Correlation of Blood and Salivary pH Levels in Healthy, Gingivitis, and Periodontitis Patients before and after Non-Surgical Periodontal Therapy.

Periodontitis is an infectious illness which leads to the inflammation of protective tissues around the teeth and the continuous loss of alveolar bone and conjunctive tissue. Biomarker analysis in serum and saliva helps in the evaluation of disease progression and activity. It is also established that every inflammatory change along with resultant damage of tissues ends up in altered pH values in the fluids and tissues. AIM: To correlate the connection of pH levels in both blood as well as saliva in healthy, periodontitis, and gingivitis patients. MATERIALS AND METHODS: The current research involved 145 subjects amidst the age of 20 and 55 years. The subjects were split into three different groups: healthy (Group A), gingivitis (Group B), and finally chronic periodontitis (Group C). The recording of clinical parameters was done by gingival index (GI), probing depth (PD), and plaque index (PI). pH of saliva and blood was analyzed with the help of digital single electrode pH meter. Subjects have gone through scaling and root planning (SRP) coupled with the instructions of oral hygiene. They were recalled post 4 weeks, and saliva and blood samples were gathered for analyzing pH. RESULTS: Clinical parameters GI and PI were statistically important in both group C as well as group B post SRP. A crucial change has been observed in attachment levels (AL) and PD in the case of periodontitis group post SRP. The difference in the salivary pH values were significant between group B vs. C and A vs. C before the treatment because the values for group C were acidic, whereas in groups B and A the pH was alkaline. After the treatment, the values were still significant because the pH has become more alkaline compared to preoperative value in both group B and C. Saliva's pH levels have demonstrated a statistically significant reduction in group C post SRP. CONCLUSION: Salivary pH levels and blood evidently became alkaline in the group C patients post SRP and there is a positive correlation between them and the clinical parameters.

Effect of iatrogenic factors on periodontal health: An epidemiological study.

INTRODUCTION: Periodontitis is a multifactorial disease. Among conglomerate etiological factors, overhanging interproximal restorations are viewed as contributing factors causing gingival inflammation due to their retentive capacity for bacterial plaque leading to periodontal destruction. Hence this study is intended to determine the prevalence of overhanging restorations and its effect on periodontal status of the teeth and to assess the iatrogenic effects of overhanging margins on periodontal health. MATERIALS AND METHODS: A total of 100 subjects of 15-65 years of age were recruited for this study. Dental restorations which affect periodontal health like amalgams, composite or glass ionomer restorations (overhanging margins proximally), fixed prosthesis, cervical abrasions, class V restorations extending sub-gingivally were included in the study. Patients with known systemic diseases, smokers, and on any medication in past 6 months were excluded from the study. Various parameters like bleeding on probing, probing depth, clinical attachment loss, biological width, gingival recession, duration of restoration were assessed according to the site of the restorations. STATISTICAL ANALYSIS: A commercially available SPSS version 20.0 Software, was used to perform the statistical analysis. The data were distributed normally and it was investigated using paired t-test. The prevalence of overhanging restorations was done through percentages comparison between restorative sites with non-restorative sites. RESULTS: The presence of sub-gingival restorations was greater in males than in females. This can be attributed to the oral hygiene maintenance of the subjects. The prevalence of sub-gingival restorations was more prevalent in the age groups between 35 and 45 years of age. CONCLUSION: This study clearly identified a higher prevalence, 50.8% of sub-gingival restorations causing gingivitis and has shown significant influence on periodontal status of the tooth.

Coronally Advanced Flap with Amniotic Membrane in the Treatment of Gingival Recession: Three Case Reports.

Gingival recession is defined as an apical displacement of soft tissues to the cementoenamel junction. Various treatment options for the management of gingival recessions include laterally positioned flap, double papillae flap, coronally advanced flap (CAF) with or without guided tissue regeneration, free gingival autografts, and autogenous subepithelial connective tissue grafts. Three patients with multiple adjacent gingival recessions in the upper jaw were treated utilizing amniotic membrane (Tata memorial) with CAF. The results of this procedure show that amniotic membrane can be used in the treatment of gingival recession defects with significant root coverage and to increase the thickness of keratinized gingiva. There was an increase in height and thickness of keratinized gingiva from 3 to 3.5 mm and 1.5 to 2 mm, respectively. The present results suggest that the combined approach of CAF and amniotic membrane can be considered as a treatment option for multiple adjacent gingival recessions.

Treatment of dentinal hypersensitivity using low-level laser therapy and 5% potassium nitrate: A randomized, controlled, three arm parallel clinical study.

AIM: The present randomized study was aimed to compare the efficacy 5% potassium nitrate (KNO3) toothpaste, low-level laser therapy (LLLT), and LLLT with 5% KNO3 toothpaste in the treatment of dentinal hypersensitivity (DH). MATERIALS AND METHODS: Total of 45 patients complaining of DH with visual analog scale (VAS) score being ≥2 were recruited and were divided into three groups. Group A was treated with 5% KNO3 toothpaste, Group B using LLLT along with the application of 5% KNO3 toothpaste, and Group C using LLLT alone. VAS scores were recorded at the baseline, 1st, 2nd, and 3rd weeks by the examiner who is blinded toward the treatment. The sensitivity response was evaluated using air spray and tactile sensation (explorer). RESULTS: A greater reduction of DH was recorded at the end of 3 weeks in Group C and Group B when compared to Group A. Better results were noted in Group C at the end of the 1st week when compared to Group B. According to this study, there was no additional benefit of using toothpaste along with LLLT. CONCLUSION: A greater reduction of DH was recorded at the end of 3 weeks in Group C and Group B when compared to Group A. Better results were noted in Group C at the end of the 1st week when compared to Group B. According to this study, there was no additional benefit of using toothpaste along with LLLT.

Comparative Evaluation of Pain Scores during Periodontal Probing with or without Anesthetic Gels.

Context. The initial periodontal examination which includes full-mouth periodontal probing is one of the discomforting procedures for a patient. Aim. To evaluate the efficacy of two local anesthetic gels in the reduction of pain during periodontal probing using Florida probe in CGP patients in comparison with manual probing. Materials and Methods. Ninety systemically healthy patients with moderate to severe CGP patients were recruited. In each patient, the quadrants were randomly assigned to manual probing with UNC-15 probe, probing with Florida probe, and Florida probing with lidocaine 10% gel and with benzocaine 20% gel. In the quadrants undergoing probing with anesthetic gels, the sites were isolated and the gel was injected using syringe and a blunt-end cannula. Pain was measured using 10 mm horizontal VAS. Statistical Analysis. The analysis was carried out using SPSS version 18. The comparison of mean VAS scores was done using repeated measures ANOVA with post hoc Bonferroni test. Results. Mean VAS for manual probing was significantly more than Florida probing. Further, the mean VAS score for Florida probing was higher than the two gels. Conclusion. It is suggested that the gels might be useful in reducing pain experienced during full-mouth periodontal probing in patients with CGP.

Long palatal connective tissue rolled pedicle graft with demineralized freeze-dried bone allograft plus platelet-rich fibrin combination: A novel technique for ridge augmentation - Three case reports.

Replacement of missing maxillary anterior tooth with localized residual alveolar ridge defect is challenging, considering the high esthetic demand. Various soft and hard tissue procedures were proposed to correct alveolar ridge deformities. Novel techniques have evolved in treating these ridge defects to improve function and esthetics. In the present case reports, a novel technique using long palatal connective tissue rolled pedicle graft with demineralized freeze-dried bone allografts (DFDBAs) plus Platelet-rich fibrin (PRF) combination was proposed to correct the Class III localized anterior maxillary anterior alveolar ridge defect. The present technique resulted in predictable ridge augmentation, which can be attributed to the soft and hard tissue augmentation with a connective tissue pedicle and DFDBA plus PRF combination. This technique suggests a variation in roll technique with DFDBA plus PRF and appears to promise in gaining predictable volume in the residual ridge defect and can be considered for the treatment of moderate to severe maxillary anterior ridge defects.

Multi-centre, randomized clinical trial on the efficacy and safety of recombinant human platelet-derived growth factor with ß-tricalcium phosphate in human intra-osseous periodontal defects.

AIM: the objective of the study was to evaluate the safety and efficacy of a formulation containing recombinant human platelet-derived growth factor (rhPDGF-BB) and ß-tricalcium phosphate (ß-TCP) in patients with periodontal defects and to compare it with those of ß-TCP alone. MATERIALS AND METHODS: in this double-blind, prospective, parallel, active-controlled, randomized, multi-centre clinical trial, 54 patients with periodontal osseous defects were randomly assigned to rhPDGF-BB+ß-TCP or ß-TCP. Following periodontal surgery, respective implantation was performed. The primary and secondary end points of treatment were evaluated at the third and the sixth month. RESULTS: among the outcome measures, the extent of linear bone growth (p<0.01) and per cent bone fill (p<0.004) at the sixth month over baseline were significantly higher in the rhPDGF-BB+ß-TCP group when compared with the ß-TCP group. Similarly, it also resulted in significantly higher area under the curve clinical attachment level gain at 0-6 months (p<0.01), CAL gain and greater reduction in probing depth at the third and the sixth month than that with ß-TCP treatment alone. The incidence of adverse events was similar in both the groups and no serious adverse events were reported in any of the patients. CONCLUSIONS: rhPDGF-BB+ß-TCP is safe and effective in the treatment of periodontal defects. It increases bone formation and soft tissue healing (clinicaltrials.gov, number NCT00496847; CTRI No.: CTRI/2008/091/000152).