Management of grade II and III furcation defects with intramarrow penetration along with indigenously prepared DFDBA and amniotic membrane: a clinical and radiographic study.

Managing furcation defects constitutes a problem in successful periodontal therapy. Guided tissue regeneration (GTR) is the mainstay for the management of such defects but is expensive. This study makes use of indigenously prepared demineralized freeze-dried bone allograft (DFDBA) and amniotic membrane (AM) as a cost-effective alternative. The purpose of the study was to compare the clinical outcome of grade II and III furcation defects with and without using indigenous DFDBA and AM prepared at Central Tissue Bank, MAIDS. 18 systemically healthy patients with chronic periodontitis displaying either grade II or III furcation defects were treated with open flap debridement (OFD) + intramarrow penetration (IMP) (control group) and OFD + IMP + DFDBA + AM (test group). The clinical and radiographic parameters were recorded at 3 and 6 months postoperatively. All parameters were statistically analyzed. Both treatment modalities resulted in improvement in all clinical variables evaluated. Radiographic dimensions evaluating bone fill showed a statistically significant difference in the test group compared to the control group. Within the limitations of this study, data suggest GTR using indigenously prepared DFDBA and amniotic membrane to be an economical and viable option for treating furcation defects.

Histological evaluation of decellularization of freeze dried and chemically treated indigenously prepared bovine pericardium membrane.

Decellularization is regarded as a xenogenic antigen-reduction technique because it effectively eliminates all cellular and nuclear components while mitigating any negative impact on the composition, biological functionality, and structural integrity of the remaining extracellular matrix. This study aimed to histologically evaluate native, freeze dried and chemically decellularized bovine pericardium membrane. Also, this study focused on preservation of extracellular matrix after decellularization. Bovine pericardium membrane was decellularized by freeze thaw cycle followed by freeze drying and 1% sodium dodecyl sulphate. Unprocessed pericardium was used as control. The effectiveness of Decellularization was assessed based on the reduction of histologically visible nuclei. Decellularization by freeze thaw cycle followed by freeze drying resulted in 17.84% reduction in nuclei content and decellularization by sodium dodecyl sulphate results in 92% reduction in nuclei content compare to control group. Picrosirius red staining for freeze dried group displayed loosely organised, thin collagen bundles that exhibit reddish-yellow birefringence and sodium dodecyl sulfate group revealed dense collagen bundles that are parallelly organised and compact, exhibiting reddish-yellow birefringence and showed good structural integrity. These results suggested that the sodium do decyl sulfate showed optimal decellularization results with better extracellular matrix preservation. It may be a suitable protocol for producing a suitable scaffold for periodontal tissue regeneration.

Effect of gamma and Ultraviolet-C sterilization on BMP-7 level of indigenously prepared demineralized freeze-dried bone allograft.

The presence of bone morphogenetic proteins in demineralized freeze-dried bone allograft (DFDBA) are responsible for developing hard tissues in intraosseous defects. The most common mode of sterilization of bone allografts, i.e., Gamma rays, have dramatic effects on the structural and biological properties of DFDBA, leading to loss of BMPs. Ultraviolet-C radiation is a newer approach to sterilize biodegradable scaffolds, which is simple to use and ensures efficient sterilization. However, UV-C radiation has not yet been effectively studied to sterilize bone allografts. This study aimed to compare and evaluate the effectiveness of Gamma and Ultraviolet-C rays in sterilizing indigenously prepared DFDBA and assess their effect on the quantity of BMP-7 present in the allograft. DFDBA samples from non-irradiated, gamma irradiated, and UV-C irradiated groups were tested for BMP-7 level and samples sterilized with gamma and UV-C rays were analysed for sterility testing. The estimated mean BMP-7 level was highest in non-irradiated DFDBA samples, followed by UV-C irradiated, and the lowest in gamma irradiated samples. Our study concluded that UV-C rays effectively sterilized DFDBA as indicated by negative sterility test and comprised lesser degradation of BMP-7 than gamma irradiation.

Condensation in the phase space and network topology during transition from chaos to order in turbulent thermoacoustic systems.

The emergence of oscillatory dynamics (order) from chaotic fluctuations is a well-known phenomenon in turbulent thermoacoustic, aero-acoustic, and aeroelastic systems and is often detrimental to the system. We study the dynamics of two distinct turbulent thermoacoustic systems, bluff-body and swirl-stabilized combustors, where the transition occurs from the state of combustion noise (chaos) to thermoacoustic instability (order) via the route of intermittency. Using unweighted complex networks built from phase space cycles of the acoustic pressure oscillations, we characterize the topology of the phase space during various dynamical states in these combustors. We propose the use of network centrality measures derived from cycle networks as a novel means to characterize the number and stability of periodic orbits in the phase space and to study the topological transformations in the phase space during the emergence of order from chaos in the combustors. During the state of combustion noise, we show that the phase space consists of several unstable periodic orbits, which influence the phase space trajectory. As order emerges in the system dynamics, the number of periodic orbits decreases and their stability increases. At the onset of oscillatory dynamics, the phase space consists of a stable periodic orbit. We also use network centrality measures to identify the onset of thermoacoustic instability in both the combustors. Finally, we propose that the onset of oscillatory instabilities in turbulent systems is analogous to Bose-Einstein condensation transition observed for bosons, if we define phase space cycles as particles and the periodic orbits as energy levels.

Bursting during intermittency route to thermoacoustic instability: Effects of slow-fast dynamics.

Intermittency observed prior to thermoacoustic instability is characterized by the occurrence of bursts of high-amplitude periodic oscillations (active state) amidst epochs of low-amplitude aperiodic fluctuations (rest state). Several model-based studies conjectured that bursting arises due to the underlying turbulence in the system. However, such intermittent bursts occur even in laminar and low-turbulence combustors, which cannot be explained by models based on turbulence. We assert that bursting in such combustors may arise due to the existence of subsystems with varying timescales of oscillations, thus forming slow-fast systems. Experiments were performed on a horizontal Rijke tube and the effect of slow-fast oscillations was studied by externally introducing low-frequency sinusoidal modulations in the control parameter. The induced bursts display an abrupt transition between the rest and the active states. The growth and decay patterns of such bursts show asymmetry due to delayed bifurcation caused by slow oscillations of the control parameter about the Hopf bifurcation point. Further, we develop a phenomenological model for the interaction between different subsystems of a thermoacoustic system by either coupling the slow and fast subsystems or by introducing noise in the absence of slow oscillations of the control parameter. We show that interaction between subsystems with different timescales leads to regular amplitude modulated bursting, while the presence of noise induces irregular amplitude modulations in the bursts. Thus, we speculate that bursting in laminar and low-turbulence systems occurs predominantly due to the interdependence between slow and fast oscillations, while bursting in high-turbulence systems is predominantly influenced by the underlying turbulence.

Effect of periodontal disease on electromyographic activity of muscles of mastication: A cross-sectional study.

AIM: This study aims to compare surface electromyographic activities (EMG) of four muscles, that is anterior temporalis (AT), masseter (MST), sternocleidomastoid (SCM) and anterior belly of digastric (ABD), between chronic periodontitis patients and periodontally healthy individuals as well as to correlate these EMG findings with periodontal parameters. METHODS: Thirty chronic periodontitis patients were recruited in Group I and 30 periodontally healthy individuals in Group II. Clenching and resting EMG for 4 muscles (AT, MST, SCM and ABD) were recorded for each participant. These EMG values were compared between the groups and correlated with periodontal parameters (plaque index, modified sulcular bleeding index, probing depth and clinical attachment loss). RESULTS: Resting EMG (rEMG) showed no significant difference between the groups for any muscle. Clenching EMG (cEMG) values were significantly lower in Group I than Group II for AT and MST (P = .001), but not so for SCM and ABD. Within Group I, AT and MST showed a significant negative correlation of cEMG with probing depth and clinical attachment loss (P < .05). CONCLUSION: Electrical muscle activities of AT and MST are lower in chronic periodontitis than periodontally healthy individuals.

Effect of antibiotic impregnation time on the release of gentamicin from cryopreserved allograft bone chips: an in vitro study.

Freezing is the most common method for storing bones until use in skeletal reconstruction. However, the effect of freezing at different temperatures on antibiotic delivery from antibiotic-coated bone chips has not been evaluated. In this study, we compared antibiotic delivery in vitro from gentamicin-coated human bone stored at different temperatures impregnated for different time periods. Bone chips obtained from human femur heads were chemically cleaned and mixed with gentamicin sulfate solution for 1 h and 10 h respectively. Samples of both groups were cryopreserved for 4 months at - 20 °C, 4 months at - 80 °C, or evaluated immediately without freezing. Antibiotic release from the bone chips was measured using Bacillus subtilis as an indicator strain. Zones of inhibition and rates of gentamicin were higher for the samples impregnated for 10 h as compared to 1 h. There was no significant difference between non-cryopreservation, cryopreservation at different temperatures of - 20 and - 80 °C on the release of gentamicin from bone chips even after storage for 4 months.

Comparative evaluation of bioburden and sterility of indigenously prepared bone allograft with and without gentamicin.

During bone allograft processing, despite stringent donor screening and use of aseptic techniques, microbial invasion may occur due to the porous nature of the graft and cause potentially fatal infections. The aim of the present study was to prepare bone allograft with and without gentamicin and to compare bioburden and sterility in the obtained grafts to evaluate the role of antibiotic in enhancing graft safety. Fifty samples of demineralized freeze-dried bone allograft were prepared from suitable donors according to international standards. Randomly selected 25 samples were placed in 8 mg gentamicin/gram bone solution for 1 h. Packaging and sealing was done to ensure no microbial ingress during transportation. 40 samples were selected for bioburden testing. Remaining 10 were subjected to 25 kGy gamma radiation and tested for sterility. Microbiological evaluation revealed no evidence of colony forming units in all the samples of both the groups (Bioburden = 0). Post-radiation sterility testing also revealed no bacterial colony in the tested samples from both the groups. Favorable results validate the processing protocol while comparable results in both groups indicate no additive benefit of gentamicin addition. Nil bioburden may be used in further studies to determine a lower radiation dose to achieve adequate sterility and minimize the disadvantages of radiation like collagen cross-linking and decreased osteoinductive capacity.

Viruses: Bystanders of periodontal disease.

Bacterial etiology of periodontal disease is an established fact today. However, despite advances in the field of pharmacology with advent of newer and better antibiotics prevalence of the disease could not be abated. Moreover, unpredictable remissions and indefinite pattern in a single host force us to go back to the exact etiology of the disease. Present is a short review highlighting the role and plausible mechanisms by which viruses can affect the development of periodontal disease. This broadens our concept and will help establish a better treatment protocol for periodontal disease.

A Multidisciplinary Approach to the Management of Unusual Bilateral Gingival Recession Due to a Factitious Nail-Scratching Habit: A Case Report.

Self-inflicted gingival injuries have been reported in children and adolescents as a result of multiple factors such as accidental trauma, fingernail biting, sucking on objects such as pencils, or a nail-scratching habit. Management of these lesions requires a multidisciplinary approach that includes psychotherapy, behavioral counseling, and definitive treatment of oral soft tissue lesions. This paper illustrates the diagnosis and treatment of a 16-year-old male patient with a bilateral gingival recession in mandibular canines due to habitual nail scratching. A multidisciplinary approach for treatment included behavior and psychological counseling, topical application of anesthetic & antimicrobial gels, and surgical management of gingival recession defects using a modified lateral pedicle flap with and without an indigenously prepared amnion-chorion membrane. Excellent soft tissue health was found at a two-year follow-up.

Surgical Correction and Oral Health-Related Quality of Life (OHRQoL) Evaluation of Non-syndromic Congenital Double Lip: A Case Report and Literature Review.

Congenital double lip is a rare clinical finding that is more common in the upper lip, but the lower lip can also be involved in a few cases. It has no gender predilection, and its incidence rate is yet unknown. It can be classified into two types: congenital or acquired. Congenital type results from the persistence of the sulcus between the pars glabrosa and the pars villosa, while the acquired type occurs secondary to trauma and oral habits such as lip sucking and lip biting. It can be syndromic or non-syndromic based on the other systemic involvement. In the present case, a 24-year-old male patient presented to the outpatient department (OPD) with the chief complaint of an excessive tissue fold visible in relation to his upper lip while smiling and talking, which posed an aesthetic concern to the patient and decreased his self-esteem. The oral health-related quality of life (OHRQoL) was taken before and after the treatment to assess patient satisfaction and improvement in quality of life after surgery. The patient was diagnosed with a non-syndromic congenital double lip based on clinical history and oral examination. The surgical removal of excessive lip tissue was done, and the lesion healed completely with no recurrence up to a six-month follow-up. This case report illustrates the uncomplicated surgical treatment for congenital double lips and improves the patient's aesthetic.

Emergence of order from chaos through a continuous phase transition in a turbulent reactive flow system.

As the Reynolds number is increased, a laminar fluid flow becomes turbulent, and the range of time and length scales associated with the flow increases. Yet, in a turbulent reactive flow system, as we increase the Reynolds number, we observe the emergence of a single dominant timescale in the acoustic pressure fluctuations, as indicated by its loss of multifractality. Such emergence of order from chaos is intriguing. We perform experiments in a turbulent reactive flow system consisting of flame, acoustic, and hydrodynamic subsystems interacting nonlinearly. We study the evolution of short-time correlated dynamics between the acoustic field and the flame in the spatiotemporal domain of the system. The order parameter, defined as the fraction of the correlated dynamics, increases gradually from zero to one. We find that the susceptibility of the order parameter, correlation length, and correlation time diverge at a critical point between chaos and order. Our results show that the observed emergence of order from chaos is a continuous phase transition. Moreover, we provide experimental evidence that the critical exponents characterizing this transition fall in the universality class of directed percolation. Our paper demonstrates how a real-world complex, nonequilibrium turbulent reactive flow system exhibits universal behavior near a critical point.

Metastatic Sarcomatoid Renal Cell Carcinoma: A Journey From the Kidney to the Gingiva.

Oral metastatic lesions are very rare and are often diagnosed at a later stage, complicating treatment. Renal cell carcinoma (RCC) is the third most frequent neoplasm to metastasize to the oral cavity, following breast and lung cancers. These metastatic lesions are usually asynchronous and develop after the initial diagnosis, affecting the overall survival rate. This report describes a known case of RCC with a growth in the mandibular gingiva. Multiple pulmonary and femoral metastases appeared five years after the initial renal lesion. The gingival growth was excised and referred for histopathological examination, which revealed a pleomorphic sarcomatoid cellular morphology. Immunohistochemistry with an array of markers led to the diagnosis of sarcomatoid RCC, a rare high-grade tumor. This case underscores the importance of detailed history-taking, interpretation of clinical findings, and emphasis on histopathological examination to arrive at a conclusive diagnosis.

Validation of sub-segmental visual scoring for the quantification of ischemic and nonischemic myocardial fibrosis using late gadolinium enhancement MRI.

PURPOSE: To determine the accuracy and reproducibility of late gadolinium enhancement (LGE) MRI scar quantification using visual sub-segmental analysis (VSSA) versus signal threshold-based analysis in ischemic and nonischemic cardiomyopathy. MATERIALS AND METHODS: One-hundred sixty-one patients with abnormal LGE imaging underwent VSSA and signal threshold-based analysis. VSSA was performed using a 68 sub-segmental model. Signal threshold-based analysis was performed using cutoffs of ≥2, ≥3, and ≥5 standard deviations (SD) above the mean signal of normal myocardium. Comparison of VSSA and signal threshold-based analysis was performed by linear regression and Bland Altman plots. RESULTS: Seventy (44%) patients had ischemic scar, 76 (47%) had nonischemic scar, and 15 (9%) had a combined pattern. Correlation coefficients for VSSA versus signal threshold-based analysis at ≥2, ≥3, and ≥5SD thresholds were r = 0.63, r = 0.79, r = 0.81 (P < 0.001) for all patients, r = 0.74, r = 0.81, r = 0.81 (P < 0.001) in those with ischemic scar, and r = 0.46, r = 0.69, r = 0.72 (P < 0.001) in those with nonischemic scar. Bland Altman analysis revealed no significant bias in total scar volume among all patients (-4.3 ± 7.9%), those with ischemic scar (-4.8 ± 7.8%), or those with nonischemic scar (-2.6 ± 7.6%). Intra-observer and inter-observer variability of the VSSA technique was excellent with a mean difference in total percent scar of 0.3% (-8.3-8.9%) and -0.4% (-9.5-8.5%), respectively. CONCLUSION: A VSSA-based model of myocardial scar quantification is accurate and reproducible in ischemic and nonischemic cardiomyopathy.

Oral Hemangiolymphangioma Presenting As Gingival Enlargement: A Rare Case With Literature Review.

Vascular malformations are anomalies that are caused by disturbances in vasculogenesis. Depending upon the dominant structure present histologically, they may be found in different combinations of vascular elements and are named hemangiolymphangioma (HLA) or lymphangiohemangioma (LHA). HLA occurs in multiple anatomical sites, such as the head and neck, axilla, abdominal cavity, extremities, and urinary bladder, but it is infrequent in the oral cavity. An 18-year-old male with a history of abdominal tuberculosis presented with an asymptomatic mandibular gingival swelling that was histologically diagnosed as HLA. A six-month follow-up revealed no recurrence. The observations reported in this case are unusual, and our literature review revealed no previously documented case of gingival HLA.

Gingival presentation of mucormycosis post infection with COVID-19: series of 3 cases.

Through the evolution of this global pandemic, it became increasingly clear that patients with pre-existing conditions such as diabetes mellitus, chronic kidney diseases (CKD), chronic cardiovascular disease, underlying malignancies, organ transplant recipients, and chronic liver disease are at increased risk for developing severe post COVID-19 complications. One such complication seen after COVID-19 is mucormycosis. Oral mucormycosis is a rare but highly fatal disease. Early diagnosis and timely treatment of rhinomaxillary mucormycosis are necessary to limit the spread of infection, which otherwise can lead to high morbidity and mortality. Dental healthcare practitioners should be familiar with its initial presentation, which if left undiagnosed or ignored can rapidly spread to the orbital and cerebral region leading to death. The case series describes the gingival clinical presentation in its initial stage, relevant basic clinical investigations, treatment, and the importance of an inter-professional team approach in the early management of patients with mucormycosis after post covid-19 infection.

A Unique Presentation of Gingival Melanoacanthoma: Case Report and Review of Literature.

Melanoacanthoma is a benign, deeply pigmented condition of the oral mucosa characterized by the proliferation of melanocytes and keratinocytes. A 60-year-old male, with no history of systemic diseases or medical treatment, presented with an asymptomatic diffuse pigmentation involving the maxillary and mandibular gingiva. The histopathology of the anomalous pigmented area was analyzed and the dendritic melanocytes expressed positively for Masson-Fontana, S-100, and HMB-45. The clinical and microscopic findings were indicative of melanoacanthoma. Depigmentation with a diode laser was performed in the areas of esthetic concern. A regular periodic screening was done to rule out any alteration in color, size, and shape. A one-year follow-up disclosed no new lesions. The observations noted in this case are rare, and our literature review identified only a single previously documented case of gingival melanoacanthoma in the Indian subpopulation.

Literature review of oral tuberculosis and report of a case with unique histological presentation.

As a consequence of the emergence of drug resistant tuberculosis (TB) and various immuno-compromised states, there is a re-emergence of many forgotten extrapulmonary manifestations of TB including oral TB, which must be taken into consideration while diagnosing oral lesions. The present article discusses the geographical burden, temporal evolution, demographic variables, clinical presentation and treatment of oral TB. The occurrence is most commonly secondary to pulmonary TB but oral symptoms may precede systemic symptoms. The most common presentation is ulceration (71%) and histopathological specimens demonstrate the characteristic epithelioid and langhans cells. In a unique case, presented here, an ulcerative tuberculous gingival lesion demonstrated dense plasma cell infiltration histologically and closely mimicked plasma cell gingivitis which made the diagnosis challenging.

Current status of the anterior middle superior alveolar anesthetic injection for periodontal procedures in the maxilla.

Periodontal procedures require adequate anesthesia not only to ensure the patient's comfort but also to enhance the operator's performance and minimize chair time. In the maxilla, anesthesia is often achieved using highly traumatic nerve blocks, apart from multiple local infiltrations through the buccal vestibule. In recent years, anterior middle superior alveolar (AMSA) field block has been claimed to be a less traumatic alternative to several of these conventional injections, and it has many other advantages. This critical review of the existing literature aimed to discuss the rationale, mechanism, effectiveness, extent, and duration of AMSA injections for periodontal surgical and non-surgical procedures in the maxilla. It also focused on future prospects, particularly in relation to computer-controlled local anesthetic delivery systems, which aim to achieve the goal of pain-free anesthesia. A literature search of different databases was performed to retrieve relevant articles related to AMSA injections. After analyzing the existing data, it can be concluded that this anesthetic technique may be used as a predictable method of effective palatal anesthesia with adequate duration for different periodontal procedures. It has additional advantages of being less traumatic, requiring lesser amounts of local anesthetics and vasoconstrictors, as well as achieving good hemostasis. However, its effect on the buccal periodontium appears highly unpredictable.