Microsurgical approach for the management of gingival cleft: A case series and decision-making process.

BACKGROUND: Gingival clefts, once known as "Stillman's Cleft", now considered an obsolete phenomenon, cannot be neglected in clinical practice, especially when it is persistent and epithelialized. The attached gingiva and alveolar mucosa are composed of epithelial layers with subjacent connective tissue. Gingival clefts, notwithstanding their intrinsic differences, may exhibit keratinized or non-keratinized tissue. Coupled with additional risk factors, it can result in progressive attachment loss and gingival recession. METHODS: Two cases with three distinct types of gingival clefts were described. Case 1 was identified as having a 2 mm white cleft coupled with lack of attached gingiva, while Case 2 was described as having a 3 mm white and red cleft which were treated with gingival cleft approximation subsequent to connective tissue grafting, non-surgical periodontal therapy and cleft approximation, respectively. The diagnostic confirmation was verified using an operating microscope set at a magnification of 5×, while the subsequent surgical stages were carried out with a magnification of 8×. These treatments yielded complete elimination and closure of the gingival clefts in addition to increased width of attached gingiva and soft tissue phenotype in Case 1 where bilaminar approach was utilized. The three clefts were effectively addressed using an operating microscope for both non-surgical and surgical interventions in the cleft management. RESULTS: All the three clefts exhibited complete elimination and closure of the gingival cleft. At 3 years follow up, there was reduction of the probing depth (1 mm) and attachment gain (1 mm) in all the three clefts. There was increase in width of attached gingiva to 3 mm and increase in soft tissue thickness in Case 1, where connective tissue graft was utilized. As microsurgical treatment approach was employed, the patients did not manifest with any intra-operative or postoperative complications. The first case showed the presence of soft tissue bulk at the treated site warranting debulking at 12 months postoperatively. The stability of the width of attached gingiva was maintained over the course of the 3-year follow-up period. The use of a microsurgical method in these settings enhances the predictability of outcomes than a macrosurgical approach. CONCLUSIONS: The utilization of microsurgical techniques for the closure of gingival clefts allows for the accurate and meticulous insertion and placement of grafts, resulting in improved outcomes and enhanced aesthetic results. These techniques also minimize tissue trauma and postoperative discomfort. The treatment technique should be personalized to the individual's specific needs, considering factors such as type and extent of cleft, etiology and amount of attached gingiva. Nonetheless, microsurgical approaches for such cases are no more a discretion but an obligation. KEY POINTS: Identification of gingival cleft should not be overlooked during routine periodontal examination. Diagnosed gingival clefts should be observed for clinical changes after completion of Phase I therapy. Only "white" gingival clefts require definitive surgical treatment. Untreated clefts can lead to root sensitivity, root caries and marginal tissue recession.

Histological and whole-genome sequencing analysis of coronally advanced flap with connective tissue graft for the treatment of gingival recession-A case study.

BACKGROUND: Oral tissue morphogenesis is innately determined and genetically controlled by underlying connective tissue. The connective tissue graft (CTG) harvested from palatal donor sites originally retains "regional specificity" and is considered to be responsible for epithelial keratinization. METHODS: This case study presents histological and genomic outcomes of coronally advanced flap (CAF) with CTG for the management of marginal tissue recession (MTR). The tissue samples harvested at 12-month postoperative period, during the debulking procedure of the treated site were subjected to Masson's trichrome staining (MTS) and whole-genome sequencing (WGS). RESULTS: Clinically, the mean root coverage as compared to baseline at 6 months (90%), 12 months (95%), and 24 months (95%) postoperatively was achieved. Overbulking of treated site was evident even after 12 months. Nevertheless, clinically discernible alterations in epithelial keratinization were not present. Although MTS revealed areas of non-keratinization and para-keratinization, WGS revealed a significant expression of keratinization genes, neural crest, and positional marker genes. CONCLUSIONS: CAF with CTG is still considered the "gold standard" in treatment of MTR. The keratinization of overlying epithelium at sites hitherto where non-keratinized mucosa is advanced over CTG may not be complete even after 12 months. It is evident from the analysis of the reported case that clinically such sites may appear non-keratinized despite the expression of genes for keratinization. The complex interplay between genomic and phenotypic expressions serves as a foundation of biological concepts. Nevertheless, it is imperative to acknowledge that the phenotype of an organism is not solely determined by genetic expression and is often influenced by a complex interaction between genetic background and environmental factors. KEY SUMMARY: The connective tissue serves as a medium for transmitting the genetic code and exerting an influence on the properties of the overlying epithelial tissue. Concrete evidence implies connective tissue plays a significant role in influencing the keratinization process of the overlying epithelium. Epithelial keratinization following a coronally advanced flap with connective tissue graft is also governed by environmental factors in addition to inherent potential within the graft. Differences in gene expression profiles may vary from individuals, teeth and among sites.

Sampling Methods and their Prospects in Liquid-Based Cytology of Oral Mucosa: A Comparative Study.

Examining epithelial cells in the mouth cavity is simple and non-invasive with exfoliative cytology. Liquid-based cytology is an additional diagnostic technique that can improve the specificity and sensitivity of conventional cytology. The purpose of our study was to describe the consistency of normal oral mucosa samples obtained with three different tools: the Cytobrush®, dermatological curette, and OralCDx® for liquid-based cytology. Literature review was done, and reporting of the improvements in the field of investigation and diagnosis has been reported. The present communication aims toward comparing three different sampling instruments such as Cytobrush, curette, and OralCDx for liquid-based cytology of the oral mucosa.

Dactoscopy in Human Identification: A Retrospective Study in Bhubaneswar City.

Anthropometry, fingerprints, age estimation, gender determination, blood types, DNA, and dental features are examples of traditional techniques for identifying a person. The present study aimed toward observing the patterns of fingerprints and their reliability toward human identification. A retrospective study was conducted in a tertiary care unit in Bhubaneswar city. Fingerprints were recorded, and the individual identification mark was noted for each individual. Reporting of the patterns was done. Sir Henry Galton's classification was used to study the fingerprint patterns. IBM Statistical Package for Social Sciences was used for the statistical analysis. Type A was the most common type seen for the right-hand little finger. Type A was the most common type seen for the left-hand little finger; Type C was the most common type seen for the left-hand ring finger. Statistically significant correlations between gender and dermatoglyphics were found, supporting their usage as trustworthy forensic evidence.

Assessment of Skeletal Age using Hand-Wrist Radiographs Following BJORK System Sample Size - Prospective Study.

Introduction: The planning of effective orthodontic therapy greatly benefits from an understanding of the skeletal maturation and stage of growth of the patients seeking orthodontic treatment. However, the patient's various craniofacial structures have varying levels of growth potential. The patient is exposed to additional radiation when hand-wrist radiographs are regularly used to forecast growth. As an alternative, cervical vertebrae in the lateral cephalograph have been suggested. When arranging orthodontic treatment for growing children, it is important to take into account the pubertal growth spurt, which is a crucial time in therapy. Conclusion: Finding out how much growth a patient with skeletal discrepancy would experience during adolescence is one of the key goals of conducting a hand and wrist radiograph.

Traditional halal meat production without stunning versus commercial slaughter with electrical stunning of slow-growing broiler chicken: impact on meat quality and proteome changes.

Impact of traditional halal meat production without stunning (NST) and commercial slaughter with electrical stunning (ST) of 100 slow-growing broiler chicken on blood plasma and different biochemical, enzymatic, hormonal, meat quality, and proteomic changes was evaluated. The results revealed lower (P < 0.05) postmortem pH values and higher redness (a*) scores for ST samples relative to NST group. Myofibrillar fragmentation index and bleeding efficiency (%) were lower (P < 0.05) in ST compared to NST samples. The ST group had higher (P < 0.05) creatinine, total protein, alanine aminotransferase (ALT), and triiodothyronine (T3) than NST group, however, no difference (P > 0.05) in blood glucose, lactate dehydrogenase (LDH), creatine kinase (CK), thyroxine (T4), cortisol, and aspartate aminotransferase (AST) was observed relative to NST samples. The 2-dimensional gel electrophoresis (2-DE) coupled to MALDI-TOF MS of meat samples has identified 14 differentially abundant proteins between 2 groups. Proteins demonstrating positive correlation with stress namely adenylate kinase isoenzyme-1, Rho guanine nucleotide exchange factor (NST), and apolipoprotein A-I (ST) were overabundant. From the current study, it is concluded that electrical stunning of broilers prior to slaughter or traditional halal slaughter without stunning does not adversely affect the meat quality.

Characteristics and Management of Children With Suspected COVID-19 Admitted to Hospitals in India: Implications for Future Care.

INTRODUCTION: There is a growing focus on researching the management of children with COVID-19 admitted to hospital, especially among developing countries with new variants alongside concerns with the overuse of antibiotics. Patient care can be improved with guidelines, but concerns with the continued imprudent prescribing of antimicrobials, including antibiotics, antivirals, and antimalarials. OBJECTIVE: Consequently, a need to document the current management of children with COVID-19 across India. Key outcome measures included the percentage of prescribed antimicrobials, adherence to current guidelines, and mortality. METHODOLOGY: A point prevalence study using specially developed report forms among 30 hospitals in India. RESULTS: The majority of admitted children were aged between 11 and 18 years (70%) and boys (65.8%). Reasons for admission included respiratory distress, breathing difficulties, and prolonged fever. 75.3% were prescribed antibiotics typically empirically (68.3% overall), with most on the Watch list (76.7%). There were no differences in antibiotic prescribing whether hospitals followed guidelines or not. There was also appreciable prescribing of antimalarials (21.4% of children), antivirals (15.2%), and antiparasitic medicines (27.2%) despite limited evidence. The majority of children (92.2%) made a full recovery. CONCLUSION: It was encouraging to see low hospitalization rates. However, concerns about high empiric use of antibiotics and high use of antimalarials, antivirals, and antiparasitic medicines exist. These can be addressed by instigating appropriate stewardship programs.

Comparative evaluation of postoperative pain and tissue response in patients undergoing conventional flap surgeries with or without 940 nm diode laser exposure - A randomized clinical study.

BACKGROUND: Over the past few years, a growing body of evidence has allowed us to ascertain that the initiation of periodontitis stems from the existence of oral microbial biofilm and that this requires definitive treatment. Owing to its exceptional usability, affordability, and antibacterial activity, the "diode laser" (DL) has increasingly become a popular and important tool in a dentist's armamentarium. However, there is a scarcity of scientific evidence on the utility and advantages of using "diode laser" in periodontal flap surgery. The study aimed to determine the efficacy of 940 nm diode laser exposure in combination with conventional periodontal flap surgery for the treatment of chronic periodontitis to evaluate postoperative discomfort and clinical parameters. MATERIALS AND METHODS: A total of 10 subjects (7 males and 3 females) with generalized chronic periodontitis were recruited and completed the study without any dropouts. For this split-mouth study, 40 sample sites with pocket probing depth (PPD) 5-7 mm post periodontal Phase I therapy were selected. The quadrants were randomly allocated to Groups A, B, C, and D using the fish bowl lottery method. Kirkland flap surgery with laser and modified Widman flap (MWF) with laser were performed in Group A and C, respectively, while Kirkland flap surgery and MWF surgery were performed in Group B and Group D. Clinical parameters including visual analog scale (VAS) score and gingival inflammation were determined at 3rd and 7th day postoperatively while PPD, clinical attachment level (CAL), and sulcus bleeding index (SBI) were recorded at baseline and 6 months following treatment. Wilcoxon signed-rank test and Kruskal-Wallis test were used for intra-group and inter-group comparison of parameters, respectively. RESULTS: Statistically significant difference was attained with postoperative discomfort in laser-assisted groups on 1st and 3rd day postoperatively (P < 0.001). There was no significant difference in the proportion of subjects with gingival inflammation. A statistically significant reduction in mean PPD at 6 months postoperatively was seen among all study groups (P < 0.05) but the inter-group difference was not statistically significant. SBI score reduced significantly from baseline to 6 months follow-up among all four groups (P < 0.05). However, we did not find the inter-group difference to be statistically non-significant. CONCLUSION: Diode laser as an adjunct to the surgical procedure can demonstrate appreciable benefits by increasing the CAL and minimizing the postoperative pain and the probing pocket, but such additional effects were not observed with gingival inflammation.

Modified laser-assisted lip repositioning surgery to treat gummy smile.

Excessive gingival display (EGD), known as "gummy smile," is a major esthetic hurdle in today's population. The condition occurs due to various etiologies such as skeletal, dentoalveolar, or soft-tissue origin. The treatment modalities range from orthognathic surgery to periodontal plastic procedures. Lip-repositioning surgery (LRS) is a better alternative for the conventional orthognathic surgery and laser-assisted LRS can be a reliable and a less invasive alternative to conventional (scalpel) LRS. The present case describes the successful treatment of a young female exhibiting an EGD caused by hypermobility of the upper lip and was treated with a modified laser-assisted LRS coupled with gingival recontouring. In a study published earlier, a mild recurrence was observed and hence, to overcome the recurrence, a modified technique, by excising a strip of mucosa with an additional 2 mm of tissue along with the muscular attachment rather than scraping, was attempted.

Adenomatoid odontogenic tumor mimicking a lateral periodontal cyst - A rare case report in the mandible.

Adenomatoid odontogenic tumor (AOT) is benign tumor of the oral cavity characterized by its slow growth accounting to 3%-7% of the odontogenic tumors. AOTs mostly occur in the maxillary anterior region and most often than not associated with impacted anterior teeth. It affects the younger age group, especially below 20 years and is commonly seen in females. It occurs as two main variants - (a) central/intraosseous which is more common and (b) peripheral which is rare. The location of the lesion, its association with the impacted tooth, is the basis for the classification of AOT. The intraosseous type may be related to unerupted tooth (follicular variant) or may not be related to unerupted tooth (extra-follicular variant). Radiologically, AOT presents predominantly as a unilocular cystic lesion enclosing the unerupted tooth. The lesion presents rarely with a cystic component. Radiopacities on the intraoral periapical radiograph are seen as discrete foci having a flocculent pattern within radiolucency even with the presence of minimal calcified deposits. AOT being benign in nature is enucleated with least chances of recurrence. Here, we present a rare case of extra-follicular variant of adenomatoid odontogenic tumor in a 19-year-old female patient.

Buccinator muscle repositioning: A rare case report, short discussion, and literature review.

Anatomical abnormalities are commonly associated with many problems. Among all anomalies, one is crestal attachment of the frenum or muscle on the alveolar process. Crestal attachment of the buccinator muscle is a rare phenomenon. It may cause various problems in routine oral exercises or restore the edentulous area. The present case report is a case of abnormal buccinator muscle attachment, which was relocated apically by surgical means using an acrylic stent. The healing was uneventful, and significant apical repositioning was observed. The area was then considered for implant placement. An implant was placed, and the long-term results were assured because the patient could maintain oral hygiene well after the muscle repositioning.

Calcifying epithelial odontogenic cyst.

OBJECTIVE: The Calcifying Odontogenic Cyst was first described as a distinct clinicopathologic entity by Gorlin and his colleagues in 1962. Gold (1963) chose a similar, but not identical term for the lesion, namely 'keratinizing and calcifying odontogenic cyst'. The calcifying cystic odontogenic tumor (CCOT) is a new designation of calcifying odontogenic cyst (COC) recommended by the 2005 classification of the World Health Organization (WHO). The calcifying odontogenic cyst is not a common lesion; the dentinogenic ghost cell tumor is even less common and should be considered rare. The lesions have in common the peculiar abnormal keratinization of odontogenic and metrical (hair) epithelial cells that is termed 'ghost cell' or 'shadow cell' keratinization. A rare, well-circumscribed, solid or cystic lesion derived from odontogenic epithelium that resembles follicular ameloblastoma but contains 'ghost cells' and spherical calcifications. The so-called calcifying odontogenic cyst (COC) represents a heterogeneous group of lesions that exhibit a variety of clinicopathologic and behavioural features. Because of this diversity, there has been confusion and disagreement on the terminology and classification of these lesions. Here we present a classic case of Calcifying Odontogenic Cyst (COC) or Calcifying Cystic Odontogenic Tumor in a 37 years old male patient. which is provisionally diagnosed by means of clinical & radiographical findings and later on confirmed by histological examination.

Comparative evaluation of diode laser ablation and surgical stripping technique for gingival depigmentation: A clinical and immunohistochemical study.

INTRODUCTION: There are various treatment modalities to remove the black patches of melanin pigmentation. The aim of the study is to clinically compare the diode laser ablation and surgical stripping technique for gingival depigmentation and to evaluate their effect on the histological changes in melanocyte activity. MATERIALS AND METHODS: A total of 40 sites of 20 patients with bilateral melanin hyperpigmentation were treated with the surgical stripping and diode laser ablation technique. Change in Hedin index score, change in area of pigmentation using image analyzing software, pain perception, patient preference of treatment were recorded. All 40 sites were selected for immunohistochemical analysis using HMB-45 immunohistochemical marker. RESULTS: At 12 months post-operative visit, in all sites, repigmentation was observed with different grades of Hedin index. Paired t-test, analysis of variance, and Chi-square tests were used for statistical analysis. Repigmentation in surgical stripping is significantly lesser compared to laser ablation. Lesser numbers of melanocytes were found on immunohistological examination at 12 months postoperatively. Comparison for patient preference and pain indices give statistically significant values for diode laser techniques. CONCLUSION: Gingival hyperpigmentation is effectively managed by diode laser ablation technique and surgical stripping method. In this study, surgical stripping technique found to be better compared to diode laser ablation.

Comparative evaluation of subgingivally delivered 1% alendronate versus 1.2% atorvastatin gel in treatment of chronic periodontitis: a randomized placebo-controlled clinical trial.

AIM: Alendronate (ALN) and atorvastatin (ATV) are known to inhibit osteoclastic bone resorption and were proposed to have osteostimulative properties. The aim of the study was to evaluate and compare the efficacy of 1% ALN and 1.2% ATV gel as a local drug-delivery system in adjunct to scaling and root planning (SRP) for the treatment of intrabony defects in chronic periodontitis patients. METHODS: A total of 90 intrabony defects were treated with either 1% ALN, 1.2% ATV, or placebo gel. Clinical parameters (plaque index, modified sulcus bleeding index, probing depth (PD), and clinical attachment level (CAL)) were recorded at baseline, 3, 6, and 9 months. Intrabony defect depth (IBD) and defect depth reduction (DDR%) was calculated on standardized radiographs at 6 and 9 months. RESULTS: The mean PD reduction, CAL gain, and DDR% were greater in the ALN and ATV group than in the placebo group at 3, 6, and 9 months. Furthermore, a significantly greater DDR% was found in the ALN group at 6 and 9 months than in the ATV and placebo groups. CONCLUSION: Local delivery of 1% ALN results in significantly greater improvement in PD, CAL, IBD depth, and DDR% as compared to 1.2% ATV gel.