An Overview of Chitosan and Its Role in Periodontics.

Chitosan is a biopolymer with numerous biological properties such as antibacterial, anti-inflammatory, and wound healing. Chitosan also stimulates cell proliferation and osteogenesis and thus used as a scaffold material in tissue engineering. The physical proprieties of chitosan such as biocompatibility and biodegradability give promising results in periodontal therapies. This review gives an updated explanation of the applications of chitosan in dentistry and periodontics. Furthermore, the review demonstrates the actions of chitosan in detail and its role in the regeneration of periodontal structures.

Idiopathic Desquamative Gingivitis.

Desquamative gingivitis is described as an erythematous, desquamated gingival lesion. There are many etiologic factors for the appearance of such lesions. The aim of this case report is to diagnose the cause of the lesion by analyzing the complete medical, dental, and personal histories. An elaborated differential diagnosis is done, and the lesion is successfully treated accordingly. The gold standard treatment is usually provided by systemic or topical corticosteroids. Another treatment option is antioxidant therapy which provides rapid healing of the tissue.

Clinical Significance of Talon Cusp in a Mixed Dentition Patient.

Talon cusp is a developmental dental anomaly with supernumerary structure projecting from the dento-enamel junction towards the incisal edge of an anterior tooth. The etiology is usually unknown but studies states that talons cusp can occur due to the hyperactivity of the enamel organ during morph differentiation. The incidence is 0.04-10% and the prevalence is more in maxillary incisors than mandibular incisors and more in palatal aspect of the teeth. The most common complications are esthetics, increased risk for caries and occlusal accommodation. This article reports a case of talon cusp on the palatal surface of the permanent maxillary lateral incisor. Due to its clinical significance the dentist should be able to diagnose the supernumerary tooth and definitive treatment should be done.

Mucormycosis during Coronavirus Disease Pandemic: A Diagnosis we Cannot Afford to Miss.

Mucormycosis is a very aggressive, devastating opportunistic fungal infection commonly involving nasal, maxillary,orbital, and cerebral regions. In the second wave of the coronavirus disease 2019 (COVID-19) pandemic, a high frequency of mucormycosis infections has been seen because of the triad of COVID-19, systemic steroids, and preexisting diabetes mellitus. A patient might present with a simple mobile tooth/teeth with multiple gingival abscesses Necrotic bone could be seen in the palate. Blackish discoloration might be present in the oral mucosa. There might be extraoral swelling . If rhino-oculo cerebral mucormycosis is diagnosed, then there are two immediate treatment modalities to be followed. Both surgical and medical treatment are necessary. Surgical is thorough debridement of the necrotic tissue. To prevent the occurrence of mucormycosis, meticulous glycemic control and rational use of steroids and antibiotics for the shortest possible time with adequate attention toward the ventilators and tubing are necessary.

Chlorhexidine: An Elixir for Periodontics.

Chlorhexidine is a cationic bisbiguanide with broad antibacterial activity, and wide spectrum of activity encompassing gram-positive and gram-negative bacteria, yeasts, dermatophytes and some lipophilic viruses. Its antibacterial action is due to the disruption of the bacterial cell membrane by the chlorhexidine molecules, increasing the permeability and resulting in cell lysis. Thus, chlorhexidine plays a key role in the dentistry and is used to treat or prevent periodontal disease, and has earned its eponym of the gold standard. This article reviews in detail about the mechanism of action, indications, forms and various studies related to chlorhexidine.

Clinical and Radiological Evaluation of Delayed and Early Loading of Single-Tooth Implant Placement: A 6-Month, Prospective, Randomized, Follow-up Clinical Study.

PURPOSE: The purpose of the study was to compare delayed and early loaded single-tooth implant technique. MATERIALS AND METHODS: A randomized, prospective clinical trial was conducted to evaluate the clinical and radiological parameters of delayed and early loading of single-tooth implant placement. Fourteen male or female patients were selected randomly, who had single tooth missing in mandibular posterior region. A delayed implant placement technique was followed in these regions. A Hi-Tech implant (Life Care Implants) was performed. The patients were divided into two groups: delayed loading group and early loading group. In delayed loading groups, implants were loaded after 3 months, and in early loading groups, implants were loaded within 7 days to 2 months. Soft tissue and radiological bone loss were assessed at baseline, 3 months, and 6 months. The parameters assessed were plaque index, gingival index, probing pocket depth, thickness of peri-implant mucosa, and bone loss (radiographically). RESULTS: The results show that there was no statistical difference in indexes taken between delayed loading and early loading groups. CONCLUSION: In this study, after first 6 months there was no difference in success rate between delayed loading or early loading of implants. This study also showed that more bone loss occurred around delayed loading implants. So it can be concluded that early loading technique can be successfully practiced instead of delayed loading of implants.

Ancient Seed for Modern Cure - Pomegranate Review of Therapeutic Applications in Periodontics.

Punica granatum (pomegranate), the member of Punicaceae family, is used in the prevention and treatment of health disorders. P. granatum contains diverse range of phytochemicals including ellagic acid, punicalagin, pedunculagin, quercetin, rutin, tannic acid, polyphenol, anthocyanins, and catechins. This review aims at providing an overview of the chemical constituents, antibacterial, anti-inflammatory, and antioxidant properties of P. granatum, and its role in the prevention and treatment of gingival and periodontal diseases.

Cherubism with idiopathic gingival enlargement: A rare case report.

Cherubism is a congenital childhood disease of autosomal dominant inheritance. It is a benign, familial giant cell lesion characterized by gradually progressive painless swelling of the jaws. Idiopathic gingival enlargement is a rare condition and may be associated with some uncommon syndromes. This case report describes an 11-year-old patient with unusual clinical form of gingival enlargement, cherubic facial appearance. Clinical examination revealed the presence of the hyperplastic gingiva, which completely covered all teeth. The bilateral swelling of mandible and the appearance of the sclera beneath the iris suggested cherubism. The diagnosis was confirmed by histopathological examination, which revealed multinucleated giant cells. Computed tomography scan showed multiple osteolytic zones in the mandible. A full mouth gingivectomy was performed in four stages. Lesion healed successfully, and no recurrence observed after 1-year follow-up. There was a marked improvement in esthetics and function through the surgical excision of the overgrowth.

Evaluation of efficacy of probiotic (BIFILAC) on Porphyromonas gingivalis: In vitro study.

BACKGROUND: Periodontitis is inflammation of the periodontium and causes destruction of the connective tissue attachment of the teeth and alveolar bone. Porphyromonas gingivalis is the primary pathogen for the destructive periodontal diseases. The aim of the study is to evaluate the efficacy of probiotic on P. gingivalis. MATERIALS AND METHODS: An in vitro study was done to analyze the effectiveness of probiotic BIFILAC on P. gingivalis was determined using disc diffusion method. The minimum inhibitory concentration for BIFILAC lozenges was also determined using microdilution method. RESULTS: In disc diffusion method, the antibacterial activity of BIFILAC was analyzed using various concentrations such as 2.5, 5, 10, and 20 µg/ml, of which 20 µg/ml was proved to have a maximum inhibitory zone of 22 mm. In microdilution method, concentration ranging from 7.25 to 100 µg/ml was used and 25 µg/ml was found to have the minimum inhibitory effect on P. gingivalis. CONCLUSION: The present in vitro study confirms that probiotic BIFILAC has an antimicrobial effect against P. gingivalis. Thus, proving that BIFILAC probiotic can be used as an adjunctive therapeutic modality in periodontitis.

Evaluation of superoxide dismutase levels in local drug delivery system containing 0.2% curcumin strip as an adjunct to scaling and root planing in chronic periodontitis: A clinical and biochemical study.

AIM: Curcumin has proven properties such as anti-inflammatory, antioxidant, antimicrobial, and it also accelerates wound healing. The purpose of this study was to investigate the level of superoxide dismutase (SOD) enzyme, in gingival crevicular fluid (GCF), and the impact of nonsurgical treatment on the antioxidant profile using 0.2% curcumin strip as local drug delivery. MATERIALS AND METHODS: A total of twenty subjects of age 35-55 years and 15 subjects with chronic periodontitis, each with bilateral 5-6 mm probing pocket depth, were selected for this study. Healthy group consists of 5 sites in which no bleeding on probing, no pocket depth. Group I - It consists of 15 sites with chronic periodontitis, in which scaling and root planing (SRP) was done (control group). Group II - It consists of 15 sites, in which SRP followed by the placement of curcumin strip inside the pocket (SRP + curcumin strip) (test group). GCF collection was done preoperatively and postoperatively after 21 days. The SOD activity was assessed using enzyme-linked immunosorbent assay. RESULTS: In this study, all the clinical parameters were significantly reduced in test and control sites. Further, SOD levels were significantly improved in test sites when compared with control sites. CONCLUSION: Thus, the present study concluded that curcumin strip can be effectively used as an adjunct to SRP in treatment of chronic periodontitis and serves as antioxidant in subgingival environment.

Cumulative effect of microwave sterilization on the physical properties of microwave polymerized and conventional heat-polymerized acrylic resin.

AIMS: To evaluate and compare the flexural strength and impact strength of conventional and microwave cured denture base resins before and after repeated sterilization using microwave energy to consider microwave curing as an alternative to the conventional method of sterilization. MATERIALS AND METHODS: The conventional heat cure acrylic resin (DPI heat cure material) Group A and microwave-polymerized acrylic resin (Vipi Wave Acrylic resin) Group B were used to fabricate 100 acrylic resins samples using a standard metal die of (86 mm × 11 mm × 3 mm) dimensions. The criterion was flexural strength and impact strength testing which had Group A and Group B samples; 50 samples for flexural strength and 50 samples for impact strength measurement. For each criterion, five control samples were taken for Group A and Group B. The samples were stored in water before experimenting. The test samples were subject to four cycles of microwave sterilization; followed by flexural strength testing with a 3-point flexural test in universal testing machine (UNITEK 94100) and impact strength testing with impact testing machine (ENKAY Pr09/E1/16). RESULTS: The physical properties had significant changes for conventionally cured denture base resins, whereas no changes found for microwave-cured resins after repeated sterilization cycles.

Comparative analysis of gingival crevicular fluid a disintegrin and metalloproteinase 8 levels in health and periodontal disease: A clinic-biochemical study.

AIM AND BACKGROUND: A disintegrin and metalloproteinase 8 (ADAM8) is a marker belonging to the class of ADAM family of metalloproteinase which is found to be involved in inflammation and bone resorption in periodontal disease by acting as osteoclast stimulating factor. In several systemic inflammatory diseases, elevated levels of ADAM8 are detected in human serum and other body fluids. Recently, ADAM8 was even detected in gingival crevicular fluid (GCF) of patients with periodontal diseases. Hence, the aim of the study was to estimate the levels of ADAM8 in GCF of healthy and chronic periodontitis subjects. MATERIALS AND METHODS: Periodontal examination and collection of GCF by the extracrevicular method was performed in 30 subjects selected randomly and categorized into two groups. Group I (healthy, n = 15) and Group II (chronic periodontitis, n = 15). ADAM8 levels in GCF were estimated by enzyme-linked immunosorbent assay. RESULTS: ADAM8 was detected in both Group I and II. Highest mean ADAM8 concentration was obtained for Group II, whereas the lowest concentration was seen in Group I. This suggests that ADAM8 levels increase proportionally with the progression of periodontal disease. There was a significant correlation between ADAM8 levels and clinical parameters in the study group. CONCLUSION: The results of our study indicate that the ADAM8 levels in GCF are positively associated with periodontal disease, which may provide a useful tool in monitoring its progression. Nevertheless, further longitudinal studies are required with larger sample sizes in which ADAM8 levels are progressively estimated and compared to baseline values.

LASER curettage as adjunct to SRP, compared to SRP alone, in patients with periodontitis and controlled type 2 diabetes mellitus: A comparative clinical study.

AIM: To compare the effect of scaling and root planning (SRP) alone, and laser curettage as an adjunct to SRP, on the clinical parameters of patients with periodontitis and controlled type 2 diabetes mellitus. MATERIALS AND METHODS: Ten patients were divided into two equal groups in a split-mouth design - Group I: SRP alone, Group II: SRP + laser curettage. The following clinical parameters were recorded: (i) Gingival index (ii) plaque index (iii) sulcular bleeding index (iv) probing depth (PD) and (v) clinical attachment level (CAL). SRP was done in one quadrant using Gracey curettes and in another quadrant SRP plus laser curettage was done. Three weeks after the therapy, the clinical parameters were recorded and the results were analyzed and the percentage of improvement were evaluated. RESULTS: The results of this study indicated that both SRP and SRP + laser curettage were efficient for reducing gingival inflammation and PD. Group II showed more reduction in PD and more gain in CAL than Group I. Mean reduction in PD was 20.22% in Group I and 26.76% in Group II. Mean CAL gain is 32.5% in Group II and 22.34% in Group I. CONCLUSION: In both the groups, gingival inflammation was reduced. When laser curettage was used as adjunct to SRP more reduction in PD and CAL was seen.

Comparative evaluation of depigmentation techniques in split-mouth design with electrocautery and laser.

Excessive gingival pigmentation is a major esthetic concern for many people. Melanin pigmentation is known to be caused by melanin granules within the gingival epithelium. Smile is determined not only by the shape, the position, and the color of the teeth, but also by the gingival tissues. Gingival health and appearance are essential components of an attractive smile. It is not a medical problem, but it feels unesthetic for the patient and particularly in patients having a very high lip/smile line. Depigmentation is not a clinical indication but a treatment of choice where esthetics is a concern and is desired by the patient. For depigmentation of gingival, different treatment modalities have been reported such as bur abrasion, scraping, partial thickness flap, cryotherapy, electrosurgery, and laser. The present case series describes two simple and effective surgical depigmentation techniques treated with diode laser and electrosurgery.

Pink esthetics in periodontics - Gingival depigmentation: A case series.

Smile expresses a feeling of joy, success, sensuality, affection, and courtesy, and reveals self-confidence and kindness. The harmony of the smile is determined not only by the shape, the position, and the color of the teeth, but also by the gingival tissues. Although melanin pigmentation of the gingiva is completely benign and does not present a medical problem, complaints of "black gums" are common, particularly in patients having a very high smile line. Thus, perio-esthetic treatment modalities strive to achieve a harmonious inter-relationship of the pink with white, which is imperative of all treatment procedures. For depigmentation of gingival, different treatment modalities have been reported, such as bur abrasion, scraping, partial thickness flap, cryotherapy, electrosurgery, and laser. In the present case series, scraping, electrosurgery, and diode laser have been tried for depigmentation, which are simple, effective, and yield good results, along with good patient satisfaction.

Lasers in periodontics.

Laser is one of the most captivating technologies in dental practice since Theodore Maiman in 1960 invented the ruby laser. Lasers in dentistry have revolutionized several areas of treatment in the last three and a half decades of the 20(th) century. Introduced as an alternative to mechanical cutting device, laser has now become an instrument of choice in many dental applications. Evidence suggests its use in initial periodontal therapy, surgery, and more recently, its utility in salvaging implant opens up a wide range of applications. More research with better designs are a necessity before lasers can become a part of dental armamentarium. This paper gives an insight to laser in periodontics.