Effectiveness of Surgical Periodontal Therapy in Oral Health-Related Quality of Life.

Background and objective The objective of this study is to evaluate and compare the surrogate and true end points following surgical periodontal therapy using the Oral Health Impact Profile-14 (OHIP-14) questionnaire. Materials and methods The study included a total of 30 participants, comprising 15 males and 15 females aged between 25 and 50 years. All individuals who had undergone periodontal flap surgery for generalized chronic periodontitis at the Department of Periodontology, Saveetha Dental College and Hospitals were included in the study. The OHIP-14 questionnaire was used to assess the patient-centered outcomes (true end points) pre- and post-flap surgery at baseline and six months. Surrogate end points such as the clinical attachment level (CAL), probing pocket depth (PPD), and gingival index (GI) were recorded at baseline and six months pre- and post-flap surgery. Results Clinical parameters such as the GI (p=0.03*), CAL (p=0.03), and PPD (p=0.02*) showed a statistically significant improvement after surgery. Patient-centered outcomes showed statistically significant differences in terms of taste perception, reduction in pain sensation, improvement in self-consciousness and reduction in anxiety levels, diminution of the feeling of embarrassment and enhancement in the ability to relax due to problems associated with gums, and improvement in the workplace (p<0.05) post-operatively. Conclusion Surgical periodontal therapy plays a pivotal role in improving oral health-related quality of life (OHRQoL) among patients with chronic periodontal disease. Utilizing OHIP-14 as an assessment tool enables a comprehensive evaluation of treatment outcomes, encompassing various dimensions of oral health impact. Patient-centered outcomes such as psychological discomfort and functional limitations can be achieved only by an interdisciplinary approach.

Synthesis and Analysis of Novel Hyaluronic Acid-Based Dual Photocrosslinkable Tissue Adhesive: An In Vitro Study.

Background Tissue adhesives are mainly used for aiding in the attachment of adjacent tissues or to nearby hard tissue surfaces. They promote the natural healing processes of the tissues, especially for less painful closure, simple application, no need for sutures following surgery, and localized drug release. This study aimed to synthesize and assess the properties of hyaluronic acid (HA)-based, dual photocrosslinkable tissue adhesive. Materials and methodology N-hydroxysuccinimide (NHS), 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide (EDC), HA, and polymethylmethacrylate, which served as a photoinitiator, were combined to synthesize a tissue adhesive. The prepared formulation was characterized, and its biocompatibility was assessed. Results Surface morphology, mechanical properties, and biological properties of the HA adhesive were comparable to those of conventional fibrin glue. Scanning electron microscopy (SEM) analysis showed the average size of the molecules, 10-25 mm in diameter, and also showed a smooth and nonporous surface. The specimens experienced maximum compressive stress of 0.06 ± 0.02 MPa, compressive strain of 3.07 ± 2.02, and a compressive displacement at break of 3.04 ± 1.23 mm, with a maximum force of 2.33 ± 0.07 N at break. The cytotoxicity assay results for HA and fibrin glue are almost equal. Conclusion HA-based photocrosslinkable tissue adhesive could be a potential biomaterial in various applications in the field of medicine, especially in soft tissue management.

Comparative Assessment of Catalase Levels in Peri-Implant Health and Disease.

Peri-implant disease pathogenesis is similar to periodontal disease pathogenesis resulting in production of pro-inflammatory mediators. These mediators alter the redox balance leading to decrease in antioxidants, among which catalase is one of the enzymatic antioxidants. The aim of the study was to compare the levels of catalase in peri-implant health and disease. The present observational study was carried out from June 2022 to December 2022 in the Department of Implantology, Saveetha Dental College and Hospitals, Chennai, India. A total of 60 patients with peri-implant health (Group 1; n = 20), peri-implant mucositis (Group 2; n = 20) and peri-implantitis (Group 3; n = 20) were enrolled. Unstimulated salivary samples were collected and subjected to ELISA for catalase analysis. Catalase levels were then compared between the groups using ANOVA. The mean catalase level in peri-implant health, peri-implant mucositis, peri-implanti-tis were 25.07 ± 0.44 U/mL, 18.5 6 ± 0.65 U/mL, and 11.25 ± 0.76 U/mL respectively. The difference between the three groups were statistically significant (P < 0.05). Catalase level decreases with severity of peri-implant diseases. Therefore, catalase can be used as a diagnostic marker for peri-implant diseases.

Comparative Evaluation of C-Reactive Protein Levels among Peri-Implant Health and Disease Conditions.

Peri-implant disease pathogenesis results in production of pro-inflammatory mediators, among which C-reactive protein (CRP) is one of the acute phase reactants. The aim of the study was to comparative CRP levels among peri-implant health and disease conditions. The present study was carried out in the Department of Implantology, Saveetha Dental College and Hospitals, Chennai, India. A total of 40 patients with peri-implant health (n = 10), peri-mucositis (n = 10), early peri-implantitis (n = 10) and advanced peri-implantitis (n = 10) were enrolled. Unstimulated salivary samples were collected and subjected to latex agglutination assay for CRP analysis. CRP levels were then correlated with peri-implant health and diseases. CRP level in peri-implant health, peri-implant mucositis, early peri-implantitis and advanced peri-implantitis were 0.18 ± 0.04 mg/dL, 2.05 ± 0.61 mg/dL, 4.14 ± 1.82 mg/dL and 6.21 ± 1.35 mg/dL respectively. There was a statistically significant difference in CRP levels between all the tested groups (ANOVA, P = 0.03). Pearson correlation coefficient analysis revealed a strong positive correlation between CRP and peri-implant health status. CRP level was high among patients with peri-implantitis followed by peri-implant mucositis and peri-implant health. Also, CRP level increases with severity of peri-implant diseases and there exists a positive correlation between CRP level and peri-implant health status.

Clinical Efficacy of Different Concentrations of Povidone Iodine in the Management of Peri-Implant Mucositis.

Mechanical plaque control is the first line of management of peri-implant diseases. Povidone iodine is one of the broad spectrum and potent antiseptics available at various concentrations. The aim of the study was to assess and compare the efficacy of various concentrations of povidone iodine in the management of peri-implant mucositis. In the present double blinded, parallel designed, randomized clinical trial, a total of 60 patients with peri-implant mucositis (20 participants in each group [Group 1 (povidone iodine 0.1%), Group 2 (povidone iodine 2%) and Group 3 (povidone iodine 010%)] were enrolled. Scaling and root planing was done and then the peri-implant sulcus was irrigated with respective irrigant and repeated once in a week for 4 weeks. Loe and Silness Gingival Index (GI) and Mombelli Modified sulcular bleeding index (BI) were recorded at baseline and after a month and compared. Statistical analysis was done using One-way ANOVA and Tukey's HSD post hoc test. A statistically significant difference (P = 0.000) observed between the three concentrations when compared after 1 month. Also, a statistically significant difference between Group 1 and Group 3 and Group 2 and Group 3 was observed in terms of post GI (P = 0.000) and post BI (P = 0.000) but statistically no significant difference was observed between Group 1 and Group 2 in terms of post GI (P = 0.171) and post BI (P = 0.338). The 2% and 10% povidone iodine showed significant improvement in gingival index and bleeding index and hence it could be an effective adjunct to scaling and root planing in the management of peri-implant mucositis.

Correlation of C-Reactive Protein and Severity of Peri-Implant Diseases.

Peri-implant disease pathogenesis is similar to periodontal disease pathogenesis resulting in production of pro-inflammatory mediators. These mediators are released during the inflammation phase, among which C-reactive protein (CRP) is one of the acute phase reactants. The aim of the study was to correlate the levels of CRP with the severity of peri-implant diseases. The present observational study was carried out from June 2022 to December 2022 in the Department of Implantology, Saveetha Dental College and Hospitals, Chennai, India. A total of 60 patients with peri-implant health (n = 20), peri-mucositis (n = 20) and peri-implantitis (n = 20) were enrolled. Unstimulated salivary samples were collected and subjected to latex agglutination assay for CRP analysis. CRP levels were then correlated with severity of peri-implant diseases. The mean CRP level in peri-implant health, peri-implant mucositis, peri-implantitis were 0.25 ± 0.36 mg/dl, 3.56 ± 0.85 mg/dl and 5.07 ± 0.74 mg/dl, respectively. Pearson correlation coefficient analysis revealed a strong positive correlation between CRP and peri-implant parameters suggesting that the CRP level increased as the severity of peri-implant disease increased. CRP level increases with severity of peri-implant diseases and there exists a positive correlation between CRP level and peri-implant parameters. Therefore, CRP can be used as a diagnostic marker for peri-implant diseases.

Efficacy of Ozonated Olive Oil Gel in the Management of Peri-Implant Mucositis.

Peri-implant mucosistis is similar to gingivitis, the former affects the mucosa around implants without bone loss. The aim of this study was to determine the effectiveness of ozonated olive oil gel in the management of peri-implant mucositis. A randomized controlled clinical trial was conducted among 50 patients with peri-implant mucositis within the age group of 25-50 years. They were randomly divided into two groups with 25 participants in each group based on the intervention [Group A (Ozonated olive oil gel), Group B (Chlorhexidine gel)]. Silness and Loe plaque index (PI) and Loe and Silness gingival index (GI) were recorded at baseline and after 4 weeks. Paired t-test and independent t-test was used to test the significance. Within the groups, there was a statistically significant reduction in PI and GI from baseline (P < 0.05). However, the difference in PI and GI between both the groups was statistically insignificant (P > 0.05). Ozonated olive oil gel was equally effective to chlorhexidine gel in the management of peri-implant mucositis.

Preparation and Evaluation of Antimicrobial Property and Anti-inflammatory Activity of Fenugreek Gel Against Oral Microbes: An Invitro Study.

Aim Periodontal dressings play a crucial role in periodontal surgery and dental procedures. These dressings have several functions and benefits, similar to surgical wound dressings used in other surgical contexts. Periodontal dressings protect the surgical site and control bleeding in the oral cavity as they exert pressure on tissue and blood vessels. By protecting the wound and stabilizing the tissues, periodontal dressings create an environment that encourages proper and faster healing. Recently, the use of periodontal pack has reported various postoperative discomfort to the patients. This led to the development of an interest in considering fenugreek as an alternative to periodontal dressing as it possesses various antidiabetic and hypolipidemic effects. Thus, fenugreek can be used as an alternative to periodontal dressing. The study aimed to prepare and evaluate the antimicrobial nature of fenugreek gel in oral microbes and the anti-inflammatory properties of gel with protein coagulation in egg albumin. Materials and methods The fenugreek gel preparation was done by grinding 100 g of fenugreek seeds into a powder and adding 100 ml of distilled water to the powder and then heating the mixture at 70°C for 30 minutes. Five milliliters of the fenugreek concentrate were added to an equal mixture of carboxymethyl cellulose and Carbopol which was mixed thoroughly to form a gel. The antimicrobial nature of fenugreek has been evaluated in various organisms such as Streptococcus mutans, Lactobacillus, Enterococcus faecalis, and Candida albicans whereas the anti-inflammatory property was evaluated by protein coagulation method in egg albumin. Results The results stated that the fenugreek gel at a concentration of 100 µg/ml showed a greater zone of inhibition (5.39 ± 0.05) compared with doxycycline (1.1 ± 0.08) for a high antimicrobial potential against all oral microbes. The anti-inflammatory activity of the gel by protein coagulation method in egg albumin showed greater inhibition (67.15±1.36) at 100 µg/ml of fenugreek extract when compared with aspirin (64.43±2.93). Paired t-test was done for both the properties and the p-value was less than 0.5 stating that the difference between the groups was statistically significant. Conclusion The present study showed that the fenugreek gel possesses higher antimicrobial and anti-inflammatory properties when compared with doxycycline and aspirin, respectively. Hence, fenugreek gel can be used as an alternative periodontal dressing to reduce postoperative inflammation.

Analgesics/Anti-Inflammatory Drugs Preferred Following Implant Placement: A Retrospective Study.

BACKGROUND: In dentistry, pain is a rather inevitable perception that often plagues both the care provider and receiver. Pain, which was described by Rene Descartes in the sixteenth century, has been defined as an unpleasant sensory and emotional experience associated with tissue damage or described in terms of such damage. Various dental procedures also provoke a perception of anxiety that culminates with pain and exaggerates the perception of pain. Hence, adequate pain control and assurance are of utmost importance during and following implant surgery. AIM: The aim of the present study was to assess the analgesics and anti-inflammatory drugs preferred following implant placement and also to find an association between gender, age, and various analgesics/anti-inflammatories prescribed following implant surgery. MATERIALS AND METHODS: Retrospective data collection was conducted from June 2019 to March 2020 among 200 patients who underwent implant surgery, based on records management system software to analyze the most commonly prescribed analgesics/anti-inflammatory drugs following implant surgery. RESULTS: Among 200 patients the frequency distribution showed that 87% of the patients were prescribed with combination of Aceclofenac (100 mg), Paracetamol (325 mg), and Serratiopeptidase (15 mg), 10% of the patients were prescribed with Paracetamol (650 mg), whereas 3% of the patients were prescribed with Piroxicam (20 mg). CONCLUSION: The present study showed that combination of Aceclofenac, Paracetamol, and Serratiopeptidase was the commonly prescribed analgesic/anti-inflammatory drug for postoperative pain management following implant placement. Also there was no significant association between gender vs. various analgesics/anti-inflammatory drugs prescribed following implant placement.

A short review on guided implant surgery and its efficiency.

Ideal implant placement may reduce surgical complications, such as nerve injury and lingual cortical plate perforation, and minimize the likelihood of functional and prosthetic compromises. Guided implant surgery [GIS] has been used as the means to achieve ideal implant placement. GIS refers to the process of digital planning, custom-guide fabrication, and implant placement using the custom guide and an implant system-specific guided surgery kit. GIS includes numerous additional steps beyond the initial prosthetic diagnosis, treatment planning, and fabrication of surgical guides. Substantial errors can occur at each of these individual steps and can accumulate, significantly impacting the final accuracy of the process with potentially disastrous deviations from proper implant placement. Pertinent overall strategies to reduce or eliminate these risks can be summarized as follows: complete understanding of the possible risks is fundamental; knowledge of the systems and tools used is essential; consistent verification of both diagnostic and surgical procedures after each step is crucial; proper training and surgical experience are critical. This review article summarizes information on the accuracy and efficacy of GIS, provides insight on the potential risks and problems associated with each procedural step, and offers clinically relevant recommendations to minimize or eliminate these risks.

Comparison between conventional and micro-assisted periodontal surgery: Case series.

Microsurgery is a minimally invasive procedure that uses a surgical microscope, specially designed equipment, and suture materials. Even though this equipment and expertise of numerous surgeries are required to meet patient esthetic reckoning, doctors must be ready to invest time and effort into becoming familiar with novel surgical methods and devices. The ambition of this case series is to compare conventional macro surgery and microsurgery in terms of clinical approach. This study included four cases, two flap surgery, and two root coverage. Clinical parameters for root coverage, increase in keratinized tissue (KT), gain in clinical attachment level (CAL) and complete root coverage (CRC), dentin hypersensitivity index-Schiff's index and for flap surgery, probing depth, clinical attachment level. Healing and pain analysis were done. There was no significant difference seen between conventional and clinical outcomes of a microsurgical technique such as clinical attachment level, probing depth, increase in KT, gain in clinical attachment level (CAG), and CRC, dentin hypersensitivity index-Schiff's index. When patient-based outcomes such as healing index and Visual Analog Scale, a significant difference was seen. If a microsurgical method is used instead of a traditional macroscopic approach, the early healing index can be significantly improved and there will be less postoperative pain.

Management of inadequate width of attached gingiva using mucograft.

Attached gingiva around the teeth is crucial in preserving periodontal health. Plaque development and soft-tissue recession are both prevented by adequate attached gingiva. The processes for harvesting soft-tissue grafts are frequently accompanied by some level of morbidity which results in commercially available xenogeneic collagen matrices. The blood clot is more effectively stabilized by this collagen matrix, which also promotes vascularization. Furthermore, this biomaterial enhances root coverage and keratinized gingiva regeneration in both width and thickness. The purpose of the case report is to increase the width of attached gingiva using Mucograft®. This case report highlights a case scenario where a patient presented with probing depth of 6-8 mm in relation to 24, 25, 26, 27, and 28, Grade I mobility in relation to 25.26, and 1 mm of the width of attached gingiva in relation to 25, 26, and 27. Flap surgery was done and simultaneously vestibular deepening was done in relation to 25, 26, and 27, and mucograft was placed and stabilized. On a 3-month follow-up, probing pocket depth was 3 mm and 4 mm of width of the attached gingiva was seen in 25, 26, and 27. The Mucograft® was beneficial in this clinical case for the purpose of extending the width of the associated gingiva, making it a feasible treatment option for soft-tissue augmentation.

Soft tissue re-growth after different crown lengthening techniques among Indian patients.

Patients often report complaining of fractured or decayed teeth with severe morphological deformities. However, all these clinical scenarios require the same level of care and consideration to rehabilitate form, function and esthetics. Some cases have sufficient clinical crown height while others often require an interdisciplinary approach in the form of orthodontic/surgical extrusion or surgical periodontal options. A common factor delaying treatment is soft tissue regrowth after crown lengthening which delays the impression required for final prosthesis. Therefore, it is of interest to compare the prevalence of soft tissue regrowth a week after different crown lengthening techniques including laser gingivectomy, electrocautery gingivectomy, modified Widman flap and apically repositioned. The parameters assessed included 1-week postoperative soft tissue regrowth after crown lengthening, age of patients and gender. It was observed that laser and electrocautery-assisted gingivectomy had a higher rate of soft tissue regrowth as compared to surgical techniques. It was further noted that laser and electrocautery assisted gingivectomy had a higher frequency of soft tissue rebound growth compared to surgical crown lengthening using modified widman flap and apically repositioned flap, which was statistically insignificant. Patients within the age groups of 26-60 years were found to have a higher tendency of soft tissue regrowth, which was found to be clinically and statistically significant (p<0.05).