Amniotic membrane versus platelet-rich fibrin in treatment of gingival recession- a randomized control trial.

Objective: To determine the efficacy of latelet-rich fibrin (PRF) and Amniotic membrane (AM) along with the coronally advanced flap (CAF) technique in treating Miller's class I gingival recession (GR) defects. Material and methods: A total of 32 sites with Miller's class I GR defects were distributed into Group A (CAF + PRF, n = 16) and Group B (CAF + AM, n = 16). Clinical parameters like gingival index (GI), plaque index (PI), gingival bleeding index (GBI), gingival sulcus depth (GSD), relative attachment level (RAL), and gingival marginal level (GML) were measured at baseline and at 3, 6 and 9 months after surgical intervention. Results: PRF and AM with CAF were effective treatment modalities for treating Miller's class I GR defects, with an average root coverage value of 2.00 ± 0.75 mm in Group A and 1.5 ± 0.3 mm in Group B. Complete coverage (100 %) was obtained in 57 % sites of group A and 49 % sites of group B. At the 9-month follow-up, there was a significant increase in relative attachment levels in both groups when compared to baseline. Conclusion: In the present study it was observed that there was a clinically and statistically significant improvement in root coverage with both groups. PRF-treated sites showed > 50 % complete coverage and hence were superior. AM showed comparable results to PRF and could be used as an alternative.

Levels of peri-implant sulcular fluid levels of soluble urokinase plasminogen activator receptor and TNF-α among cigarette smokers and non-smokers with peri-implantitis.

BACKGROUND: Soluble urokinase plasminogen activator receptor (suPAR) and tumor necrosis factor-alpha (TNF-α) are inflammatory biomarkers. No studies have yet assessed the suPAR levels in relation with TNF-α in the peri-implant sulcular fluid (PISF) among cigarette smokers and non-smokers with peri-implantitis. OBJECTIVE: The aim was to evaluate PISF levels of suPAR, and TNF-α among cigarette smokers and non-smokers with and without peri-implantitis. METHODS: Sixty male patients with peri-implantitis were included. There were 20 cigarette smokers and 20 and non-smokers with peri-implantitis (Groups 1 and 2), and 20 non-smokers without peri-implantitis (Group 3). Demographic data and information related to cigarette smoking was recorded. Peri-implant clinicoradiographic parameters (plaque index [PI], gingival index [GI], probing depth [PD] and crestal bone loss [CBL]) were assessed. The PISF samples were collected and levels of suPAR and TNF-α were measured. Sample-size estimation was performed and all parameters were statistically assessed. Level of significance was set at P< 0.05. RESULTS: Sixty individuals were included in Groups 1, 2 and 3 (20 in each). Peri-implant PI (P< 0.01), PD (P< 0.01) and mesial (P< 0.01) and distal (P< 0.01) CBL were significantly higher in Group 1 than in Groups 2 and 3. The PISF volume (P< 0.01) and suPAR (P< 0.01) and TNF-α levels (P< 0.01) were significantly higher in Groups 1 and 2 than in Group 3. There was no difference in PISF volume and suPAR and TNF-α levels between patients in Groups 1 and 2. In Group 2, there was a statistically significant correlation between peri-implant PD and PISF suPAR and TNF-α levels (P< 0.01). The suPAR and TNF-α levels are expressed in high concentrations in the PISF of smokers and non-smokers with peri-implantitis compared with non-smokers without peri-implantitis. CONCLUSION: In non-smokers, PISF suPAR and TNF-α levels are correlated with peri-implant PD.

Effect of LASER photobiomodulation on the cell viabilities of periodontal ligament fibroblasts of older and younger individuals - An in vitro study.

Background and Objectives: Fibroblasts form the major cell type of the periodontal ligament and most often studied for periodontal regeneration. The aim of the present study was to investigate the effects of photobiomodulation (PBM) on aged periodontal fibroblasts and compare the viability of periodontal fibroblasts of older and younger individuals. Materials and Methods: A total of 32 patients were divided into four groups: A, B, C, and D. Groups A and C and B and D comprised of extracted teeth of older (>60 year) and younger individuals (<25 year), respectively. Extracted teeth from Groups A and B received PBM, (diode laser, 660 nm, 100 mW at 4J) whereas Groups C and D did not. Tissue from extracted teeth of all groups was processed and cultured and subjected to 3-(4,5 dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay to assess their viability. Results: The difference between the groups in terms of viability was significant (P < 0.0001). The mean viability of A and B (PBM) was 1.04 and 1.19, respectively. The mean viability for C and D (non-PBM) was 0.95 and 0.85, respectively. Conclusion: Older fibroblasts have lower viability than younger fibroblasts. PBM improves viability in both older and younger fibroblasts and more so in younger fibroblasts. However, more than one PBM would be required to sustain the effect longer.

Assessment of Healing and Pain Response at Mandibular Third Molar Extraction Sites with and Without Pre- and PostOperative Photobiomodulation at Red and Near-Infrared Wavelengths: A Clinical Study.

Background: Photobiomodulation (PBM), formerly known as low-level laser therapy, has been successfully used for its anti-inflammatory and analgesic properties in postoperative care. It is also known to have a positive effect on healing and regeneration, at an appropriate power and wavelength. Aim: The main objective was to assess the effect of preoperative as well a postoperative irradiation with low power of 100 milliwatts (mW) and 810-nanometer (nm) (near-infrared) and 660-nanometer(nm) (red) wavelengths on healing as well pain at mandibular third molar extraction sockets. Methodology: Twenty-six patients who were scheduled for mandibular third molar extractions were enrolled in the study and were randomly assigned to the experimental and control group. The experimental group consisted of 13 patients who were subjected to 810-nm irradiation at 100 MW at the site immediately before and after the extraction was completed. In addition, they also received a transcutaneous irradiation of 660-nm wavelength light 1-day postoperatively. The control group received no irradiation immediately after postextraction or the day after. Pain and healing were assessed using the visual analog scale and Turnbull and Howley's Index for soft-tissue healing on the 7th and the 21st days. Data were analyzed using the Mann-Whitney test. Results: The results showed clinically significant improvements in healing index scores and pain scores of the experimental group than the control group (P < 0.0001). Conclusion: PBM at an appropriate wavelength is a potential tool for the management of pain and accelerating healing at mandibular third molar extraction sites.

Assessment of gingival crevicular fluid levels of gamma glutamyl transferase in chronic periodontitis patients before and after non-surgical periodontal therapy: A clinico-biochemical study.

Objectives: Gamma-glutamyl transferase (GGT) enzyme is a routinely used diagnostic marker to detect various systemic diseases, elevation of which indicates destructive activity. Elevated GGT levels in GCF of destructive periodontal diseases hence can be expected. Hence, the aim of this study was to investigate if gamma glutamyl transferase would be a good indicator of on-going disease activity and to also assess the effect of non-surgical therapy on Gamma glutamyl transferase in gingival crevicular fluid of clinically healthy and chronic periodontitis patients. Methods: GCF samples from 20 chronic periodontitis patients and 20 clinically healthy individuals of age group 35-45 years were collected. Clinical parameters were recorded and GGT levels in GCF assessed using semi-autoanalyser before and after appropriate non-surgical periodontal therapy in both the groups. Results: GGT levels were higher in chronic periodontitis group compared to healthy group at baseline. There was a significant reduction in the GGT levels and clinical parameters at 30th and 90th day post treatment. Conclusion: The significant reduction in the GGT levels after Non Surgical Periodontal Therapy at every recall interval may indicate that GGT can be used as a potential diagnostic marker of periodontitis.

Detection of Enterococcus faecalis in subgingival biofilms of healthy, gingivitis, and chronic periodontitis subjects.

BACKGROUND: Enterococcus faecalis is a Gram-positive, facultative anaerobic coccus that can survive under harsh conditions. Studies have shown a positive relationship between biofilm formation and gelE gene expression in E. faecalis. The production of gelatinase (MMP 2) has been detected in 50% of E. faecalis isolates from endodontic and periodontal infections, which suggests its role in the pathogenesis of apical and marginal periodontitis. Although E. faecalis is not considered a periodontopathogen, this species has been more frequently detected in subgingival samples with periodontitis than from periodontally healthy subjects, suggesting that the local conditions in periodontitis may favor its colonization. Hence, the aim of the current study was to detect and compare the presence of E. faecalis in subgingival biofilms of healthy, gingivitis, and periodontitis subjects. MATERIALS AND METHODS: A total of 100 subjects aged between 25 and 55 years, from the Outpatient Department of Periodontics were recruited for the study. All the subjects were screened for gingival and periodontal status using plaque index, gingival index, and clinical attachment loss. They were divided into three groups based on the clinical findings.• Group A: 18 healthy individuals (gingival index with score zero)• Group B: 34 gingivitis patients (gingival index with score >1)• Group C: 48 chronic periodontitis patients (clinical attachment loss >5 mm in >30% of sites).Subgingival plaque samples of all the enrolled subjects were collected using a sterile curette, later poured into a transport medium (Viability Medium Goteborg Agar III) and sent for microbial culturing within 2 h for detection of E. faecalis. RESULTS: E. faecalis was detected in 26.8% of all samples evaluated. There was a significantly higher frequency of E. faecalis in subgingival biofilms of periodontitis group (41.7%), compared to gingivitis (5.9%) and healthy group (0%). CONCLUSION: Enterococci may contribute to increased collagen and periodontal destruction and may further lead to disease progression in patients with chronic periodontitis.

Evaluation of Periodontal Status among Men Undergoing Infertility Treatment.

AIMS: It has been estimated that >30% of male infertility cases are of idiopathic etiology. Recent studies revealed a positive connection between periodontal pockets and sperm submotility, which proposes that periodontitis may have a role in male infertility and inadequate semen quality. The aim of the present investigation was to inspect the relationship between male fertility parameters and the periodontal status of male patients attending in vitro treatment (IVF) clinic. MATERIALS AND METHODS: The study participants comprised 85 men going to the facility for sperm investigation before semen insemination. The nature of sperm was surveyed by the WHO 2010 criteria. On the same day, male patients were examined for periodontal parameters. RESULTS: The patients were determined to have either gingivitis (24.7%) or periodontitis (75.3%). Normospermia was credited to 23.5% and oligozoospermia to 43.5%. Sperm submotility was seen in 76.4% of patients. A higher number of sites with clinical attachment loss showed a positive correlation with sperm submotility and sperm count. CONCLUSIONS: The findings of the present study showed a conceivable relationship between male infertility, decreased semen quality, and periodontal diseases in men visiting IVF centers. Periodontitis may subsequently play a role in male infertility.