Clinical evaluation of the combined efficacy of injectable platelet-rich fibrin along with scaling and root planing in the non-surgical periodontal therapy of stage III and grade C periodontitis patients having type 2 diabetes mellitus: A randomized controlled trial.

BACKGROUND: This randomized controlled trial was aimed to evaluate the combined efficacy of injectable platelet-rich fibrin (i-PRF) and scaling and root planing (SRP) in type 2 diabetes mellitus subjects having periodontitis. METHODS: Twenty-six Stage III, grade C periodontitis subjects (HbA1c > 7) were recruited in this split-mouth study. Following SRP, the test sites received subgingival application of i-PRF, while the control sites received saline. Plaque index, bleeding on probing, modified gingival index, probing pocket depth (PPD) and clinical attachment level (CAL) were measured at baseline, 3 and 6 months. RESULTS: Twenty-three participants completed the course of research. The Friedman test followed by Dunn's post hoc test, revealed significant improvement in all the clinical parameters from baseline to 3 and 6 months in both the study groups (p ≤ 0.05). The mean PPD and CAL decreased from 6.30 ± 1.25 and 7.48 ± 1.75 at baseline to 3.48 ± 1.34 and 4.39 ± 1.67 at 6 months in control sites and from 6.57 ± 1.56 and 7.61 ± 1.69 to 3.39 ± 1.23 and 4.26 ± 1.81 at 6 months in test sites (p ≤ 0.0001). Intergroup analysis found no statistical significant differences in the evaluated parameters across all time intervals (p > 0.05) CONCLUSION: The results indicated that the adjunctive application of i-PRF to SRP provided similar benefits as saline and SRP in diabetes mellitus subjects. KEY POINTS: Question: To find the combined efficacy of injectable platelet-rich fibrin (i-PRF) along with scaling and root planing (SRP) in the management of periodontal pockets of Stage III and Grade C periodontitis patients having Type 2 Diabetes Mellitus (T2DM). FINDING: All of the treated sites showed satisfactory healing. Both the treatment modalities (i-PRF + SRP and Saline + SRP) were effective in the treatment of periodontal pockets. At 3 and 6 months, there were no significant differences in periodontal parameters between groups. Meaning: The application of i-PRF as an adjunct to SRP provided similar benefits as saline and SRP in improving clinical parameters in subjects with stage III and grade C periodontitis patients having T2DM (HbA1C > 7).

Evaluation of serum and salivary PCSK9 and IL6 and its association with periodontal inflammation and atherosclerotic cardiovascular diseases.

Background: and Purpose: The aim of this study was to assess, compare and correlate the ability of PCSK9 and IL6 as potential common serum and salivary biomarkers for stage III/IV periodontitis and the risk of developing atherosclerotic cardiovascular diseases. Methods: 76 patients were alloted into 4 groups consisting of subjects with clinically healthy periodontium and stage III/IV periodontitis with and without ACVD. Clinical parameters - PD, CAL, number of teeth, PI, mSBI, TC, Tg, HDL and LDL were recorded. Serum and saliva samples were obtained and subjected to ELISA for quantifying the biomarker levels. Results: The level of these biomarkers was found to be the lowest (IL6 Serum: 21.92 ± 14.54, IL6 Saliva: 12.34 ± 7.72, PCSK9 Serum: 178.82 ± 35.07, PCSK9 Saliva: 80.82 ± 25.43) in group I and highest in group IV (IL6 Serum: 73.4 ± 24.86, IL6 Saliva: 37.66 ± 15.77, PCSK9 Serum: 346.54 ± 45.11, PCSK9 Saliva: 157.72 ± 43.28). The clinical parameters PI, mSBI, PPD, CAL, total number of teeth, TC, HDL and LDL showed a significant correlation with biomarkers PCSK9 and IL6. Conclusion: This study features the elevation of serum and salivary PCSK9 and IL6 in periodontitis and ACVD. A triad of serum and salivary PCSK9 and IL6 along with the clinical markers of periodontal disease can relatively predict the future risk of developing ACVD.

Congenital Heart Diseases and Periodontal Diseases-Is There a Link?

An understanding in the field of periodontal medicine explains the fact that the oral cavity serves as a niche for numerous pathogenic microorganisms. When these microorganisms or their by-products disseminate to the various parts of the body, they are capable of triggering diseases characterized by an altered host immune-inflammatory response in the anatomically distinct organ. This mechanism is reported in the propagation of cardiovascular diseases with respect to periodontal medicine. Abundant amount of literature suggests an association between atherosclerotic cardiovascular disease and periodontal diseases. However, there is very less data available to highlight the association between periodontal disease and non-atherosclerotic cardiovascular disease, such as congenital anomalies of the heart. This review outlines the relationship between periodontal diseases and congenital heart diseases and also helps us understand whether the presence of periodontal disease can worsen the preexisting congenital cardiac disease.

Evaluation of "soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), interleukin-1ß, and matrix metalloproteinase-8" as a short panel of salivary biomarkers in patients with and without stage III/IV periodontitis and type 2 diabetes mellitus.

BACKGROUND AND AIM: Periodontitis involves a dynamic disease process, demanding the identification of biomarkers to diagnose the current state of disease activity. Therefore this study assessed the potential of "sTREM-1, IL-1ß, and MMP-8" as a short panel of biomarkers of host biological process indicating the inflammatory burden in periodontium and thereby serving as a panel of diagnostic markers in periodontal disease. METHODS: Sixty eight patients were recruited and allotted into four groups comprising of subjects with clinically healthy gingiva and Stage III/IV Periodontitis with and without type 2 diabetes with HbA1c levels in the range of 6.5-7.9%. Periodontal parameters were measured and full mouth radiographic assessment was done. Whole saliva (unstimulated) samples were collected from all patients and estimation of the levels of markers was done employing ELISA. RESULTS: All the three biomarkers were noted to be the lowest in group I (sTREM-1: 75.63 ± 13.77; IL-1ß: 15.67 ± 3.39; MMP-8: 85.83 ± 22.32) and highest in group IV (sTREM-1: 138.83 ± 14.89; IL-1ß: 39.19 ± 7.20; MMP-8: 201.15 ± 50.32) with statistically significant difference. The difference observed between groups II and III for all the biomarkers assessed were statistically insignificant. The clinical parameters and HbA1c levels had positive correlation with the levels of biomarkers which was statistically significant. CONCLUSION: This study unveils the potential of the short panel of biomarkers ("sTREM-1, IL-1ß, and MMP-8") to be used as diagnostic and possible prognostic markers for Periodontitis. It further corroborates the role of type 2 diabetes mellitus in amplifying the diverse processes that result in periodontal destruction.

An emphasis of T-cell subsets as regulators of periodontal health and disease.

BACKGROUND: The pathogenesis of complex diseases like periodontitis is moderated by the balance in immune inflammatory responses. T-lymphocytes are immune cells that descend from the bone marrow. Furthermore, they develop in the thymus playing an indispensable role in adaptive immune responses. The periodontal microenvironment allows differentiation of various groups of T-lymphocytes such as CD4+ (Th1/Th2/Th17/Treg/Tfh/Th9/T22), CD8+ cells, gamma-delta (γd) T cells, or memory cells based on the current regional cytokine milieu to secrete distinct cytokines and other molecules required for resolution of inflammation or result in progression of the disease based on interactions among various cells. AIM: The dynamism of T-lymphocytes in the immunopathogenesis of periodontal diseases resulting in tissue destruction is established but the mechanisms of immunoregulation that underpins periodontal disease progression are cumbersome. This review aims to understand the distinct types of T cells and their effector functions with their portrayal in periodontal disease. RELEVANCE FOR PATIENTS: This review gives valuable insights on the possibility of predicting periodontal disease progression, on the management and its prognosis by evaluating specific cytokines of destructive T-cell phenotype, and on the future perspectives of therapeutic modalities including ways of modulating host immune and inflammatory responses to establish periodontal homeostasis and areas of research.

Effect of Low-Level Laser Therapy and Platelet-Rich Fibrin on the Treatment of Intra-bony Defects.

Introduction: Attempts to regenerate the periodontal osseous defect, which is lost as a result of periodontal disease, require the tapping of the innate healing potential of periodontium through appropriately designed therapeutic strategies. A multitude of grafted and non-grafted approaches have been used in the management of Intra-bony defects. However, they do not provide predictable periodontal regeneration. The aim of this study was to evaluate the combined effect of low-level laser therapy (LLLT) and platelet-rich fibrin (PRF), in site modulated intra-bony defects (decortication), which were accessed using a simplified papilla preservation flap (SPPF), on the clinical and radiographic outcomes of periodontal disease. Methods: A total of 30 patients with intra-bony defects were recruited for the study and randomly distributed in two groups (n=15). Test group sites were accessed with SPPF and the defects received intra-marrow Penetration (IMP) following debridement and were irradiated with a low-level laser followed by PRF grafting and suturing done. The control group defects were accessed with SPPF and grafted with PRF before being secured by sutures. The plaque and bleeding score, PPD, CAL, and the position of the gingival margin with radiographic defect depth were recorded and analyzed at baseline and six months post-intervention using the student's t test and Wilcoxon signed rank test. Results: The test group showed a clinically relevant increase in mean PPD reduction, CAL gain, and radiographic bone fill (3.6 ± 1.35 mm, 3.26 ± 1.16 mm and 2.44 ± 1.24 mm) compared to the control group (2.93 ±1.1 mm, 2.267 ± 1.33 mm and 1.26 ± 0.99 mm) six months post-intervention. However, intergroup comparison between the test and control groups did not show any statistically significant difference. Conclusion: These results highlights that test protocol had greater amelioration of the effects of periodontal disease and all the investigated clinical and radiographic parameters showed considerable improvement from baseline to 6 months within test and control group, but intergroup comparison between the test and control groups did not show any statistically significant difference, indicating statistical equivalence between the test and control protocol.

Association of Receptor for advanced glycation end products G82S polymorphism with chronic periodontitis in type II diabetic and non-diabetic South Indians.

AIM The current study investigated the association of RAGE G82S polymorphism with chronic periodontitis in South Indians with and without type II Diabetes mellitus. MATERIALS AND METHODS: 405 individuals were enrolled into 3 groups-systemically and periodontally healthy with no attachment loss (n = 135), generalized chronic periodontitis (n = 135)and generalized chronic periodontitis with type II diabetes mellitus(n = 135). Periodontal clinical parameters were recorded. RFLP-PCR was utilized for genotyping. RESULTS: Frequencies of genotype GG, GA and AA were 133, 2, 0 in group I respectively, 131, 4, 0 in group II respectively and 118, 13, 4 in group III respectively. Pearson's Chi squared test demonstrated a significant difference in the genotype distribution between the three groups (χ2 = 19.88,P < 0.001). Fischer exact-test showed that the variant GA/AA genotype was associated with a significantly increased risk for generalized chronic periodontitis in type II diabetics when compared with the GG genotype of systemically and periodontally healthy subjects (OR-9.58, 95% CI 2.168-42.339, P < 0.001) and non-diabetic chronic periodontitis subjects (OR- 4.71, 95% CI: 1.54-14.42, P < 0.05). No association and increased susceptibility to chronic periodontitis was observed in subjects with GA/AA genotype when compared with systemically and periodontally healthy subjects (OR- 2.031, 95% CI: 0.366-11.277 P > 0.05). Furthermore, comparison of clinical parameters based on genotype distribution revealed statistically significant higher mean plaque (P < 0.05) and sulcus bleeding score (P < 0.001) in group-III subjects. CONCLUSION: RAGE G82S gene polymorphism confers susceptibility to generalized chronic periodontitis in type II diabetic subjects of South Indian Tamilian ethnicity.

Benefits of Aloe vera in dentistry.

Aloe vera (Aloe barbadensis) is a plant that belongs to Liliaceae family. The name Aloe derives from the Arabic word "Alloeh" meaning shining bitter substance while "vera" in Latin means true. It contains various minerals and vitamins. It has got various properties such as immunomodulatory, antiviral and antiinflammatory in nature. A. vera can play a significant role in dentistry in treatment of lichen planus, oral submucous fibrosis, recurrent aphthous stomatitis, alveolar osteitis, periodontitis, etc.

Electrocautery assisted harvesting of free gingival graft to increase the width of attached gingiva - an uncommon case report.

Procuring a free gingival autograft for the purpose of gingival augmentation has been advocated in areas of inadequate width of attached gingiva that result in gingival recession and/or accumulation of local factors. As obtaining the graft from the palatal donor site with conventional scalpel techniques can result in problems such as prolonged bleeding, increased surgical time and patient discomfort, alternative methods have been advocated to procure such grafts using lasers and electrocautery. This case report elaborates, a free gingival graft harvested for the purpose of increasing the width of attached gingiva using electrocautery principles. The parameters assessed included the extent of patient reported discomfort at the donor site and clinical gain of keratinized and attached gingival width.

The importance of dental aesthetics among dental students assessment of knowledge.

OBJECTIVE: The aim of this study is to assess the dental esthetics awareness among dental students in a private university in Chennai as none is available in Chennai, Tamil Nadu. MATERIALS AND METHODS: The dental esthetics awareness questionnaire consisting of a battery of 19 questions under five aspects that is, physical, functional, social, knowledge, and psychological aspects was administered to a sample of 100 dental college students aged between 18 and 27 years in a private college in Chennai, India. Gender variations on the responses of their effects and the impact on dental esthetics awareness had been analyzed using a Chi-square test. RESULTS: With respect to physical aspects, pigmentation shows more significance as students want to get treated for their pigmentation of lips and gums. With respect to functional aspects, eating shows more significance as students have difficulty while eating. In social aspects, habits show more significance as it affects their esthetics. With respect to psychological aspects, mental depression shows more significance as students feel more deprived due to their unesthetic appearance. CONCLUSION: This study shows a high level of self-consciousness and the findings of the studies prove that even the slightest of variations have a greater impact on the above-mentioned dimensions in particular to psychological, functional, and physical aspects.

Predictable aesthetic outcome with immediate placement and early loading of one piece mini implant - A 5 year follow-up case report.

One piece mini implants are viable and predictable options to conventional implants in areas of deficit bone width. These can be placed without complex surgical augmentation procedures and are cost effective. Four mini implants were placed in a 40 year old female patient replacing her mobile mandibular anterior teeth. Provisional restoration was given after 2 weeks followed by individual ceramic crowns after 6 months. 5 year follow-up showed aesthetic soft tissue contours and successful osseointegration. One piece mini implants are viable treatment option in the aesthetic management of partial edentulism especially in the mandibular anterior region. How to cite the article: Mohan CS, Harinath P, Cholan PK, Kumar DL . Predictable aesthetic outcome with immediate placement and early loading of one piece mini implant - A 5 year follow-up case report. J Int Oral Health 2014;6(2):132-5.

Conservative surgical approach and aesthetic management of a focal gingival hyperplastic lesion.

Focal reactive hyperplastic lesions of the gingiva are quite common soft tissue enlargements of the oral cavity. Presence of local factors, tissue irritation and endocrinal discrepancies contribute to its etiology. The fact that these lesions are caused by diverse pathological conditions and its histo-pathological resemblances poses a great diagnostic challenge. Due to the site predilection of the these lesions to the maxillary anterior region, this article presents a case report of focal gingival hyperplastic lesion in the anterior maxillary region and its conservative management leading to pleasing results and soft tissue esthetics.

Prevalence of dental anxiety among patients attending a dental educational institution in Chennai, India--a questionnaire based study.

OBJECTIVES: Anxiety and fear towards dental treatment are common problems frequently experienced by patients worldwide, hence for better understanding, management and development of treatment strategies for dentally anxious patients, the present study was undertaken. The study aimed to evaluate the prevalence of dental anxiety and the factors influencing dental anxiety among the patients attending the outpatient department of a dental institution in India. METHOD: 468 patients, 18-70 years were selected for the study. The assessment tools consisted of a consent form, history form, and a questionnaire form containing the Modified Dental Anxiety Scale which was used to assess the level of dental anxiety. RESULTS: Cronbach alpha for test retest samples was 0.863.The mean total anxiety score of the 468 samples was 10.29 (SD = 3.767). 3% were dentally phobic. One way ANOVA showed a significant difference between the age groups in relation to their mean total anxiety score (p<0.05) and it decreased with increasing age. Independent t test showed a highly significant difference in the mean total score between the patients with good and bad previous dental experience (p<0.05). Postponement of dental visit showed a significant positive correlation with anxiety score (p<0.001). CONCLUSION: Tooth drilling for restorative purposes and local anaesthetic injections, were the most common reasons for dental anxiety. Younger respondents, uneducated, unemployed and lower income group were more anxious. The study also showed that postponement of dental visit and past negative dental experience were associated with higher anxiety scores.