Revisiting failures in mucogingival surgery.

Failures of soft tissue grafting are relatively common and can be stressful when encountered for both the clinicians and patients. Soft tissue grafting has predictable success most of the time when proper selection and implementation of surgical procedure is done. This case report describes management of soft-tissue surgery failure after multiple mucogingival grafting for enhancing the soft-tissue quality, quantity, and aesthetic outcomes. Augmentation by free gingival graft using periodontal microsurgical principle resulted complete coverage of the defect suggesting that careful treatment planning, immaculate execution by skillful technique definitely helped to achieve a successful result. Simultaneous use of photobiomodulation (PBM) helped in faster and better healing of the grafted area.

Clinico-immunological evaluation of use of omega-3 fatty acids as nutraceutical approach in management of patients with chronic periodontitis: A randomized clinical trial.

Background: Subgingival bacterial colonization and biofilm formation are known to be the main etiology of periodontal disease progression. This biofilm elicits host response and the interaction between host defence mechanisms with plaque microorganisms and their products results in periodontal disease. Host modulatory therapy (HMT) is a form of treatment of periodontitis that focuses on treatment of the host in the host-bacteria interaction. Omega-3 fatty acids have emerged as a potential HMT agent to treat inflammation associated with periodontal disease. Methods: A total of 60 cases of chronic periodontitis were allocated into two groups; the test group (n = 30) were treated with scaling and root planing (SRP) and given a dietary supplementation of omega-3 fatty acid while the control group were treated with SRP alone. Clinical parameters carried out were plaque index (PI), gingival bleeding index (GBI), pocket probing depth (PPD) and clinical attachment level (CAL) and immunological parameter included interleukin-1ß level in saliva at baseline, 3 months and 6 months after therapy. Results: At 6 months, both the groups showed significant improvements with regards to all clinical and immunological parameters compared to baseline (all p < 0.05). However, test group presented with more favourable statistically significant results. Conclusion: The use of omega-3 fatty acid as nutraceutical agent to conventional method acted as beneficial therapeutic measures and effective in patients with chronic periodontitis when compared with SRP alone.

A comparative evaluation of management of hyperpigmented gingiva using surgical stripping technique and diode laser: A clinical study.

Background: To compare the treatment outcome of laser and its effectiveness in the management of gingival hyperpigmentation over scalpel surgical method. Methods: The patients were selected and were divided into two groups by the split-mouth design. Group A: Right half upper and lower central incisors to premolars were treated using the laser technique. GROUP B: Left half upper and lower central incisors to premolars were treated by Scalpel technique. This study was a comparative, split-mouth analytical study, and the results were observed for a period of 9 months. Results: Diode laser technique gave better results in this perio-esthetics procedure as compared to scalpel technique. However, recurrence of pigmentation has been reported even after this duration. Diode laser was superior over the scalpel technique in the aspect of operator convenience, reduced postoperative bleeding, and reducing the incidence of repigmentation in terms of intensity and extent of pigmentation. Patient comfort was more in scalpel technique. Conclusion: Laser can be used for better periodontal esthetic procedure over the standard scalpel technique, although repigmentation was reported in both groups. But delayed healing occurred on the laser side due to the thermal effect of the laser on the adjacent tissues. Provision of such advanced instruments to dental surgery can give better satisfaction to patient clientele in terms of good esthetic results.

Identification of second arginine-glycine-aspartic acid motif of ovine vitronectin as the complement C9 binding site and its implication in bacterial infection.

Vitronectin (Vn), a multifunctional protein of blood and extracellular matrix, interacts with complement C9. This interaction may modulate innate immunity. Details of Vn-C9 interactions are limited. Vn-C9 interactions were assessed by employing a goat homologous system and observing Vn binding to C9 in three different assays. Using recombinant fragments, C9 binding was mapped to the N-terminus of Vn. Site directed mutagenesis was performed to alter the second arginine glycine aspartic acid (RGD) sequence (RGD-2) of Vn. Changing R to G or D to A in RGD-2 caused significant decrease in Vn binding to C9 whereas changing of R to G in the first RGD motif (RGD-1) had no effect on Vn binding to C9. These results imply that the RGD-2 of goat Vn is involved in C9 binding. In a competitive binding assay, the presence of soluble RGD peptide inhibited Vn binding to C9 whereas heparin had no effect. Vn binding to C9 was also evaluated in terms of bacterial pathogenesis. Serum dependent inhibition of Escherichia coli growth was significantly reverted when Vn or its N-fragment were included in the assay. The C-fragment, which did not support C9 binding, also partly nullified serum-dependent inhibition of bacterial growth, probably through other serum component(s).

Kimura's disease: A case presentation of postauricular swelling.

Kimura's disease (KD) is a rare chronic inflammatory disease of subcutaneous tissues and occurs predominantly in head and neck region. It is seen primarily in young Asian males. Typical clinical presentations are painless subcutaneous masses, regional lymph node enlargement, blood and tissue hypereosinophilia, and increased serum IgE levels. Here, we present a case of a 27-year-old female who presented with unilateral single nodular swelling in the right postauricular region. The diagnosis of KD was done based on characteristic histopathologic finding in conjunction with peripheral eosinophilia and increase in serum IgE levels.

Plasma cell gingivitis: A perplexing and rare clinical entity.

Plasma cell gingivitis (PCG) is a diagnostic dilemma for clinicians. It is also referred to as atypical gingivostomatitis, idiopathic gingivostomatitis, allergic gingivostomatitis, and plasma cell gingivostomatitis which are characterized by bright fiery red gingiva with spontaneous bleeding on slight provocation. It is often confused with inflammatory gingival enlargement, erythematosus lichen planus, and other lesions. One such rare and benign entity is discussed in this article and managed after thorough clinical, radiological, histopathology, immunohistochemistry analysis.

Evaluation of Aerosol and Water Contamination and Control of Cross Infection in Dental Clinics.

BACKGROUND: The oral cavity is an unique environment which provides an ideal medium for bacterial growth. As a result of repeated exposure to the microorganisms present in blood and saliva, the dental health professionals and the patients are at a higher risk for developing many infectious diseases. A pilot study was carried out in the Dept of Dental Surgery, Armed Forces Medical College to assess the risk of cross infection in dental clinics. METHODS: Samples were collected from different dental surgeries of the Dept of Dental Surgery, Armed Forces Medical College and sent for microbiological culture and identification to the Dept of Microbiology, Armed Forces Medical College. The sampling was carried out in two stages, before and after implementing a set protocol. RESULT: All dental unit waterlines were coated with a well established biofilm made up of filamentous and bacillus-like microorganisms in first stage of study. There was marked reduction in the number of colonies from the samples collected during second stage. Same findings were observed in the samples of aerosol produced by ultrasonic scalers. CONCLUSION: The present study concluded that the new set protocol followed is significantly effective in reducing the microbial load in the water tubing, container and aerosol production. It is an effective measure for reducing the chances of cross infection in the dental surgery.

Central mucoepidermoid carcinoma.

Central mucoepidermoid carcinomas (MECs) are extremely rare tumors, comprising 2-3% of all MECs reported in the literature. We report a rare case of clear cell variant of central MEC with calcifications occurring in the left posterior mandible in a 37-year-old male patient.

Effect of mechanical trauma on the tooth germ of rat molar--a scanning electron microscope study.

OBJECTIVE: Clinical and histopathological evaluation of mechanical trauma on the development of maxillary first molar with Scanning Electron Microscope. DESIGN: Experimental study with four newborn Wistar rats. Trauma induced on 1st, 3rd, 7th and 10th postnatal days with dental K file. Right first molar region of the maxilla was the experimental side and the left side as control. Animals were sacrificed on the 42nd Postnatal day when the teeth came into functional occlusion. Teeth were evaluated clinically and SEM study of the crown was performed. RESULTS: Marked disfigurement of cusps, roughened defective, enamel, crown dilacerations and enamel hypoplasia were observed. Damage was less severe to the tooth subjected to trauma on the 10th postnatal day.

Histopathological and radiographic evaluation of rat molar teeth after traumatic injury-a pilot study.

OBJECTIVE: Radiographic and histopathological evaluation of mechanical trauma on the development of maxillary molars in rat. MATERIALS AND METHODS: Experimental study with 7-day-old five new born Wistar rats. Trauma induced on 7(th) postnatal day with #55 K file. Right first molar region of the maxilla was the experimental side, and the left side as control. Each animal was sacrificed for histopathological observation on 8(th) day (immediately next day of injury), 10(th) day (after 3 days of injury), 13(th) day (Enamel completion), 19(th) day (Emergence into oral cavity) and 42(nd) day when all the teeth came into functional occlusion. RESULTS: On the 42(nd) day experimental side of the study, the 1(st) molar tooth had not erupted and the radiographs taken revealed conglomerate mass suggestive of complex odontome. Reduced tooth size, altered enamel and dentin formation, abscess formation and complex odontome like structure were observed histopathologically. CONCLUSION: The diversity of morphlogical and histopathological changes to intrusive force implies intricate mechanism involved in tooth development.

Management of localized gingival recession by two-stage surgical procedure - Double pedicle flap with CTG and coronally advanced flap: A novel technique.

Cosmetic treatments have become an integral part of periodontal treatment. One of the commonly used esthetic periodontal procedures is coverage of denuded root surface. While considering the elimination of these defects two criteria should be considered, the esthetic aspects and the functional aspects. This case report has describes a two stage surgical technique using double pedicle flap with connective tissue graft followed by coronally advanced flap for the treatment of a severe localized gingival recession measuring 15 mm. The recession measurement at the end of 12 months was 1 mm. It showed a predictable result at the end of one year. The advantages of this technique are excellent colour matching, dual blood supply to graft and very predictable results. The promising result suggest that this technique can be used in severe gingival recession cases with minimum amount of keratinized tissue.