Comparative Evaluation of Recession Coverage Obtained Using the Pinhole Surgical Technique With and Without Platelet-Rich Fibrin: A Randomized Clinical Trial.

This randomized controlled clinical trial evaluated the pinhole surgical technique (PST) combined with platelet-rich fibrin (PRF) for the management of multiple recession defects compared to PST alone. Ten patients with 51 Miller Class I/ II or III gingival recessions were selected. Control sites were treated with PST alone, whereas test sites were treated with PST with PRF. Gingival recession depth (GRD), gingival recession width (GRW), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), total soft tissue gain (TSTG), Plaque Index (PI), Gingival Index (GI), and gingival bleeding index (GBI) were measured at baseline and at 1, 3, and 6 months posttreatment. Both groups showed statistically significant root coverage. The mean recession coverage was 60.25% in the test group and 49.6% in the control group. The recession reduction from baseline was 2.50 mm for the test group and 1.88 mm for the control group. At the end of 6 months, all sites achieved adequate root coverage. PRF is a feasible alternative to connective tissue grafts as an adjunct to PST for the treatment of multiple recession defects.

Synthetic mineral collagen composite bone graft with ribose cross linked collagen membrane for lateral ridge augmentation.

A combination of calcium phosphate-based mineral with carbon apatite structure and type 1 collagen derived from bovine Achilles tendon has been introduced for augmentation of alveolar ridge and periodontal defects. Carbon apatite structure of mineral mimics natural bone in terms of resorption and remodeling, while collagen provides three-dimensional structure; both together aid in higher osteoconduction. The aim of present case report was to investigate if synthetic mineral collagen composite bone graft (CBG) with ribose cross-linked collagen membrane (RCLM) may be successfully used to obtain lateral augmentation of alveolar ridge that is planned for dental implant placement. Lateral augmentation of ridge was performed by elevating a full-thickness mucoperiosteal flap, followed by debridement and decortication of the defect area. CBG was soaked in saline and molded onto the defect area. RCLM was used to cover the graft site, followed by stabilization of membrane and the flap by suturing. Preoperative and postoperative ridge widths were measured using cone-beam computed tomography scans. The use of synthetic mineral collagen CBG with RCLM for lateral ridge augmentation may lead to increase in ridge width making it suitable for dental implant placement.

Comparative evaluation of efficacy and patient-reported outcome measures of oral hygiene instruction methods for calibrated interdental brush.

OBJECTIVES: To compare the efficacy and patient-reported outcome measures of oral hygiene instruction methods for calibrated interdental brush. MATERIALS AND METHODS: A total of 60 participants, with 30 each in control and test group, participated in the study. Clinical examination included gingival index, full mouth bleeding scores and approximal plaque index. Supragingival scaling was performed. Interdental access probe was used to assess the size of interdental brush and corresponding interdental brush were given to the participants. For the control group, oral hygiene instructions were given through demonstration with model and video. For the test group, oral hygiene instructions were given through 'Touch-to-Teach' method. At 4-week follow-up, oral hygiene instructions were repeated to respective groups. After 3 months, clinical examination was done and exit survey on patient-reported outcome measures was administered. Statistical analysis was done. RESULTS: Intergroup comparison of gingival index, full mouth bleeding index and approximal plaque index showed statistically significant difference between test and control group. 'Touch-to-Teach' method of oral hygiene instruction was found to be 'Good'. Acceptance of interdental brush was regarded to be 'Good'. CONCLUSION: Within limitations of the study, Touch-to-Teach method of oral hygiene instruction method was found to be effective and more acceptable and participants used the interdental brush regularly.

Using a Composite Graft of Natural 15% Chitosan Gel in the Management of Intrabony Defects: A Case Series.

INTRODUCTION: The purpose of this study was to compare effects of smoking and smokeless forms of tobacco consumption (tobacco chewing) on periodontal disease parameters and response of these subjects to non-surgical periodontal therapy. MATERIALS AND METHODS: Ten patients aged between 30 and 55 years with intrabony defects greater than or equal to 3 mm and pocket probing depth (PPD) greater than or equal to 5 mm were selected. All participants received chitosan gel (15% w/v) plus bovine porous bone mineral as a composite bone graft. Clinical and radiographic measurements were recorded at baseline, 3 months after healing and at 6 and 9 months. Significance was set at 0.05. RESULTS: After nine months, all the defects treated with this combination showed PPD reduction of 5.30 ± 0.822 mm, relative clinical attachment level (CAL) gain of 5.80 ± 0.499 mm, reduction in intrabony defect (IBD) depth of 3.00 ± 0.497 mm and defect resolution of 78.32 ± 5.80 %, all of which were statistically significant. CONCLUSION: Within the limits of this study, this case series study suggests that chitosan gel, along with bovine porous bone mineral, has a promising role to play in periodontal regeneration.

Dental unit water lines decontamination with the aid of nanotechnology.

AIM: This article reviews the issue of dental unit waterline (DUWL) contamination which affects all the clinical and hospital settings. The contaminating microorganisms commonly isolated from these settings and the most pathogenic among them have serious consequences. Over the years several measures are inculcated for decontamination of water, their advantages and shortcomings have been addressed. Options using nanotechnology which are available in the market are described briefly. MATERIALS AND METHODS: A manual and electronic search was conducted. Google and PubMed were searched for relevant material from studies up to 2013. Medical Subject Headings words looked for were "Nanotechnology," "Water purification," and "Biofilms." Reviewed findings were summarized by topic, using the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement for reporting. Seventy articles were shortlisted for articles pertaining to our topic of discussion. A systematic approach was followed by two independent reviewers and included eligibility criteria for study inclusion, data extraction, data synthesis, and drawing of conclusion. RESULTS: Dental waterline contamination is widespread in any type of dental setting having serious implications on clinicians and patients alike, especially elderly and immune-compromised. Hence, international bodies like center for disease and control and American Dental Association have come up with stringent measures for maintenance of water quality. A gamut of procedures has been tried to overcome this problem ranging from chlorinated products, water filters to the usage of distilled water. The use of nanoemulsions, nanofilters, nanomembranes, etc., and their applicability for routine usage is discussed. CONCLUSIONS: Biofilm formation in DUWLs is inevitable with the subsequent release of part of microbiota into the otherwise sterile dental settings. These consequences can be quite serious on clinicians and dental patients. Though conventional measures in water decontamination have been partly successful, the quest for more foolproof methods has led to the use of latest technology, i.e., nanotechnology. The most practical option has to be chosen based on the ease of their usage.

The Autosomal Dominant Inheritance of Hereditary Gingival Fibromatosis: A Case Report.

Hereditary gingival fibromatosis (HGF) is a rare disorder characterized by progressive and varying degrees of gingival overgrowth. Oral manifestations vary from minimal to generalized enlargement, and HGF may occur as an isolated disorder or a feature of a syndrome. Unaesthetic appearance and functional impairment due to excessive gingival tissue dictate the need for surgical intervention. This article describes a family with three generations afflicted with a non-syndromic form of HGF with distinctive clinical, histological characteristics. Further, it highlights the need for genetic analysis and appropriate surgical technique to manage gingival enlargement and avoid recurrence.

Effect of non-surgical periodontal therapy on plasma homocysteine levels in Indian population with chronic periodontitis: a pilot study.

AIM: Homocysteine (Hcy) is implicated in the development of cardiovascular diseases (CVD). The effect of periodontal disease and periodontal therapy on plasma Hcy remains controversial. Hence, in this pilot study we assessed the effect of periodontal disease and non-surgical periodontal therapy (NSPT) on plasma Hcy in systemically healthy Indian subjects. MATERIALS AND METHODS: Forty participants (30 to 39 years) were enrolled in the study and were divided into two groups based on gingival index, probing depth, and clinical attachment level (CAL): Healthy (control group; n = 20) and Chronic Periodontitis (test group; n = 20). Plasma samples were collected and quantified at baseline and 12 weeks after scaling and root planing (SRP) for Hcy using High Performance Liquid Chromatography with fluorescent detection (HPLC-fld). RESULTS: Plasma Hcy levels of chronic periodontitis (17.87 ± 1.21 µmol/l) subjects was significantly higher than healthy subjects (9.09 ± 2.11 µmol/l). Post-therapy, the plasma Hcy concentration reduced significantly (11.34 ± 1.87 µmol/l) (p < 0.05). CONCLUSION: The rise and descent of plasma Hcy levels with periodontal inflammation and therapy, respectively, indicate a direct relationship of Hcy with chronic periodontitis. NSPT may be employed as an adjunctive Hcy Lowering Therapy, contributing towards primary prevention against CVD's.

Comparative evaluation of transdermal diclofenac patch with oral diclofenac as an analgesic modality following root coverage procedures.

Diclofenac sodium is a nonsteroidal anti-inflammatory drug and is effective in the management of pain following periodontal surgery. However, oral administration of diclofenac can lead to gastrointestinal (GI) complications. To overcome these drawbacks, diclofenac is formulated as a transdermal patch, which delivers the drug into systemic circulation through skin. Twenty patients were selected for root coverage procedures with subepithelial connective tissue grafts bilaterally. Following the surgical procedure on the control sites, oral diclofenac sodium 100 mg was administered QD for 3 days. Following the surgical procedure on the contralateral test site, a transdermal diclofenac patch (TDP) was applied every 24 hours for 3 days. The TDP was effective in postoperative pain control following root coverage procedures with subepithelial connective tissue grafts. Pain tolerance was higher with the TDP as compared to oral administration, as it did not cause any GI complications.

Current applications of nanotechnology in dentistry: a review.

With the increasing demand for advances in diagnosis and treatment modalities, nanotechnology is being considered as a groundbreaking and viable research subject. This technology, which deals with matter in nanodimensions, has widened our views of poorly understood health issues and provided novel means of diagnosis and treatment. Researchers in the field of dentistry have explored the potential of nanoparticles in existing therapeutic modalities with moderate success. The key implementations in the field of dentistry include local drug delivery agents, restorative materials, bone graft materials, and implant surface modifications. This review provides detailed insights about current developments in the field of dentistry, and discusses potential future uses of nanotechnology.

Gingival crevicular fluid and interleukin-23 concentration in systemically healthy subjects: their relationship in periodontal health and disease.

BACKGROUND AND OBJECTIVE: There is a substantial magnitude of data implicating the role of interleukin-23 (IL-23) in the initiation and progression of periodontal disease. The main aim of this study was to evaluate the levels of IL-23 in the gingival crevicular fluid of systemically healthy subjects in periodontal health and disease. In addition, we explored the effectiveness of periodontal interventional therapy on the levels of IL-23 in subjects with chronic periodontitis to obtain a deeper insight into the possible role of IL-23 in three separate periodontal conditions in three different populations. MATERIAL AND METHODS: In this study, 54 individuals, satisfying the study inclusion and exclusion criteria, were recruited. They were categorically divided, on the basis of gingival index, probing pocket depth and relative attachment loss, into three groups: Group 1 (patients with a clinically healthy periodontium, n = 18); Group 2 (patients with gingivitis, n = 18); and Group 3a (patients with chronic periodontitis, n = 18). Samples taken from all 18 subjects of Group 3a, 3 mo after the initial therapy, constituted Group 3b. All clinical parameters were recorded at baseline and 3 mo after scaling and root planing. Gingival crevicular fluid samples were obtained in which the IL-23 concentration was measured using ELISA. RESULTS: The highest mean IL-23 concentration in gingival crevicular fluid was found for Group 3a (16448.69 pg/mL) and the lowest for Group 1 (2565.28 pg/mL). The mean IL-23 concentrations in Group 2 (5425 pg/mL) and Group 3b (6272.22 pg/mL) lay between the maximum and minimum values. This implies a positive correlation between the gingival crevicular fluid IL-23 concentration and relative attachment loss (p < 0.05). CONCLUSION: A noteworthy increase in the gingival crevicular fluid IL-23 concentration was seen that was proportional to the amount of periodontal tissue damage. As the IL-23 concentration in gingival crevicular fluid is directly proportional to the severity of the periodontal affliction, it can be speculated that IL-23 has a possible role in the pathogenesis of periodontal disease.

Mechanized scaling with ultrasonics: Perils and proactive measures.

Mechanized scaling for plaque removal is a routine procedure in the practice of periodontics. Though it appears innocuous by itself, there are retinues of hazards associated with it on various organ systems in the body. Some of these unwanted effects and measures to avoid or ameliorate the same are elaborated here. Exposure to ultrasonic scaling is inevitable before any other treatment procedure. Aerosol contamination, vibrational hazards, thermal effects on the dental pulp, altered vascular dynamics, disruption in electromagnetic device, diminished hearing and dental unit waterline contamination are some of the probable off-shoots a patient has to bear. Uses of barrier devices, proper attention to usage of equipment, protection for ear and water treatment are few of solutions for the same. Though documented evidence for the existence of all effects is lacking, it is never the less significant for the overall safety of the patient. A conscientious clinician should therefore inculcate the available steps to overcome the hazards of ultrasonic scaling.

Peripheral osteoma of the hard palate.

Osteomas are benign slow growing, osteogenic lesions which may arise from proliferation of either cancellous or compact bone. They are usually sessile tumours composed of dense sclerotic, well formed bone projecting out from the cortical surface, most often of the skull and facial bones. This paper reports a case of a peripheral osteoma in the hard palate of a 45-year-old man, which was treated by periodontal flap surgery with surgical excision of the bony lesion. Peripheral osteomas of jaw bone are uncommon and usually associated with Gardner's syndrome. Histological examination confirmed the clinical impression of a peripheral osteoma. Patient was reviewed after one year and was asymptomatic with no recurrence of the lesion.

Cryosurgical Treatment of Gingival Melanin Pigmentation - A 30-Month Follow-Up Case Report.

INTRODUCTION: Cryosurgery is a branch of therapeutics that makes use of local freezing for the controlled destruction or removal of living tissues. Cryosurgery has been tried with satisfactory results for gingival depigmentation. However, documented evidence in the literature is extremely limited. The present case report describes the successful management of excessive gingival pigmentation by cryosurgery. The patient underwent follow-up for 30 months. CASE PRESENTATION: A 21-year-old South Indian dark-skinned female presented with dark brown to black gingival melanin pigmentation. The darkly pigmented gingiva had been present since birth. Cryosurgery using nitrous oxide and gas expansion cryoprobe cooled to -70°C was used for the depigmentation. The depigmentation was performed from maxillary right cuspid to maxillary left cuspid in a single appointment. The patient reported no adverse effects and no repigmentation of the treated areas for a period of 30 months. CONCLUSIONS: Cryosurgery is an easy procedure, with lack of bleeding and scar formation. The esthetic outcome may be maintained for 30 months as shown in the present case. Cryosurgery can be considered a desirable treatment option for gingival depigmentation.

Alveolar ridge augmentation--a case series.

This study presents case reports of patients with osseous defects who were treated with autogenous bone grafts from the symphysis region, alloplast grafts with barrier membrane, and the use of free gingival onlay grafts for alveolar ridge augmentation. The patients were followed for a period of six months.

Comparison of two different forms of varnishes in the treatment of dentine hypersensitivity: a subject-blind randomised clinical study.

PURPOSE: Dentine hypersensitivity is one of the most frequently recorded complaints of dental discomfort. Current evidence implicates patent dentinal tubules in hypersensitive dentine, and it follows that one effective way to reduce dentine sensitivity is to occlude the dentinal tubules. The purpose of this study was to compare the efficacy of two different desensitising agents, Cervitec varnish and Gluma varnish. MATERIALS AND METHODS: Two hundred fifty patients self-reporting dentine hypersensitivity completed the paired split mouth randomised, subject-blind study. Each participant had a minimum of two sensitive teeth in at least two different quadrants and displaying a response of ≥3 cm to an evaporative stimulus. The hypersensitivity levels were measured with a tactile stimulus (scratchometer), thermal stimulus (cold water test), and an evaporative stimulus (air blast test) using a visual analogue scale. The teeth were evaluated immediately after treatment, and at 4 and 12 weeks after application of the chlorhexidine-containing varnish Cervitec and the glutaraldehyde-containing varnish, Gluma Desensitizer. RESULTS: Statistical analysis indicated that both the desensitising varnishes were effective in alleviating dentine hypersensitivity at all time intervals compared to baseline. There was a highly statistically significantly greater reduction in dentine hypersensitivity to evaporative stimulus, cold stimulus, and tactile stimulus after application of Cervitec than after Gluma Desensitizer (P < 0.001). CONCLUSION: Both the varnishes have a therapeutic potential to alleviate dentine hypersensitivity at all time intervals compared to baseline. However, Cervitec varnish is more efficacious in reducing dentine hypersensitivity than Gluma varnish at both 4 weeks and 12 weeks post-treatment.

Fibrin glue application in conjunction with tetracycline hydrochloride root conditioning and semilunar coronally repositioned flap in the treatment of gingival recession.

The purpose of this case report is to present the results of Fibrin Adhesive System (FAS) application, a topical biological tissue adhesive in the treatment of maxillary buccal recessions. A 40-year-old male patient presented with a pair of class I buccal recession defects on maxillary cuspids. Clinical parameters were recorded at baseline, 1 month, and 3 months. Semilunar coronally repositioned flap (Tarnow's technique), root debridement, root conditioning with tetracycline hydrochloride solution and one of the defect was treated with FAS application. Significant recession, height reduction, and attachment gain were observed with the FAS application defect site. About 50% of root coverage was noted in the FAS-treated defect and almost no root coverage in the defect site with no FAS application. Semilunar coronally repositioned flap with FAS application is an effective procedure for root coverage in anterior teeth. The addition of FAS improves the amount of root coverage, especially in relatively shallow defects.

Comparative evaluation of the efficacy of 10% doxycycline hyclate in the periodontal treatment of smokers - a clinical and microbiological study.

PURPOSE: The aim of this present clinical and microbiological study was to evaluate the efficacy of the association of locally delivered 10% doxycycline hyclate (Atridox®) with scaling and root planing in the periodontal treatment of smokers. MATERIALS AND METHODS: Forty-five patients with chronic periodontitis having a minimum of two periodontal pockets (>5 mm) and satisfying the inclusion and exclusion criteria were selected. Sites were randomly assigned to scaling and root planing (SRP) or scaling and root planing followed by local application of 10% doxycycline hyclate (SRP-D). Plaque index (PI), gingival index (GI), periodontal pocket depth (PD), clinical attachment level (CAL) and total anaerobic colony count (TACC) were recorded at baseline, one month and three months respectively. Differences between baseline and each period were considered for analysis. RESULTS: There was a significant reduction in plaque score, gingival score, periodontal pocket depth and total anaerobic colony count from baseline in both groups at all time intervals. Clinical attachment level showed a significant gain in both groups. However, PD reduction (P < 0.001) and CAL gain (P < 0.001) were significant in the test group as compared to control at the end of 3 months. Reduction in total anaerobic colony count from baseline was significant (P = 0.02) in the test group compared to control at the end of 3 months. CONCLUSIONS: The use of locally delivered doxycycline may constitute an important adjunct for the treatment of chronic periodontitis in smokers.

Efficacy of lycopene in the treatment of gingivitis: a randomised, placebo-controlled clinical trial.

PURPOSE: The aim of the present study was to compare the effect of systemically administered lycopene (LycoRed) as a monotherapy and as an adjunct to scaling and root planing in gingivitis patients. MATERIALS AND METHODS: Twenty systemically healthy patients showing clinical signs of gingivitis were involved in a randomised, double-blind, parallel, split-mouth study. The subjects were randomly distributed between the two treatment groups: experimental group (n = 10), 8 mg lycopene/day for 2 weeks; and controls (n = 10), placebo for 2 weeks. Quadrant allocation within each group was randomised with two quadrants treated with oral prophylaxis (OP) and two quadrants not receiving any form of treatment (non-OP). Bleeding index (SBI) and non-invasive measures of plaque (PI) and gingivitis (GI) were assessed at baseline, 1 and 2 weeks. Salivary uric acid levels were also measured. RESULTS: All the treatment groups demonstrated statistically significant reductions in the GI, SBI and PI. Treatment with OP-lycopene resulted in a statistically significant decrease in GI when compared with OP-placebo (p < 0.05) and non-OP-placebo (p < 0.01). Treatment with non-OP-lycopene resulted in a statistically significant decrease in GI when compared with non-OP-placebo (p < 0.01). The OP-lycopene group showed a statistically significant reduction in SBI values when compared with the non-OP-lycopene group (p < 0.05) and the non-OP-placebo group (p < 0.001). There was a strong negative correlation between the salivary uric acid levels and the percentage reduction in GI at 1 and 2 weeks in the OP-lycopene group (r = -0.852 and -0.802 respectively) and in the non-OP-lycopene group (r = -0.640 and -0.580 respectively). CONCLUSIONS: The results presented in this study suggest that lycopene shows great promise as a treatment modality in gingivitis. The possibility of obtaining an additive effect by combining routine oral prophylaxis with lycopene is also an exciting possibility, which deserves further study.