Efficacy of leukocyte-platelet-rich fibrin membrane in immediate postextraction implant placement: A randomized controlled trial.

Background: Leukocyte-platelet-rich fibrin (L-PRF) membrane is an emerging autologous healing biomaterial that promotes angiogenesis and healing in immediate implant sites. The purpose of the study was to evaluate hard and soft tissue outcomes of immediate implant placement with or without L-PRF. Materials and Methods: A total of 18 immediate implants were divided randomly into two groups of 9 implants each, i.e., Group 1 and Group 2. All sites received a definitive restoration after 3 months of implant placement and were followed up for a period of 6-months. Results: Addition of L-PRF in the extraction sockets when placing immediate implants resulted in statistically nonsignificant benefit in terms of clinical and radiographic parameters when compared to immediate implant placement without L-PRF. Conclusion: Immediate implant placement in Group 2 demonstrated marginal but statistically significant benefit as compared to sites in Group 1.

Comparison of two techniques of harvesting connective tissue and its effects on healing pattern at palate and recession coverage at recipient site.

AIM: To compare the healing pattern in palate following harvestation of connective tissue graft by two different techniques and to compare the recession coverage at the recipient sites. MATERIALS AND METHODS: 30 recession sites with Miller's class I and II recession in 16 patients were recruited for this study. Sites were randomly divided into 2 treatment groups. Group I used Unigraft Knife to harvest the connective tissue whereas in group II patients Langer & Langer techniques was used to harvest the connective tissue graft from the palate. Healing was evaluated at the donor site using- wound size(WS), immediate bleeding (iB) and delayed bleeding (dB), complete wound epithelialization (CE), sensibility disorders (S) and post operative pain (PP) at baseline, 1(st), 4(th), and 12(th) week postoperatively. Recession coverage was assessed by measuring Clinical Attachment Level (CAL), vertical recession (VR), width of keratinized gingiva (KT). RESULTS: On comparison between Group I and II, a statistically significant larger wound size was observed in Group I. CWE was higher in Group II. A non significant difference was observed when SD, and delayed bleeding were compared at all time intervals. A non-significant difference was observed in the clinical parameters at the recipient site. CONCLUSION: When evaluating the WS and CWE, the Langer and Langer technique was found to be better than the Unigraft knife technique for harvesting the connective tissue graft, whereas both the techniques were found to be effective in root coverage procedure outcomes.

The use of nanocrystalline and two other forms of calcium sulfate in the treatment of infrabony defects: A clinical and radiographic study.

BACKGROUND: Calcium sulphate(CS) is one of the oldest alloplastic graft materials used because of its biocompatibility, handling characteristics, porosity, different rates of dissolution, chemico-physical resemblance to bone mineral, ability to induce release of growth factors and potentially unlimited supply at a modest cost. Aim of the study was to evaluate the efficacy of 3 forms of calcium sulphate i.e. Nanogen (nCS)(+), BoneGen(+) and Dentogen(+) in treatment of infrabony defects and to compare their efficacy as bone grafting substitutes. MATERIALS AND METHODS: A prospective randomized, double blind controlled study was conducted on 45 sites from 16 subjects having Moderate to Advanced Periodontitis who were divided into 3 groups i.e. Group I (Nanogen), Group II (Dentogen) and Group III (BoneGen) clinical along with radiographic measurements were taken at baseline, 6 and 12 months postoperatively. RESULTS: There was no significant inter-group difference in mean clinical attachment level (CAL) values at different time intervals whereas Intra-group changes in CAL at 6 and 12 months as compared to baseline were significant statistically. In Group I, changes in CAL between 6 and 12 months were found to be statistically significant in comparison with Group II and III. CONCLUSION: Both Nanogen and BoneGen TR can be considered valuable options in the treatment of infra-bony periodontal defects. The faster degradation of Dentogen may negatively affect its bone regeneration potential.

Comparative evaluation of recession coverage with sub-epithelial connective tissue graft using macrosurgical and microsurgical approaches: A randomized split mouth study.

AIMS: The aim was to compare the recession coverage outcomes when done macrosurgically and microsurgically. BACKGROUND: Increasing interest in esthetics and the related problems such as hypersensitivity and root caries have favored the development of many root coverage procedures. Recession coverage up to a certain extent has solved these problems, but these procedures need good maintenance after the surgery for long-term benefits. With increasing advances in the field of recession coverage, microscope has added another dimension in undertaking the surgical procedure. MATERIALS AND METHODS: Thirty Miller's Class I and II recession were treated using the sub-epithelial connective tissue graft from the palate. In 15 sites, the graft was placed at the recipient site with unaided eye (Group A) and in other 15 sites the graft was placed using surgical microscope (Group B). Clinical evaluation was done at baseline, 12 weeks and 24 weeks postoperatively using plaque index, gingival index, vertical recession (VR), probing depth, clinical attachment level (CAL), width of attached gingiva, papilla height (PH) and width, malalignment index (MI) and esthetic appearance. STATISTICAL ANALYSIS USED: Paired and unpaired Student's t-test along with Wilcoxon Z-test were used to analyze the results and probability of P < 0.05 were accepted to reject the null hypothesis. Pearson correlation was used to correlate two parameters such as VR and CAL and MI and VR. RESULTS: Both the techniques demonstrated predictable mean root coverage (Group A 61.78% and Group B 67.58%) at 6 months postsurgery. CAL gain was slightly better in Group B patients when compared to Group A patients. A moderate positive correlation for Group A while a mild correlation in Group B was seen between the MI and VR. CONCLUSION: The use of the microscope enhances the results, but obtaining an expertise in using needs a lot of practice. The periodontal healing by both techniques should be evaluated histologically.

Semilunar vestibular technique: A novel procedure for multiple recession coverage (a report of two cases).

The procedures for root coverage have been greatly refined over the past few decades. Still as compared to the other periodontal surgical procedures, predictability of mucogingival procedures remains uncertain which is more in patients who present with multiple recessions or recession complicated with periodontal involvement. Techniques which claim success almost always involve a second surgical site. A novel technique avoiding second surgical site and good predictability for multiple recessions was described by Dr. P.D. Miller in a conference at Pune in 2011. A semilunar vestibular incision technique described by Dr. P.D Miller was performed on two patients who presented with multiple recessions in the maxillary anterior teeth. About 90-100% root coverage was observed when the patients were on a follow-up for 1-year with a significant increase in the vestibular depth. The semilunar vestibular incision technique used in two cases resulted in predictable root coverage with a good color blend, an esthetic marginal morphology and most importantly the avoidance of the second surgical site.

An overview of gene therapy in head and neck cancer.

Gene therapy is a new treatment modality in which new gene is introduced or existing gene is manipulated to cause cancer cell death or slow the growth of the tumor. In this review, we have discussed the different treatment approaches for cancer gene therapy; gene addition therapy, immunotherapy, gene therapy using oncolytic viruses, antisense ribonucleic acid (RNA) and RNA interference-based gene therapy. Clinical trials to date in head and neck cancer have shown evidence of gene transduction and expression, mediation of apoptosis and clinical response including pathological complete responses. The objective of this article is to provide an overview of the current available gene therapies for head and neck cancer.

Comparative evaluation of locally delivered minocycline and metronidazole in the treatment of periodontitis.

OBJECTIVE: The aim of this study was to evaluate and compare the efficacy of subgingivally delivered Minocycline microspheres and 25% Metronidazole gel when used as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. MATERIALS AND METHODS: A randomized, controlled, single center study was conducted involving 60 sites in 20 patients suffering from moderate to advanced chronic periodontitis. Each patient contributed three sites which were randomized to three treatment groups: SRP + insertion of Minocycline microspheres at day 1 (Group A), SRP + insertion of Metronidazole gel at day 1 and at day 7 (Group B), and SRP alone (Group C). Gingival index (GI), plaque index (PI), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at day 1, 1 month, and 3 months post therapy. RESULTS: All treatments showed significant reductions in PPD and CAL at 1 and 3 months when compared to baseline values (P < 0.001). At 3 months, sites treated with minocycline showed an additional reduction in PPD of 0.85 ± 0.03 mm, significantly greater than SRP alone. Differences in mean PPD reduction between Group B and Group C and between Group A and Group B were not significant. At 3 months, difference in CAL gain between Group A and C was 0.50 ± 0.45, which was statistically significant and between Group B and C was 0.35 ± 0.11, which was not found to be statistically significant (P = 0.20). Differences in relative CAL between Group A and Group B were also not found to be statistically significant (P = 0.53). CONCLUSION: The results concluded that treatment with Minocycline microspheres and Metronidazole gel improve PPD and CAL in patients with periodontitis compared to SRP alone.

Is Pederson Index a True Predictive Difficulty Index for Impacted Mandibular Third Molar Surgery? A Meta-analysis.

The aim of this meta-analysis was to find out the clinical reliability of Pederson index in assessing the difficulty of surgery for impacted mandibular 3rd molar. The relevant articles were selected by Hand search and electronic media (Medline, Pubmed, Embase Cochrane library, ISI web of science) from Jan 2000 to Dec 2010. All the relevant articles were properly screened and findings were extracted from the articles. Pederson index had shown low sensitivity and specificity in predicting the difficulty of surgery for impacted mandibular 3rd molar. Positive and negative likelihood ratio had also shown the unreliability of Pederson index. The meta-analysis of the current literature concluded that Pederson index is not a reliable test to predict the surgical difficulty of impacted mandibular 3rd molar.

Plasma cell gingivitis - A rare case related to Colocasia (arbi) leaves.

Plasma cell gingivitis is an uncommon inflammatory condition of uncertain etiology often flavoured chewing gum, spices, foods, candies, or dentifrices. The diagnosis of plasma cell gingivitis is based on comprehensive history taking, clinical examination, and appropriate diagnostic tests. Here we are presenting a rare case of plasma cell gingivitis caused by consumption of colocasia (arbi) leaves. Colocasia is a kind of vegetable, very commonly consumed in the regions of North India.

Autogenous bone block in the treatment of teeth with hopeless prognosis.

BACKGROUND: Autogenous bone graft, although considered as a gold standard, has been relegated to background because of limited quantity and donor site morbidity. Revival of interest in its use has been reflected by its tremendous capacity for regeneration in less than ideal situation. Bone blocks have been used for implant site augmentation, with varied success. AIM: Aim of the study was to evaluate the efficacy of autogenous bone block in the regeneration of bone, for saving teeth with a hopeless prognosis. SETTINGS AND DESIGN: A total of six patients and 12 sites with grade II and III mobile teeth were treated with autogenous bone blocks and fiber splinting. SUBJECTS AND METHODS: Attachment loss, probing depths, and radiographic bone loss were recorded at baseline and at 12 months interval. STATISTICAL ANALYSIS USED: The Student paired t test was used for evaluation of the changes from baseline to 12 months. RESULTS: At 12 months post-operatively, there was a highly significant amount of bone gain as compared to the baseline. The mean amount of bone loss reduced from 9.41 ± 1.16 to 5.41 ± 1.01. The clinical attachment loss reduced from 7.37 ± 1.24 mm to 3.79 ± 0.89 mm and probing depth reduced from 7 ± 1.67 mm to 5.5 ± 0.63 mm. The grafted bone was observed to have been incorporated with the host bone in most of the sites as evidenced by radiographs. CONCLUSIONS: For teeth with hopeless prognosis, this method can be considered to be a very viable alternative to extraction and replacement by costly implants.

Management of medical records: facts and figures for surgeons.

Medical records are the document that explains all detail about the patient's history, clinical findings, diagnostic test results, pre and postoperative care, patient's progress and medication. If written correctly, notes will support the doctor about the correctness of treatment. Inspite of knowing the importance of proper record keeping in India, it is still in the initial stages. Medical records are the one of the most important aspect on which practically almost every medico-legal battle is won or lost. This article discusses the various aspect of record maintenance.