Expression dynamics of microRNA-223/Ras-associated binding protein 12 axis in Stage III/Grade B periodontal disease: A case-control analysis.

Background: The intricate interplay between periodontal polymicrobial flora and an altered immune response is the central cause of periodontal disease. Multiple cell death methods and their interactions, along with the associated signaling pathways, significantly impact the initiation and advancement of periodontitis. Our speculation revolves around the role of the miR-223/Ras-associated binding protein (RAB12) signaling axis in regulating autophagy-induced pyroptosis, contributing to the pathophysiology of periodontitis. Thus, this study aimed to investigate miR-223 and RAB12 expression patterns in Stage III/Grade B periodontal disease. Materials and Methods: The study included 50 healthy individuals and 50 patients diagnosed with Stage III/Grade B periodontal disease. Clinical parameters were cataloged for each participant. miRNA-223 underwent an in silico analysis to identify its potential target genes. Gingival crevicular fluid (GCF) samples were collected from the subjects for real-time polymerase chain reaction to evaluate the expression of both miR-223 and the RAB12 gene. Results: The miRTargetLink2.0 analysis highlighted the RAB12 gene as a prime target for miR-223. In periodontal disease patients, miR-223 and RAB12 gene expressions significantly increased (15.21 and 34.70-fold changes, respectively; P < 0.05). Receiver operating characteristic analysis suggested that miR-223 is a potential biomarker for periodontal disease, with 76% diagnostic accuracy and an area under the curve of 0.777 (P < 0.01). Conclusion: MicroRNA-223 and its target gene RAB12 exhibit high expression levels in GCF samples from individuals with periodontal disease. This suggests modulation of autophagy and the signaling mechanism for pyroptotic cell death in periodontal tissues during pathogenesis. Consequently, the miR-223/RAB12 axis might represent a plausible link for periodontal disease.

Marine Collagen Matrix Carrier with Injectable Platelet-Rich Fibrin in Management of Gingival Recession Defects.

Background: The gold standard in the management of gingival recession (GR) defects has been connective tissue graft (CTG) with coronally advanced flap (CAF). But patient morbidity associated with graft harvesting is a major drawback and has led to the development of various substitute biomaterials which have been tried and tested. Aim: Our study is aimed at checking the efficacy of marine collagen matrix (MCM) impregnated with injectable platelet-rich fibrin (I-PRF) with modified CAF in the treatment of Miller's class I and II recession defects. Case Description. Six patients with ten GR defects in maxilla were treated with CAF + MCM + I-PRF. Clinical parameters like recession height (RH), recession width (RW), root coverage (RC%), width of attached gingiva (WAG), keratinized tissue height (KTH), probing pocket depth (PPD), clinical attachment level (CAL), gingival biotype (GB), plaque index (PI), and visual analogue score (VAS-E) esthetic scores were evaluated up to six months. There was significant root coverage observed at three- and six-month follow-ups. Conclusion: The proposed treatment was effective in the management of GR defects and improvement in soft tissue biotype without the morbidity associated with soft tissue harvest.

Comparison of the Clinical Efficacy of Bioresorbable Xenogeneic Peritoneal Membrane vs Connective Tissue Graft in the Management of Gingival Recession Defects: A Randomized Controlled Clinical Trial.

This randomized controlled trial aimed to determine the clinical efficacy of xenogeneic collagen membrane (XCM) derived from porcine peritoneum in combination with a coronally advanced flap (CAF) in the management of gingival recession defects and to compare the outcomes to those of connective tissue grafts (CTGs). A total of 12 systemically healthy individuals presenting with 30 isolated/multiple Cairo RT 1/2 gingival recession defects in maxillary canines and premolars were randomly treated either with CAF + XCM or CAF + CTG. Recession height (RH), gingival biotype (GB), gingival thickness (GT), width of keratinized gingiva (WKG), and width of attached gingiva (WAG) were recorded at baseline and at 3, 6, and 12 months. Patient perceptions of pain and esthetics and the modified root coverage esthetic score (MRES) were also documented. From baseline to 12 months, both groups showed a significant reduction in mean RH (CAF + CTG: 2.73 ± 0.79 mm to 0.33 ± 0.61 mm; CAF + XCM: 2.73 ± 0.88 mm to 1.20 ± 0.77 mm). At 12 months, CAF + CTG sites had a mean root coverage percentage (MRC%) of 85.60% ± 28.74%, whereas CAF + XCM sites had an MRC% of 55.13% ± 31.22%. CAF + CTG-treated sites had significantly better outcomes, with a greater number of sites achieving complete root coverage (n = 11) and higher MRES scores than the porcine peritoneal membrane group (P < .05).

Clinical evaluation of the combined efficacy of injectable platelet-rich fibrin along with scaling and root planing in the non-surgical periodontal therapy of stage III and grade C periodontitis patients having type 2 diabetes mellitus: A randomized controlled trial.

BACKGROUND: This randomized controlled trial was aimed to evaluate the combined efficacy of injectable platelet-rich fibrin (i-PRF) and scaling and root planing (SRP) in type 2 diabetes mellitus subjects having periodontitis. METHODS: Twenty-six Stage III, grade C periodontitis subjects (HbA1c > 7) were recruited in this split-mouth study. Following SRP, the test sites received subgingival application of i-PRF, while the control sites received saline. Plaque index, bleeding on probing, modified gingival index, probing pocket depth (PPD) and clinical attachment level (CAL) were measured at baseline, 3 and 6 months. RESULTS: Twenty-three participants completed the course of research. The Friedman test followed by Dunn's post hoc test, revealed significant improvement in all the clinical parameters from baseline to 3 and 6 months in both the study groups (p ≤ 0.05). The mean PPD and CAL decreased from 6.30 ± 1.25 and 7.48 ± 1.75 at baseline to 3.48 ± 1.34 and 4.39 ± 1.67 at 6 months in control sites and from 6.57 ± 1.56 and 7.61 ± 1.69 to 3.39 ± 1.23 and 4.26 ± 1.81 at 6 months in test sites (p ≤ 0.0001). Intergroup analysis found no statistical significant differences in the evaluated parameters across all time intervals (p > 0.05) CONCLUSION: The results indicated that the adjunctive application of i-PRF to SRP provided similar benefits as saline and SRP in diabetes mellitus subjects. KEY POINTS: Question: To find the combined efficacy of injectable platelet-rich fibrin (i-PRF) along with scaling and root planing (SRP) in the management of periodontal pockets of Stage III and Grade C periodontitis patients having Type 2 Diabetes Mellitus (T2DM). FINDING: All of the treated sites showed satisfactory healing. Both the treatment modalities (i-PRF + SRP and Saline + SRP) were effective in the treatment of periodontal pockets. At 3 and 6 months, there were no significant differences in periodontal parameters between groups. Meaning: The application of i-PRF as an adjunct to SRP provided similar benefits as saline and SRP in improving clinical parameters in subjects with stage III and grade C periodontitis patients having T2DM (HbA1C > 7).

CBCT Evaluation of Sticky Bone in Horizontal Ridge Augmentation with and without Collagen Membrane-A Randomized Parallel Arm Clinical Trial.

Guided bone regeneration (GBR) is a reliable technique used to treat ridge deficiencies prior or during implant placement. Injectable-platelet rich fibrin (i-PRF) laced with a bone substitute (sticky bone) has heralded the way for advancing the outcomes of bone regeneration. This study evaluated the efficacy of sticky bone in horizontal ridge augmentation with and without collagen membrane. A total of 20 partially edentulous patients (Group-I n = 10; Group-II n = 10) that indicated GBR were included, and the surgical procedure was carried out. In Group-I, the sticky bone and collagen membrane were placed in ridge-deficient sites and Group-II received only sticky bone. At the end of 6 months, 20 patients (Group-I (n = 10); Group-II (n = 10)) completed the follow-up period. A CBCT examination was performed to assess changes in the horizontal ridge width (HRW) and vertical bone height (VBH). A statistically significant increase in HRW (p < 0.05) was observed in both groups with mean gains of 1.35 mm, 1.55 mm, and 1.93 mm at three levels (crest, 3 mm, and 6 mm) in Group-I and 2.7 mm, 2.8 mm, and 2.6 mm at three levels in Group-II. The intergroup comparison revealed statistical significance (p < 0.05) with respect to HRW and KTW (Keratinised tissue width) gains of 0.775 at the 6-month follow-up. Sticky-bone (Xenogenic-bone graft + i-PRF) served as a promising biomaterial in achieving better horizontal bone width gain.

Association of the CASP3 rs4647602 Gene Polymorphism with Periodontitis in South Indians of Tamil Ethnicity.

Objective: Caspase-3 activation is central to apoptosis and is involved in periodontal disease pathogenesis. Thus, CASP3 gene polymorphisms in a population may influence the severity of periodontal disease. In this study we examined the association of the CASP3 rs4647602 alleles and genotypes with periodontitis using cohorts of periodontally diseased and healthy South Indian subjects of Tamil ethnicity. Materials and Methods: Allele specific polymerase chain reaction genotyping were performed to identify CASP3 rs4647602 gene polymorphism in 145 periodontally healthy subjects and 145 periodontitis patients. The associations between gene polymorphism frequencies and the risk of periodontitis were analyzed by the Pearson chi-square test, the Mann Whitney U test, t test, logistic regression and assessed by odds ratio (ORs) and 95% confidence interval (95% CIs). Results: The statistical test results demonstrated a significant difference in genotype distribution between the two groups (p < 0.001) with the variant GG genotype associated with a significantly increased risk for periodontitis (OR = 3.55, 95% CI = 1.89-6.68, p < 0.001). Furthermore, all clinical parameters were highly significantly correlated with the genotypes in periodontitis subjects (p < 0.05). Conclusion: The present study suggests that the rs4647602 GG genotype of CASP3 is associated with the increased periodontitis risk in South Indians of Tamil ethnicity. Clinical Trial Registration Number: (CTRI/2021/03/032412).

Comparative Evaluation of Clinical Efficacy of Leukocyte-Rich Platelet-Rich Fibrin with Advanced Platelet-Rich Fibrin in Management of Gingival Recession Defects: A Randomized Controlled Trial.

BACKGROUND: The aim of this research was to determine and compare the clinical efficacy of leukocyte platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF) in combination with coronally advanced flap (CAF) in the treatment of gingival recession defects. METHODS: Systemically healthy subjects presenting with 30 Miller's class I or II gingival recession defects in maxillary anteriors and premolars, were treated with either CAF + L-PRF or CAF + A-PRF. Clinical parameters such as recession height (RH), width, probing pocket depth, clinical attachment level (CAL), keratinized tissue height (KTH), and width of attached gingiva (WAG) were measured at baseline, 3, and 6 months. Gingival biotype was evaluated at baseline and 6 months post-surgery. Mean root coverage percentage (MRC%) was evaluated at 3 and 6 months. RESULTS: Statistically significant reduction in mean RH was observed from baseline (2.53 ± 0.74 mm, 2.63 ± 0.82 mm) to 6 months (0.87 ± 0.83 mm, 0.53 ± 0.91 mm) in CAF + L-PRF and CAF + A-PRF groups, respectively. The MRC% achieved at 6 months was 67.20 ± 32.81 in the CAF + L-PRF group and 81.66 ± 28.21 in the CAF + A-PRF group. Statistically significant gain in CAL, WAG, and KTH was observed in both therapeutic groups (p < 0.05). Intergroup analysis revealed no statistically significant differences among study parameters between groups at any time point (p > 0.05). CONCLUSION: Based on the findings of this study, both L-PRF and A-PRF may be suggested as viable treatment options for the management of gingival recession in maxilla.

Evaluation of Clinical Efficacy of Advanced Platelet-Rich Fibrin in the Management of Gingival Recession Defects: Case Series.

INTRODUCTION: The purpose of this case series is to evaluate the clinical efficacy of advanced platelet-rich fibrin (A-PRF) in combination with coronally advanced flap (CAF) in the management of gingival recession defects and its first of its kind. CASE SERIES: Fourteen systemically healthy patients presenting with 35 RT1 recession defects were treated with A-PRF + CAF. Recession height (RH), recession width (RW), probing pocket depth (PPD), clinical attachment level (CAL), keratinized tissue height (KTH), and width of attached gingiva (WAG) were measured at baseline, 3, and 6 months. Gingival thickness (GTH) and phenotype were evaluated at baseline and 6 months postsurgery. Mean root coverage percentage (MRC%) was estimated at 3 and 6 months. At the end of 6 months, esthetics was measured on the scale of visual analogue scale (VAS) and recession esthetic scale (RES). Statistically significant reduction in mean RH was observed from baseline (2.49 ± 0.65 mm) to 6 months (0.66 ± 0.80 mm). At 6 months, the MRC% attained was 75.94 ± 26.72. Complete root coverage was achieved in 18 sites. At 6 months, there was a significant gain in GTH, CAL, WAG, and KTH (p ≤ 0.001). The mean RES and VAS esthetic scores were 8.54 ± 1.57 and 8.83 ± 1.17, respectively. CONCLUSION: Based on the findings of this study, A-PRF may be suggested as a viable treatment option for the management of recession in maxillary anteriors and premolars.

Association of CST3 Gene with Its Protein: Cystatin C in Health and Severe Periodontal Disease.

Background: Cystatin C (CSTC), a cysteine protease inhibitor, is found to be elevated in periodontal disease in an attempt to counterbalance the proteolytic enzymes and increased osteoclastic activity. Evidence on CSTC levels in periodontal health and disease has reported contradicting results, making its role as a biomarker in periodontal pathogenesis inconclusive. Aim: To evaluate CST3 gene expression and correlate it with CSTC levels in periodontal health and severe periodontal disease. Materials and Methods: A total of 50 patients with 25 in each group (Group I-periodontally healthy, Group II-Stage III/IV periodontitis) were recruited. Clinical parameters were assessed following which gingival crevicular fluid and gingival tissue samples were collected from tooth deemed for extraction. CSTC protein level and CST3 gene expression were analyzed using enzyme-linked immunosorbent assay (ELISA) and real-time polymerase chain reaction, respectively. Results: Elevated concentrations of CSTC protein and CST3 gene expression were observed in Group II in comparison with Group I, which was considered statistically significant (p < 0.001). Further, a highly significant (p < 0.001) positive correlation was witnessed between CSTC protein and CST3 gene in both groups. In addition, the overall correlation between CSTC protein, CST3 gene, and clinical parameters was positive and highly significant (p < 0.001). Conclusion: CSTC protein levels and CST3 gene expression were significantly higher in periodontal disease compared with health, and there was a positive correlation between the gene and protein levels. Therefore, it can be concluded that CST3 gene can be used as a reliable indicator of periodontal disease pathogenesis. Clinical Trial Registration number: CTRI/2020/03/023926.

Evaluation of combined efficacy of photodynamic therapy using indocyanine green photosensitizer and non-surgical periodontal therapy on clinical and microbial parameters in the management of chronic periodontitis subjects: A randomized split-mouth design.

BACKGROUND: The clinical efficacy of multiple applications of Photodynamic therapy (PDT) needs to be better investigated for the management of chronic periodontitis subjects. AIM: The aim of this study was to evaluate the clinical and antimicrobial efficacy of multiple application of PDT as an adjunct to scaling and root planning in management of moderate periodontal pockets. MATERIALS AND METHODS: 33 patients with bilateral periodontal destruction in mandibular posterior sextants were randomly treated with either test (SRP + multiplePDT) or control (SRP) intervention. PDT was employed with diode laser(810 nm) and Indocyanine green(ICG) dye at baseline, 1 st, 2nd and 4th week post SRP. Probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), gingival bleeding index (GBI) were recorded at baseline, 3 and 6 months. Subgingival plaque samples were analysed for Porphyromonas gingivalis (P.g), Aggregatibacter actinomycetemcomitans (A.a), Tannerella forsythia (T.f), Fusobacterium nucleatum (F.n), Treponema denticola (T.d). RESULTS: Statistically significant improvement was noted in all clinical parameters in both the groups from baseline to 3 and 6 months. The mean PPD and CAL decreased in control sites from 5.83 ± 0.64 and 5.60 ± 0.72 at baseline to 3.80 ± 0.40 and 3.70 ± 0.91 at 6 months and in test sites from 5.93 ± 0.82 and 5.73 ± 0.69 to 3.40 ± 0.56 and 3.00 ± 0.91 at 6 months (P ≤ 0.05). Test sites showed significantly greater reduction in P.g, A.a, T.f, F.n and T.d compared to control sites at 3 and 6 months (P ≤ 0.05). CONCLUSION: The outcomes suggested that adjunctive multiple applications of PDT to SRP shows significant reduction in periodontal pathogens over SRP alone.

Evaluation of Endocan and Tumor Necrosis Factor-α as Inflammatory Biomarkers in Type 2 Diabetes and Periodontal Disease.

Purpose: Type 2 diabetes mellitus (type 2 DM) and periodontitis encompass vascular endothelial changes. Endocan, a marker of endothelial dysfunction, has not been previously evaluated in diabetic patients with periodontal disease. This study was designed to evaluate the levels of endocan and tumor necrosis factor-alpha (TNF-α) in chronic periodontitis (CP) subjects with type 2 DM before and after nonsurgical periodontal therapy (NSPT). Materials and Methods: This study included 75 subjects with varying degrees of CP. Group I-included 25 systemically healthy individuals with CP, and Groups II and III-included 25 CP patients each with type 2 DM under good control (hemoglobin A1c [HbA1c] <7%) and poor control (HbA1c >8%), respectively. Periodontal parameters were assessed, and gingival crevicular fluid collections were performed for all patients at baseline and again following three months of NSPT. Levels of endocan and TNF-α were assessed using enzyme-linked immunosorbent assay. Results: Endocan levels were elevated in CP subjects with type 2 DM at baseline. There was a significant reduction in the Endocan and HbA1c levels (p < 0.01) among all the groups after NSPT. Conclusion: Endocan may be used as a novel diagnostic marker for pateints with type 2 DM and CP and as a potential prognostic marker for monitoring improvement in periodontal and glycemic status during NSPT.

Comparative evaluation of cathepsin K levels in gingival crevicular fluid among smoking and nonsmoking patients with chronic periodontitis.

BACKGROUND: The aim of the study is to comparatively evaluate the levels of cathepsin K (CSTK) in gingival crevicular fluid (GCF) among smoking and nonsmoking patients with chronic periodontitis (CP). MATERIALS AND METHODS: A total of 160 systemically healthy male patients were included in the study. Based on probing pocket depth, clinical attachment level, plaque index, and modified sulcular bleeding index, the patients were allotted into four groups: Group I - with forty subjects who were smokers with healthy periodontium, Group II - with forty nonsmoking subjects with healthy periodontium, Group III - forty patients who were smokers with CP, and Group IV - with forty nonsmoking CP patients. Those who claimed to have never smoked were recruited into the nonsmoker group, whereas subjects who reported smoking ≥10 cigarettes per day for more than 5 years were recruited into the smoker group. The GCF samples were collected using microcapillary pipettes and analyzed for levels of CSTK using enzyme-linked immunosorbent assay. RESULTS: The GCF concentration of CSTK was expressed in pg/µl. The mean CSTK levels in the groups were Group I - 0.158 ± 0.043 pg/µl, Group II - 0.145 ± 0.026 pg/µl, Group III - 15.768 ± 12.40 pg/µl, and for Group IV - 11.59 ± 12.15 pg/µl, respectively. The levels of CSTK were statistically higher in Group III when compared with Group IV (P = 0.037) (P < 0.05). CONCLUSION: CSTK levels were significantly increased in smokers with CP than nonsmokers, suggesting a positive influence of smoking on CSTK which could possibly play a role in the increased susceptibility for osteoclastic bone destruction in smoker subjects.

Fenugreek, diabetes, and periodontal disease: A cross-link of sorts!

AIMS: The aim of this study was to observe the sequelae of fenugreek adjunctive to nonsurgical periodontal therapy and its comparison to a group treated with scaling and root planing (SRP) and metformin alone by assessing their respective effects on periodontal parameters, glycemic status, and serum lipid levels. MATERIALS AND METHODS: The study comprised eighty patients who were further divided into two groups. Each group consisted of 40 patients. Group 1 consisted of uncontrolled noninsulin-dependent diabetes mellitus (NIDDM) patients with chronic generalized periodontitis, who received SRP and treatment with metformin. Group 2 consisted of uncontrolled NIDDM with chronic generalized periodontitis, who received SRP and metformin plus fenugreek powder. Periodontal parameters such as gingival index, plaque index, bleeding on probing, pocket depth, and clinical attachment levels were evaluated before treatment and 1 month after nonsurgical periodontal therapy. The values of low-density lipoprotein (LDL), triglycerides, total cholesterol (TC), and glycosylated hemoglobin (HbA1c) were assessed by collecting the blood samples before treatment and 1 month after treatment. RESULTS: There was a statistically significant change in all the parameters seen clinically in both the groups. The glycemic status also showed a statistically significant reduction for fasting blood sugar (P < 0.001) on intragroup comparison. Intragroup comparison shows a statistically significant reduction (P < 0.001) for serum lipids, whereas intergroup comparison showed a statistically significant reduction after treatment only in TC and LDL levels (P < 0.02 and <0.012). CONCLUSION: This study shows that fenugreek powder can be used adjunctive to SRP to control the glycemic status and serum lipid levels in uncontrolled NIDDM patients.

The CD14 rs2569190 TT Genotype is Associated with Chronic Periodontitis.

AIM: The genetic variation in the CD14 rs2569190 promoter region contributes to the susceptibility of developing periodontitis. Since, CD14 gene polymorphism studies among various ethnic populations have produced conflicting results, the present study was designed to unearth the association between the CD14 rs2569190 gene polymorphism and generalized chronic periodontitis (GCP) in a South Indian population of Tamil ethnicity. METHODS: Polymorphisms in the CD14 rs2569190 promoter region were analyzed in 96 subjects who were periodontally healthy and 96 patients with GCP. DNA extracted from peripheral venous blood was genotyped by polymerase chain reaction-restriction fragment length polymorphism analysis. One-way analysis of variance, Chi-square testing, and logistic regression analysis were used to test association between GCP and the CD14 rs2569190 single nucleotide polymorphism (SNP). RESULTS: The distribution of the CD14 rs2569190 genotypes and allele frequencies showed significant differences between the test and control groups. Prevalence of the polymorphic TT genotype and T allele of the CD14 rs2569190 were significantly increased in GCP patients when compared with healthy controls. CONCLUSION: The results of the present study suggest that the T allele and the TT genotype of the rs2569190 SNP in the promoter region of the CD14 gene are associated with GCP in a South Indian population of Tamil ethnicity.

Staged Hard and Soft Tissue Reconstruction Followed by Implant Supported Restoration in the Aesthetic Zone: A Case Report.

Alveolar ridge deficiency is a common clinical consequence following tooth loss due to chronic periodontitis complicating ideal implant placement. Advanced hard and soft tissue augmentation procedures have been developed in the recent past with predictable clinical outcomes. A male patient presented with a Grade III mobile upper right central incisor associated with advanced bone loss and soft tissue deficit. Following extraction of tooth #11, socket augmentation was done using an autogenous cortico-cancellous block graft and subsequent soft tissue augmentation was done with palatal connective tissue graft. At the end of six months, a tapered self tapping implant fixture was placed with adequate primary stability and after eight weeks, second stage implant surgery was done with the Misch technique in order to recreate papillae and the implant was prosthetically restored. The alveolar ridge was adequately recontoured following the staged surgical protocol. The implant was well integrated at the end of 15 months. Execution of sequential surgical procedures in a highly deficient edentulous site made it possible to achieve of optimal pink and white aesthetics with stable implant supported fixed prosthesis.

Evaluation of Micronutrient (Zinc, Magnesium, and Copper) Levels in Serum and Glycemic Status after Nonsurgical Periodontal Therapy in Type 2 Diabetic Patients with Chronic Periodontitis.

AIMS AND OBJECTIVES: To find out the effect of nonsurgical periodontal therapy on serum zinc (Zn), magnesium (Mg), and copper (Cu) concentration and glycemic status in type 2 diabetes with chronic periodontitis (CP). MATERIALS AND METHODS: One hundred and twenty patients were included in this study, which was further divided into three groups. Group 1 consisted of forty patients with CP, Group 2 consisted of forty patients of CP with controlled diabetes, and Group 3 consisted of forty patients of CP with uncontrolled diabetes. Periodontal parameters such as plaque index, gingival index, bleeding on probing, pocket depth, and clinical attachment levels (CALs) were evaluated. Blood samples were collected to assess the levels of fasting blood sugar, glycosylated hemoglobin, Zn, Mg, and Cu. All parameters were evaluated at baseline and 3 months after nonsurgical periodontal therapy. RESULTS: The results showed statistically significant reduction in all the clinical parameters within the groups except for the CAL in group 1 patients (P = 0.05). The glycemic status also showed a statistically significant reduction after treatment (P < 0.001). The intragroup comparison was taken between the values of micronutrients, showed substantial increase in the levels of both Zn and Mg and decrease in the level of Cu after nonsurgical periodontal treatment (P < 0.001). CONCLUSION: Patients with diabetes and periodontitis had altered metabolism of Zn, Mg, and Cu contributing to the progression and complication of diabetes mellitus and periodontitis. Nonsurgical periodontal treatment improved the variation and concentration of plasma micronutrients and also the periodontal status and glycemic level.

Evaluation of TLR2 and 4 in Chronic Periodontitis.

INTRODUCTION: Periodontal disease is the major cause of adult tooth loss and is commonly characterized by a chronic inflammation caused by infection due to oral bacteria. Members of Toll-Like Receptor (TLR) family recognize conserved microbial structures, such as bacterial lipopolysaccharides and activate signalling pathways that result in immune responses against microbial infections. AIM: The aim of the present study was to assess the mRNA expression of Toll-Like Receptor 2 and 4 in tissues with or without chronic periodontitis. MATERIALS AND METHODS: Gingival tissue samples were collected from controls (30 subjects with healthy periodontal tissues) and experimental group (30 subjects with chronic periodontitis). Total RNA was extracted and RT-PCR was done for evaluation of TLR-2 and TLR-4. Mann Whitney U-test, Pearson Chi-square Test was used for statistics. RESULTS: The results showed that there is a significant (p-value= 0.004) association between TLR-4 and the experimental group comprising of chronic periodontitis patients in comparison to the insignificant (p-value= 0.085) TLR-2 expression. CONCLUSION: This study concludes that TLR-2 and TLR-4 expressed in the gingival tissues recognize different bacterial cell wall components thus helping us to associate its potential in diagnosing periodontal disease. Hence, in the future, these scientific findings can pave the way in using TLR as a diagnostic biomarker for periodontal disease.

Full mouth rehabilitation with zygomatic implants in patients with generalized aggressive periodontitis: 2 year follow-up of two cases.

Rehabilitation of severely atrophied maxillae is often a challenge and patients with generalized aggressive periodontitis (GAP) make it even more complicated. This clinical report describes rehabilitation of GAP patients with zygomatic implants and followed-up for 2 years. Two patients of age 33 and 44 reported to a private dental practice and were diagnosed with GAP. Various treatment options were considered after which it was decided to do a full mouth implant supported fixed rehabilitation, with a combination of conventional and zygomatic implants. Two zygomatic and four conventional implants were placed and immediately loaded with a provisional prosthesis. After 6 months, definitive prosthesis was delivered. Implants and prostheses were followed-up for 2 years. No implant failures occurred, but a few biological complications were observed. The most common clinical observation in these patients during recall visits was peri-implant soft-tissue inflammation, which is a biological complication. This was with no trouble, controlled by using proper oral hygiene aids and maintenance. Within the limitations of this study, we can state that it can definitely be considered as a viable treatment option treating patients with GAP. However, studies with more follow-up time and controlled clinical trials should be performed in order to document the longevity of this treatment modality.

Assessment of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in Down's syndrome subjects and systemically healthy subjects: A comparative clinical trial.

OBJECTIVES: To compare and quantify the presence of periodontal pathogens Aggregatibacter actinomycetemcomitans (Aac) and Porphyromonas gingivalis (Pg) in Down's syndrome (DS) and systemically healthy subjects with periodontitis and gingivitis. MATERIALS AND METHODS: Fifty-nine age-matched subjects were categorized into four groups; Group I: DS subjects with gingivitis, Group II: DS subjects with periodontitis, Group III: Systemically healthy subjects with gingivitis and Group IV: Systemically healthy subjects with periodontitis. Plaque samples from all the four groups were collected and analyzed to evaluate the presence of Aac and Pg using real time polymerase chain reaction. The indices used were oral hygiene index simplified, community periodontal index for treatment needs and plaque index. RESULTS: This study showed a statistically significant detection in the levels of both Aac (<0.001) and Pg (<0.001) in DS subjects with periodontitis when compared with the healthy controls with periodontitis; moreover, there was a statistically significant increase in Pg levels compared to Aac in DS gingivitis group. CONCLUSION: There was a statistically significant presence of Pg and Aac in both DS gingivitis and DS periodontitis over control groups with increased levels of Pg compared with Aac in DS gingivitis group.

A Novel Esthetic Approach using Connective Tissue Graft for Soft Tissue Defect Following Surgical Excision of Gingival Fibrolipoma.

The aim of the present case report is to evaluate the adjunctive use of a connective tissue graft to overcome soft tissue defects following excision of a gingival fibrolipoma in the aesthetic region. Connective tissue graft has been well documented for treating defects of esthetic concern. However, the literature does not contain many reports on the esthetic clinical outcome following the use of connective tissue graft secondary to excision of soft tissue tumours. A 28-year-old male patient reported with a complaint of a recurrent growth in relation to his lower front tooth region. The lesion which was provisionally diagnosed as fibroma was treated with a complete surgical excision, following which a modified coronally advanced flap and connective tissue graft was adopted to overcome the soft tissue defect. The excised growth was diagnosed histologically as fibrolipoma. One year follow up showed no recurrence of the lesion and good esthetics.The adjunctive use of the connective tissue graft and modified coronally advanced flap predictably yields optimal soft tissue fill and excellent esthetics. Hence, routine use of this procedure may be recommended for surgical excision of soft tissue growths in esthetically sensitive areas.