Platelet Rich Fibrin in Management of Complex Endoperio Cases.

Endo-perio lesions have been a dilemma to the dental practitioner. Both tissues share the same anatomical origin. Sometimes exact etiological passage of disease process cannot be traced; nevertheless traditional and newer treatment modalities must be employed to ensure best treatment possibilities. Patient reported with pain and pus exudates in upper left anterior region. Past dental history revealed no history of trauma. Initial examination revealed draining sinus with respect to 22. However, no Caries and pockets could be detected. Tooth was nonresponsive to vitality test. Patient symptoms did not relieve even two months after completion of RCT. Apical surgery was planned. Apicectomy was done and osseous defect was filled with PRF coagulum. Patient was followed up every three months and showed complete resolution of all symptoms. Radiographs showed complete resolution of osseous defect in nine months. PRF can be used to enhance bone augmentation in treatment of periapical defects as a potential treatment alternative for faster healing.

Zinc Incorporated Nano Hydroxyapatite: A Novel Bone Graft Used for Regeneration of Intrabony Defects.

BACKGROUND: To enhance the bioactivity of hydroxyapatite (HA), various ions have been incorporated into its porous structure such as zinc. Zinc has shown to have a stimulatory effect on osteoblastic cells. This study attempts to evaluate the efficacy of an indigenously prepared zinc incorporated nanohydroxyapatite (ZINH) bone graft in the treatment of intrabony defects. MATERIALS AND METHODS: A split-mouth study, which consists of 11 systemically healthy subjects with 45 sites, were randomly treated with ZINH or with nanoHA alone. Plaque index, gingival index, gingival bleeding index, pocket depth (PD) and clinical attachment level (CAL) were assessed at baseline, 3, 6, 9, and 12 months. Bone probing depth (BPD) and radiographic parameters were assessed at baseline, 6, and 12 months. Statistical analysis used was student's t-test and one-way analysis of variance. RESULTS: At 12 months, PD and BPD reduction was more in test (4.37 ± 0.989 mm and 3.36 ± 0.446 mm) than control (2.81 ± 0.084 mm and 2.15 ± 0.159 mm). Gain in CAL for test (3.08 ± 0.148 mm) was higher than control (2.33 ± 0.278 mm). Furthermore amount and percentage of bone fill was higher in test (1.92 ± 0.702 mm, 54.7 ± 20.286, respectively) than control (1.38 ± 0.650 mm, 40.2 ± 20.972, respectively). Statistically significant improvements in all parameters were seen in the test sites at 12 months. CONCLUSION: ZINH bone graft can be considered as a prospective bone regenerative material.

Clinical and Radiographic Evaluation of Citric Acid-Based Nano Hydroxyapatite Composite Graft in the Regeneration of Intrabony Defects - A Randomized Controlled Trial.

BACKGROUND: Conventional periodontal therapy with various bone grafts has limited scope and the results are not predictable. To improve their utility, the hybridization of bioceramics and biodegradable polymers has been widely adopted to reform the mechanical properties of bone grafts. One such biodegradable polymer is POC (Poly 1,8 octanediol). Secondly, citric acid is considered as the key material in bone mineralization, which is related to the overall stability, strength and fracture resistance of bone. Hence citric acid is incorporated in a polymer and Nano hydroxyapatite to form a composite graft, for periodontal bone regeneration. This study attempts to evaluate the efficacy of citric acid based Nano-hydroxyapatite composite graft for the treatment of intrabony defects in chronic periodontitis patients over 12 months. METHODS: A split mouth study, which consists of 10 systemically healthy patients, were randomly treated with Citric acid based Nano hydroxyapatite composite graft (test sites, n=18) or with Nano hydroxyapatite alone (control sites, n=15). Plaque index, gingival index, gingival bleeding index, probing pocket depth (PPD), clinical attachment level (CAL), bone probing depth (BPD) and hard tissue parameters such as amount of defect fill, percentage of defect fill, and changes in alveolar crest were assessed over a period of 12 months. Statistical analysis used was student's t-test and One-Way ANOVA. RESULTS: Both test and control sites demonstrated statistically significant reduction of PD, BPD, gain in CAL and radiographic bone fill. Nevertheless the test sites showed Statistically significant improvements in all the parameters as compared to control sites at 12 months. CONCLUSION: Citric acid based Nano hydroxyapatite composite graft can be considered as a newer material for periodontal regeneration.

Evaluation of moxifloxacin-hydroxyapatite composite graft in the regeneration of intrabony defects: A clinical, radiographic, and microbiological study.

BACKGROUND: The formation of new connective periodontal attachment is contingent upon the elimination or marked reduction of pathogens at the treated periodontal site. An anti-microbial agent, i.e. moxifloxacin has been incorporated into the bone graft to control infection and facilitate healing during and after periodontal therapy. MATERIALS AND METHODS: By purposive sampling, 15 patients with at least two contralateral vertical defect sites were selected. The selected sites in each individual were divided randomly into test and control sites according to split-mouth design. Test site received moxifloxacin-hydroxyapatite composite graft and control site received hydroxyapatite-placebo gel composite graft. Probing depth (PD) and Clinical attachment level (CAL) were assessed at baseline, 3, 6, 9, and 12 months. Bone probing depth (BPD) and hard tissue parameters such as amount of defect fill, percentage of defect fill, and changes in alveolar crest were assessed at baseline, 6, and 12 months. Changes in subgingival microflora were also assessed by culturing the subgingival plaque samples at baseline and at 3-month follow-up. The clinical, radiographic, and microbiological data obtained were subjected to statistical analysis using descriptive statistics, paired sample t-test, independent t-test, and contingency test. RESULTS: On intragroup comparison at test and control sites, there was a significant improvement in all clinical and radiographic parameters. However, on intergroup comparison of the same, there was no statistically significant difference between test and control sites at any interval. Although test sites showed slightly higher amount of bone fill, it was not statistically significant. There was a significant reduction in the counts of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis at both sites from baseline to 3 months. In addition, there was a significant reduction at test sites as compared to control sites at 3-month follow-up (P = 0.003 and P = 0.013). CONCLUSION: The reduction in microbial counts found in test sites at 3-month follow-up could not bring similar significant improvements in the clinical and radiographic parameters though the test sites showed slightly higher bone fill.

A clinicomicrobiological study to evaluate the efficacy of manual and powered toothbrushes among autistic patients.

AIM: To compare the efficacy of powered toothbrushes in improving gingival health and reducing salivary red complex counts as compared to manual toothbrushes, among autistic individuals. MATERIALS AND METHODS: Forty autistics was selected. Test group received powered toothbrushes, and control group received manual toothbrushes. Plaque index and gingival index were recorded. Unstimulated saliva was collected for analysis of red complex organisms using polymerase chain reaction. RESULTS: A statistically significant reduction in the plaque scores was seen over a period of 12 weeks in both the groups (P < 0.001 for tests and P = 0.002 for controls). This reduction was statistically more significant in the test group (P = 0.024). A statistically significant reduction in the gingival scores was seen over a period of 12 weeks in both the groups (P < 0.001 for tests and P = 0.001 for controls). This reduction was statistically more significant in the test group (P = 0.042). No statistically significant reduction in the detection rate of red complex organisms were seen at 4 weeks in both the groups. CONCLUSION: Powered toothbrushes result in a significant overall improvement in gingival health when constant reinforcement of oral hygiene instructions is given.

Comparative evaluation of oral hygiene practices and oral health status in autistic and normal individuals.

AIM: The present study attempts to explore the oral hygiene practices and oral health status in autistic patients as compared to nonaffected, same aged healthy individuals. MATERIALS AND METHODS: The oral hygiene practices, prevalence of caries and periodontal status were evaluated in 117 autistic patients and 126 healthy individuals. The test and control groups were divided into three categories, based on the type of dentition as Primary dentition (Category 1), Mixed dentition (Category 2) and Permanent dentition (Category 3). Plaque and gingival status was recorded by plaque index (Loe, 1967) and gingival index (Loe, 1967), periodontal status by community periodontal index of treatment needs and dental caries by DMFT/DEF index. Statistical analysis was done using descriptive statistics, independent sample t-test, contingency coefficient test and one-way ANOVA test by SPSS 14 software. RESULTS: There was no statistically significant difference in the brushing habits between autistics and controls (P = 0.573); however, Autistics required assistance in brushing. Prevalence of caries was significantly lower in autistic patients (P = 0.000). Plaque and gingival scores were significantly higher in autistic patients (P = 0.000) and prevalence of periodontal disease was significantly higher in autistic patients (P = 0.000). Greater number of autistic patients required professional scaling and root planing (P = 0.000). CONCLUSION: The present study suggests that autistic patients have a higher rate of periodontal disease and lower caries compared to controls. Attempts should be made by parents, general dentists and periodontists to teach oral hygiene methods to these patients by constant repetition and patience, as autistic individuals can develop skills over a period of time and lead a more productive and independent life.

Comparison of glycosylated hemoglobin levels in periodontitis patients and healthy controls: a pilot study in Indian population.

BACKGROUND: Periodontitis is associated with glycemic control in patients with diabetes. The purpose of this study was to determine if glycosylated hemoglobin is elevated in patients with periodontitis who are non-diabetic adults. MATERIALS AND METHODS: A total of 36 patients were selected and were divided into test and control groups. Test group included 18 adults without diabetes, but with periodontitis (having at least five teeth with probing depth (PD) ≥5 mm, bleeding on probing (BOP), and clinical attachment loss (>1 mm) on >5 teeth or radiographic bone loss), and the control group included 18 healthy adults (PDs ≤4 mm and BOP ≤15% and no clinical attachment loss). Glycosylated hemoglobin (HbA1c) was assessed in laboratory for these patients. Groups were compared using the t test,kruskal-wallis test, pearsson correlation. RESULTS: Both the groups showed similar HbA1c levels, but there was a marginal increase in levels in the test group (cases), which was not statistically significant (cases- 6.06%, controls-5.8%; P=0.101).There was no significant difference found in the mean HbA1c levels among males and females and among various age groups. Mean BMI among the cases and controls was found to be similar. When inter and intra group comparisons were done according to BMI categories among the cases and controls, we found similar mean HbA1c values. CONCLUSION: Indians are at a high risk of developing periodontitis and diabetes. These data suggest a possible link between periodontitis and glycemic control in non-diabetic individuals. Periodontal disease may be a potential contributor to development of type 2 diabetes.