Minimally invasive periodontal therapy.

Historically, surgical techniques were governed by specific incisions and surgical designs. With the advent of anesthesia, the complicated cases were managed but at the cost of the tissues leading to morbidities of various degrees. The innovations and the advances in the surgical techniques led to the ideology that surgeries could be done with minimal tissue manipulation and sacrifice. Thus the concept of "minimally invasive dentistry" was introduced with the primary goal to achieve satisfactory therapeutic results with minimal trauma during the process. In context to the management of periodontitis, this modality includes use of conservative incisions which preserves as much soft tissue as possible, avoiding continuous incisions and vertical incisions, use of magnification etc. The ultimate goal of any treatment modality is the resolution of the disease and regeneration if possible with minimal postoperative pain and morbidity. Minimal invasive periodontal therapy involves treatment options which cure the disease with reduced postoperative pain, improved healing and better patient acceptance. This paper covers the advent of minimal invasive periodontal therapy modalities both surgical and non-surgical along with the literature review.

Digital Smile Design-An innovative tool in aesthetic dentistry.

A fundamental objective of an aesthetic treatment is the patient's satisfaction and that the outcome of the treatment should meet the patient's expectation of enhancing his/her facial aesthetics and smile. A patient constantly doubting the end result of the treatment, which is an irreversible procedure, can be motivated and educated through Digital Smile Designing (DSD) technique. DSD is a technical tool which is used to design and modify the smile of patients digitally and help them to visualize it beforehand by creating and presenting a digital mockup of their new smile design before the treatment physically starts. It helps in visual communication and involvement of the patients in their own smile design process, thus ensuring predictable treatment outcome and increasing case acceptance. This article reviews the aspects of digital smile designing in aesthetic dental practice pertaining to its use, advantages, limitations and future prospects.

Impact of altered gingival characteristics on smile esthetics: Laypersons' perspectives by Q sort methodology.

INTRODUCTION: Smile esthetics includes the white esthetics related to the teeth and the pink esthetics related to the mucosa. Many surveys have been conducted to evaluate laypersons' perceptions to altered dental characteristics, but few have focused on the soft tissue factors. This study was designed to determine the perceptions of laypeople to variations in soft tissue esthetics during smile. METHODS: An ideal smile photograph was intentionally altered to produce variations in gingival inflammation, pigmentation, contour, position of free gingival margins (with and without recession), zeniths, and interdental papilla. Sixty-seven images thus produced were rated for attractiveness by 100 laypersons with the Q sort technique. RESULTS: Variations in interdental papilla (black triangles) were the most negatively ranked gingival factor by laypersons closely followed by color changes of the gingiva due to inflammation and pigmentation. Alteration of gingival contour and gingival zenith had the least impact on smile esthetics, and changes in the free gingival margin with and without recession were moderately perceived. Furthermore, laypersons considered unilateral or asymmetric alterations more unesthetic compared with bilateral or generalized alterations for factors such as free gingival margin without the recession, and color changes caused by inflammation and pigmentation. CONCLUSIONS: Laypersons have considerable negative perception to asymmetric gingival alterations and to optical color changes caused due to black triangles, inflammation, and pigmentation of the gingiva. Whereas alteration in gingival contour and zenith have least impact on smile esthetics.

An Enigmatic Clinical Presentation of Plasma Cell Granuloma of the Oral Cavity.

Plasma cell granuloma is a rare benign lesion characterized by the infiltration of plasma cells; primarily occurring in the lungs. It is also seen to occur in the brain, kidney stomach, heart, and so on but its intraoral occurrence is a rarity. This case report represents one of the uncommon locations in the oral cavity affected by plasma cell granuloma, its clinical and histological features, and establishes the differential diagnosis with other malignant or benign disease entities and planning the treatment accordingly. This report discusses the diagnostic enigma and the associated terminology of plasma cell granulomas and reinforces the need for performing biopsy and a histopathological or immune histochemical study, irrespective of the clinical features and clinical diagnosis of the lesion. In this case a 52-year-old female, presented with gingival enlargement in the mandibular anterior region, treated by excisional biopsy. Histological evaluation revealed plasma cell infiltrates in the connective tissue. The immune-histochemistry revealed kappa and lambda light chains with a polyclonal staining pattern, which confirmed the diagnosis of plasma cell granuloma.

Periodontal Flap Surgery along with Vestibular Deepening with Diode Laser to Increase Attached Gingiva in Lower Anterior Teeth: A Prospective Clinical Study.

BACKGROUND: Chronic periodontitis in lower anterior teeth results in rapidly progressive gingival recession (GR), loss of alveolar bone, decreased vestibular depth (VD) with consequential tooth mobility, and tooth loss. Treatment option for such cases in this esthetically important area of the oral cavity includes extraction followed by implants for which sufficient bone height and mucogingival complex are a prerequisite. Henceforth, an attempt was made to prolong the life of lower anterior teeth and postpone the need for implants by the treatment of chronic periodontitis with periodontal flap surgery followed by vestibular deepening in single surgical procedure. MATERIALS AND METHODS: In this clinical, prospective study, conventional periodontal flap surgery was done on 74 sites in lower anterior teeth in 16 patients with attachment loss >5 mm due to chronic periodontitis. Vestibular deepening with diode laser at (wavelength - 810 nm, output power: 0.5-7 W, continuous wave, contact mode) was done after suturing the flap. All the clinical parameters: GR, pocket depth (PD), clinical attachment loss (CAL), width of keratinized gingiva, width of attached gingiva, and VD were assessed preoperatively after Phase I therapy and 6 months postoperatively. RESULTS: At all the 74 sites, there was highly significant gain in attached gingiva, keratinized gingiva, and VD (P ≤ 0.001). Highly significant reduction in PD (P ≤ 00.001), significant reduction in attachment loss (P ≤ 0.01) but no significant reduction in GR (P = 0.897) was observed. CONCLUSIONS: The combination of periodontal flap surgery with vestibular deepening with diode laser may be a suitable cost-effective treatment option to prolong the life of periodontally involved lower anterior teeth. The surgical technique can postpone the need for extraction of teeth along with all the intangible benefits of periodontal therapy.

Association of chronic periodontitis with metabolic syndrome: A cross-sectional study.

BACKGROUND: Prevalence of metabolic syndrome (MeS) is high among Asians, including Indians and is rising, particularly with the adoption of modernized lifestyle. Various studies have reported a significant relationship between periodontal status and MeS. The objective of this study is to investigate the association between periodontitis and MeS. MATERIALS AND METHODS: The study included 259 subjects (130 cases with chronic periodontitis, 129 controls without chronic periodontitis) who underwent medical and periodontal checkup. Five components (obesity, high blood pressure, low- and high-density lipoproteins, cholesterol, hypertriglyceridemia, and high plasma glucose) of MeS were evaluated, and individuals with ≥3 positive components were defined as having MeS. The periodontal parameter was clinical attachment level (CAL) on the basis of which cases were selected with moderate (CAL loss 3-4 mm) and severe (CAL loss ≥5 mm) generalized chronic periodontitis. The association between chronic periodontitis and MeS components was investigated using odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The association of MeS and chronic periodontitis was strong and significant with OR: 2.64, 95% CI: 1.36-5.18, and P < 0.003. Comparison of mean values of components of MeS between cases and controls reveals that the mean waist circumference (mean difference: -4.8 [95% CI: 7.75--1.84], P < 0.002) and mean triglycerides level (mean difference: -25.75 [95% CI: -49.22--2.28], P < 0.032) were significantly higher in cases than in control groups. Although mean systolic blood pressure, diastolic blood pressure, and fasting blood sugar level were higher in cases (125.77, 82.99 and 86.38, respectively) compared with control (122.81, 81.3 and 83.68, respectively), it was statistically insignificant. CONCLUSION: The results of this study suggest that there is a strong association between chronic periodontitis and MeS. The association was independent of the various potential confounding risk factors affecting the chronic periodontitis such as age, sex, residential background, and tobacco consumption.

A novel single-step surgical technique for vestibular deepening using laser in conjunction with periodontal flap surgery.

Moderate-to-severe chronic periodontitis results in clinical loss of attachment, reduced width of attached gingiva (AG), periodontal pockets beyond mucogingival junction (MGJ), gingival recession, loss of alveolar bone, and decreased vestibular depth (VD). The encroachment of frenal and muscle attachments on marginal gingiva increases the rate of progression of periodontal pockets, prevents healing, and causes their recurrence after therapy. Loss of VD and AG associated with continuous progression of pocket formation and bone loss requires two-stage surgical procedures. In this article, one-stage surgical procedure is being described for the first time, to treat the periodontal pockets extending beyond the MGJ by periodontal flap surgery along with vestibular deepening with diode laser to increase the AG. One-step surgical technique is illustrated whereby pocket therapy with reconstruction of lost periodontal tissues can be done along with gingival augmentation by vestibular deepening.

Influence of female sex hormones on periodontium: A case series.

Dental plaque is the primary etiologic factor for the periodontal diseases. Although pathogenic bacteria in dental plaque are necessary for the incidence of periodontal disease, but a susceptible host is as important. The susceptibility of the host can be modified by various systemic factors with hormones level being one. The periodontium shows an exaggerated inflammatory response to plaque modified by female sex hormone during puberty, pregnancy, in women taking oral contraceptives and at the postmenopausal stage. This paper presents such few cases where periodontium is influenced by variation in sex steroid hormones of female during different phases of their life time and to discuss how much a same hormone at different age and stage shows an exaggerated gingival response to plaque.

Tooth polishing: The current status.

Healthy teeth and gums make a person feel confident and fit. As people go about their daily routines and with different eating and drinking habits, the tooth enamel turns yellowish or gets stained. Polishing traditionally has been associated with the prophylaxis procedure in most dental practices, which patients know and expect. However, with overzealous use of polishing procedure, there is wearing of the superficial tooth structure. This would lead to more accumulation of local deposits. Also, it takes a long time for the formation of the fluoride-rich layer of the tooth again. Hence, now-a-days, polishing is not advised as a part of routine oral prophylaxis procedure but is done selectively based on the patients' need. The article here, gives an insight on the different aspects of the polishing process along with the different methods and agents used for the same.

Effect of hydrogen peroxide mouthwash as an adjunct to chlorhexidine on stains and plaque.

AIM: To investigate whether the use of an oxidizing mouth rinse as an adjunct to chlorhexidine is efficacious in reducing stains and plaque. MATERIALS AND METHODS: This study had a single-blind, three-group (n = 35 each) parallel design, including a 21 days experimental period during which group I rinsed with chlorhexidine (CHX) 0.2% alone, group II used chlorhexidine (CHX) followed by hydrogen peroxide (H2O2) 1.5%. Group III rinsed with the same mouthwashes in reverse order. Patients were randomly assigned to one of the three groups. The examination for plaque, and stains was done after 1, 2, and 3 weeks of rinsing. RESULTS: Group II showed significantly less stain intensity in comparison with group I after 14 and 21 days (P values 0.025 and 0.005, respectively). The proportion of stained surfaces was less in the group II than in the group I and was significant at the end of 1 week. The plaque formation was significantly less in groups II and III than group I at 7, 14, and 21 days. CONCLUSION: The adjunctive use of hydrogen peroxide to chlorhexidine proved to be superior to chlorhexidine alone with regard to the inhibition of plaque and development of stains.

Gingival enlargement in neurofibromatosis type 1: a case report and literature review.

AIM: The purpose of this article is to describe a rare case of neurofibromatosis1 (NF1) of the gingiva and a review of the current literature. BACKGROUND: Neurofibromatosis1 (NF1) of the gingiva is an uncommon cause of gingival enlargement. The disease is clinically characterized by epidermal melanosis, nevi, and flabby skin or bone malformations; in addition, the lesions may undergo malignant transformation. Involvement of the gingiva with or without concurrent skin lesions has been reported only occasionally. CASE DESCRIPTION: A 40-year-old male patient with a history of NF1 came to us with a chief complaint of enlargement of the gums. Clinical examination revealed diffuse gingival enlargement with no signs of inflammation. The characteristic skin lesions associated with NF1 were also present. A gingival specimen was sent for biopsy. RESULTS: Based on the history, clinical, and histological findings, NF1 was established as the cause of the gingival enlargement. SUMMARY: NF1 may affect the gingival tissue; considering the neurological complications and malignant potential, NF1 must be diagnosed early and monitored regularly. CLINICAL SIGNIFICANCE: The clinician should be aware of clinical and histopathological findings of NF1 considering the fact that the condition has malignant potential.

Management of recalcitrant oral pemphigus vulgaris with CO(2) laser - Report of two cases.

Laser has been used efficiently for treatment of oral lichen planus, leukoplakia, aphthous ulcers and oral manifestations of HIV. Two cases of recalcitrant oral pemphigus vulgaris that were successfully treated with CO(2) laser are described. The patients had been treated by a dermatologist with pulse therapy of methyl prednisolone and cyclophosphamide over a period of 6 to 8 months, but the clinical course was characterized by episodes of painful flare-ups and nonresponsiveness. The patients were extremely uncomfortable with recurrent oral lesions. CO(2) laser at low power was used to irradiate the lesions. It was shown to be effective in relieving pain and healing of lesions, with nonrecurrence. To the best of our knowledge, this is the first case report of such a treatment of oral pemphigus vulgaris. Further clinical studies are warranted to confirm efficacy and to optimize the treatment protocol.