Bilateral Interrelationship of Diabetes and Periodontium.

Periodontitis is a chronic inflammatory disease characterised by destruction of the supporting structures of the teeth which is a common cause of tooth mortality in all individuals throughout the world. Diabetes is a group of metabolic dysregulation, primarily of carbohydrate metabolism, characterized by hyperglycemia that results from defects in insulin secretion, impaired insulin action, or both. Systematic reviews and meta-analysis have shown that the prevalence of periodontitis is increased in diabetic patients. Based on the evidence, degree of hyperglycemia and severity of periodontitis are inter- related. Diabetic patients with severe periodontitis have six times more poor glycemic control than patients with healthy periodontium. However, improved glycemic control has been postulated to reduce the severity of periodontal disease. In this mini-review, we have presented the previously reviewed studies from the literature and focused on a two-way relationship of diabetes and periodontitis, various pathways involved in it such as RANK/RANKL/OPG axis, AGE-RAGE pathway, Oxidative stress mechanism, and obesity that influence the possibility of periodontitis-Diabetes Mellitus (DM).

Management of Multiple Gingival Recessions with the VISTA Technique: An 18-Month Clinical Case Series.

The purpose of the present study was to evaluate the efficacy of the vestibular incision subperiosteal tunnel access (VISTA) technique with collagen membrane, bioactive glass, and platelet-rich fibrin. A total of 22 systemically and periodontally healthy subjects with multiple gingival recession defects (Miller Class I and II) in the maxillary esthetic zone were enrolled in the study. The primary outcome measures were mean root coverage and alteration in gingival thickness. There were no surgical complications; however, one patient reported swelling of the upper lip area on the first postoperative day, which resolved spontaneously. A statistically significant increase in gingival thickness (0.45 mm) and 94.17% ± 8.42% mean root coverage was observed at 18 months. Within the limitations of this study, it was concluded that the VISTA technique augmented with collagen membrane, bioactive glass, and platelet-rich fibrin is a predictable modality in multiple recession management.

Analgesic efficacy and safety of transdermal and oral diclofenac in postoperative pain management following dental implant placement.

The aim of this study was to compare the efficacy and safety of transdermal and oral routes of diclofenac for postoperative pain management in patients undergoing dental implant placement. Twenty systemically healthy, partially edentulous patients who required dental implants bilaterally in the mandibular first molar region were included. While the patient was under local anesthesia, an implant was placed in the mandibular first molar region of one quadrant. After a minimum of 4 weeks, an implant was placed in the contralateral quadrant under local anesthesia. Patients were prescribed 50 mg of oral diclofenac, taken twice daily for 3 days, following implant placement on the first side and a 100-mg diclofenac transdermal patch, placed once daily for 3 days, after surgery on the contralateral side. Postoperative pain was documented using the Numeric Rating Scale, Verbal Rating Scale, and Pain Relief Scale. Demographic, intraoperative, and postoperative characteristics were comparable in all the patients. The data obtained with the 3 subjective scales were analyzed by the Mann-Whitney test. No statistically significant differences in scores were discerned between the oral and transdermal routes of diclofenac delivery. None of the patients developed any adverse effects when using the transdermal patch, whereas 3 patients reported gastric irritation and a mild burning sensation when taking oral diclofenac. Thus, while the efficacy of transdermal and oral diclofenac for postoperative pain management was similar, the safety of the transdermal diclofenac patches was evidently superior. Further research with larger patient samples is necessary, but delivery of diclofenac through a transdermal route is a promising approach to the management of postoperative pain.

Knowledge, attitudes, and perceptions of undergraduate dental students toward dental implants--an all India survey.

PURPOSE: This study aims to gauge the knowledge and perceptions of undergraduate dental students or residents toward dental implants. MATERIALS AND METHODS: The dental colleges in India were divided into 5 zones, and by random selection method, 7 colleges were selected from each zone. Thus, a total of 35 dental institutions were selected, which included 2800 residents. A printed questionnaire consisting of 15 questions, which assessed the level and source of information regarding implants, was prepared and distributed. RESULTS: A total of 2800 questionnaires were posted of which 2041 responses were received (response rate was 72.89%). This study shows that 81.1% of the residents believed that they were not provided sufficient information and a whopping 91.7% of them coveted more information about implants in their undergraduate curriculum. CONCLUSION: This study concludes that a revision in the undergraduate dental curriculum is required to make the students better equipped with the technicalities of implant dentistry.

Effect of phase 1 periodontal therapy on gingival crevicular fluid levels of matrix metalloproteinases-3 and -13 in chronic periodontitis patients.

AIM: The aim of the present study was to estimate the gingival crevicular fluid (GCF) levels of matrix metalloproteinases (MMP)-3 and -13 in periodontally-healthy controls and chronic periodontitis (CP) patients, and also to investigate the effect of phase 1 periodontal therapy on MMP-3 and -13 levels in CP patients. METHODS: Fifty-five systemically-healthy patients were divided into two groups: group 1 (healthy) and group 2 (CP). The recording of clinical parameters and GCF sampling was done at baseline for both groups and again at 6 weeks post-therapy for group 2. The MMP level was determined by ELISA. RESULTS: A significant increase in the mean MMP-3 and -13 was found between healthy and CP patients. There was a statistically-significant reduction of GCF MMP-3 and -13 concentration after periodontal therapy in the CP group. A positive correlation was found between clinical parameters and GCF MMP-3 and -13 levels. CONCLUSIONS: A lower concentration of GCF MMP-3 and -13 was found in healthy patients, and a higher concentration was noted for CP patients, which was reduced after periodontal therapy. This indicates the important role played by these MMP in periodontal destruction. Thus, MMP-3 and -13 could be used as inflammatory biomarkers in diagnosing periodontal disease severity.

Comparative evaluation of plasma ROM levels in chronic periodontitis patients before and after non-surgical and surgical periodontal therapy: A clinical trial.

OBJECTIVE: Chronic periodontitis (CP) is associated with increased levels of blood reactive oxygen species (ROS). So, treatment of CP may lead to decrease in blood ROS. However, not much literature is available comparing the effect of surgical and non-surgical periodontal treatment on blood ROS levels. Reactive oxygen metabolites (ROMs) are a useful measure of blood ROS. The aim of this study was to investigate the effect of periodontal treatment on plasma ROM levels in CP patients. MATERIALS AND METHODS: Thirty CP patients and 15 controls were monitored. Plasma samples were collected at baseline and the clinical parameters were recorded. The CP patients were randomly divided into two groups: Scaling and root planing (Group II) and periodontal flap surgery (Group III). Both groups were re-evaluated 1 and 2 months after therapy. Clinical parameters were reviewed, plasma samples collected, and ROM levels were determined using a spectrophotometric technique. RESULTS: At baseline, the ROM levels for Group II and Group III were 519.8 ± 62.4 and 513.4 ± 74.7 CARR U, respectively, which were higher than Group I value (282.9 ± 23.9, P < 0.001). Periodontal treatment in CP patients resulted in improvement of clinical parameters and a highly significant reduction in plasma ROM level (P < 0.001) after 2 months. Also, there was a more significant reduction in plasma ROM levels in Group III as compared to Group II (P < 0.05). CONCLUSIONS: In CP patients, surgical periodontal treatment was more effective in lowering the plasma ROM levels than when non-surgical periodontal treatment was performed alone and, therefore, may be more beneficial in reducing systemic oxidative stress.

Interleukin-1ß level in peri-implant crevicular fluid and its correlation with the clinical and radiographic parameters.

BACKGROUND AND OBJECTIVES: Assessing only the clinical and radiographic parameters for evaluation of dental implants may not be enough as they often reflect extensive inflammatory changes in the periodontal tissues. As peri-implant crevicular fluid (PICF) can give us a more prompt and objective measure of the disease activity, the purpose of this case series is to assess the peri-implant health status of single tooth dental implants not only clinically and radiographically but also biochemically. MATERIALS AND METHODS: Thirteen patients were subjected to dental implants at single edentulous sites using a conventional surgical approach. At baseline, 6 months, and 12 months after implant placement, the clinical and radiographic parameters were recorded. Additionally, IL-1ß in PICF was estimated using the ELISA kit at 6(th) and 12(th) month. RESULTS: The clinical and radiographic parameters differed significantly around the implants at different time intervals with IL-1ß levels showing highly significant differences between 6 months (31.79 ± 12.26 pg/µl) and 12 months (113.09 ± 51.11 pg/µl). However, Spearman's correlation coefficient showed no correlation with the clinical and radiographic parameters. INTERPRETATION AND CONCLUSION: Assessment of the various parameters confirmed that all the implants had a healthy peri-implant status. Although the levels of IL-1ß in PICF were elevated at the 12(th) month, they were well within the healthy range as observed by previous studies. This indicates that IL-1ß, a biochemical marker, can be used as an adjunct to clinical and radiographic parameters in the assessment of EARLY inflammatory changes around implants.

Knowledge and attitudes of dental interns in Karnataka state, India, regarding implants.

Implant treatment today is highly reliable as a valid restorative option for missing teeth. As more patients worldwide opt for implant treatment, it is now imperative for dental practitioners to have sound information about dental implants so they can help patients make informed decisions. This study sought to define the knowledge and attitudes regarding dental implants of dental interns in the state of Karnataka, India, and to evaluate the dental implant curriculum structure at the undergraduate level. A survey was conducted of dental interns (students in their fifth, clinical year of undergraduate study) in seven of the forty-five academic dental institutions in this state. The questionnaire consisted of fifteen questions that assessed the respondents' level of knowledge and source of information regarding implants. A total of 500 questionnaires were distributed, and 417 interns responded for a response rate of 83.4 percent. In the results, 73.3 percent reported they were not provided sufficient information about implants in their undergraduate curriculum, and 95.7 percent of them wanted more. Also, 63.5 percent of the respondents believed that high costs could limit the use of dental implants as a tooth replacement modality in India. This study concludes that revision in the undergraduate dental curricula at these schools is needed to better prepare students for practicing implant dentistry.

Gingival enlargement as an early diagnostic indicator in therapy-related acute myeloid leukemia: A rare case report and review of literature.

Treatment for Hodgkin's lymphoma (HL) has resulted in excellent survival rates but is associated with increased risks of secondary therapy-related acute myeloid leukemia (t-AML). Gingival enlargement associated with bleeding and ulceration is the most common rapidly appearing oral manifestations of leukemic involvement. An 8 months pregnant patient reported with generalized gingival enlargement, with localized cyanotic and necrotic papillary areas. Co-relating the hematological report with the oral lesions and her past medical history of HL, a diagnosis of t-AML secondary to treatment for HL was made by the oncologist. As oral lesions are one of the initial manifestations of acute leukemia, they may serve as a significant diagnostic indicator for the dental surgeons and their important role in diagnosing and treating such cases. Furthermore, this case report highlights the serious complication of t-AML subsequent to HL treatment and the important role that a general and oral health care professional may play in diagnosing and treating such cases.

Role of platelet-rich-fibrin in enhancing palatal wound healing after free graft.

Platelet-rich fibrin has long been used as a wound healing therapy in skin wounds and recently evidence has suggested its usage in oral cavity for different treatment procedures. This article proposes an overview of use of platelet-rich fibrin in management of complicated oral wounds. Excessive hemorrhage of the donor area, necrosis of epithelium, and morbidity associated with donor site have been described as the possible complications after harvesting subepithelial connective tissue graft, but little has been mentioned about their management. The article includes a case report of a 45-year-old male patient who showed a delayed wound healing after subepithelial connective tissue graft harvestation, which was treated with platelet-rich fibrin.

Evaluation of interleukin -1B (+3954) gene polymorphism in patients with chronic and aggressive periodontitis: A genetic association study.

BACKGROUND: IL-1 cytokines have central roles in the pathogenesis of periodontal disease. Polymorphism in the locus +3954 (C/T) of the human IL-1B gene has been shown to affect the levels of this cytokine. AIM: The aim of the present study was to investigate the association between the IL-1 B (+3954) gene polymorphism and the occurrence of different clinical forms of periodontitis. MATERIALS AND METHODS: Genomic DNA was obtained from 90 individuals and amplified using the PCR with specific primers flanking the locus +3954 of IL-1B. PCR products were submitted to restriction endonuclease digestion and analyzed by gel electrophoresis, allowing for the determination of the genotypes and detection of the polymorphism. STATISTICAL ANALYSIS: Fisher's exact test was used for comparing the frequency of genotype distributions between groups. RESULTS: The chronic periodontitis group displayed a higher percentage of T alleles (38%) when compared to the aggressive periodontitis group (20%) and to the control group (19%). CONCLUSION: Our study data states that polymorphism in the locus +3954 of IL-1B gene could be a risk factor for chronic periodontitis in a sample of Indian population of Karnataka state.

Evaluation of chemical composition and efficacy of Chinese propolis extract on Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans: An in vitro study.

BACKGROUND: Propolis as a natural remedy has maintained its popularity over long periods of time. The aim of this study was to determine the chemical composition in terms of total phenolic compounds and flavonoids present in Chinese propolis and to carry out an in vitro evaluation of its antimicrobial activity and the minimal inhibitory concentrations for Porphyromonas gingivalis (Pg) and Aggregatibacter actinomycetemcomitans (Aa). MATERIALS AND METHODS: From the ethanolic extract of propolis (EEP), total phenol content was determined by the Folin-Ciocalteau method, flavones and flavonols by the modified aluminum chloride colorimetric method, and flavanones by the 2.4-dinitrophenylhydrazine (2,4-DNP) method. Agar well diffusion assay was used to evaluate the antimicrobial potential of propolis against Pg and Aa. The minimum inhibitory concentration of propolis against the two bacteria was determined using serial tube dilution technique. RESULTS: The total concentration of phenol in the EEP was 19.44%, flavones and flavonols 2.616%, and flavanones 16.176%. The inhibitory zone depicting antimicrobial activity ranged from 18 to 25 mm for Pg and from 12 to 14 mm for Aa. The concentration range of Chinese propolis that is sensitive to inhibit the growth of Pg was 0.1-0.0125 µg/ml and for Aa it was 0.1-0.025 µg/ml. CONCLUSION: These data suggest that Chinese propolis has potent antimicrobial activity against the two periodontopathogens, suggesting its possible use as a natural alternative to the widely used synthetic antibiotics for periodontal therapy.