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.

Evaluation of the Difference in the Rate of Canine Retraction Assisted by Piezocision and Discission in Human Subjects: A Preliminary Parallel-Arm Prospective Clinical Study.

Objective: The objective of the study was to evaluate the rate of orthodontic tooth movement assisted by piezocision and discission in extraction cases. Methods: Twelve adults (20-35 years) requiring upper premolar extraction for orthodontic treatment were included in this preliminary parallel-arm clinical study. Participants (randomly allocated) in Groups A and B received piezocision and discision-assisted corticotomy cuts at the premolar extraction site, respectively, contralateral side served as the control. Canine retraction was started bilaterally using closed coil NiTi (Nickel titanium) springs. A schedule of fortnightly activation was followed for 3 months. Stage models were made monthly (M0, M1, M2, M3). Models were scanned using a 3-shape intraoral scanner, and the displacement of the canine was measured bilaterally in the stage models. A self-designed questionnaire was used to assess patients pain and satisfaction levels on a visual analogue scale. Results: The rate of canine retraction at the piezocision site was twice that at the control site in group A (p=0.007). The rate of canine retraction at the dissection site was twice that at the control site in group B (p=0.012). However, there was no significant difference in the rate of retraction between the two surgical techniques. Pain and disturbance were noticed in the discission group at 50 and 67% respectively. Conclusion: Discision is comparable to piezocision for accelerating orthodontic tooth movement. Although dissection can speed orthodontic treatment, it should be used with caution as it could pose technical and clinical difficulties, particularly in the posterior buccal region of the oral cavity.

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).

The Impetus of Artificial Intelligence on Periodontal Diagnosis: A Brief Synopsis.

The current advances in digitized data additions, machine learning and computing framework, lead to the swiftly emerging concept of "Artificial Intelligence" (AI), that are developing into areas that were formerly contemplated for human expertise. AI is a relatively rapid paced mechanics wherein the computer technology is tuned to perform human tasks. An auxiliary domain of AI is machine learning (ML), and Deep learning, a subclass of ML technique comprehends multi-layer mathematical operations. AI-based applications have tremendous potential to improve and systematize patient care thereby alleviating dentists from laborious regular tasks, and facilitate personalized, predictive and preventive dentistry. In the dental clinic, AI can execute a variety of easy tasks with greater accuracy, minimal manpower, and with fewer mistakes over human equivalents. These tasks range from appointment scheduling and coordination to helping with clinical evaluation and therapy. Besides, this could assist in the early diagnosis of dental and maxillofacial abnormalities like periodontal ailments, root caries, bony lesions, and facial malformations in addition to automatically identifying and classifying dental restorations on digital radiographs. This brusque narrative review describes the AI-based systems, their respective applications in periodontal diagnosis, the multifarious studies, possible limitations and the predictable future of AI-based dental diagnostics and treatment planning.

Navigating Oral Hygiene Challenges in Spastic Cerebral Palsy Patients: A Narrative Review for Management Strategies for Optimal Dental Care.

In the realm of well-being, the essence of maintaining optimal oral health is gaining more recognition. This quantifying quotient is being compromised in cerebral palsy (CP) patients due to multitude variations. Spastic CP predominantly impacts bodily motions, muscle synchronization, command, muscle tone, reflexes, stance, equilibrium, and can additionally influence both delicate and large-scale motor abilities. For individuals with spastic CP, the rigidity extends its influence over both their upper and lower limbs. When this stiffness takes hold in the upper limb, it poses significant challenges in executing everyday activities, causing issues with precise grasping and coordination of muscle movements. Consequently, using a toothbrush effectively becomes a formidable task resulting in widespread caries and periodontal diseases in spastic CP patients. The central focus of this review is to explore the oral health challenges of spastic cerebral palsy patients and mapping out a path towards the most efficient time-tested and innovative dental management approaches for preserving oral health in these patients.

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.

Evaluation of serum and salivary PCSK9 and IL6 and its association with periodontal inflammation and atherosclerotic cardiovascular diseases.

Background: and Purpose: The aim of this study was to assess, compare and correlate the ability of PCSK9 and IL6 as potential common serum and salivary biomarkers for stage III/IV periodontitis and the risk of developing atherosclerotic cardiovascular diseases. Methods: 76 patients were alloted into 4 groups consisting of subjects with clinically healthy periodontium and stage III/IV periodontitis with and without ACVD. Clinical parameters - PD, CAL, number of teeth, PI, mSBI, TC, Tg, HDL and LDL were recorded. Serum and saliva samples were obtained and subjected to ELISA for quantifying the biomarker levels. Results: The level of these biomarkers was found to be the lowest (IL6 Serum: 21.92 ± 14.54, IL6 Saliva: 12.34 ± 7.72, PCSK9 Serum: 178.82 ± 35.07, PCSK9 Saliva: 80.82 ± 25.43) in group I and highest in group IV (IL6 Serum: 73.4 ± 24.86, IL6 Saliva: 37.66 ± 15.77, PCSK9 Serum: 346.54 ± 45.11, PCSK9 Saliva: 157.72 ± 43.28). The clinical parameters PI, mSBI, PPD, CAL, total number of teeth, TC, HDL and LDL showed a significant correlation with biomarkers PCSK9 and IL6. Conclusion: This study features the elevation of serum and salivary PCSK9 and IL6 in periodontitis and ACVD. A triad of serum and salivary PCSK9 and IL6 along with the clinical markers of periodontal disease can relatively predict the future risk of developing ACVD.

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.

Nexus between COVID-19 and periodontal disease.

Over the past several decades, studies have demonstrated the existence of bi-directional relationships between periodontal disease and systemic conditions. Periodontitis is a polymicrobial and multifactorial disease involving both host and environmental factors. Tissue destruction is primarily associated with hyperresponsiveness of the host resulting in release of inflammatory mediators. Pro-inflammatory cytokines play a major role in bacterial stimulation and tissue destruction. In addition, these cytokines are thought to underlie the associations between periodontitis and systemic conditions. Current research suggests that increased release of cytokines from host cells, referred to as the cytokine storm, is associated with disease progression in patients with coronavirus disease 2019 (COVID-19). An intersection between periodontitis and pulmonary disease is biologically plausible. Hence, we reviewed the evidence linking COVID-19, cytokines, and periodontal disease. Plaque control is essential to prevent exchange of bacteria between the mouth and the lungs, reducing the risk of lung disease. Understanding these associations may help identify individuals at high risk and deliver appropriate care at early stages.

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.

Root Conditioning with Citric Acid and Ethylenediaminetetraacetic Acid and their Effect on Fibrin Clot Adhesion to Dentin-A Scanning Electron Microscopic Study.

INTRODUCTION: Root biomodifiers are used to remove the smear layer formed on the roots as a result of mechanical debridement and also to expose collagen fibers making the root surfaces biologically acceptable. Further, the blood element linkage to demineralized roots and clot stabilization by collagen fibres are vital for the wound healing and success of periodontal surgery. AIM: The aim of this study was to evaluate and compare the distribution of fibrin network to dentin surfaces conditioned with citric acid and Ethylenediaminetetraacetic Acid (EDTA) using Scanning Electron Microscope (SEM). MATERIALS AND METHODS: Thirty human dentin blocks (4 mm x 3 mm x 1 mm) were prepared and equally divided into three groups. The control Group A specimens were treated with Phosphate Buffered Saline (PBS). The study Group B and C specimens were treated with citric Acid and EDTA respectively. After conditioning, a drop of fresh human whole blood was placed on the dentin specimens and was allowed to clot. The specimens were then processed using standardized protocol for SEM. The dentin surfaces were then analysed for fibrin network linkage under SEM and scored according to the degree of fibrin linkage to the dentin surface. Statistical analysis was done using Kruskal Wallis test to compare the score values between the study groups. Pairwise comparison between the study groups was done using Mann Whitney U test with Bonferroni correction. RESULTS: The fibrin network formed on the dentin network were analysed and scores were given. Kruskal Wallis test and Mann Whitney U test with Bonferroni correction were used for statistical analysis. It was found that most of the dentin specimens conditioned with citric acid and covered with human blood exhibited dense fibrin network compared to EDTA. However, statistical analysis showed that there were no significant differences found between the groups (p=0.35). CONCLUSION: Citric acid and EDTA has almost comparable effect in promoting the adhesion of fibrin network onto the dentin surface which may further enhance connective tissue attachment to the root surface.

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.

Oral Health Related Quality of Life among Tamil Speaking Adults Attending a Dental Institution in Chennai, Southern India.

INTRODUCTION: Oral Health-Related Quality of Life (OHRQoL) indicates an individual's perception of how their well-being and quality of life is influenced by oral health. It facilitates treatment planning, assessing patient centred treatment outcomes and satisfaction. AIM: The study aimed to identify the factors influencing OHRQoL among Tamil speaking South Indian adult population. MATERIALS AND METHODS: Non-probability sampling was done and 199 subjects aged 20-70 years were recruited for this observational study. The subjects were requested to fill a survey form along with the validated Tamil General Oral Health Assessment Index (GOHAI-Tml) questionnaire in the waiting area following which clinical examination was done by a single experienced Periodontist. RESULTS: The mean score with standard deviation for physical dimension was 4.34±0.96, psychological dimension was 4.03±1.13 and pain was 4.05±1.09 on GOHAI. Greater impacts were seen for psychosocial dimensions like pleased with the appearance of teeth/denture Q7 (3.7±1.2), worried about the problems with teeth/denture Q9 (3.7±1) and pain or discomfort in teeth Q12 (3.8±1). Functions like swallowing Q3 (4.5±0.8) and speaking Q4 (4.6±0.7) were minimally affected. As age increased subjects perceived more negative impacts as indicated by lower ADD-GOHAI and higher SC-GOHAI scores (p<0.01). Subjects complaining of bad breath, bleeding gums and Temporomandibular Joint (TMJ) problems, reported poor OHRQoL (p<0.05). It was observed that as self-perceived oral and general health status deteriorated, OHRQoL also worsened (p<0.01). Subjects with missing teeth, cervical abrasion, restorations, gingival recession and mobility had more impacts on OHRQoL (p<0.05). Subjects diagnosed with periodontitis had lower OHRQoL as reported on the scale than gingivitis subjects (p<0.01). CONCLUSION: In this study minimal impact was seen in all the three dimensions assessed with GOHAI. Factors like age, education, employment status, income, self-reported oral health, self-perceived general health, satisfaction with oral health, perceived need for treatment and denture wearing status influenced perceived OHRQoL. Bad breath, bleeding gums, TMJ problems, more number of missing teeth, decayed teeth, cervical abrasion, gingival recession and mobility were associated with poor OHRQoL.