial parameters including the Facial index (FI), lip size, and Gingival thickness (GT) for maxillary and mandibular incisors were measured using a digital vernier calliper. Maxillary and mandibular incisors inclination was measured using cephalometric analysis. RESULTS: Significant differences were observed among both the genders in terms of FI and facial forms, upper lip size, and angulations of mandibular anterior teeth and the periodontal phenotype. The GT was found to be strongly associated with the FI and mandibular anterior teeth angulation. CONCLUSION: The FI, and teeth inclinations are associated with the GT and shows sexual dimorphism. The evaluation of the periodontal phenotype and anthropometric parameters is essential during diagnosis and treatment planning for potential orthodontic patients and prediction of its influence on the periodontal tissues. CLINICAL SIGNIFICANCE: The gingival thickness varies with the facial index, facial form, teeth inclination, and lip size and thereby can be used to predict the pros and cons of orthodontic treatment and the need for prior periodontal therapy.

Evaluation of the clinical efficacy of 1.2% atorvastatin in the treatment of periodontal intraosseous defects by CBCT: A randomized controlled clinical trial.

Background. Atorvastatin (ATV), which belongs to the statin class of drugs, is the formidable inhibitor of 3-hydroxy-2- methyl-glutaryl coenzyme A reductase. This clinical trial evaluated and compared the clinical and radiographic changes in chronic periodontitis (CP) patients, obtained through 1.2% ATV as an adjunct to scaling and root planing (SRP) in the treatment of intraosseous defects. Methods. Twenty CP patients, with a minimum of one pair of bilateral intraosseous, were randomly selected for this splitmouth study. Group 1 included 20 sites treated with SRP and subgingival delivery of a placebo gel, whereas an equal number of sites in group 2 were treated by SRP along with subgingival delivery of 1.2% ATV gel. The plaque index (PI), modified sulcus bleeding index (mSBI), probing pocket depth (PPD) and clinical attachment level (CAL) were evaluated at baseline and 3- and 6-month intervals, while the intraosseous defect was assessed at baseline and 6-month interval using cone-beam computed tomography (CBCT). Paired t-test was used to determine statistical significance. Results. A greater reduction in the mean PPD and gain in CAL was found in group 2 compared to group 1 at 3- and 6-month intervals. Furthermore, a significantly greater bone fill was obtained in group 2 (1.70±0.54 mm) compared to group 1 (0.22±0.43 mm) after six months. Conclusion. ATV, as an adjunct to SRP, enhanced periodontal regeneration, as a noninvasive way to treat periodontal intraosseous defects.