Clinical efficacy of subepithelial connective tissue graft and A-PRF in the treatment of gingival recession.

OBJECTIVE: The current study was designed to clinically compare and evaluate subepithelial connective tissue graft (SCTG) and advanced platelet-rich fibrin (A-PRF) membrane-based root coverage in the treatment of gingival recession type 1 (RT1). METHOD AND MATERIALS: The current study involved 17 patients with bilateral gingival recession (RT1). Thirty-four sites were randomly allocated to test (A-PRF) and control (SCTG) sites and all the procedures were performed by a single operator. A single blinded observer evaluated the test and control sites at baseline, 3 months, and 6 months. The clinical parameters such as recession depth, recession width, width of keratinized gingiva, clinical attachment level, and percentage of root coverage were recorded. P < .05 was considered statistically significant. RESULTS: The mean recession depth at baseline for control and test groups was 3.06 ± 0.56 mm and 2.35 ± 0.49 mm, respectively (P < .001). At the end of the study period, the mean recession depth was 0.53 ± 0.62 mm in the control group and 1.12 ± 0.49 mm in the test group (P < .05). No complications were associated with both the groups. The mean percentage of root coverage was 84.31 ± 17.89% in the control group and 51.96 ± 15.45% in the test group (P < .001). CONCLUSION: In conclusion, the study results suggest that both SCTG and A-PRF can be used in treating gingival recessions. However, SCTG is a better material in achieving root coverage and increasing keratinized tissue width. (Quintessence Int 2023;54:134-141; doi: 10.3290/j.qi.b3512389).

Autologous platelet-rich fibrin as an adjunct to non-surgical periodontal therapy-A follow up clinical pilot study.

The aim was to evaluate the effectiveness of autologous platelet-rich fibrin (PRF) as an adjunct to scaling and root planing (SRP) in moderate periodontal pockets. The split-mouth study involved 32 sites from 16 patients. Baseline parameters were recorded followed by complete full-mouth SRP. The test and control sites were randomly selected and autologous PRF was placed in the test site and other site served as control. The blinded examiner recorded clinical parameters at baseline, 60 days, and 90 days. No statistical significance was found at baseline in probing depth (PD) and clinical attachment level (CAL). Statistically, significant improvement was observed within test and control groups at 90 days compared to baseline values. A statistically significant difference in test sites was found in terms of reduction in PD and clinical attachment gain (CAG) compared to the control sites at the end of the study period (p value <0.05). This split-mouth pilot study emphasized a statistically significant improvement in pocket depth reduction and CAL gain when PRF was used as an adjunct to SRP in moderate periodontal pockets.

Gingival biotype as an indicator for the buccal bone thickness - a systematic review of the literature.

Introduction A relationship between thin gingiva and thin buccal bone has been proposed but concrete evidence for this is lacking. This study was undertaken to assess the reliability of measuring gingival thickness in estimating the buccal bone thickness.Objectives To answer the following PICO question: do periodontally healthy individuals exhibit any correlation between gingival biotype and buccal/labial/facial bone thickness?Data sources and selection An electronic search was performed in PubMed and Embase databases. English language articles that have met the inclusion and exclusion criteria were selected. Only observational studies were considered. Since the studies have demonstrated heterogeneity, conducting a meta-analysis was not possible, so the results were synthesised using a vote counting method and narrative synthesis.Data synthesis After screening the titles and abstracts, 13 studies which met the study criteria were included in the systematic review. Out of these 13 studies, nine studies assessed only the maxillary anterior/premolars; one study assessed the mandibular anterior, and three studies assessed both maxillary and mandibular anterior/premolars.Conclusions The findings of this systematic review indicated that the gingival biotype may be a reliable indicator for estimating the thickness of buccal bone in maxillary anterior. However, its relation to the buccal bone thickness in mandible is unclear.

Interproximal Papilla Volumization Using Vestibular Incision Subperiosteal Tunneling Access Technique in Esthetic Rehabilitation.

An accurate diagnostic and interdisciplinary approach is essential for obtaining suitable, conservative, and predictable results in areas with high esthetic demand. Patients reporting with an improper prosthesis that has a black triangle pose a challenge for soft-tissue esthetic rehabilitation. Re-restoration of such cases with conventional fixed prosthesis would be undesirable due to imbalance in pink and white esthetics. This case report describes an interdisciplinary approach to maintain the existing midline diastema and correction of black triangle in the interproximal area between abutment and pontic in the esthetic zone. Minimally invasive vestibular incision subperiosteal tunneling access technique with connective tissue graft was planned for reconstructing the interdental papilla, followed by prosthetic rehabilitation of edentulous site with fixed partial denture using loop connector design to maintain the midline diastema. Postoperative result showed a comprehensive, pink and white rehabilitation to meet the patient's esthetic demand.

Finite element submodeling technique to analyze the contact pressure and wear of hard bearing couples in hip prosthesis.

Finite element (FE) simulation plays a major role in computing stress and predicting the failure of biomedical components. Normally in past, researchers focused on developing a global computational model from the scanned data of patients to analyze the stresses and deformations. To compute the wear of the hip prosthesis, mostly the global model (GM) is used to predict the expected life for million cycles using nodal updating technique which leads to high computational effort and time. The proposed work utilizes a submodeling finite element technique to analyze the contact pressure and wear of biomaterials for three different combinations in hip prosthesis including metal, ceramic and polycrystalline diamond materials. Initially the global model boundary and loading conditions are transferred to the submodel. The mesh is refined further using finer mesh and then the results are computed which consumes lesser time. The contact stress as well as the linear wear of biomaterials is found to be quite high for the local model (LM) when compared with the global model. However, no changes in volumetric wear of these biomaterials are observed when compared with previous experimental results. The computational time as well as accuracy in estimating the contact stress and the wear of bearings is improved effectively. Among local model with different element sizes, 0.75 mm element size of local model showed improved results in estimating the contact stress and linear wear of bearing.

Comparison of Endothelial Function in Healthy Patients and Patients With Chronic Periodontitis and Myocardial Infarction.

BACKGROUND: The inflammatory burden as a result of severe periodontal disease acts as an insult to the endothelium. This disruption in the function of the endothelium predisposes it toward formation of atherosclerotic plaque, which may be a subsequent risk for coronary artery disease. The aim of this study is to estimate and compare endothelial function via flow-mediated dilation (FMD) assessment in periodontal health and disease. METHODS: A total of 120 patients were selected and categorized equally into three groups: 1) healthy (control); 2) chronic periodontitis (CP); and 3) myocardial infarction (MI). Periodontal inflamed surface area (PISA) and FMD were assessed in all patients. Fasting blood samples were collected to estimate lipid profile. Analysis of variance was used for comparison of lipid profile, whereas Kruskal-Wallis test was used for comparison of FMD and PISA scores among the study groups with P <0.05. RESULTS: Comparison of FMD levels among the three groups showed statistically significant difference, with P <0.001. The value was statistically significant when the healthy group was compared with the CP and MI groups but not when the CP group was compared with the MI group. Lipid profile levels were statistically significant on comparison between the healthy and CP groups and between the CP and MI groups. CONCLUSION: Endothelial function was impaired in patients with CP compared with healthy patients, and the dysfunction observed was similar to that observed in the MI group based on FMD values.

The comparison of the effects of different whitening toothpastes on the micro hardness of a nano hybrid composite resin.

AIM: The aim of this study was to compare the micro hardness of a nanohybrid composite resin after brushing with two herbal and one non-herbal whitening toothpastes. MATERIALS AND METHODS: We divided Eighty disk-shaped specimens of a nanohybrid composite (Tetric N Ceram, Ivoclar Vivadent, Asia) into 4 groups of 20 specimens each: Groups A, B, C, and D. Group A was control, Group B was brushed with Colgate total advanced whitening (Colgate-Palmolive (India) Limited), Group C with Salt and Lemon, Dabur (Dabur International Limited, Dubai, UAE), and Group D with HiOra Shine, Himalaya (The Himalaya Drug Company, India). The specimens were polished using medium, fine, and superfine discs (Sof-lex, 3M, ESPE, USA) and subsequently placed at 37°C in distilled water. They were brushed for 2 minutes twice daily with a soft motorized toothbrush (Colgate 360 sonic power battery-operated tooth brush, Colgate Palmolive, India) for 30 days. The samples were rinsed under running water to remove the toothpaste and stored in distilled water at 37°C until the readout was taken on the Vickers's hardness tester for microhardness. RESULTS: The results revealed that the difference among the groups was statistically significant (P < 0.001). Tukey's test showed that reduction in microhardness for Group B was significantly higher than that for Group C and Group D (P < 0.001). CONCLUSION: Within the limitations of this study, non-herbal whitening toothpaste had a greater impact on the microhardness of nanohybrid resin composite than herbal whitening toothpastes.

Appendicocalicostomy: A case of mistaken identity.

Anatomical structures with similar appearance may at times be confused for each other. This situation can be compounded by lack of normal anatomical planes. We did ureterocalicostomy on a 32-year-female with secondary pelvi-ureteral junction obstruction. Post-operatively, it was discovered that she had a long appendix running parallel to ureter in retroperitoneum, which was misidentified as ureter and anastomosed to the lower pole of the kidney. She was re-explored, appendix was removed, ureter was identified and ureterocalicostomy was done. Patient is asymptomatic at 1 year follow-up.

Johanson-Blizzard syndrome: dental findings and management.

AIM: Oral rehabilitation of a child with Johanson-Blizzard syndrome (JBS). BACKGROUND: JBS is an extremely rare inherited disorder characterized by unusually small nose that appears 'beak shaped' due to the absence (aplasia) or underdevelopment (hypoplasia) of the nostrils (nasal alae), abnormally small, malformed primary (deciduous) teeth and misshapen or absent secondary (permanent) teeth, hearing disorder, hypothyroidism, dwarfism, malabsorption and mental retardation. It is sometimes described as a form of ectodermal dysplasia. CASE REPORT: Oral findings in JBS are very obscure in the literature. The present report describes oral findings in an 8 years old boy with JBS and his oral rehabilitation. CONCLUSION: JBS has an emotional consequence for the affected individuals at early ages. Oral rehabilitation in this case had a very positive impact on the child's mind. CLINICAL SIGNIFICANCE: Early identification and treatment of this disease is of great importance to rehabilitate the patient on functional, esthetic and psychological front.

Effect of casein phosphopeptide-amorphous calcium phosphate containing chewing gum on salivary concentration of calcium and phosphorus: an in-vivo study.

AIM: Caries clinical trials of sugar-free chewing gum have shown that the gum is noncariogenic and in fact has anticariogenic effect through the stimulation of saliva. Sugar-free gums, therefore, may be an excellent delivery vehicle for safe and effective additive, capable of promoting enamel remineralization. Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) nanocomplexes incorporated into sugar-free chewing gum have shown to remineralize enamel subsurface lesions in situ. So this study was conducted to evaluate the effect of CPP-ACP containing sugar-free chewing gum on salivary concentration of calcium and phosphorous. MATERIALS AND METHODS: Unstimulated saliva from each 24 selected subjects was collected. Then each subject was given two pellets of chewing gum containing CPP-ACP and asked to chew for a period of 20 min, after which saliva samples were collected from each individual. Once all the samples were collected they were assessed for calcium and phosphorous concentration using affiliated reagent kits and photometer. STATISTICAL ANALYSIS USED: Data obtained were analyzed using student's paired t test. RESULTS: Significant difference was found in the calcium and phosphorus concentration of saliva before and after chewing CPP-ACP containing chewing gum. CONCLUSIONS: Chewing of CPP-ACP containing chewing gum showed a significant increase in the salivary concentration of calcium for a prolonged period of time hence it may help in the remineralization of tooth surfaces.

Association of genetic variants of mannan-binding (MBL) lectin-2 gene, MBL levels and function in ulcerative colitis and Crohn's disease.

Ulcerative colitis and Crohn's disease are the two major forms of inflammatory bowel disease (IBD). A series of reports have hypothesized interplay of genetic and environmental factors in the pathogenesis of IBD. Polymorphism in the mannan-binding lectin-2 (MBL-2) gene is known to affect the structural assembly and function thereby predisposing subjects to various diseases. The present study was designed to evaluate effect of MBL-2 gene polymorphism on MBL levels and function in IBD patients. Genomic DNA was isolated from blood samples collected from 157 ulcerative colitis, 42 Crohn's disease and 204 control subjects. Genotyping for different polymorphic sites at exon1 of MBL-2 gene was performed by refractory mutation system-PCR and amplification followed by restriction digestion (PCR-RFLP). Serum MBL concentration and C4 deposition levels were estimated using ELISA. Mannan-binding lectin-2 genotypic variants were calculated in IBD and healthy controls. The frequency of single nucleotide polymorphisms at codon 54 was significantly higher in ulcerative colitis patients than controls (P < 0.0001). Ulcerative colitis patients with 'codon 54'-variation showed low serum MBL concentrations coupled with altered MBL function compared to controls. In conclusion, single nucleotide polymorphism in the MBL-2 gene is an important risk factor significantly affecting MBL levels and function in the development of ulcerative colitis among Indians.